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Biomedical subjects

K Wilhelm

Publications and source records attributed to K Wilhelm.

At least 199 records · Page 11Linked to original sources
PubMed1990

Hormonal responses to fenfluramine in depressive subtypes.

In order to study putative differences in central neurotransmitter function in depressive subtypes, serum cortisol and prolactin responses to the putative serotonin agonist fenfluramine were examined in 30 subjects with major depression. Patients with endogenous depression (melancholia) as defined by each of ICD-9, DSM-III, RDC and Newcastle scale demonstrated a reduced prolactin response to 60 mg oral fenfluramine when compared with non-endogenous subjects. This was independent of either prolactin or cortisol baseline levels, and indicates that there are differences in brain neurotransmitter function in the endogenous and non-endogenous subtypes of depression. Basal prolactin levels were reduced in bipolar compared with unipolar subjects, and delusional compared with non-delusional patients, although there were no differences in the prolactin responses to fenfluramine between these subgroups. Basal cortisol levels and cortisol response to fenfluramine did not distinguish between any of the subtypes.

Administration, Oral↗
PubMed1990

Reliability of the parental bonding instrument and intimate bond measure scales.

The long-term reliability of the Parental Bonding Instrument (PBI) and of the Intimate Bond Measure (IBM) are examined in a non-clinical group, with data being examined over eleven and five years for the two respective measures. Such reliability data are compared with reliability data on a number of personality measures within the same cohort. Results demonstrate considerable stability in the PBI over an extended period and moderate stability in IBM scores.

Adult↗
PubMed1990

[Treatment of phalangeal fractures].

Due to anatomical reasons the therapy of phalangeal fractures is a domain of conservative treatment in contrary to metacarpal fractures. Special attention must be focused on defective position in axis and rotation of the fractured phalanx. We use the Iselin splint. The indication for operation depends on the patients compliance, the type of fracture and its localisation. Indications for operation in our opinion are open fractures, dislocated, non reponible fractures, fractures involving the joint, condylar fractures. Conservative treatment gains the more importance the more the fracture is localized at the end of the phalanx.

Bone Screws↗
PubMed1990

[Nerve compression syndromes of the elbow and hand].

The importance of nerve compression syndrome in the upper extremity for making a diagnosis or differential diagnosis in orthopedics, surgery, especially hand surgery, and neurology is evident. We review the characteristics of this entity, demonstrate the pathophysiological findings, and stress their importance on the diagnosis, therapy, indications for operation, and operative techniques in our patients. With special regard to the topographic anatomy each of these nerve compression syndromes of the elbow and the wrist region is demonstrated systematically and consequences are discussed for surgical therapy.

Carpal Tunnel Syndrome↗
PubMed1990

[Incisura scapulae syndrome].

The suprascapular nerve may rarely be entrapped in the suprascapular notch. This causes weakness of the supra- and infraspinatus muscles and pain in the glenohumeral and acromioclavicular joints, which are innervated by this nerve. The entrapment syndrome may result from direct or indirect trauma, fracture of the neck of the scapula, kinking or traction on a sling affecting the nerve, from the shape of the notch, compression by a ganglion, or its cause may be idiopathic. Diagnosis of the syndrome is based upon deep unceasing pain reported at the postero-lateral shoulder, atrophy of the supra- and infraspinatus muscles, and impaired shoulder external rotation and a lidocaine test. The final proof is taken from polyphasic EMG potentials which are decreased in amplitude and increased in distal latency. Initially the entrapment neuropathy may be treated by immobilization, analgesics, and physiotherapy. A tear of the rotator cuff as well as a frozen shoulder have to be excluded by arthrography. In persistent cases of pain and pathologic EMG findings surgical decompression of the nerve should be done. The trapezius muscle is approached by a postero-superior incision. Via the suprascapular fossa the notch may be reached. Then the nerve is decompressed by removing the transverse scapular ligament. Reports of the cases operated so far are promising, though their number is small.

Humans↗
PubMed1990

[Reconstructive surgery of malunited joint fractures of the hand].

Malunion of fractures, joint fractures and pseudoarthroses leads to therapy-resistant pain during function and loading, especially in the wrist, with a risk of early arthrosis. In spite of the extraordinary adaptability of the hand, malunion in the axis and rotation can lead, for example, to cross-finger malfunction. Because of the relatively thin layer of soft tissue, secondary operations to correct the axis, rotation and the length of the phalanx are possible. Each reoperation on the hand diminishes the blood flow, and the anatomical structures change with cicatrices. Thus, the risk of damaging blood vessels or nerves is increased. Operative correction of the position, arthroplasties, joint prostheses, arthrodeses, arthrolyses and denervation are all part of the operative repertoire. It is necessary to repair the joint surface as well as the capsule-ligament structures. Furthermore, we also express our opinion regarding the indications and contraindications of secondary operations. We discuss the risks and complications during operations and especially stress the aspect of having enough patient information. Finally, we describe the operative techniques in special cases. The necessity for reconstructive secondary operations is increasing as more and more replantations are being done and hand lesions in polytraumatized patients are being neglected. To date, not enough attention has been given to these problems in the scientific literature.

Arthrodesis↗
PubMed1990

[Roentgenological follow-up studies of silicone joint surface replacement in hand surgery as exemplified by scaphoid total and partial prosthesis].

Frequently, the clinical evaluation of a silicon prosthesis does not correspond to radiologic findings. Therefore, an extensive examination of 52 patients (total 85 patients) following a partial or total prosthetic replacement of the scaphoid or any other carpal bone, was performed. To obtain comparable information as to mobility, 12 wrists of "normal" persons and 17 wrists of volleyball players were exactly measured. Interestingly, in flexion the volleyball players demonstrated a considerably larger range of motion than the normal group. These findings applied for the total as well as for the partial prostheses. It could be shown that total scaphoid prosthesis lead to the best mobility. Subjectively however, these excellent results are surpassed by the proximal partial prosthesis. The most unfavorable results were found in distal prostheses of the scaphoid fixed within the proximal scaphoid alone. The best results are obtained by the distally and proximally fixed distal prosthesis of the scaphoid. Altogether, the results are encouraging. They indicate that radiological findings do not correlate to clinical findings. The reasons for this are presented in detail.

Adult↗
PubMed1989

Is sex necessarily a risk factor to depression?

To isolate and quantify possible determinants of any increased prevalence of depressive disorders in women we studied a select group of men and women, initially similar in terms of a number of putative social determinants of depression, and reviewed the sample five years later when social role diversity was anticipated. We used the Diagnostic Interview Schedule (DIS) to generate DSM-III and RDC diagnoses to estimate lifetime depressive disorders, and established (via corroborative reports) the likely accuracy of those data. Despite lifetime depression being a relatively common experience, no significant sex differences in depressive episodes were demonstrated, suggesting the possible irrelevance of biological factors in determining any sex difference. As there was not major social role divergence over the five year study, we interpret the lack of a sex difference as a consequence, and suggest that findings support the view that social factors are of key relevance in determining any female preponderance in depression described in general population studies.

Adult↗
PubMed1989

[Determining the position of the prosthesis using arthrography of the wrist joint].

During the last twelve months twelve patients with different silicone prostheses of the wrist region underwent examination with arthrograms two to twenty-four months after the operation. The arthrography showed the relation of the implant to its surrounding structures. For either radiocarpal or intercarpal arthrography a very distant access was used. In eight patients the prostheses were surrounded entirely by contrast medium. There was no contrast-medium on one side of the implant in two patients. In one patient a complete disconnection from the capsule to the site of the prosthesis was seen. In one other patient there was evident shrinking of the capsule. Wrist arthrography was very helpful for the evaluation of further clinical proceeding and control of wrist-function.

Arthrography↗
PubMed1989

[The scaphoid-trapezium-trapezoid arthrosis. A clinical study 1982-1985].

The present study deals with patients in whom the diagnostic procedures applied in rhizoid arthrosis were considered to reveal scaphoid-trapezium-trapezoid (STT) arthrosis. Between 1982 and 1985, 21 of 396 rhizoid arthrosis patients developed symptoms of STT arthosis. Examination of the case histories showed that in 20 STT patients the pathogenesis included trauma. In addition, the majority of these 396 patients (71.5%) had to be retreated because of new traumata and the resultant problems. The time lapse between the first trauma considered sufficiently severe to have caused STT arthrosis and its diagnosis was up to 7.1 years. Our improved facilities for diagnosis of pathologic conditions of the wrist enabled us to distinguish four types of STT arthrosis. Persistent complex instability of the capsular ligament appears to be the major cause of post-traumatic STT arthrosis. Extended diagnostic techniques based on standardized radiograms allow the development of a design for treatment aimed at preventing posttraumatic STT of the hand as far as possible.

Aged↗
PubMed1989

[Skier's thumb].

Over a period of 9 years (1979-1988), more than 1000 patients have been seen in the Department of Hand Surgery with a tentative diagnosis of skier's thumb or a painful metacarpophalangeal of the thumb. Most injuries were treated conservatively, but 562 operations on the ulnar collateral ligament were done during this period. An X-ray Film was taken in all cases to exclude a fracture. The indications for an operation depend on the clinical symptoms. Swelling, pain just over the ulnar collateral ligament, and instability of the joint with a widening of the ulnar aspect of the joint of more than 30 degrees in comparison to the other hand are typical clinical symptoms, which together with the widening in the flexion position, prove a rupture of the collateral ligament. As part of our standard examination we take X-ray films of the hand in two projections to exclude a fracture, followed by abducted stress views in comparison to the other side. The best results were obtained when surgical therapy was performed within the first 8 days. Fractures of the base of the proximal phalanx of the thumb were operated on by pin wire fixation of the bone fragment in the anatomically correct position along with temporary transarticular pin wire arthrodesis. In ligamentous ruptures, periostal sutures together with a temporary arthrodesis were carried out. Old injuries without sufficient regeneration of the ligament and capsule necessitated plastic surgery using the long pulmar tendon or a PDS wire. In each case the joint was immobilized with a cast for 5-6 weeks, followed by active physiotherapy.

Adolescent↗
PubMed1988

The development of a measure of intimate bonds.

This paper discusses the relevance of assessing the nature of intimate relationships and reports on the development of such an instrument. The Intimate Bond Measure (IBM) is a self-report measure assessing two key underlying dimensions, care and control. Its properties are assessed in separate studies, establishing its high test-retest reliability, the homogeneous nature of the isolated dimensions, its insensitivity to broad socio-demographic influences and its minimal sensitivity to depressed mood state. Support for its validity, in terms of both perceived and actual characteristics of care and control, is demonstrated. It provides a simple and efficient measure of central constructs underlying intimate relationships, and is of potential use in studies attempting to assess the relevance of intimate relationships to the onset and course of psychiatric disorders.

Adult↗
PubMed1988

[NMR tomography of lunate malacia].

Conventional radiographs are not always able to exclude ischemic necrosis of the lunate in the early stages of the disease. Tomograms on two planes have a higher sensitivity than radiographs in two planes. Sensitivity during middle and late stages of ischemic necrosis of the lunate is approximately the same as that of magnetic resonance imaging. MRI is indicated if conventional techniques are negative or doubtful and where there are clinical signs of malacia (Decoulx stages 0 to 1). For these indications MRI is a justifiable additional method for diagnosing ischemic necrosis of the lunate.

Adolescent↗
PubMed1988

[Arthrography of the wrist joint in determination of the prosthesis site].

Arthrography was performed during the last 12 months in 14 patients who had 2 months to 10 years after implantation of a silicone-elastomer- or fascia-lata-prosthesis recurrent complaints in their operated wrists. Following an extensive radiological native examination either midcarpal or radiocarpal arthrography was performed in dependence of the site of carpal-bone-substitute. Inflammatory changes of the prosthetic bed, missing penetration of contrast medium into the periprosthetic space and other less common additional findings showed the advantages of the relatively handsome procedure.

Adolescent↗
PubMed1987

The establishment of a mood disorders unit.

The establishment within a general hospital psychiatry ward of a mood disorders unit (MDU), a specialised facility for the assessment and treatment of patients with affective disorders, is described. The aims include provision of a clinical service, a teaching resource for affective disorders and the development of a research centre. Details are provided of the organisation of the MDU, the development of programs for management of patients and the difficulties encountered. In the first year, 164 patients were assessed, of whom 36 were judged not to have a primary mood disorder. For the remainder, the most common DSM-III diagnosis was major depressive episode (n = 68), with about half having the melancholic sub-type. It is argued that a specialised diagnosis-related facility is feasible within a general hospital psychiatry service with area health commitments.

Affective Disorders, Psychotic↗