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Biomedical subjects

J Steurer

Publications and source records attributed to J Steurer.

At least 55 records · Page 3Linked to original sources
PubMed1999

[Personality of patients with somatoform disorders].

36 patients of a medical outpatient clinic with cardiopulmonary and gastrointestinal somatoform complaints were interviewed two times at an interval of one year about physical symptoms, personal characteristics and need for professional assistance. The investigated patients felt more depressed than a normal cohort of comparable age. In 25% of the tests a disorder of personality according to ICD-10 was diagnosed. Anxious/depressive and obsessive/compulsive personality traits were predominant. Patients with suspected personality disorder felt more disturbed by a somatoform disorder, had more diffuse complaints and suffered more from symptoms of exhaustion. They were less satisfied with the obtained treatment but did on an average not demand more medical help than patients without personality disorders. The results are discussed with regard to the importance to treat patients with somatoform disorders and to the prognosis of the further course of disease.

Adolescent↗
PubMed1999

[Comparison of a D-dimer rapid-test with a plasma-immunoassay for diagnosis of venous thrombosis or pulmonary embolism in a medical emergency unit].

The level of D-dimer in the blood reflects the level of lysed, cross-linked fibrin, and is useful in the diagnosis of clinically suspected deep venous thrombosis and pulmonary embolism. We compared two assays for the measurement of D-dimer levels, the whole-blood immunoassay SimpliRED which can be performed in two minutes, and the plasma immunoassay NycoCard. D-dimer levels were determined with these two techniques in 100 patients. With clinically suspected deep vein thrombosis and positive D-dimer levels a compression ultrasonography using a colour coded Duplex instrument, or a phlebography were done. For clinically suspected pulmonary embolism a ventilation/perfusion scan was done in patients with normal x-ray. Patients with radiographic abnormalities were investigated with spiral computed tomography or pulmonary arteriography. When both assays showed negative results a diagnostic procedure was only done if there was a high clinical suspicion for thromboembolism. Both assays showed a correct positive result in seven of the eight diagnosed thromboembolic events and one false negative result each. The SimpliRED assay exhibited a sensitivity of 87.5% and a specificity of 61%, the negative predictive value was 98.3%, positive predictive value 15.9%. The NycoCard assay displayed also a sensitivity of 87.5%, specificity was lower with 39.6%, the negative predictive value was 97.4%, positive predictive value 10.7%. The SimpliRED assay can be a valuable tool when laboratory facilities for a plasma immunoassay are not accessible. The negative predictive value is very high, therefore this test is considered to be helpful for excluding a thromboembolic event.

Adult↗
PubMed1999

[Indications and results of thyroid gland ultrasound imaging of ambulatory care patients].

Sonography permits investigations which furnish impressive information whose practical benefit for the patient, however, has not been documented so far. The thyroid lends itself extremely well to sonographic study because of its superficial localization. The efficiency of this investigation has also not been elucidated. This study addresses the question of correlation between clinical and sonographic examination. Sonographic imaging did not have a great clinical impact and therapeutic consequences were rarely generated. A definitive diagnosis was usually possible after fine needle aspiration or hormonal analysis. Solitary thyroid nodules are an indication for sonography. Whether sonography is useful in patients with euthyreotic nodular goiter is debatable.

Adolescent↗
PubMed1999

[Diagnosis and therapy of lymph node tuberculosis].

Due to an increase of lymph node tuberculosis and associated diagnostic problems the question for the easiest and most accurate diagnostic measures was asked. Furthermore, the success of surgical and pharmacologic treatment was evaluated. A total of 16 patients (nine females, seven males) treated at the medical outpatient clinic between 1977 and 1995 because of lymph node tuberculosis were evaluated retrospectively. Diagnosis had been established in all cases either by fine needle aspiration or surgical excision. The mean age was 31 years (range 17-68). In 10 patients cervical lymphomas were found. Other localisations were supraclavicular, inguinal, axillary and mediastinal. In 94% of the patients a fine needle aspiration was performed to ascertain diagnosis. Acid-fast bacilli were found in 36% and mycobacteria were cultured in 92%. Five patients (31%) had a surgical excision with acid-fast bacilli in two and positive cultures from all specimens. All patients had chemotherapy, in most cases started by a combination of three and followed by a combination of two drugs. According to our results a fine needle aspiration is justified as a first diagnostic step if lymph node tuberculosis is suspected. A positive result can be regarded as conclusive and spares surgical intervention. Since negative results do not exclude tuberculosis they justify surgical excision for final diagnosis.

Adolescent↗
PubMed1998

[Diagnostic costs for ambulatory care patients].

Few analyses of the costs of diagnostic plans have been published. We have determined and analyzed the diagnostic costs of 1000 consecutively evaluated patients at the medical outpatient clinic. A data base was developed for this purpose. Based on the itemized tarif the total costs amounted to 622,553.25 SFR. Medical services (consultations) required 20 per cent of this sum, laboratory services and technical investigations 40 per cent each. The average number of consultations per patient was 2.83 +/- 1.85. As expected the first consultation was the most expensive. It amounted on the average to 350.-SFR, 54% of which were used for laboratory and 27% for technical procedures. Chest X-ray, ECG, abdominal ultrasound and upper gastrointestinal endoscopy caused about 20% of the total diagnostic costs. Cost reduction could probably be achieved by using more stringent indications for laboratory and technical services.

Adolescent↗
PubMed1998

[Check-up studies at an internal medicine polyclinic: reasons, diagnostic tests, results and therapeutic consequences].

Data of an investigation on initial motives for and outcome of so-called diagnostic check-ups are presented. Over a period of about one year a total of 82 persons applying for such a check-up have been investigated. Concrete reasons for this step were not given initially, however, elucidated in 87% of cases after special interrogation. Mostly fear of carcinoma or HIV-infection because of unspecific symptoms or diseases of family members or friends was reported. Clinical status and additionally arranged investigations (laboratory and others) revealed as a rule no further relevant pathological findings, thus, acting mainly to exclude rather than prove a disease. If motives for such check-ups could be elucidated in time, a more focussed, cost-effective investigation could be initiated, with more benefit for the patient and higher satisfaction for the physician. Such a screening consultation might represent furthermore a good opportunity to communicate preventive aspects to the patient.

Adult↗
PubMed1998

[Diagnostic costs of various symptoms and disease pictures].

Diagnostic costs have been investigated in a prospective study based on symptoms and diagnoses of 1000 patients of the medical outpatient clinic. The two most common reasons for consultation were abdominal and chest complaints and diseases of the cardiovascular and digestive system respectively. The most frequent cases concerned patients without definitive diagnosis (i.e. diarrhea of undetermined origin). When costs of diagnostic procedures were grouped according to symptoms constipation and abdominal complaints ranged first with costs of 880 SFr. If costs were determined on the basis of the definitive diagnosis duodenal and gastric ulcers and pneumonia were the most expensive (ca. 1000 SFr), common cold or upper airway infections the cheapest diagnoses (ca. 400 SFr). Both methods for cost estimate either according to symptoms or according to diagnosis had high variances. The maximal expense was in some examples 50 times higher than the minimal cost. These results show that diagnostic costs can not be determined in advance and that flat rates per case are problematic.

Adolescent↗
PubMed1998

Idiopathic oedema with increased cytokine production: a pathogenetic link?

We describe four patients with idiopathic oedema and elevated cytokines. All patients shared increased serum concentrations of soluble interleukin-2 receptors (sIL-2R). In three patients tumour necrosis factor alpha (TNF-alpha), gamma interferon (IFN-gamma) and interleukin-2 (IL-2) were transiently elevated. There was no evidence for an underlying disease. Based on experimental and clinical data it is hypothesized that oedema formation in our patients is the consequence of cytokine induced alteration of endothelial cells.

Adult↗