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PubMed1978

[The 3 phases of schizophrenic psychosis and their phase-specific psychotherapy].

It is not the diagnostic evaluation but merely the phase in which we find our patient, that determines about the process of psychotherapy with schizophrenic patients. There are three phases--or, more approximately, four phases (phase one to three plus "phase zero")--to be differentiated: Phase Zero: This phase precedes an obvious clinical appearance of psychosis. Patients feel ridiculous in their anxiety and are not yet capable to create the symptomatology of psychosis.--Intensive participation in those strange perceptions and the attempt to witness the same experiences as the patient does, often help to prevent the formation of a severe psychosis. Phase One: Deep psychosis with common symptomatology. Verbal communication in the usual form is no more possible. Only answering the patient in his own language--speaking as he speaks and behaving as he does--helps to overcome his permanent isolation. Phase Two: Stage where the patient leaves his psychotic world and does not yet live in the world of his "healthy" surroundings.--In this phase psychotherapy intends to lead towards a confrontation with the previous psychotic experiences in order to integrate them into his personality. Phase Three: Phase of return towards a more adequate behaviour.--In this phase the therapist helps his patient to build up his "narcissistic coat" in order to create a shelter, where he can retreat; out of this "cocoon" he is able to observe what happens around him, without being thrown back into a severe psychotic crisis. On the other hand there may arise situations of "relapses" (so-called intermediary stages). These phases, which resemble common depression, can be understood as substitutes of the former psychotic situation. It is insight in its uttermost distinction that leads to secondary stages. Therefore psychotherapy will be most helpful, when the understanding of the circumstances that lead to such situations, is not evaded but promoted; the more intensely these promotions, the better the prognosis.

Humans↗
PubMed1981

[Comparison of 2 steroid parameters by means of the 3 phase test in hirsutism patients].

The excretion of the C19O2-fraction of 17-oxosteroids in urine (C) and the concentration of testosterone in serum (T) have been compared in 15 women with hirsutism during tests with suppression of the adrenals and the ovary and with stimulation of the ovary. The behaviour of both parameters seemed to be only qualitatively similar in all three phases of the tests. In one of the test phases a statistically significant correlation between the percentage of decrease or increase of C and T has been observed (First phase: r = 0.242; second phase; r = 0.457; third phase r = 0.392). The mean relative changes of C in the adrenal suppression phase was more distinct (P less than 0.002) than that of T. Both parameters seem to be of different diagnostic meaning.

17-Ketosteroids↗
PubMed1993

[Awakening from traumatic coma and its future. 3 phases of dynamic reconstruction].

After the question of TC patient's survival in Intensive Care Units, many other questions, during-coma awakening phase, appear to family, care team, and the patient himself i.e. will the patient be handicapped or will he be as before? which after-effects of this passage? The vital functions and autonomy conquest goes with a permanent adjustment of psychical functions for keeping together an "exploded" subject. Each patient's singular history, its expression and meanings, are catched into initial trauma, coma, intensive care and awakening phase framework. Clinical observations leads to describe three evolutive periods, specific of awakening but also bound up with each other.

Brain Injuries↗
PubMed1995

[3-phase spiral CT--a new noninvasive procedure for the differentiation of multifocal liver lesions].

Dynamic CT is an established method for the differentiation of focal liver lesions by monitoring the contrast enhancement. It is especially restricted in the assessment of small and multiple lesions due to respiratory organ movements. Spiral-CT allows the examination of large volumes in the breathhold technique. Spiral-CT with controlled i.v. contrast media administration can be used for the assessment of the entire liver in distinct phases of perfusion. We describe the use of this new technique in a patient with multifocal nodular hyperplasia (FNH), for whom assessment with dynamic CT was not suitable. The lesions were first located with a conventional contrast-enhanced CT-scan. The impossibility to assess all the lesions with dynamic CT led to the decision to perform a three-phase spiral-CT with three sequential scans (native, arterial, and portal perfusion phase). The entire liver was scanned after power injector-controlled i.v. administration of contrast media with the following parameters: 1) arterial phase: 70 ml contrast media, 2 ml/s, start delay 18 s; 2) portal phase: 80 ml contrast media, 2 ml/s, start delay 60 s; slice 8 mm, table feed 8 mm, increment 4 mm; 24 s of breathhold data acquisition.

Adult↗
PubMed1994

[Semi-quantitative analysis of 3-phase bone scintigraphy data in algodystrophy of the limbs].

Three-phase bone scanning of the extremities (foot or hand) was performed in 40 normal subjects and in 56 patients with an unequivocal clinical diagnosis of reflex sympathetic dystrophy. Ten patients were in the "cold" or atrophic stage of the disease process, whereas 46 were in the "hot" or acute phase. The scintigraphic parameters studied were the ratios of tracer activity in the affected side over the healthy side established for blood flow (BF), blood pool (BP), early vasculo-tissular fixation (EF), and late bone fixation (LF). In the controls, blood flow, blood pool, and early fixation showed considerable interindividual variation and only the variation of late fixation remained within narrow limits. Among the patients, those at the hot stage of the disease had significantly higher values for all four parameters than those at the cold stage. The group at the cold stage did not differ from the controls except for a significantly higher late fixation value. Furthermore, among hot stage patients, 15% to 25% had normal or diminished blood flow, blood pool and early fixation values. At the cold stage of the disease, radionuclide parameters were similar in affected feet and hands, whereas at the hot stage values at the feet were double those at the hands. Finally, statistical analysis revealed that late fixation was most closely correlated with early fixation, which in turn was most close correlated with blood pool. The clinical and pathophysiological significance of these data is discussed.

Adult↗
PubMed1997

Intralesional fluorouracil/epinephrine injectable gel for treatment of condylomata acuminata. A phase 3 clinical study.

BACKGROUND AND DESIGN: A new intralesional sustained-release chemotherapy is under development as a treatment for condylomata acuminata; it is administered as an injectable gel that consists of fluorouracil and epinephrine with a purified bovine collagen as the gellant (fluorouracil/epinephrine gel). In this randomized, double-blind study, we evaluated the safety and efficacy of this intralesional treatment in 401 patients, using 2 active drug formulations (fluorouracil/epinephrine gel and fluorouracil gel alone) and a placebo. Each lesion was injected once a week for up to 6 weeks, and patients were followed up for 3 months. RESULTS: A total of 359 patients with 1926 condylomata underwent evaluation. For all lesions treated with fluorouracil/epinephrine gel, the complete response (CR) rate was 77%. For all patients treated with fluorouracil/epinephrine gel, the CR rate was 61%. The fluorouracil/epinephrine gel was significantly more effective (P < .002) in treating condylomata than the fluorouracil gel without epinephrine (CR rate, 43%); both were superior to placebo (CR rate, 5%). At 3 months after completion of treatment, recurrence rates in patients with CRs were as follows: fluorouracil/epinephrine gel group, 50%; fluorouracil gel group, 58%. No clinically significant drug-related systemic reactions occurred. Finally, the type and severity of local tissue reactions of patients with a positive pretreatment collagen skin test result (6/401 [1.5%]) were similar to those of patients with a negative collagen skin test result. CONCLUSION: The fluorouracil/epinephrine injectable gel is a safe and effective treatment for condylomata acuminata.

Adolescent↗
PubMed1998

Decisive diagnosis of seronegative polyarthritis by 3-phase bone scintigraphy.

Inflammatory joint disease is mainly diagnosed on grounds of clinical investigation, laboratory testing (acute phase reactants), and radiography. Radionuclide imaging has recently been added to the armamentarium of clinician. This case report points out the role of three-phase bone scan and HIG (human immunoglobulin) scan in the discovery of the inflammatory nature of polyarthralgia in a young woman with equivocal clinical and laboratory results. In the aim of diagnosing arthritis early in its course scintigraphy proved to be superior to conventional radiography. It also allows more discriminating selection of subsequent X-ray examination to limit radiation exposure.

Acute-Phase Proteins↗
PubMed1983

Efficacy and safety of verapamil in patients with angina pectoris after 1 year of continuous, high-dose therapy.

The long-term efficacy and safety of high-dose verapamil therapy (480 mg/day) was assessed in 26 patients with chronic stable angina pectoris during a 3-phase protocol: Phase 1--an initial, 6-week placebo-controlled, double-blind crossover assessment; Phase 2--an open label, 1-year follow-up; and Phase 3--a final drug withdrawal and rechallenge 10-week study. Three patients withdrew during Phase 2 (1 had hepatitis and 2 underwent coronary bypass surgery). Adverse effects during Phase 2 were mild, consisting of constipation (6 patients) and prolongation of the P-R interval (5 patients); however, no patient required alteration of the 480 mg/day dosage. At the end of Phase 2, 10 patients underwent the Phase 3 study, commencing with a 2-week period in which verapamil was either tapered gradually or abruptly discontinued. This was followed by an 8-week double-blind, placebo-controlled crossover rechallenge study with verapamil. The clinical and exercise responses to verapamil compared with placebo were similar during the Phase 3 protocol and the initial Phase 1 study (treadmill time increased by 55% and anginal attacks per week decreased by 63% during Phase 3, compared with a 28% increase and a 42% decrease, respectively, during Phase 1, p = not significant [NS]). Withdrawal of verapamil produced a similar return of anginal symptoms whether the drug was abruptly discontinued or its administration tapered. No patient had unstable angina pectoris or acute myocardial infarction. These investigations demonstrate that verapamil is safe and effective when evaluated after 1 year of continuous therapy using a dosage of 480 mg/day. There is no evidence of drug tachyphylaxis, nor does verapamil appear to cause an abrupt withdrawal syndrome in patients with chronic stable angina pectoris.

Adult↗
PubMed2001

A(3)Tt(5) phases Sr(3)Sn(5), Ba(3)Pb(5), and La(3)Sn(5). Structure and bonding in a series of isotypic metallic compounds with increased electron count and their comparison with the nominal zintl phase La(3)In(5).

A series of compounds that contain square pyramidal Tt(5) polyanions of tin and lead has been obtained in alkaline-earth or rare-earth metal-tetrel systems by direct fusion of the elements at 570 degrees C (Sr(3)Sn(5)), 1000 degrees C (Ba(3)Pb(5)), or 1300 degrees C (La(3)Sn(5)) followed by slow cooling or annealing. The crystal structures for all three have been refined in the Pu(3)Pd(5) structure type (orthorhombic, Cmcm, Z = 4) with cell dimensions of a = 10.644(2), 11.154(7), and 10.352(5) A, b = 8.588(1), 9.049(7), and 8.290(6) A, and c = 10.895(2), 11.370(5), and 10.652(5) A for Sr(3)Sn(5), Ba(3)Pb(5), and La(3)Sn(5), respectively. Square pyramidal clusters of the tetrel elements are weakly interlinked into chains via two types of longer intercluster interactions that are mediated by bridging cations and substantially influenced by cation size and the free electron count. The new compounds are all metallic (rho(295) approximately 10 (Sr(3)Sn(5)) to approximately 25 (La(3)Sn(5)) muOmega.cm), in agreement with simple valence considerations that predict two and five extra electrons per formula unit, respectively, beyond that necessary for closed-shell nido-Tt(5)(4)(-) anions. Extended Hückel tight-binding calculations on the new compounds as well as on La(3)In(5) reveal that bonding in the regions below and around the Fermi energies are dominated by general cation-anion interactions, that is, lattice covalency. Closed-shell bonding features for the classical Sn(5)(4)(-), In(5)(9)(-), etc. ions are also obvious but subsidiary to the heteroatomic interactions with the cations. The intercluster contacts are relatively unimportant in bonding.

Journal Article↗
PubMed2002

The feasibility of full computerization in the ED.

For understanding the feasibility of full computerization of an emergency department (ED), we investigated the completion rate performed by doctors, nurses, or registration clerks since the implementation of full computerization in our ED. We evaluated the changing style of chart-recording, from hand-writing pattern to full computer recording, by recording the execution rate of different information keyed by doctors, nurses, or registration clerks according to their work in ED. We recorded and analyzed different monthly reports of the execution rate in the 18-month period of study. Statistical analysis was performed using Wilcoxon rank-sum test or Kruskal-Wallis one-way ANOVA. The average monthly census was 4570.1 +/- 580.7 (95% confidence interval [CI] for mean: 4281.3, 4858.9). The average execution rate for mode of arrival and triage classification were 97.1 +/- 4.1% (95% CI for mean: 95.1%, 99.1%) and 97.2 +/- 4.1% (95% CI for mean: 95.2%, 99.2%), respectively. In comparison with the execution rate for disposition status between the period of the first 10 months (keying data by nurses) and the late 8 months (keying data by clerks), it showed 72.0 +/- 33.2% v 96.7 +/- 2.0%; 66.7 +/- 35.0% v 95.8 +/- 1.9%; 57.5 +/- 32.0% v 88.2 +/- 8.2% in nontrauma, trauma and pediatric section, respectively, with statistic significance (P <.01). To compare the rate of execution performed by physicians, we divided the study period into 3 phases (phase 1: first 6 months, phase 2: 7-12 months, phase 3: 13-18 months of the study period). The results were statistically significant (P =.004) in phase 3 (83.4 +/- 5.3%) with higher execution rate than phase 1 (69.7 +/- 7.7%) and phase 2 (75.2 +/- 4.9%) in trauma physician. In the pediatric section, it was also significantly higher in phase 3 than phase 2 (88.2 +/- 7.7% v 70.7 +/- 5.9%, P =.012). We concluded that it is efficient to key in data by registration clerks instead of nurses, and it takes time to persuade and educate most physicians to cooperate in using the computer while seeing patients.

Analysis of Variance↗
PubMed1993

Self-injurious behavior within the menstrual cycle of women with mental retardation.

There are no reports of an association between the menstrual cycle and self-injurious behavior (SIB) in the mentally retarded population. However, the endogenous opiate system has been implicated in both menstrual cycling and SIB. Catamenial and behavioral records of 9 women with mental retardation who exhibited SIB were analyzed for 6 months to determine the association between phases of the menstrual cycle and rates of SIB. Menstrual cycles were divided into four phases: (a) menses and early follicular phase, (b) late follicular phase, (c) early luteal phase, and (d) late luteal or premenstrual phase. Analysis showed that the highest frequency of SIB occurred in the first two phases: 43.5% during early follicular phase and 47.3% in the late follicular phase. Pairwise t and binomial expansion tests confirmed that SIB was cyclic across the menstrual cycle with Phase 1 > Phase 3, Phase 1 > Phase 4, Phase 2 > Phase 3, and Phase 2 > Phase 4. Seven of the 9 women were cyclers and manifested identical phase/SIB relations. The cyclical character of SIB may relate to changing peripheral and central endorphin and pain threshold during the cycle.

Adolescent↗
PubMed2001

Quantitative analysis of end-tidal carbon dioxide during mechanical and spontaneous ventilation in infants and young children.

Capnography provides a substitute for monitoring of arterial carbon dioxide tension (PCO(2)). We performed a prospective study to evaluate a new application of capnography, using quantitative curve analysis in the pediatric ICU. Twenty-five infants and children admitted to the pediatric ICU after cardiovascular surgery for congenital heart diseases were included in the study. Capnographic curves were recorded during 3 phases of mechanical and spontaneous ventilation: phase 1, immediate postoperative period; phase 3, preextubation period; and phase 2, period between phases 1 and 3. Each recording included 17 sec of capnographic tracings from consecutive spontaneous and/or ventilator-driven breaths. Quantitative curve analysis was made to define parameters including peak value of exhaled PCO(2) (P), mean rate of rise of PCO(2) (R), and area under each capnographic curve (A). Qualitative inspection of the wave contour showed no obvious difference in phase 3 during spontaneous and mechanically assisted ventilator breaths. However, an obvious difference existed between spontaneous and mechanically assisted breaths in phase 2. For each parameter (P, R, and A), there was a significant difference in phases 2 and 3 from spontaneous breaths. However, there was no significant difference in phases 2 and 3 from ventilator-assisted breaths. We further calculated the ratio of parameters of spontaneous breaths (S) and ventilator-assisted breaths (V) in phase 2 and phase 3. The ratio of S/V for P, R, and A showed significant differences between phase 2 and phase 3. We conclude that quantitative analysis of exhaled end-tidal PCO(2) curves revealed significant changes of specific parameters during the transition from the ventilator-dependent state to the spontaneously breathing ventilator-independent state. This new approach provides a new way to estimate respiratory status in infants and children receiving ventilator therapy. Through quantitative capnographic curve analysis, if P, R, and A from spontaneous breaths approached those of ventilator-assisted breaths, patients have resumed reasonable pulmonary mechanics, and extubation may then be considered.

Capnography↗
PubMedDate not supplied

Treatment effect size of memantine therapy in Alzheimer disease and vascular dementia.

The purpose of this paper is to assess the clinical relevance of the significant results reported in clinical trials of memantine therapy for Alzheimer disease (AD) and vascular dementia. We sought to understand what clinically detectable changes would be evident to the patient with dementia, their caregivers, and the treating physician during a trial of memantine therapy. A literature search was performed on MedLine, PsycInfo, and the Cochrane database. The statistically significant findings from the memantine literature were reviewed using treatment effect size as a measure of clinical meaningfulness. There have been 3 phase 2 studies of memantine in dementia, and 6 phase 3 studies published as of August 1, 2005. Of the 6 published phase 3 trials of memantine in dementia; 2 were in mild-moderate vascular dementia, 1 in mild-moderate AD, 2 in moderate-severe AD, and 1 in severe dementia (both AD and vascular dementia). The most convincing evidence of a clinically meaningful treatment effect of memantine therapy is in the moderate-severe AD patient population. Cognition, as measured by the Severe Impairment Battery, had an effect size of 0.32 and 0.49 in the 2 published trials, indicating a small-to-medium effect of the medication. Global, functional, and behavioral scales also showed a small-to-medium response to memantine.

Alzheimer Disease↗