PubMed Health⌕ Search

Biomedical subjects

W Löffler

Publications and source records attributed to W Löffler.

At least 37 records · Page 2Linked to original sources
PubMed1997

Continuous extracorporeal stool-transport system: a new and economical procedure for transitory short-bowel syndrome in prematures and newborns.

Between May 1994 and June 1995, nine newborns underwent surgery due to mechanical ileus or intrauterine perforation of the small bowel. Three were very-low-birth-weight infants weighing between 520 and 1,200 g. Surgery was performed in the first 2 days of life and split ileo- or jejunostomas were implanted. Early oral nutrition was initiated. To avoid non-use of the distal bowel and short-bowel syndrome, the aboral stoma was irrigated a few days later with the proximal feces. A new technique was applied to transport the chyle continuously from the oral to the aboral stoma: the stool was collected in an especially constructed stoma bag and transported distally by a roller pump. No major complications were seen. The general outcome was excellent in all cases, and reanastomosis under optimal bowel conditions was achieved in all patients without further problems.

Feces↗
PubMed1997

What do we really know about late-onset schizophrenia?

Actual knowledge on classical late-onset schizophrenia, i.e. the schizophrenic disorders with onset after age 40 years, is reviewed regarding incidence, symptomatology and course. As is shown, sound empirical knowledge is scarce. Reasons for this are, on the one hand, the conceptual and terminological confusion which has occurred internationally regarding this illness group, and, on the other hand, the methodological limitations of the empirical studies conducted on this clinical picture thus far. If we only draw on classical late-onset schizophrenia, as originally defined by Bleuler, and primarily on methodologically sound studies, as well as on own studies, we can nevertheless conclude that the term "late-onset schizophrenia" could be omitted. Late-onset schizophrenia does not seem to be a distinct entity, but instead seems to belong to the same illness group as classical schizophrenia with earlier onset. Slight differences in symptomatology and course are probably due to unspecific influences of age. The markedly higher proportion of women among late-onset cases, as well as our finding that symptomatology and course of late-onset women are comparably poor, could possibly be explained by an effect of the female sex hormone oestradiol.

Age of Onset↗
PubMed1996

[Psychiatric handicap--precursor or social sequelae of schizophrenia?].

Having finalized the ICD 10, the WHO is now preparing a new version of the "International Classification of Impairments, Disabilities and Handicaps" (ICIDH). At present this threefold scheme is designed to classify the consequences of mental illness. Impairment is defined as either a loss of function or a damage to structure. Disability is the resulting limitation in performance. The restriction in the ability to fulfill social roles is known as role handicap. These three aspects conceptualised in strict sequence have thus far been understood only in terms of the result of the illness. The planned review of the ICIDH will most likely consist of substituting this rather rigid scheme by a more flexible one. This will allow for feedback mechanism between the different levels. Premorbid disabilities/handicaps as possible risk factors for the development of mental illness may even be taken into consideration. The analyses within the Mannheim ABC schizophrenia study have convincingly shown that social disability and role handicaps are present in a high percentage of patients (57%) prior to the onset of the first psychotic symptom. On an average they begin about two to four years before the first hospitalisation and one to three years prior to the first psychotic symptom. While the correlation between social disability and positive symptoms is not significant, disability and negative symptoms are closely related. In addition to this only part of this correlation can be explained as a conceptual overlap (i.e. the SANS subscales Avolition and Anhedonia have items comparable to the Disability Assessment Schedule). In fact, we found comparably high correlations between affective blunting and alogia and social disability as well. Patients with early disability not only have an overall unfavourable course of negative symptoms but negative symptoms are shown to be useful predictors for social disability three years after the first hospitalisation.

Adult↗
PubMed1995

When and how does schizophrenia produce social deficits?

The present study is an empirical contribution to the controversy over whether the poor social performance and lower social class of schizophrenic patients are consequences of the illness, consequences of changes in the individuals predisposed to develop schizophrenia or are due to the adverse social conditions that lead to schizophrenia. The study focuses on the socioeconomic status at onset, on the performance of social roles in the early course of schizophrenia by taking age, gender and the individual level of social development into account. In a representative sample of 232 first episodes of schizophrenia age and type of onset.type and accumulation of symptoms and social functioning in the prodromal and the psychotic prephase and at first admission were assessed and analysed for their predictive power concerning social disability 2 years after first admission. In a case-control study expected and observed social functioning from onset until first admission were compared. The subsequent course was followed up prospectively in five cross sections until 2 years after first admission. In women the age at onset was significantly higher than in men, whereas symptomatology and type of onset showed no gender differences. In 73% of the sample the prodromal phase covered 5 years on average, and the psychotic prephase (until the maximum of positive symptoms) 1.1 years. Deficits in social functioning occurred predominantly during the prodromal and the psychotic prephase. The course over 14 years showed stable group trends in social and symptom measures. By the end of the prodromal phase it was possible to predict social disability 2 years after first admission with a correct classification of 81%. The main factor determining social outcome appeared to be the acquired social status during the prodromal phase of the disorder. The unfavourable early course in men was due mainly to their significantly lower age at onset. These results raise questions concerning an earlier therapeutic and rehabilitative intervention.

Adolescent↗
PubMed1995

Case management for schizophrenic patients at risk for rehospitalization: a case control study.

In many countries deinstitutionalization of psychiatric patients is accompanied by fragmentation of care, giving responsibility to an array of different services and providers. One of the possible side effects of this is an increased rehospitalization rate and length of stay. The need to coordinate the services involved for the benefit of individuals has led to the conceptual development of case management. However, despite an apparent belief in the effectiveness of case management, there is only limited scientific evidence to support this assumption. In the case control study presented we compared a group of 97 schizophrenic patients in the aftercare of case management services with a group of patients who received no outpatient care by case management services after discharge from hospital. Each patient in the case-managed group was exactly matched with a control patient with regard to diagnosis and known risk factors for rehospitalization. Additionally, we considered influencing factors that result from general health system conditions such as regional differences and different types of hospital care. Our analyses demonstrate that, during an observation period of 2.5 years, case management had neither a significant effect on the risk of rehospitalization nor on the length of time in hospital in the event of rehospitalization.

Adult↗
PubMed1995

Mortality among patients in psychiatric hospitals in Germany.

Data from 7 psychiatric hospitals with defined catchment areas were analyzed; 14,195 episodes of treatment in acute psychiatry wards were recorded within 30 months. During their stay in hospital 196 patients died, 174 from natural causes and 22 by suicide, compared to the expected 32 deaths. Standardized mortality ratios (SMRs) were calculated for the different diagnostic and age groups, mortality risk being highest in organic mental disorder (SMR 7.55), followed by functional psychoses (SMR 4.55) and the "other disorders" (alcoholism, neurotic and related disorders, SMR 3.25). Roughly one half of the 196 deaths were due to cardiovascular disorders and pneumonia. In patients with nonorganic psychiatric syndromes, suicide was the most frequent cause of death (21 of 58 fatalities). With regard to the elevated mortality risk of patients with acute mental illness, a reduction of fatality rates from natural and unnatural causes should remain a major objective of hospital care in psychiatry.

Adult↗
PubMed1995

Symptom assessment in casenotes and the clinical diagnosis of schizophrenia.

It is well known from several international studies that the incidence rates for schizophrenia, based on first-admission samples, are low in Denmark, especially in females, compared with other countries. This might be due to special diagnostic traditions in Denmark. To analyze how Danish psychiatrists reach a diagnosis of schizophrenia, a stratified subsample of 122 cases out of all 1,259 patients, aged between 12 and 64 years, with a first hospital admission in 1976 under the diagnosis of schizophrenia, paranoid psychosis, acute reactive paranoid psychosis, or casus limitaris was selected. For this subsample, psychopathological symptoms, as documented in the clinical casenotes, were rated by PSE-9 symptom lists for subsequent CATEGO analysis. The core syndrome of schizophrenia, as defined by the CATEGO class S+, showed no association with the clinical schizophrenia diagnosis compared with the other diagnoses mentioned. Also, positive symptoms of schizophrenia did not determine the diagnosis, but for typical negative symptoms such associations were indicated. Some negative symptoms also seemed to be linked to a depressive state. Furthermore, the present work indicates that using first-admission data leads to a higher age at schizophrenia onset and a lower first-admission rate in Denmark compared with Germany.

Adolescent↗
PubMed1995

Excess mortality among elderly psychiatric in-patients with organic mental disorder.

BACKGROUND: Many studies have shown hospitalised mentally ill patients to have a higher mortality risk than the general population. METHOD: Data of patients with organic mental disorders of ICD-9 categories 290, 293, 294 and 310 from seven psychiatric hospitals with defined catchment areas were analysed. During an observation period of 2.5 years 1821 treatment periods in these diagnostic categories were recorded. RESULTS: During hospitalisation 137 patients died from natural causes. The age- and sex-adjusted mortality rates show an increased mortality risk of 7.5 times, compared to the general population. The odds ratio of a logistic regression demonstrate the overwhelming influence of the medical diagnosis. CONCLUSION: Medical factors, including pneumonias, contribute most to the excess mortality.

Aged↗
PubMed1995

[Traumatic injury of the internal carotid artery in the extracranial segment. Description of a severe late complication].

Blunt traumatic injury to the extracranial internal carotid artery may lead to a dissection with resultant stenosis, occlusion, or a dissecting aneurysm. Delayed clinical presentation weeks, months, and even years after the injury is rare, but has important diagnostic, therapeutic and forensic implications. In the current era, where computed tomography is replacing angiography as the main diagnostic procedure, it is extremely important to keep this diagnosis in mind. We report the case of a 31-years-old male patient, who did well after a motorcycle accident with head and neck injury for six years. Since then he only showed left-side Horner's syndrome, which unfortunately was ignored. In 1993 the patient developed occlusion of central retinal artery, and after a therapy with streptokinase he presented with right-side palsy and complete aphasia. CT-scan revealed a large edematous infarction in the middle cerebral artery territory. Transfemoral digital subtraction angiography however demonstrated a dissecting aneurysm of the left extracranial internal carotid artery as the source of intracranial embolization. Severe sequelae of this kind can only be warded of by early diagnosis and proper surgical therapy of vascular injury. Therefore even minimal symptoms suggesting the possibility of a traumatic injury to the carotid artery are recommending timely angiographic investigation.

Adult↗
PubMed1994

Interaction of allopurinol and hydrochlorothiazide during prolonged oral administration of both drugs in normal subjects. I. Uric acid kinetics.

The interaction of allopurinol (300 mg/day) and hydrochlorothiazide (50 mg/day) was studied in seven healthy male volunteers during prolonged coadministration of the two drugs using defined dietary conditions. A formula diet was administered with the allopurinol throughout the 24-day study, while hydrochlorothiazide was added during days 11-21. After the addition of hydrochlorothiazide both plasma uric acid and plasma oxipurinol rose for 6 days--24% and 30%, respectively, compared to steady-state levels during allopurinol alone (P < 0.01 each). In neither substance were variations in renal excretion significant. By the end of combined treatment (day 21), the changes induced by hydrochlorothiazide had already been reversed to a considerable extent. It is concluded that both in normal individuals and in patients with normal renal clearance of uric acid the effect of hydrochlorothiazide on the plasma concentration and renal excretion of oxipurinol is small. When taking both drugs, there is no increased risk during long-term treatment, and a risk is even questionable during the first days.

Administration, Oral↗
PubMed1994

Interaction of allopurinol and hydrochlorothiazide during prolonged oral administration of both drugs in normal subjects. II. Kinetics of allopurinol, oxipurinol, and hydrochlorothiazide.

The kinetics of allopurinol and hydrochlorothiazide were investigated in seven healthy male subjects during prolonged coadministration of two drugs. Subjects were maintained on an isoenergetic, purine-free formula diet with RNA supplementation for 24 days. Allopurinol (300 mg) was given orally on days 1-24. Hydrochlorothiazide (50 mg daily) was added to days 11-21. On day 43 a single oral dose of 50 mg hydrochlorothiazide was administered. Plasma concentration-time profiles of allopurinol and its main metabolite oxipurinol were obtained on days 1, 10, and 21; hydrochlorothiazide profiles were assessed on days 21 and 43. In addition, 24-h plasma concentrations of oxipurinol were measured repetitively, and 24 h urine samples were collected for the determination of allopurinol, oxipurinol, and hydrochlorothiazide. For oxipurinol, mean Cmax was not altered on hydrochlorothiazide treatment (13.8 +/- 1.4 micrograms/ml and 14.7 +/- 2.6 micrograms/ml, respectively); mean AUC0-24 was 259 and 290 micrograms h-1 ml-1, respectively. The small difference in AUC0-24 values does not explain the increase in plasma uric acid concentration during hydrochlorothiazide treatment, nor do the variations in allopurinol and hydrochlorothiazide kinetics.

Administration, Oral↗
PubMed1994

Beginning schizophrenia observed by significant others.

As a part of the ABC Schizophrenia Study, a large-scale investigation of the influences of age and gender on the onset and course of schizophrenia, this study compared retrospective reports about emerging symptomatology during the early course of schizophrenia given by patients and their significant others in a representative first admission sample. The Interview for the Retrospective Assessment of the Onset of Schizophrenia (IRAOS), a comprehensive interview assessing early signs and symptoms, revealed that, in most cases, patients as well as informants perceived negative, depressive, and unspecific symptoms as early signs of the disorder. Pairwise agreement about the presence of certain symptoms was good for a limited number of signs, e.g., substance abuse, suicidal behavior, parental and marital role deficits, and paranoid delusions. These items mainly concern abnormal behaviors that can be observed easily. In contrast, there was little agreement between reports about perceptual and formal thought disorder, i.e., subjective internal phenomena. The results supported a continuity model for the observability of symptoms in schizophrenia.

Adolescent↗
PubMed1994

[Depression in the early course of schizophrenia].

Depressive syndromes in schizophrenia are reported in the prodromal stage of the early course, during the first or later psychotic episodes, but also after the fading out of an acute episode and as a precursor of relapse. According to these multiple conditions several explanations also exist as to how to understand depression in schizophrenia. Some authors interpret it as an elementary part of the schizophrenic symptomatology, which is only masked by positive symptoms (revealed depression). However, it can also be understood as a reactive depression or as caused by neuroleptic treatment, as part of the negative syndrome or as co-morbidity. In the ABC-Schizophrenia-Study, depression in the early course was analysed for patients in their first psychotic episode at index admission and an ICD-9 diagnosis of schizophrenia (ICD 295). In 81% of this sample depression was observed, beginning on average 4.3 years prior to index admission. In 42% of the patients depression began in the prepsychotic phase. In 18% the positive and the depressive syndrome developed within one month, and in 21% depression started after the first positive symptom occurred. We could only observe a clear sequence of depressive, negative and positive symptoms in the subgroup characterised by prepsychotic depression. A clear order of negative and positive symptoms was not observed in the other groups. Patients without depression in the early course have lower symptom levels at index admission. They present less positive symptoms (CATEGO-subscore DAH), fewer behavioural disturbances (subscore BSO) and also lower scores of non-specific symptoms (subscores SNR and NSN). More than 80% of the patients with depression in the early course also had a simple depression (as defined by the CATEGO-syndrome SD). Contrary to this, only 20% of the patient group without depression in the early course have positive SD values. Comparable percentages of males and females have depression in the early course, but in females depression begins more frequently in the prepsychotic phase, whereas in the male subgroup it more often starts postpsychotically, i.e. after the onset of the first psychotic symptom.

Adult↗