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Biomedical subjects

F Loew

Publications and source records attributed to F Loew.

At least 19 recordsLinked to original sources
PubMed1998

[Medicine and humanism: clinical ethics and the community dimension of geriatrics].

Clinical ethics is generally related to the clinical bedside activity. Clinical ethics constitutes one aspect of bioethics. In particular, its aim consists in facilitating the solving of conflicts of values in practical care. By encouraging effective communication and discussion within the interdisciplinary team, geriatricians will be able to make adequate diagnostic and therapeutic interventions, in accordance with the fundamental desire of the patient and her or his family.

Aged↗
PubMed1997

Is there a relationship between psychological well-being and patient-carers consensus? A clinical pilot study.

Does communication with terminal cancer patients about their disease influence their psychological well-being? The degree of patient-carer consensus about the disease was compared to psychological well-being related to acceptance of the disease, emotional state, and hope. These were evaluated and scored from 6 (good) to 0 (poor) through a semi-structured interview of 10 open-ended questions. Nineteen palliative care patients were studied, 18 of whom were suffering from advanced cancer. Overall, 57 interviews were conducted with the patients, staff nurses, and medical doctors. The answers of the carers (staff nurses and doctors) were compared to the patients' answers to determine the degree of consensus in terms of communication about disease, aim of treatment, and ultimate objective of hospitalization. The consensus between patients and carers was scored from 6 (satisfactory) to 0 (unsatisfactory). A significant positive correlation between the scores of consensus and those of psychological well-being (r = 0.90, p < 0.001) was found. These results suggest that good and truthful communication may improve patients' psychological well-being.

Adaptation, Psychological↗
PubMed1996

[Attitude of Swiss Army recruits from Tessin to pain and euthanasia (1992 and 1995)].

Nineteen-year-old Swiss Army conscripts were questioned in 1992 (n = 1361) and 1995 (n = 1050) about their opinions regarding pain and euthanasia. In 1995, 85% (1992: 71%) considered pain as a fundamental part of life, 73% (1992: 77%) thought that the patient himself should decide how to control pain, and 50% (1992: 51%) would accept the idea of euthanasia at the request of a family member with an incurable disease and in pain. Significant differences were found only in correlation to the degree of religious belief.

Adult↗
PubMed1995

Postprandial hypotension and orthostatic blood pressure responses in elderly Parkinson's disease patients.

OBJECTIVE: To investigate the change in systolic blood pressure (SBP) induced by meals and to compare their impact on the orthostatic SBP response in elderly Parkinson's disease with that in control patients. DESIGN: Ten elderly patients suffering from Parkinson's disease were compared with 10 age-matched elderly control patients. METHODS: The postprandial SBP change was measured by means of ambulatory blood pressure monitoring with the patient in the supine position. Orthostatic SBP responses were measured the next day by means of active standing and passive head-up tilting tests performed before and after the patients had their lunch. RESULTS: In Parkinson's disease patients, a postprandial SBP drop of 27 mmHg in the supine position was found compared with a drop of 8 mmHg in controls. In Parkinson's disease patients, that drop was moderately correlated to the orthostatic SBP responses and significantly correlated to the preprandial supine baseline SBP level. The orthostatic fall in SBP was greater with passive than with active standing and with both it was greater in Parkinson's disease patients than in the control subjects. The fall in orthostatic blood pressure was reduced by a previous meal. In contrast, there was no difference in orthostatic heart rate responses between the patients and the controls. CONCLUSIONS: Parkinson's disease patients demonstrated a significant postprandial drop in SBP and a tendency towards orthostatic hypotension, which was not worsened by the meal, probably owing to a stronger sympathetic activation. Postprandial supine SBP change and orthostatic SBP responses were only moderately associated in Parkinson's disease patients. In addition to autonomic dysfunction, an increased baseline SBP level might contribute to both phenomena.

Aged↗
PubMed1994

[Ethics of antibiotherapy in geriatric medicine].

The high frequency of infections in the elderly, at home as well as in institutions, raises the question of the place antibiotic therapy should occupy. Too often, unfortunately, antibiotic therapy is prescribed indiscriminately in cases of infection. Between therapeutic abstention and overtreatment there is room for a more rational and adapted medical decision which is the outcome of a clinical process integrating a rigorous biomedical approach, taking due account of the environment, the functionality and the quality of life of the elderly patient. The importance of human, ecological, pharmacological and economic constraints should lead to deeper consideration of the appropriateness of antibiotic therapy in geriatric practice.

Aged↗
PubMed1994

Prognostic factors in the treatment of cerebellar haemorrhage.

A prospective study for the treatment of cerebellar haemorrhage was conducted in a non-selected group of 33 patients. All patients with cerebellar haemorrhage arriving at the Department of Neurosurgery at Homburg/Saar have been included in this study, also those in bad condition, with high risk factors, and the aged. All of them required intensive care respectively intensive supervision. The following management protocol has been established. I. Cases with small haemorrhage, in good clinical condition, without hydrocephalus and/or occlusion of the basal cisterns: intensive supervision, operative intervention only if they deteriorate into one of the following groups. II. Cases with hydrocephalus-even if not yet pronounced-but without occluded basal cisterns and without major tonsillar herniation: pressure monitored ventricular drainage, which opens at 15 mm Hg and thus prevents higher CSF pressure developing. III. a): Cases with large haematoma, occluded basal cisterns and/or tonsillar herniation, but without severe general risk factors, as a first step: pressure monitored ventricular drainage; as a second step, if they do not improve soon after the normalization of the ventricular pressure: open surgical evacuation of the haematoma, which also decompresses the posterior fossa. If present and possible, causative vascular malformations may be dealt with at the same session. III. b): Same intracranial situation, but patients with severe general risk factors: pressure monitored ventricular drainage only. IV. Cases with causative aneurysm or angioma, who initially had been treated conservatively or by ventricular drainage: secondary operation of the vascular malformation after stabilization of the general conditions.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

The paradoxes of quality of life and its phenomenological approach.

Although evaluation scales for quality of life (QOL) represent considerable progress in medicine, clinical experience shows striking discrepancies between QOL as evaluated by caregivers and QOL from the patient's point of view. Such paradoxes of QOL are analyzed and discussed. Autonomy is universally advocated but may be denied, especially in the hospital setting, where caregivers, family members, and doctors act as a pressure group. Circumstances that deepen the contradictions in QOL assessment include (a) a high degree of patient dependence, (b) a professional judgement that a patient is incompetent (c) professional values being placed over a patient's values, (d) a multidisciplinary team acting as a pressure group, (e) a lack of effective communication with the patient, and (f) a determination to minimize the symptoms at evaluation. QOL is multidimensional, complex, difficult to measure in clinical practice, and sometimes paradoxical.

Activities of Daily Living↗
PubMed1992

[Hypertrophic cardiomyopathy in the elderly].

An abnormal Q wave in the ECG of the elderly calls for differential diagnosis between an old myocardial infarction and left ventricular hypertrophy. The latter may be due to hypertrophic cardiomyopathy, the prognosis of which is good in the elderly. The echocardiogram is the only method which provides the correct diagnosis and helps to avoid incorrect treatment.

Aged↗
PubMed1992

Speech--a key function of man. Reflexions of a neurosurgeon.

Man is distinguished and differentiated from other living creatures by possessing less genetically determined characteristics, behaviour and reactions, with fewer features fitting him for a special environment. For this reason he enjoys greater freedom and adaptability. In order to be able to pass on the necessary lessons for survival, man must have command of his speech, and as a species can only exist within communities. This presupposes an instinctive drive to make rules and regulations for ordered living in society. Speech is not only a means of communication but also the basis and precondition of abstract thinking. Complete aphasia implies the loss of this ability. It would deprive man from the most important of his key functions. Therefore it is inhuman. These reflections have convinced me absolutely, that neurosurgical interventions, which would have the predictable result of total aphasia, must not be performed, even though prolongation of life, but without speech, might thus be bought.

Aphasia↗
PubMed1992

Serum concentration-effect relationship of (+/-)-nicardipine and nifedipine in elderly hypertensive patients.

The concentration-effect relationships of (+/-)-nicardipine and nifedipine have been investigated in hypertensive geriatric patients. Following a parallel group, randomised, double blind trial design, they received either slow release nifedipine 20 mg b.d. (n = 9) or slow release (+/-)-nicardipine 50 mg b.d. (n = 10) for 7 days. On Days 1 and 7 serum (+/-)-nicardipine and nifedipine, blood pressure and heart rate were measured 6 and 12 h after drug administration. (+/-)-Nicardipine showed significant cumulation (ca 2 x) without a corresponding decrease in blood pressure or increase in heart rate. Concentration-effect plots indicated that (+/-)-nicardipine was more potent than nifedipine but that it showed apparently comparable efficacy in reducing the blood pressure. Compared to young healthy volunteers, both drugs had a more pronounced effect in elderly patients.

Aged↗
PubMed1990

[Blood pressure monitoring in aged hypertensive patients treated with sustained-release nicardipine or nifedipine].

In a double-blind parallel study, 20 elderly hypertensive subjects (mean age 85 years) were treated either by nicardipine or by nifedipine in slow-release form for 7 days. Blood pressure was measured by ambulatory, non-invasive daytime monitoring. Efficacy of both drugs was similar on the seventh day of treatment. However, the hypotensive effect induced by nifedipine was maximal on the first day of treatment, in contrast to the progressive effect induced by nicardipine. In 2 cases, marked hypotension was observed after the first tablet of nifedipine.

Aged↗
PubMed1990

Absence of significant bacteremia during urinary catheter manipulation in patients with chronic indwelling catheters.

The objective of this study was to quantify the microorganisms present in blood at urinary catheter removal and at reinsertion in patients with chronic indwelling urinary catheters. This was a prospective study during a 4-month period at a university-affiliated geriatric medical center. Our subjects were 33 patients with chronic indwelling urinary catheters and positive urinary cultures; the urinary catheter was usually changed once a month. A peripheral vein line was used for blood withdrawal and urinary cultures and quantitative blood cultures (Isolator) were performed during and shortly after urinary catheter removal and insertion. All patients had significant bacteriuria (greater than 10(5) cfu/mL) with an average of 2.3 microorganisms. Among the 46 sequential quantitative blood cultures performed, only two patients had bacteremia from the urinary source and at a very low concentration; one patient had 0.13 cfu/mL Str. faecalis in blood 5 minutes after removal of the urinary catheter, and the other 0.1 cfu/mL Proteus mirabilis 5 minutes after reinsertion of a new urinary catheter. None of the patients had any subjective or objective clinical problem during the 36 hours after the urinary manipulation. Clinical symptoms and bacteremia are rare events, and prophylactic antibiotics do not appear necessary during urinary catheter removal and reinsertion in elderly institutionalized patients. Further studies are necessary to identify risk factors in the rare instances of patients with bacteremia.

Aged↗
PubMed1990

Value of selective reversible sacral nerve blockade in the diagnosis and treatment of the urge syndrome.

Interstitial cystitis, neurogenic disturbances of bladder emptying resulting from incomplete supranuclear lesions and idiopathic detrusor hyperreflexia are clinically always associated with frequency, nocturia, urgency or urgency incontinence (urge syndrome). These disturbances of bladder emptying are difficult to distinguish, even urodynamically. With selective sacral nerve blockade, it is possible to differentiate between forms urodynamically using a nerve-blocking anesthetic. Reversible selective sacral nerve blockade is also the treatment for idiopathic detrusor hyperreflexia.

Adult↗