[Eosinophilic granuloma of the spine].
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Adult↗
Biomedical subjects
K Wilhelm
Publications and source records attributed to K Wilhelm.
Actions taken to cope with depression in patients seeking specialist care.
OBJECTIVE: To assess the rates and perceived effectiveness of actions used to cope with depression and the factors influencing these in an outpatient sample seeking help for depression. METHOD: One hundred and seventy-six patients (74 male, 102 female) aged 16-82 years (M = 42, SD = 14.4 years) with a major depressive episode (DSM-IV criteria) were assessed using a number of measures that covered sociodemographics, history of psychiatric illness, actions taken to alleviate depression and their perceived effectiveness. Logistic regression analyses assessed age, gender and illness characteristics associated with the use and perceived effectiveness of strategies adopted to manage depression. RESULTS: Medical interventions were used and perceived to be effective in alleviating depressive symptoms by most of the sample, as were self-help and complementary therapies. Sociodemographic and illness-related characteristics had a significant influence, with younger age and having experienced an episode of anxiety disorder found to be the strongest predictors for the use of coping strategies. Being female was the strongest predictor for their effectiveness. CONCLUSION: A range of actions for depression, including medical and complementary interventions, were used and found to be helpful in a sample that had sought professional help for depression. Gender, age, depression and anxiety factors were all found to predict the use and perceived effectiveness of these strategies.
Adaptation, Psychological↗
[Balloon dilatation and Stentimplantation of the nasolacrimal duct for chronic epiphora].
PURPOSE: To examine the clinical outcome of the ballon dilatation in stenosis and obstruction of the nasolacrimal duct. MATERIAL AND METHODS: 63 patients (69 nasolacrimal duct systems) with epiphora and proven obstruction of the nasolacrimal duct were treated with ballon dilatation, respectively Stentimplantation. In 55 cases there was a pre- or postsaccal stenosis, in 14 cases an occlusion of the nasolacrimal duct system. The diagnosis was established by dacryocystography. RESULTS: Technical success was obtained in 61 cases (n=50/55 stenosis; n=11/14 occlusions). Over a mean follow-up of 6 months patency of the nasolacrimal duct system was achieved in 83,6% (46/55) in stenosis. In occlusion the clinical outcome was 42,9% (6/14). CONCLUSION: Balloon dacryocystoplasty and Stentimplantation are minimal-invasive alternatives, performed in local anesthesia that recover the normal anatomy of the nasolacrimal duct system. They are a good alternative in the treatment of epiphora caused by nasolacrimal duct obstructions.
Adult↗
[Balloon dilatation of the canaliculus communis for chronic epiphora].
PURPOSE: To examine the clinical outcome of the balloon dilatation in stenosis of the canaliculus communis. METHOD: 18 nasolacrimal ducts with epiphora and proven obstruction of the canaliculus communis by dacryocystography (DCG) were treated with balloon dilatation in local anaesthesia. All patients were treated electively. RESULTS: In 16/18 cases the balloon dilatation was technically successful, in 2 patients the guide wire failed to pass the obstruction and the wire could not be placed in the nasal cavity. There were no complications. Over a mean follow-up of 6 months there were 2 reobstructions, one of these led to an occlusion of the canaliculus communis. 14/18 (77,8%) cases after DCP were treated successful, 11/18 cases were free of symptoms after DCP, in 4/18 cases the epiphora improved. CONCLUSIONS: Until recently in stenosis of the canaliculus communis the only therapeutic option was surgical procedure followed by silicone tube intubation. The results were often disappointing. In contrast to this balloon dacryocystoplasty is a minimally-invasive alternative in the therapy of stenosis of the canaliculus communis resulting in good clinical outcome during follow up.
Adult↗
[Hemiconvulsion-hemiplegia-epilepsy syndrome].
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Child, Preschool↗
[Balloon dacryocystoplasty: interventional radiological therapy of congenital dacryostenosis].
PURPOSE: To evaluate the results of balloon dacryocystoplasty in the treatment of complicated development of connatal obstructed nasolacrimal duct system. MATERIALS AND METHODS: Dacryocystography under general anaesthesia was performed on 46 children with epiphora from birth and recurrent infection of the nasolacrimal duct system. 54 nasolacrimal ducts (8 children bilaterally) were treated with balloon catheter dilatation and antibiotic irrigation of the nasolacrimal sac. In all cases previous conservative treatment with eye drops and superficial massage of the lacrimal sac had failed. 11 children without clinical improvement were irrigated before catheter dilatation by an ophthalmologist. The ages ranged from 6 weeks to 7.5 years (mean 23.5 months). 39 dilatations were carried out as an out-patient procedure. The clinical results were confirmed by a questionnaire filled in by the parents. RESULTS: 15 incomplete obstructions and 39 occlusions of the Hasner valve (n = 45) or of the nasolacrimal duct system (n = 9) were demonstrated with dacryocystography. Dilatation with a 2.5 mm ballon was successfully performed in all cases and the mean radiation time was 2.1 minutes. No relevant complications occurred. The mean follow up time was 18.4 months (3 - 41 months). 39 of 46 children showed no symptoms, 6 children seldomly experienced onset of epiphora. The symptoms did not improve in only one child. The cumulative clinical success rate is 98 %. CONCLUSION: Following diagnostic dacryocystography, balloon catheter dilatation is a low risk and very successful treatment of complicated connatal obstructed nasolacrimal duct system.
Catheterization↗
Progressing a spectrum model for defining non-melancholic depression.
OBJECTIVE: To further develop a 'spectrum model' for non-melancholic disorders that encompasses underlying personality styles and clinical patterning. METHOD: In a sample of patients with non-melancholic depression, we studied four personality constructs influencing risk to depression, assessing associational strength and specificity between personality scores and symptom and coping response patterns. RESULTS: Analyses refined four personality dimensions (anxious worrying, irritability, social inhibition, and self-centredness) for testing the model. For all dimensions, personality style was specifically linked with a mirroring 'coping' response. Quantification of specific links allowed development of a spectrum model for the non-melancholic depressive disorders in which underpinning personality style showed some specific links with the clinical 'pattern' of symptoms and coping repertoires. CONCLUSION: The model has the capacity to assist clinical assessment, identify aetiological personality influences and allow specific treatment effects for the heterogeneous non-melancholic depressive disorders to be determined.
Adaptation, Psychological↗
Treatment-resistant depression: resistant to definition?
OBJECTIVE: To better define treatment-resistant depression (TRD) so as to assist clinical management and refine treatment guidelines. METHOD: In this study, we examine a broad range of clinical variables in depressed patients (n=196) referred to a tertiary referral Mood Disorders Unit (MDU). Information was collected from patients, referrers and assessors over a period of 32 months and included evaluations of treatments, treatment resistance and related variables. Data were analysed across trichotomized 'high', 'low' and 'no' treatment resistance groupings of patients. RESULTS: A significantly greater proportion of patients with melancholia were amongst the high TRD group, and this was consistent across different strategies for evaluating melancholia. CONCLUSION: Melancholia perhaps provides a prototypic TRD subset that perhaps reflects some innate aspects of melancholic depression or factors such as the impact of ageing. Research into TRD is needed to both replicate this finding and perhaps explicate it further.
Adolescent↗
Diffusion-weighted MRI in cortical ischaemia.
We carried out MRI on 16 male and three female comatose patients, aged 2 days to 79 years, with suspected cortical ischaemia referred from our intensive care units. Using a head coil, and following standard imaging, including coronal fluid-attenuated inversion-recovery images, we performed diffusion-weighted imaging (DWI) using a whole-brain multislice single-shot echo-planar sequence with b 0 and 1000 s/mm2: 5-mm slices covering the whole brain, TR 7000 TE 106 ms, 128 x 128 pixels, field of view 250 mm, one excitation. Maps of apparent diffusion coefficients (ADC) were generated automatically. DWI showed cortical, basal ganglia and watershed-area high signal in all cases, associated with a decrease in ADC to 60- 80% of normal. DWI showed lesions not seen (40%) or underestimated (40%) on conventional T2-weighted imaging. Within 24 h of the onset of symptoms, DWI showed changes not readily detectable on T2-weighted images. The cortical high signal on DWI and the ADC changes, suggesting severe ischaemia rather than oedema, was found in areas known to be affected by cortical laminar necrosis. Extension to the brain stem and white matter was associated with a higher likelihood of death.
Adolescent↗
Studying personality characteristics in bipolar depressed subjects: how comparator group selection can dictate results.
OBJECTIVE: To examine the extent to which identification of any distinct personality characteristics in bipolar subjects are influenced by selection of the comparison diagnostic group. METHOD: Scores were compared on several general measures of personality style and, additionally, the prevalence of disordered personality functioning was examined in a sample of 198 non-psychotic depressed subjects, 39 with bipolar depression and 159 with unipolar depression. RESULTS: When the bipolar subjects were separately compared with unipolar subjects, and to sub-sets of those with clinically and DSM-IV defined melancholic and non-melancholic depression, quite differing results were suggested. In essence, clinically-defined melancholic subjects had the least personality psychopathology in comparison with the non-melancholic and bipolar subjects. CONCLUSION: Whether subjects with bipolar disorder have any distinct personality characteristics or over-represented co-morbid personality disorders remains quite unclear when reference is made to the literature. We suggest that inconsistencies across studies may reflect choice and representation of depressive sub-types within the unipolar comparator group.
Adult↗
Measuring disordered personality functioning: to love and to work reprised.
OBJECTIVE: Current limitations to diagnosing and measuring the personality disorders encouraged a set of studies seeking to provide an alternate approach to modeling and measuring disordered personality function. METHOD: A large set of self-reported descriptors of disordered personality function were factor analyzed in a sample of patients with clinician-diagnosed personality dysfunction, generating 11 lower-order and two higher-order constructs. Subjects and non-clinical controls also completed a measure of personality styles underpinning formalized personality disorder groupings. Properties of the refined self-report (SR) measure were assessed in an independent sample of patients with a clinically diagnosed personality disorder. RESULTS: Limitations in 'cooperativeness' and 'coping' formed the higher-order constructs defining disordered personality function, with these constructs relevant to all personality styles. Analyses of SR, corroborative witness (CW) and clinician-rated data in an independent sample supported measuring disordered personality function by our derived 20-item SR measure, and exposed limitations to clinician-based assessment. CONCLUSION: Study findings build to a multi-axial strategy for measuring personality disorder, involving separate dimensional assessment of both disordered personality function and of personality style.
Adaptation, Psychological↗
Probable multiple system atrophy in a German family.
Multiple system atrophy (MSA) is a neurodegenerative disorder of unknown aetiology. A possible underlying genetic component has not yet been identified. A family is reported with phenotypic MSA and probable autosomal dominant inheritance. The patients presented initially with either parkinsonian or cerebellar signs, and developed severe autonomic failure and typical atrophy of the brain stem and cerebellum in the course of the disease.
Adult↗
[Wrist pain of uncertain genesis].
The leading symptom wrist pain may be caused by a number of different pathologies. These cover traumatic and non-traumatic changes to the bone (including primary arthrosis, chronic polyarthritis, aseptic bone necroses, e.g. Kienböck's disease). Other possible sources of pain may be the capsule/ligament structures of the wrist, the predominant condition in terms of incidence and severity being injuries to the scapholunar ligament. In young women in particular, differential diagnostic considerations should include instability of the wrist. The diagnostic work-up comprises history-taking, physical examination including function tests and a mandatory x-ray. An MR tomogram and interventional procedures (e.g. arthroscopy) where indicated, can provide additional information. At the center of the management plan is amelioration of pain and restoration of function. For this purpose, a range of curative or palliative, conservative or operative measures are available. Early referral to the hand surgeon may avoid secondary sequelae resulting from long-lasting complaints.
Adult↗
Distinguishing early and late onset non-melancholic unipolar depression.
AIM: We seek to determine whether unipolar non-melancholic major depression commencing early in life has a differing clinical picture, and whether it may have differing determinants. METHODS: We study a sample of such patients, comparing those with depression onset in their first 25 years against residual subjects, matching exactly by sex and controlling for age. RESULTS: There were no differences in current depression severity. Despite early onset subjects having a distinctly younger current mean age, they had a lifetime pattern of both greater depression chronicity and disability, and judged themselves as less likely to have benefited from any antidepressant medication or psychotherapy. 'Phenotypically' early onset subjects did not differ in terms of 'depressive' symptoms, but were distinguished by a greater irritability, which we interpret as reflecting a temperament dimension influencing symptom expression. Multivariate analyses indicated that the clinical pattern in those with an early onset was distinguished by more evident irritability and anxiety, that there was a distinct familial contribution to early onset depression, that its forerunners were an early personality style of behavioural inhibition or shyness, and that they were more likely to use alcohol and illicit drugs. CONCLUSIONS: While early onset unipolar depression is unlikely to be a pure depressive 'type', it may well be that certain familial temperament characteristics lead to an early onset of depression marked by irritability, a process that invokes a spectrum disorder concept linking temperament style and the depressive manifestations. Early onset depression is indicative of a poor prognosis, both in terms of response to interventions and in regard to chronicity and disability.
Adult↗
An Australian validation study of the temperament and character inventory.
OBJECTIVE: To assess the validity of the temperament and character inventory (TCI) measure in an Australian sample. METHOD: A sample of depressed subjects completed the TCI and a measure assessing personality disorder constructs (PDCs), while family members and psychiatrists also returned PDC ratings. RESULTS: Factor analyses generally supported the TCI constructs, when the temperament and character scales were analysed separately. Self-reported PDC scores were validated against corroborative witness ratings and used to assess the TCIs concurrent validity. Validation analyses supported all TCI temperament scales, but the Self-transcendence Character scale was unassociated with PDC scores. The remaining two character scales (i.e. cooperativeness and self-directedness) were non-specifically associated with all PDC scores. CONCLUSION: Study results support the validity of the TCI scales, but question the best model for conceptualizing the TCI. It is suggested that two character scales quantify disordered functioning, while temperament scales quantify style, constructs that may be inter-related or independent in individual subjects.
Adult↗
[Functions of circulating and intra-abdominal polymorphonuclear leukocytes during human secondary peritonitis].
INTRODUCTION: Aim of the study was to characterize different functions of circulating and emigrated, intra-abdominal polymorphonuclear leukocytes (cPMNs, ePMNs) during human secondary peritonitis. METHODS: In patients (n=25) with diffuse secondary peritonitis circulating and emigrated PMNs were characterized intra- and until 96 h postoperatively. Patients were allocated to two different groups, e. g. patients with septic complications (shock, organ failure, n=11) and patients without complications (n=14) during peritonitis. In addition a control group of patients (n=10) with abdominal surgery but without peritonitis was investigated. The lucigenin- and luminol-enhanced chemiluminescence was used to determine extra- and intracellular oxygen radical generation of PMNs. Besides spontaneous oxygen radical generation of PMNs, stimulated radical production was investigated after the addition of ionophores A23 187 and C3-coated zymosan. Phagocytosis by PMNs was characterized with opsonized E. coli bacteria and fluorescence-activated cell analysis. RESULTS: Especially patients with complicated peritonitis had strong and long-lasting changes of PMNs functions. The toxic and tissue-destroying production of extracellular oxygen radicals by circulating PMNs was enhanced (e. g., A23 187 - stimulated oxygen radical generation 433 +/- 89 cpm/cPMNs (peritonitis with complications) versus 90 +/- 30 cpm/cPMNs (peritonitis without complications) versus 110 +/- 44 cpm/cPMNs (controls), p < 0.05). Phagocytosis (58 +/- 9 % (ePMNs, peritonitis with complications) versus 81 +/- 6 % (ePMNs, peritonitis without complications) versus 82.2 +/- 1.6 % (ePMNs, controls), p < 0.05) and phagocytosis-associated intracellular oxygen radical generation (8.23 +/- 1.6 x 10(3) cpm/ePMNs (peritonitis with complications) versus 25.2 +/- 5.2 x 10(3) cpm/ePMNs (peritonitis without complications) versus 11.7 +/- 2.8 cpm x 10(3) cpm/ePMNs (controls) p < 0.05) were suppressed. CONCLUSION: Not for all patients with peritonitis does it seem favourable to modulate PMNs-functions. If immunomodulation would be able to down-regulate exaggerated functions of circulating PMNs and to up-regulate the suppressed functions of emigrated PMNs patients with complicated peritonitis might benefit from this therapy.
Colectomy↗
[Preliminary experience with balloon kyphoplasty for the treatment of painful osteoporotic compression fractures].
PURPOSE: To describe the technique and to evaluate the safety and efficacy of percutaneous kyphoplasty as a new treatment in patients with painful osteoporotic vertebral body compression fractures of the lumbar and thoracic spine. MATERIALS AND METHODS: In this prospective study balloon kyphoplasty was performed in 34 consecutive patients (25 females, 9 males; mean age 75 years) with 56 painful osteoporotic vertebral fractures (from T6-L5), of which 22 showed a posterior wall involvement and retropulsion on preoperative CT. The median duration of symptoms was 9.7 weeks. Symptomatic levels were identified by correlating the clinical presentation with MRI, conventional radiographs and CT including bone-densitometry. Pre- and postoperative examinations (radiographs, CT) as well as Karnofsky and visual analogy pain scores (Visual Analog Scale = VAS) were documented and compared to evaluate the success of the procedure. RESULTS: The median Karnofsky score improved from 40 % (pre-) to 70 % (post-treatment). Simultaneously, median pain scores (VAS) decreased from 64 (pre-) to 21 (post-treatment) (p < 0.001). Perioperative morbidity included one transient L2 nerve root bruise. The procedure led to a partial restoration of the height of the vertebral body by reducing the median sagittal index from 11.5(3) to 5(3). In none of our patients, the procedure led to worsening of the fracture-induced narrowing of the spinal canal. Clinically asymptomatic cement leakage occurred in 10 cases, with leakage 4 times into the paraspinal space, 3 times into the spinal canal and 3 times into the disc space. CONCLUSION: Balloon kyphoplasty is a safe and effective procedure. It is applicable even in fractures with posterior wall involvement since it is a low-pressure technique in contrast to vertebroplasty and restores vertebral body height partially. It results in immediate clinical improvement of mobility and pain relief. While short-term results are excellent, follow-up data have to be awaited for the final judgment of this method.
Aged↗