Biomedical subjects

T Herzog

Publications and source records attributed to T Herzog.

At least 19 recordsLinked to original sources

PubMed2005

Drop outs from in-patient treatment of anorexia nervosa.

OBJECTIVE: Aim of the study was to identify patient characteristics that distinguish drop outs and completers from in-patient treatment for anorexia nervosa. METHOD: A total of 133 consecutively admitted in-patients with anorexia nervosa (age range 16-50 years; 92.5% women) were analysed using sociodemographic variables as well as measures of psychopathology (SCL-90-R, EDI-2) and interpersonal difficulties (IIP-C). Patients were treated in a multimodal treatment setting, combining cognitive-behavioural and psychodynamic components. RESULTS: Patients, who reported fewer symptoms, were hospitalized before and had a comorbid depression stayed more often in psychotherapy. Patients dropping out of treatment (31.6%) showed a trend to higher levels of maturity fears. Subtype, age, duration of illness, comorbid personality disorders or previous drop outs were not predictive of dropping out. CONCLUSION: Addressing the high ambivalence and maturity fears of anorexic patients should be an essential issue in psychotherapy with this patient group.

Adolescent↗

PubMed2004

Phase III randomized trial of doxorubicin + cisplatin versus doxorubicin + 24-h paclitaxel + filgrastim in endometrial carcinoma: a Gynecologic Oncology Group study.

BACKGROUND: This study was performed to determine whether 24-h paclitaxel plus doxorubicin and filgrastim was superior to cisplatin plus doxorubicin in patients with endometrial cancer with respect to response, progression-free survival (PFS) and overall survival (OS). PATIENTS AND METHODS: Eligible chemotherapy-naïve patients were randomly assigned to doxorubicin 60 mg/m2 intravenously (i.v.) followed by cisplatin 50 mg/m2 i.v. (arm 1, n=157) or doxorubicin 50 mg/m2 i.v. followed 4 h later by paclitaxel 150 mg/m2 i.v. over 24 h plus filgrastim 5 microg/kg on days 3-12 (arm 2, n=160). Starting doses were reduced for prior pelvic radiotherapy and age > 65 years. Both regimens were to be repeated every 3 weeks for a maximum of seven cycles. RESULTS: There was no significant difference in response rate (40% versus 43%), PFS (median 7.2 versus 6 months) or OS (median 12.6 versus 13.6 months) for arm 1 and arm 2, respectively. Toxicities were primarily hematological, with 54% (arm 1) and 50% (arm 2) of patients experiencing grade 4 granulocytopenia. Gastrointestinal toxicities were similar in both arms. CONCLUSIONS: Doxorubicin and 24-h paclitaxel plus filgrastim was not superior to doxorubicin and cisplatin in terms of response, PFS or survival in advanced endometrial cancer.

Aged↗

PubMed2002

[Quality criteria for psychosomatic consultation-liaison service].

Besides the integrated psychosomatic models in various medical specialities (e.g. Internal medicine, Obstetrics and Gynaecology or Paediatrics), specific models of cooperation in the form of consultation-liaison (C-L) service between specialised psychosomatic-psychotherapeutic departments and other medical departments play a crucial role in providing psychosomatic care to patients. The concept 'liaison' expresses a particularly close form of cooperative activity, going far beyond the classical model of consultation services. In this context, the psychosomatic consultant has not only a fixed organised presence in the provision of patient care, he/she also participates in case discussions, hospital rounds, ward discussions and continuing education programmes of the 'partner' department. Thus, the liaison service is not only patient-centred, but also team-centred. Such consultation-liaison services, in Austria, were first established at the University Hospitals. As a consequence of laws regulating psychotherapeutic care, according to which such care is to be offered in general hospitals, increasingly C-L services are becoming part of regular care provision in more and more hospitals. Consensus groups, international as well as in German-speaking countries, are currently working on establishing quality standards in the area of psychosomatic C-L services. A working group of the scientific medical representatives has recently published guidelines for the structure, process and results of quality control. A second group, of the European Association of Consultation Liaison Psychiatry and Psychosomatics, is currently working on guidelines for training consultation-liaison service providers. In the present article, an overview of these projects will be presented and the results discussed against the background of the specific health policy situation in Austria.

Austria↗

PubMed2001

Radiation therapy for carcinoma of the cervix with biopsy-proven positive para-aortic lymph nodes.

PURPOSE: To evaluate local tumor control, cause-specific survival, patterns of relapse, and toxicity in patients with cervical cancer and positive para-aortic lymph nodes treated with radiation therapy alone. METHODS: This is a retrospective chart review of 43 patients with cervical cancer and biopsy-proven positive para-aortic lymph nodes treated with radiation therapy treated from 1965 to 1993. There were 15 patients with clinical Stage I disease, 12 with Stage II, and 16 with Stage III. Patients were treated with external irradiation to the pelvis and para-aortic regions combined with brachytherapy. None received chemotherapy. RESULTS: The 5-year overall survival rate was 32% and the median overall survival was 2.2 years. The 5-year cause-specific survival rate was 49% and the median cause-specific survival was 2.7 years. The cause-specific survivals at 5 years were 47% for Stage I, 64% for Stage II, and 46% for Stage III. Tumor recurrence occurred in 20 patients. The sites of recurrence were in the pelvis only in 3, the pelvis and distant metastasis in 9, and distant metastasis only in 8 patients. Severe, grade 3 complications occurred in 2 patients. One patient developed an enterovaginal fistulas and 1 developed radiation myelitis. CONCLUSION: Pelvic and para-aortic irradiation and brachytherapy resulted in a 49%, 5-year, cause-specific survival. Clinical tumor stage did not effect outcome. The majority of relapses occurred at distant sites. Toxicity was acceptable. Systemic chemotherapy should be considered as adjunctive therapy for these patients.

Adult↗

PubMed2001

No evidence for BCL10 mutation in endometrial cancers with microsatellite instability.

Previous reports have suggested that the mononucleotide repeats in BCL10 frequently are mutated in both hematologic malignancies and solid tumors. We set out to determine whether these repeats, like simple repeat sequences in other genes, are a target for mutation in endometrial cancers with defective DNA mismatch repair. Primary endometrial cancers (n = 42) and endometrial cancer cell lines (n=5) with microsatellite instability (MSI) were investigated. BCL10 exons 2 and 3 were amplified by PCR and evaluated for mutation using denaturing high-performance liquid chromatography (DHPLC) and single stand conformational variant (SSCV) analysis. Variants were directly sequenced. No BCL10 mutations were detected in exons 2 or 3 by DHPLC or SSCV. A polymorphism in exon 3 (638G-->A) was seen in 4/42 (9.5%) MSI-positive endometrial cancers and 0/5 MSI-positive endometrial cancer cell lines. Thus, mutation in the mononucleotide repeat tracts of BCL10 is not a feature of endometrial cancers with defective DNA mismatch repair.

Adaptor Proteins, Signal Transducing↗

PubMed2001

[Perthes syndrome. The classical symptom triad as a rarity in trauma surgery practice].

Perthes syndrome or traumatic asphyxia is a condition characterised by subconjunctival hemorrhage, cervicofacial petechiae and cyanosis caused by severe compression of the chest. Diagnosis is made by history and clinical examination. Associated injuries such as intrathoracic or abdominal lesions can be life-threatening and must be strictly assessed. This report demonstrates an illustrative case of this rare injury.

Abdominal Injuries↗

PubMed2001

General anesthesia for interventional neuroradiology: propofol versus isoflurane.

STUDY OBJECTIVE: To compare recovery of psychomotor and cognitive ability after isoflurane and propofol-based general anesthesia. DESIGN: Prospective, blinded interventional study. SETTING: University hospital. PATIENTS: 24 ASA physical status I and II patients undergoing embolization procedures for intracranial vascular lesions. INTERVENTIONS: Isoflurane anesthesia or propofol anesthesia was given to patients. MEASUREMENTS: Awakening time; early recovery (5 minutes, 15 minutes, 30 minutes) was assessed using orientation and Steward tests; medium recovery (30 minutes, 60 minutes, 120 minutes) was tested using Controlled World Association (COWAT) and Digit Span tests; late recovery (4 hours, 24 hours) was assessed using a Verbal Learning and Memory Test and three subtests of a computerized attention test battery. MAIN RESULTS: Awakening time and early recovery of motor and respiratory function did not differ between groups. The propofol group scored worse in COWAT and Digit Span tests up to 60 minutes after anesthesia. Both groups showed an impairment of higher cognitive functions up to 24 hours after anesthesia. CONCLUSIONS: Both isoflurane- and propofol-based anesthesia allow early extubation and recovery of basic psychomotor functions. More sophisticated tests show a decline of cognitive functions up to 24 hours after isoflurane- as well as propofol-based anesthesia. Because both anesthetics show similar recovery of psychomotor functions after long duration anesthesia, other factors such as subjective well-being and costs may be considered when deciding between these two anesthetics.

Adolescent↗

PubMed2001

Mental disturbances and perceived complexity of nursing care in medical inpatients: results from a European study.

AIMS AND OBJECTIVES: The relationship between mental disturbances - anxiety and depression, somatization and alcohol abuse - on admission to internal medicine units and perceived complexity of care as indicated by the nurse at discharge was studied. The goal was to study the utility of short screeners for mental disturbances to select patients for case-management on admission. DESIGN: The study had a cohort design: patients were included on admission and followed through their hospital stay until discharge. The study was conducted within the framework of the European Biomed 1 Risk Factor study. RESEARCH METHODS AND INSTRUMENTS: In the first 3 days of admission the patients were interviewed by a trained health care professional, who scored the SCL-8D, a somatization questionnaire based on the Whiteley-7 and the CAGE. At discharge, nurses rated the complexity of the patient's care. RESULTS: Patients with high scores on anxiety and depression (SCL-8D) and on somatization received higher ratings on perceived nursing complexity than those with low scores, with and without control for age, severity of illness and chronicity. The actual nursing intensity and medical care utilization, as measured daily by means of a checklist, could not explain these relations. No differences were found between patients with high or low scores on alcohol abuse. CONCLUSIONS: The study shows a potential use of screeners for mental disturbances to detect patients for whom nurses might need additional help. However, mental disturbance is not the sole criterion: functional status and other variables that predict medical and nursing care utilization should be included in a screening strategy for case-management programmes.

Activities of Daily Living↗

PubMed2001

Individual dosing of ASA prophylaxis by controlling platelet aggregation.

Acetylsalicylic acid is widely used in the primary and secondary prevention of cardiovascular diseases. In the current study, we used platelet aggregation ex vivo in platelet-rich plasma induced with arachidonic acid as a routine method for the determination of the individual dose of acetylsalicylic acid necessary to inhibit platelet aggregation in 108 patients with cardiovascular diseases. In 40% of all patients studied, a dose of 30 mg/day was sufficient to block the arachidonic acid-induced platelet aggregation nearly completely. In 50% of all patients, a dose of 100 mg/day was necessary. In 10% of all patients, the dose had to be further increased to 300 mg/day or even to 500 mg/day to inhibit platelet aggregation nearly completely. These results demonstrate that platelet aggregation can be used as a simple routine laboratory method to control acetylsalicylic acid treatment in patients with cardiovascular diseases and to determine individual doses of acetylsalicylic acid for a nearly complete inhibition of platelet aggregation. With a standard dose of 100 mg/day, 10% of the patients were nonresponders.

Aged↗

PubMed2001

Disposition of sulfadimethoxine in camels (Camelus dromedarius) following single intravenous and oral doses.

Single-dose pharmacokinetics of sulfadimethoxine were determined in six adult camels (Camelus dromedarius) following administration of a mean dosage of 17.5 +/- 2.7 mg/kg both i.v. and p.o. Serial blood samples were collected through an indwelling jugular catheter intermittently for 5 days for both routes. Sulfadimethoxine was assayed using high-performance liquid chromatography. Serum drug concentration versus time data for each animal was subjected to linear regression, with the best-fit model selected based on residual analysis. The data fit best into a two-compartment open model, with first-order input for oral administration. For orally administered drug, mean maximum serum concentration of 19.3 +/- 1.7 microg/ml was reached at 11.41 +/- 2.59 hr, with an elimination rate constant of 0.09/hr +/- 0.05/hr and an elimination half-life of 11.7 +/- 3 hr. Mean peak serum concentration following i.v. administration was 223 +/- 48 microg/ml. Mean volume of distribution at steady state was 0.393 +/- 0.049 L/kg. Elimination rate constants differed with i.v. and oral administration, suggesting a flip-flop model. Oral bioavailability was 103% +/- 38%. Comparison of maximum serum concentrations to the microbial breakpoint concentration reported for sulfadimethoxine (512 microg/ml) suggests that the dose used in this study, 17.5 +/- 2.7 mg/kg, is insufficient for achieving therapeutic serum levels.

Administration, Oral↗

PubMed2000

[Multinational European project and multicenter Spanish study of quality improvement of assistance on consultation-liaison psychiatry in general hospital: clinical profile in Spain].

BACKGROUND: In the frame of the European study on quality assurance in consultation liaison psychiatry and psychosomatics (supported by the BIOMED 1 program), the clinical < > of consultation-liaison psychiatry units pertaining to six Spanish general hospitals is analyzed. PATIENTS AND METHOD: A sample of 3. 608 consecutive patients referred to the consultation-liaison psychiatry units of five public general hospitals (Clínico of Zaragoza, Clínico of Barcelona, General of Alicante, Ramón y Cajal of Madrid, Princesa of Madrid) and one private gynecological hospital (Dexeus of Barcelona) was studied. The data were recorded with a standardized instrument (CL-BDoK-P), validated in a previous study. RESULTS: Consult request took place 10.6 days (on average) after the patients admission (< >), half the requests were urgent, and psychiatric consultants examined the patients 1.9 days (on average) after the request (< >). The most frequent reasons for referral were current psychiatric symptoms (50.3%), unexplained physical symptoms (15.2%), substance abuse (9.2%), psychiatric history (8.5%), suicide risk (6%) and coping with illness (5.8%). The main referral services were internal medicine (17.5%), traumatology (7.5%) and general surgery (7.3%). An important clinical activity is documented in patients frequently considered to be < >, with broad spectrum diagnostic and interventions processes and both in-hospital and out-patient follow-up. However, some problems were also detected in the clinical < >. CONCLUSIONS: The results outline the clinical importance of Spanish consultation-liaison psychiatry in the general hospital, but the possibility of improving its efficiency through the implementation of integrative models, organizational changes and modern models of < > is also emphasized.

Adult↗

PubMed2000

[Termination of inpatient treatment for anorexia nervosa].

BACKGROUND: Dropout is a neglected area of research; patients with anorexia nervosa are a group with high risk for dropout. RESEARCH QUESTIONS: 1. What are the frequency and type of dropout in disorder-specific, integrated treatment programs for anorexic patients? 2. What are the predictors for dropout? METHOD: Analysis of 80 prospectively documented, consecutive treatment episodes of anorexic inpatients, based on multimodal clinical and psychometric parameters. RESULTS: Twenty percent of patients terminated on their own initiative, often after reaching target weight; 10% were discharged by the treatment team. At least 43% of dropouts continued with some sort of psychotherapy within the 3 months after discharge. Previous dropout was a predictor for dropout in the present episodes. Patients with no comorbidity had a higher risk of dropout. Patients discharged by the team had personality disorders more often. Patients with comorbid depression stayed in treatment. CONCLUSIONS: The form of termination of treatment should be routinely assessed. Previous dropout and comorbidity are indicators of the risk of dropout.

Adolescent↗

PubMed2000

European Consultation-Liaison Psychiatric Services: the ECLW Collaborative Study.

OBJECTIVE: To describe the patterns of organization of consultation-liaison (C-L) services in 11 European countries in relation to hospital characteristics and national approaches to C-L psychiatry. METHOD: Cross-sectional survey. RESULTS: Services can best be described in terms of their size and seniority of their staff and whether or not they are multidisciplinary. Single-discipline services are based upon the standard medical consultant model, whereas those with multidisciplinary teams work in a way that is comparable with community mental health teams. German psychosomatic C-L services belonged to either model. National differences were found. CONCLUSION: This first international study provides empirical evidence for the wide variation in the organization of C-L services. In view of the increasing numbers of patients with psychiatric disorder who are being treated in general hospitals and the changing patterns of medical care there are important implications for clarification and improvement of the role of C-L services.

Cluster Analysis↗

PubMed2000

Anaesthesiological and criterial care aspects regarding the treatment of patients with arteriovenous malformations in interventional neuroradiology.

In recent years, the neuroradiological treatment of cerebral and spinal arteriovenous malformations (AVMs) has undergone significant evolution and improvement. Endovascular embolisation procedures of AVMs are mainly performed under general anaesthesia. Different pathophysiological characteristics of patients with AMVs must be considered for the choice of the anaesthetic procedures. Anaesthesiological management must aim at maintaining stable intracranial haemodynamics; thus, the drugs used must be evaluated according to their effects on brain perfusion, brain metabolism, and intracranial pressure. Rapid recovery to normal central nervous functions should be obtained postoperatively. Close-meshed neurological surveillance should be exercised in order to detect immediately any alteration of neurological state. In summary, anaesthesiological management of interventional neuroradiology is based on the same well-established principles as anaesthesia in neurosurgery.

Anesthesia, General↗

PubMed2000

Cerebral autoregulation in patients with end-stage liver disease.

OBJECTIVE: The aim of the present study was to determine whether cerebral autoregulation is absent in patients with end-stage liver disease. DESIGN: A prospective physiological study. METHODS: Thirty patients, 15 female (median age 50 years, range 33-74), with biopsy-proven cirrhosis (4 Child-Pugh class B, 26 Child-Pugh class C), had their cerebral perfusion evaluated using mean flow velocity (Vmean) in the middle cerebral artery as measured by transcranial Doppler sonography. Mean arterial pressure (MAP) was raised by intravenous noradrenaline (5-30 microg/min). Nine patients had no clinical signs of hepatic encephalopathy (HE), three were in HE stage 1, four in HE stage 2, four in HE stage 3 and ten in HE stage 4, respectively. RESULTS: Cerebral autoregulation was impaired in 13 patients, as Vmean increased from 47 (26-88) to 60 (36-109) cm/s during a rise in MAP from 61 (47-99) to 82 (65-121) mmHg. Vmean remained unchanged (preserved cerebral autoregulation) at 56 (30-119) cm/s in 17 patients when MAP was raised from 74 (59-90) to 95 (81-129) mmHg. Cerebral autoregulation was lost in 8/10 patients with HE stage 4 and only in 2/9 patients without HE (P = 0.023). The duration of HE stage 1-4 before the autoregulation study was identical for patients with preserved cerebral autoregulation compared to patients with impaired cerebral autoregulation, 5 (2-30) versus 6 (2-35) days, respectively. Baseline values of MAP were significantly lower in patients with no cerebral autoregulation compared to patients with preserved cerebral autoregulation, 61 (47-99) versus 74 (59-90) mmHg (P = 0.012). All other baseline values in the two groups were similar, including PaCO2, albumin, bilirubin, international normalization ratio, galactose elimination capacity, Child-Pugh class and age. CONCLUSION: Cerebral autoregulation is preserved in most patients with end-stage liver disease. In patients with hepatic encephalopathy and low MAP, however, cerebral autoregulation is impaired.

Adult↗

PubMed1999

Effect of magnetic resonance imaging on human respiratory burst of neutrophils.

It is known that low intensity magnetic fields increase superoxide anion production during the respiratory burst of rat peritoneal neutrophils in vitro. We investigated whether the high intensity magnetic fields (1.5 T) during magnetic resonance imaging can influence the human neutrophil function under in vivo conditions. Blood samples were obtained from 12 patients immediately before and after magnetic resonance imaging (mean time 27.6(+/-11.4 min)). The induced respiratory burst was investigated by the intracellular oxidative transformation of dihydrorhodamine 123 to the fluorescent dye rhodamine 123 via flow cytometry. The respiratory burst was induced either with phorbol 12-myristate 13-acetate, Escherichia coli, N-formyl-methionyl-leucylphenylalanine or priming with tumor necrosis factor followed by FMLP stimulation. There was no significant difference between the respiratory burst before and after magnetic resonance imaging, irrespective of the stimulating agent. Short time exposure to a high intensity magnetic field during magnetic resonance imaging seems not to influence the production of radical species in living neutrophils.

Adult↗

PubMed1999

Patterns of comorbidity in relation to functioning (GAF) among general hospital psychiatric referrals. European Consultation-Liaison Workgroup.

Improvement of services for physically ill patients with concurrent psychiatric problems is a noteworthy issue in general hospitals. Among 1249 general hospital in-patients referred for psychiatric consultation, concurrent mental and behavioural disorders (ICD-10) were diagnosed in 84% of cases. Any concurrent mental and behavioural disorder was associated with dramatically low functioning (GAF = 46), indicating serious psychosocial impairment. This is a striking new finding of clinical importance. The effect on functioning was similar for substance use disorders, other mental disorders, and combined mental and substance use disorders (dual diagnoses), with no gender differences. This finding highlights the need for specialized interventions among general hospital in-patients referred for psychiatric consultation.

Adolescent↗

PubMed1998

[Quality assurance of psychiatric consultations in somatic hospitals].

Research has shown great variety in the clinical practice of consultation-liaison psychiatry in and between different countries. This paper presents the Norwegian experiences from a European collaborative study of quality management in consultation-liaison psychiatry. We describe a dynamic model for total quality management based on regular registration of some clinical data and the subsequent feed-back on changes of these. We discuss our experiences with this model and obstacles met in everyday work. Finally we point to different ways of implementing this method on a broader base in consultation-liaison psychiatry.

Hospitals, General↗