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Biomedical subjects

K Wilhelm

Publications and source records attributed to K Wilhelm.

At least 73 records · Page 4Linked to original sources
PubMed1999

[Scaphoid pseudarthrosis of the proximal third--results of treatment with the Herbert screw].

Purpose of this study was to assess the value of the Herbert screw used with iliac crest cancellous bone graft for treatment of scaphoid nonunion in the proximal third. From 1986 to 1996, 75 patients underwent this procedure. We followed-up on 67 of them using the Martini score, which covers pain, grip strength and social activities, range of motion, X-ray results, individual, clinical and overall assessment. We found 57 patients (85.1%) with a good to excellent outcome, eight patients (11.9%) with satisfactory results and two patients with a poor result. We conclude that the Herbert screw with or without cancellous bone graft should be the first choice for surgical treatment of non-union located in the proximal third of the scaphoid bone.

Adult↗
PubMed1999

[Relation of necrosis to outcome and site of fracture in scaphoid pseudarthrosis].

Usually, untreated scaphoid fractures lead to non-union and partial or complete avascular necrosis. The purpose of our study was to examine the influence of location and fracture line on the pattern of necrosis. Therefore, 85 patients with scaphoid non-union were examined by enhanced highfield MRI. Fractures were classified by location and fracture line. A staging system based on signal intensity in T1-weighted spin-echo sequences in enhanced MRI was used to evaluate extent and location of avascular necrosis, which was found in 81% of our patients. In our patients, viability of the scaphoid was independent of the fracture line without dominance of vertical oblique fractures (2%). Based on our staging system, signal intensity as a sign of fragment viability was reduced in the proximal fragment in 46 patients, whereas in eight patients the distal fragment showed reduced viability. In 26 patients, no difference was found between proximal and distal fragments. Fractures proximal to the transition of middle to distal third showed less viability of the proximal fragment, not dependent of how proximal the fracture was seen. In triple fractures (6%) signal intensity of scaphoid bone was more reduced in enhanced MRI.

Adult↗
PubMed1999

[Variants of the hepatic artery: detection with color--coded sonography pre and post levovist injection].

PURPOSE: Detection of hepatic artery variants is of great clinical importance, for instance, pre liver transplantation, pre intraarterial chemotherapy or for measurement of the Doppler perfusion index. We therefore investigated how accurate variants of the hepatic artery can be detected using color-coded sonography pre and post Levovist injection. MATERIALS AND METHODS: 52 patients (21-78 years) were examined using color-coded sonography pre and post Levovist injection. After the sonographic examination, intraarterial digital subtraction angiography was performed and the results were compared. RESULTS: Using angiography 14 variants of the hepatic artery were detected in 13 patients. The most common variant in 10 patients were hepatic arteries originating from the superior mesenteric artery. This could be detected with unenhanced color-coded sonography in 8 and with enhanced sonography in 9 patients. In one patient in addition, a hepatogastric trunk was noted by angiography, this was not recognized by sonography. In 2 patients with a hepatogastric trunk, this variant was sonographically seen after Levovist injection in both but with unenhanced sonography in only 1 patient. CONCLUSION: Most variants of the arterial hepatic blood supply can be diagnosed using conventional color-coded sonography. In some cases enhanced sonography provides additional information, but even with these techniques all variations cannot be detected.

Adult↗
PubMed1999

[Independent radiologic prognostic factors for fatal outcome of ambulatory-acquired pneumonia requiring inpatient treatment].

PURPOSE: To evaluate the independent prognostic impact of the chest radiograph for mortality from community-acquired pneumonia requiring hospitalization. METHODS: Chest radiographs of 67 patients with hospital-treated community-acquired pneumonia were analyzed with regard to the prognostic implications of radiographic patterns, extent and density of infiltrates, and its evolution during treatment. RESULTS: Non-survivors had a significantly higher extent of infiltrates (p = 0.008), density of infiltrates (p = 0.05), and radiographic spread during follow-up within 48-75 hours (p = 0.0001). In multivariate analysis, persistent or progressive infiltrates were associated with a 47-fold increase, and persistent or progressive density of infiltrates with an 18-fold increase in risk of mortality. The presence of both parameters could correctly predict 96% of survivors and 90% of non-survivors. CONCLUSIONS: The chest radiograph is an independent predictor of the severity of pneumonia. Both persistent or progressive infiltrates and persistent or progressive density of infiltrates are independently associated with mortality from community-acquired pneumonia.

Adolescent↗
PubMed1999

[MRI diagnosis of cardiac myxomas: sequence evaluation and differential diagnosis].

PURPOSE: To evaluate native and contrast enhanced T1-weighted spin (T1-SE), cine gradient echo (Cine-GE), and T2-weighted turbo spin (T2-TSE) sequences in the diagnosis and differential diagnosis of cardiac myxomas. METHODS: 15 patients with echocardiographically suspected cardiac atrial myxomas underwent 0.5 T-MR imaging of the heart with native T1-SE, contrast-enhanced T1-SE, Cine-GE, and T2-TSE sequences. MR images were evaluated for signal intensity (SI) and lesion's conspicuity. Results were confirmed histologically (14 x) or by follow-up (1 x). RESULTS: MRI revealed myxomas in 9 patients, sarcomas in three patients, and thrombi in three patients. Lesion conspicuity was better in Cine-GE and T2-TSE compared with native and contrast-enhanced T1-SE sequences. Myxomas were characterized by an intermediate SI similar to myocardium in T1-SE, high SI similar to water in T2-TSE, and low to moderately high enhancement (range 19-75%, mean 48%). CONCLUSION: Distinct SI characteristics together with anatomical-topographical features (attachment to the interatrial septum, no infiltration of myocardium and vessels) are diagnostic for cardiac myxomas. Cine-GE and T2-TSE sequences are the sequences of choice for detection of myxomas and other atrial masses. T2-TSE and contrast-enhanced T1-weighted sequences are most useful for mass characterisation and differentiation between myxomas, malignant tumors, and thrombi.

Diagnosis, Differential↗
PubMed1999

Subtyping depression: testing algorithms and identification of a tiered model.

We seek to distinguish psychotic, melancholic, and nonmelancholic depression by clinical features and to test varying algorithm models to determine optimal criteria sets. We report a study of 269 depressed inpatients and outpatients. A latent class analysis (LCA) of 16 clinical features allowed for specificity or overrepresentation of features to be examined across the three classes. Varying algorithm models for distinguishing melancholic and nonmelancholic depression, involving endogeneity symptoms and observer-rated psychomotor disturbance (PMD) were compared. Psychotic depression was readily distinguished by the specific presence of psychotic features, and PMD was most severe in this class. Melancholic depression was most clearly distinguished from the residual nonmelancholic class by the presence of PMD. Although some endogeneity symptoms were overrepresented in the melancholic class, their specificity was unimpressive. An algorithm involving PMD components alone was highly efficient in discriminating LCA classes and, more importantly, superior to DSM-IV decision rules when examined against a range of clinical validators of melancholia. Subtyping appears assisted by a hierarchical model, based on a small set of features. The move from nonmelancholic to melancholic depression appears defined by a tier of observably rated PMD, whereas the move from melancholic to psychotic depression is determined by a tier of psychotic features and contributed to by significantly higher levels of PMD.

Adult↗
PubMed1999

Characteristics of depressed patients who report childhood sexual abuse.

OBJECTIVE: Depressed patients who had and had not been exposed to childhood sexual abuse were studied to determine differences in severity of depressed mood, lifetime histories of anxiety and depression, childhood environment, and disordered personality function. METHOD: Data were obtained from 269 inpatients and outpatients with major depression (171 women and 98 men) by means of structured clinical interviews and self-report questionnaires. RESULTS: Forty-six of the 269 patients reported childhood sexual abuse; 40 of these were women. These 40 women were compared with the 131 who did not report childhood sexual abuse. The patients who experienced abuse did not differ from those who had not on psychiatrist-rated mood severity estimates, but they did have higher self-report depression scores. They also evidenced more self-destructive behavior, more personality dysfunction, and more overall adversity in their childhood environment. Childhood sexual abuse status was associated with more borderline personality characteristics independently of other negative aspects of the patients' earlier parenting. Childhood sexual abuse status was linked strongly to adult self-destructiveness, as was early exposure to maternal indifference. CONCLUSIONS: Multivariate analyses suggest that depression is unlikely to be a direct consequence of childhood sexual abuse. Childhood sexual abuse appears to be associated with a greater chance of having experienced a broadly dysfunctional childhood home environment, a greater chance of having a borderline personality style, and, in turn, a greater chance of experiencing depression in adulthood.

Adult↗
PubMed1999

An exploration of links between early parenting experiences and personality disorder type and disordered personality functioning.

Reports of early parenting were assessed using two measures, the Parental Bonding Index (PBI) and the Measure of Parenting Style (MOPS), in a sample of 265 patients with DSM-defined major depressive disorder. Psychiatrists then rated the extent to which sample members evidenced the personality "styles" underpinning 15 separate personality disorders, returning personality vignette scores. The extent of disordered functioning was also assessed across "parameters" and "domains" by psychiatrists, referrers, and family members, using a range of measures. Those with higher scores on vignettes measuring borderline, anxious, depressive, and self-defeating personality style rated parents as uncaring, overcontrolling, and abusive. When vignettes were consolidated into scores akin to the DSM clusters, the most consistent links between perceived dysfunctional parenting were with the Cluster C (anxious), and Cluster B (dramatic) styles and were nonsignificant for Cluster A (eccentric) style. Meeting criteria for an increasing number of personality disorder clusters was associated with increasing levels of adverse parenting. Multiple regression analyses indicated that disordered functioning (as assessed by the three independent rater groups) was most distinctly associated with paternal indifference and maternal overcontrol.

Adult↗
PubMed1998

Depressed mood states and their inter-relationship with clinical depression.

A study was conducted to contrast depressed mood states in those positive and negative for lifetime depressive syndromes. A non-clinical cohort of 156 subjects was assessed on four occasions over 15 years, with 35% having had a major depression and 22% a minor depression at the most recent assessment. At 5-yearly reviews, estimates were obtained of episode frequency, duration and symptom patterns during depressed mood states. Such characteristics were then contrasted across the three groups of those who had experienced major depression, those who had suffered minor depression and lifetime non-cases. Depressive states were affirmed by at least 96% of subjects at each assessment, with the mean number of episodes per assessment year ranging from 8.6 to 21.2. Those who had experienced a lifetime episode of major depression differed from the two contrast groups (i.e. those with minor depression: non-cases) in having more episodes and more features during episodes. By contrast, there was a gradient across the three groups for two other examined features, with those having major depression being more likely than those with minor depression, who in turn were more likely than the non-cases to have longer episodes and a greater number of symptoms. The greater frequency, severity and duration of depressed mood states in those who met lifetime criteria for a major depressive episode suggest that their threshold to onset and persistence of a variety of depressive experiences is lowered, so supporting a general vulnerability hypothesis.

Adult↗
PubMed1998

Sex differences in the experience of depressed mood state over fifteen years.

A study was conducted to examine sex differences in frequency, duration and severity of experience of depressed mood state in a non-clinical group and to consider how such findings contribute to the understanding of sex differences in depressive experience. A cohort of 156 subjects, assessed initially in 1978 in their last year of teacher training, was reassessed at 5-yearly intervals over 15 years. On each occasion, the subjects completed self-report ratings of experience of "normal depression" and measures of neuroticism, trait depression, self-esteem and sex role. The study found no sex differences in the number or duration of episodes. Women reported more symptoms per episode and some specific symptoms (including tearfulness, appetite and weight gain) more often. The number of symptoms was correlated with neuroticism, self-esteem and trait depression scores, and with gender but not sex role. The number of episodes was related to trait depression and self-esteem but not neuroticism. The results showed that there are links between female gender, neuroticism and number of symptoms experienced during depressed mood state episodes. These links are related more to female gender than to feminine sex role or premenstrual problems, and are reflected in the severity of affective change (and some specific symptoms) but not in the number of episodes.

Adult↗
PubMed1998

Disordered personality style: higher rates in non-melancholic compared to melancholic depression.

OBJECTIVE: We test whether there is differential representation of disordered personality function across melancholic and non-melancholic depressive sub-types, with levels of differentiation examined against differing sub-typing measures. METHOD: In a sample of 245 subjects meeting criteria for a non-psychotic major depressive episode lasting less than 2 years, we examine for differential rates of disordered personality style across melancholic and non-melancholic depression, using four differing sub-typing measures (i.e., DSM-III-R and DSM-IV criteria, Newcastle Index, and the CORE measure). Disordered personality was assessed by psychiatrist ratings of 15 differing personality styles underpinning disorder classes, and several parameters and domains that reflect the arenas whereby disordered personality may be manifested. RESULTS: However defined, those with non-melancholic depression were distinctly more likely to rate as showing disordered personality function, with over-representation to an avoidant personality disorder style being the most consistently and strongly identified personality disorder class. Because of limitations to several of the sub-typing measures, we focus on the DSM-IV system. Discriminant function analyses indicated that those so identified as having non-melancholic depression were significantly more likely to rate as having avoidant and schizoid personality styles. A principal components analysis of our 15 differing personality disorder classes identified three molar classes corresponding to the three-cluster DSM system. Again, non-melancholic (compared to melancholic) subjects were more likely to return higher scores: in order, an 'anxious and fearful' (Cluster C) personality style, then an 'eccentric' Cluster A, and somewhat less clearly, a 'dramatic' Cluster B personality disorder style. Specificity to the non-melancholic depressive class was again suggested in relation to a large number of the parameters and domains measuring disordered personality function. CONCLUSIONS: Disordered personality function appears distinctly more likely in non-melancholic, compared to melancholic depression.

Adolescent↗
PubMed1998

Examining sex differences in the impact of anticipated and actual life events.

To examine for sex differences in anticipated and actual impact of pleasant and unpleasant life events in a non-clinical group, a cohort of 164 subjects was initially assessed in 1978 in their last year of teacher training. They were asked to participate in the life events study in 1979, and 97 subjects complied, providing us with ratings of impact of 'anticipated' life events. In 1983, the original cohort assessed the 'actual' impact of events experienced over the previous year. They also completed measures of neuroticism, state and trait depression, self-esteem, parental bonding and dependency in 1978, and gender roles in 1983. Some analyses for sex differences were undertaken for the entire cohort, with more extensive analyses for the 97 who had completed the 1979 (as well as 1978 and 1983) assessments. There were no sex differences in the scores for 'anticipated' or 'actual' impact of pleasant life events, or for 'anticipated' unpleasant life events. However, there was a statistically significant sex difference between 'actual' unpleasant life event scores, with females rating events as being either more pleasurable or unpleasant than males at both collection points. The actual impact of pleasant events was associated with higher dependency and masculinity scores, whilst unpleasant events was associated with higher dependency for females and higher parental overprotection and dependency scores for males.

Affective Symptoms↗
PubMed1998

Non-melancholic depression: the contribution of personality, anxiety and life events to subclassification.

BACKGROUND: We sought to develop a clinically useful subtyping system for the non-melancholic depressive disorders, and here we assess one weighted to central aetiological factors. METHODS: We studied 185 patients meeting DSM-III-R and/or clinical criteria for non-melancholic depression. Data were obtained by self-report, interview of patients and from corroborative witnesses. We developed a set of variables for class definition, assessing: (i) 'P', disordered personality as a vulnerability factor; (ii) 'A', meeting criteria for a lifetime anxiety disorder or positive on probe questions about trait anxiety characteristics, so assessing anxiety as a vulnerability factor; and (iii) 'L', psychiatrist and consensually-rated life event stress prior to depression onset. RESULTS: A latent class analysis generated a four-class solution for the P-A-L variables. Life event stressors had similar item probabilities across all four classes, and did not influence the four-class 'P-A' solution when deleted from the analysis, suggesting that life event stress may act more as a general provoking agent, rather than constituting any distinct 'reactive' or 'situational' depression class. Three classes generated clinically meaningful groupings, reflecting varying contributions of anxiety and disordered personality functioning, and with evidence of differential outcome over the following 12 months. CONCLUSIONS: We suggest that a refined aetiologically-weighted model may assist definition of the non-melancholic depressive disorders, and provide the logic for exploring the comparative utility of differing treatments to identified vulnerability-based classes.

Adult↗
PubMed1998

Qualitative and quantitative analyses of a 'lock and key' hypothesis of depression.

BACKGROUND: We examine a 'lock and key' ('L-K') hypothesis to depression which posits that early adverse experiences establish locks that are activated by keys mirroring the earlier adverse experience to induce depression. METHODS: Two-hundred and seventy clinically depressed patients were examined with open-ended and pre-coded interview questions to ascertain both early adverse experiences and precipitating life events. Qualitative and quantitative data analyses examined for any associations between developmental 'locks' and precipitating 'keys'. RESULTS: Qualitative assessment suggested 'L-K' links in almost one-third of the sample, and examples are provided. While quantitative analyses indicated significant associations between several identical 'lock' and 'key' constructs, evidence of specificity was rare. When individual 'locks' and 'keys' were consolidated into three higher-order constructs, variable models were suggested, including a non-specific link, a specific link and absence of any link. 'L-K' links appeared more likely in those with 'non-melancholic' (versus 'melancholic') depression, with the seemingly greater relevance to 'reactive' (versus 'neurotic') depression in the quantitative analyses inviting speculation that that 'disorder' may be more a reaction to a salient rather than a severe stressor. CONCLUSIONS: This exploratory study suggests that early adverse experiences may variably establish specific and non-specific patterns of vulnerability to having depression triggered by exposure to salient mirroring life event stressors.

Adjustment Disorders↗
PubMed1998

[Radiation exposure of radiation-sensitive risk organs--ocular lens, parotid gland, thyroid gland--in dacryocystography and therapy].

PURPOSE: Evaluation of radiation dose to the radiosensitive head and neck organs and tissues-ocular lens, parotid and thyroid glands--during dacryocystography and fluoroscopy--guided dacryocystoplasty (DCP). METHOD: Radiation dose was determined in an Alderson Rando phantom and in 13 patients. Radiation dose was measured directly using Ca-F2-thermoluminescent dosimetry crystals (TLD) which were placed on each eyelid, parotid gland and thyroid gland. RESULTS: The mean radiation dose to the lens placed next to the path of radiation was 6.58 mGy in the Alderson-Rando phantom and 5.43 mGy in patients during DCP. The mean radiation dose to the contralateral lens was 1.37 mGy and 1.7 mGy to the parotid gland placed next to the x-ray tube. Radiation dose to the thyroid gland was max. 0.4 mGy during DCP. CONCLUSION: Radiation dose to the ocular lens, parotid gland and thyroid gland during fluoroscopy-guided DCP was 25 times higher than during diagnostic dacryocystography. The radiation dose to radiosensitive head and neck organs and tissues during fluoroscopy-guided DCP is much below the threshold dose for ocular lens cataract.

Dacryocystitis↗
PubMed1998

[Native and signal-enhanced power Doppler sonography for characterization of liver lesions].

PURPOSE: To evaluate the characterisation of liver lesions using power Doppler sonography before and after intravenous injection of the ultrasound contrast agent Levovist. MATERIALS AND METHODS: 39 patients with 41 liver lesions (10 haemangiomas, 2 focal nodular hyperplasias (FNH), 2 focal fatty infiltrations, 1 echinococcal lesion, 11 hepatocellular carcinomas, 14 metastases and one cholangiocarcinoma) were evaluated prospectively. Power Doppler images before and after intravenous injection of the ultrasound contrast agent Levovist were analysed by two radiologists and one gastroeterologist, who subjectively classified the distribution (peripheral, central, diffuse) and amount (none, minimal, moderate and strong) of flow pattern in each sonographic examination. Histological verification was obtained in all liver lesions, except in haemangiomas, where MR imaging and in one FNH where scintigraphy was regarded as sufficient proof. RESULTS: On the whole, power Doppler sonography after contrast injection was superior to unenhanced power Doppler-sonography in 20 liver lesions and equal in 7. After contrast injection, previously visible flow was enhanced in 14 patients, in 6 lesions flow was detected, which was not seen before in the power mode. Moderate or strong flow signals were detected before contrast injection in 8/26, post contrast injection in 18/26 malignant tumours. Contrawise, 13/15 benign lesions did show any or only minimal flow signals before and 10/15 after contrast injection. CONCLUSION: Intratumoural flow signals favour a malignant tumour. The absence of flow signals is a frequent finding in benign lesions but does not rule out malignancy.

Carcinoma, Hepatocellular↗