Biomedical subjects

K Wilhelm

Publications and source records attributed to K Wilhelm.

At least 109 records · Page 6Linked to original sources

PubMed1997

Plumbing the depths: some problems in quantifying depression severity.

We first report further studies of the psychometric properties of the AUSSI), a brief (11-item) self-report depression measure assessing mood state severity and disability in a sample of 270 subjects. Total scores (combining mood state and disability) correlated well with another self-report measure of depression severity, the Beck, but minimally with both Hamilton and DSM-III-R Global Assessment of Function (GAF) scores. For a sub-sample where we had complete data sets (including a corroborative witness [CW] form of the AUSSI), we established moderate levels of agreement between self-report and CW AUSSI scores, important in supporting validity of its disability sub-scale. Against expectation, neither mood nor disability AUSSI scale scores differed across clinically meaningful depressive sub-types, while differentiation was demonstrated for the Hamilton and GAF measures. Differentiation for the Hamilton measure was clearly driven by several type-specific component clinical features, but also presumably contributed to by the clinician-rater format. Our study raises questions about the varying reference bases and semantics used by patients, corroborative witnesses and clinicians in rating depression severity, and which may generate similar or contrasting severity estimates across varying depressive sub-types.

Adolescent↗

PubMed1997

Distinguishing psychotic depression from melancholia.

We contrast 25 patients with "psychotic depression" (PD) against two age- and sex-matched groups of melancholic depressed patients. In terms of clinical features, specificity of PD was suggested for several features, including delusions, morbid cognitions (involving guilt and a sense of deserving punishment), hallucinations and constipation. In addition, the PDs had significantly higher levels of behaviourally rated psychomotor disturbance. A comprehensive list of risk factors to depression (e.g., socio-demographic, family history, parental influences, medical disorders, anxiety, stressors and personality style) were examined, without clear differentiation between the comparison groups apart from the suggestion that being a "worrier" and having tenuous stability under stress was over-represented in the PDs. Findings favour the view that psychotic depression is a sub-type of melancholic depression (accounting for the similar expression of the majority of clinical and possible aetiological variables across our contrasted "types'). Findings also suggest possible benefits from future phenomenological studies of psychotic depression relying more on observer-based rather than self-report or symptom data sets. Aetiological studies would benefit from focussing on those features identified as distinguishing the condition from melancholic depression.

Adult↗

PubMed1997

Altered patterns of subchondral bone mineralization in Kienböck's disease.

The pattern of subchondral bone density, which is supposed to reflect the long-term distribution of stress, was investigated in both wrist joints of nine healthy young subjects and seven patients suffering from Kienböck's disease by means of CT osteoabsorptiometry. Two density maxima were found on the distal articular surface of the radius in the healthy subjects, corresponding to the position of the scaphoid and the lunate. Our relative quantitative results showed three different physiological types of stress indicated by the predominantly monocentric density maxima either on the scaphoid or the lunate surface of the radius and the symmetrical distribution of the mineralization. In Kienböck's disease no type of mineralization predominated. In the progressive stages the lunate density maximum was absent. The overall mineralization was generally less than in controls. Changes in the pattern of mineralization were also found on the contralateral side.

Adult↗

PubMed1997

How distinct is 'distinct quality' of mood?

BACKGROUND: The DSM-IV criteria for melancholia include the clinical feature 'distinct quality', defined as a mood state differing from that experienced in bereavement. Both propositions-its specificity to melancholia and its definition- remain problematical. METHODS: We examine both propositions by analysing an adjective checklist completed by melancholic and non-melancholic depressed subjects, as well as by a bereaved sample. The checklist was refined by a principal components analysis to four scales-one assessing a general 'mood' severity or dysphoric dimension, and the other three assessing dimensions of 'fatigue', 'numbness' and 'guilt'. RESULTS: If the concept of "distinct quality' has validity, we would require specificity of the refined qualitative constructs to melancholic depression. The 'numbness' component met that requirement, but only to a degree. While bereaved subjects did differ from those with melancholic depression on a number of our refined qualitative mood domains, such differences appeared more related to lower levels of depression in the bereaved sample. CONCLUSIONS: We argue for deleting the 'distinct quality' criterion from diagnostic checklists of melancholia until its definition has been improved, its utility demonstrated and its specificity to any depressive subtype established as having clinical significance.

Adult↗

PubMed1997

Fifteen years on: evolving ideas in researching sex differences in depression.

BACKGROUND: A cohort study of a socially homogeneous group of teachers was commenced in 1978 to pursue possible risk factors contributing to the recognized female preponderance of depression. METHODS: Multiple measures of depressive experience included: (i) lifetime rates, duration and number of depressive episodes using two caseness definitions, DSM-III-R major depression and 'all depression' (which included a category of minor depression); (ii) self-report measures of state and trait depression, neuroticism, and self-esteem. DSM-III-R anxiety disorder rates are also reported and co-morbidity with major depression examined. RESULTS: At the 15-year review in 1993, the sample had a mean age of 39 years, there was a trend for a female preponderance in lifetime rates of major depression and 'all depression' (and which was more pronounced with the inclusion of data for anxiety disorders), with statistically significant differences in rates of social and simple phobias and combined anxiety disorders. Mean neuroticism scores were consistently higher for women. CONCLUSIONS: The strong association between anxiety and depressive disorders suggests that greater reporting of anxiety and higher neuroticism scores in women may be a key determinant that contributes to any female preponderance in depression rates.

Adult↗

PubMed1997

Increased rate of psychosis and psychomotor change in depression with age.

BACKGROUND: We examined the phenomenology of depression in younger (< 60 years old) versus older (> or = 60 years) subjects and, more specifically, the interaction between age and psychomotor disturbance associated with depression. METHOD: Two hundred and eighty-five patients with a DSM-III-R diagnosis of unipolar major depression referred to a mood disorders unit were assessed using the CORE rating scale, a sign-based system for defining melancholia. Subjects were also assessed using the Hamilton Rating Scale for Depression, Zung Depression Scale, Newcastle Endogenous Depression Inventory and the General Health Questionnaire. RESULTS: The total CORE score (and each of its subscales) was found to interact with age. Rates of psychotic and melancholic depression increased with age. Elderly depressives suffered more severe depression (higher HRSD scores), appetite loss and weight loss. Level of psychomotor disturbance and rates of psychosis did not differ between those elderly subjects with an early onset (before the age of 60 years) and those with a late onset (at or after 60 years) of depression. CONCLUSIONS: There appear to be robust phenomenological differences in depression between older and younger subjects. The association between age and psychomotor change may assist our understanding of the neurobiology of depression.

Adult↗

PubMed1997

The development of a refined measure of dysfunctional parenting and assessment of its relevance in patients with affective disorders.

BACKGROUND: The Parental Bonding Instrument (PBI) measures fundamental parenting dimensions (care and over-protection), but does not directly assess abusive parenting. METHODS: We describe the development of the Measure of Parenting Style (the MOPS), comprising refined PBI scales assessing parental indifference and over-control, as well as a scale assessing parental abuse. RESULTS: We examine psychometric properties of the MOPS, while several analyses build to the concurrent validity of the abuse scale as an experimental measure. We examine the extent to which both the PBI and the MOPS scales showed specificity of dysfunctional parenting to the non-melancholic depressive subtype, and across a range of anxiety disorders. Non-melancholic depressed patients returned anomalous parenting scale scores (compared to melancholic subjects), but only when such subtyping decisions were clinician-generated. Those receiving DSM-III-R lifetime anxiety diagnoses of panic disorder and of social phobia returned higher PBI protection and MOPS over-control scores than non-anxious subjects, while differences were not established for those with generalized anxiety disorder or obsessive compulsive disorder. CONCLUSIONS: We consider the likely utility of the MOPS scale and note the module capacity of separate MOPS and PBI scales, which allow a set of options for assessing perceived parenting characteristics.

Adolescent↗

PubMed1997

[The diagnosis of intra-abdominal hemorrhages with CO2 as the contrast medium].

PURPOSE: Evaluation of carbon dioxide (CO2) as contrast medium for detection of intraabdominal haemorrhage. METHOD: We performed in 5 patients 7 DSA examinations (one with upper and three with lower gastrointestinal bleeding, one traumatic spleen rupture) using an iodinated contrast-medium and CO2 for the localisation of haemorrhage. RESULTS: With iodinated contrast medium it was possible to localise the haemorrhage in three of 5 patients. With CO2 the localisation was possible in all cases. There were no side effects. CONCLUSION: CO2 is useful for detection of intraabdominal bleeding. Even in cases with negative angiographic results with iodinated contrast medium, CO2 may enable localisation of the bleeding vessel. Because of this, we use CO2 and iodinated contrast media in all cases of intraabdominal haemorrhage. Further studies are required.

Angiography, Digital Subtraction↗

PubMed1997

[Carbon dioxide (CO2) as contrast medium for the new installation and follow-up of a TIPS].

PURPOSE: To determine the efficacy of CO2 as negative contrast medium compared with iodinated contrast medium in creation and control of TIPS. MATERIAL AND METHODS: CO2 was used during TIPS procedures in 33 patients. In 21 patients a wedged hepatic venography was obtained for planning the shunt tract. Additional TIPS-control DSA was performed in 42 cases by direct portal venography to verify the TIPS function and patency. In all cases CO2 gas was used in addition to iodinated contrast medium. RESULTS: CO2 produced excellent wedged hepatic venographies in all patients. Visualisation of the portal veins and collaterals was superior to iodinated contrast medium. The TIPS-control DSA performed with CO2 were comparable to those performed with iodinated contrast medium. Complications were not observed in our study. CONCLUSION: CO2 is an effective contrast medium for TIPS procedures. In particular the visualisation of portal veins performed by CO2-wedged hepatic venography is superior to iodinated contrast medium.

Adult↗

PubMed1997

[MRI dacryocystography after applying gadolinium-containing eyedrops].

PURPOSE: To determine the efficacy of MRI for the lacrimal drainage system after conjunctival application of gadolinium-DTPA solution. MATERIAL AND METHODS: MRI dacryocystography of 32 nasolacrimal duct systems was performed in 16 patients additional to digital subtraction dacryocystography. The gadolinium solution was prepared by diluting the commercially available gadolinium-DTPA (Magnevist, Schering AG, Berlin) 1:10 in sterile saline solution. 3 x 2 drops of this contrast medium were instilled bilaterally immediately before MRI scanning. RESULTS: MRI dacryocystography provided detailed information on the nasolacrimal duct system in all 32 cases. In 16 cases localisation and functional degree of nasolacrimal duct obstruction or stenosis was determined reliably. In 15 cases normal nasolacrimal duct system showed no contrast enhancement. In one case stenosis of the canaliculus was observed. CONCLUSION: MRI dacryocystography provides detailed morphological soft tissue information of the lacrimal drainage system. Local conjunctival application of gadolinium solution allows functional tests of the lacrimal duct system in patients suffering from epiphora.

Adult↗

PubMed1997

[CO2 cholangiography].

PURPOSE: Evaluation of the benefit of carbon dioxide (CO2) as contrast medium to reduce intraductal manipulations in biliary drainage. METHOD: In 8 patients with biliary occlusion demonstrated by cholangiography with iodinated contrast medium, percutaneous CO2 cholangiography was performed by manual injection of 30-50 ml CO2 using the same approach. Capability of CO2 to pass the obstruction and delineate distal parts of the common bile duct was evaluated. RESULTS: In 5 of 8 patients CO2 visualised additional segments of the occluded bile duct. In 4 patients the poststenotic bile duct was demonstrated with CO2. In one patient 2 cm of the obstructed duct segment was visualised. The intrahepatic duct system could not be examined sufficiently by CO2 administration. CONCLUSION: Because of its low viscosity, CO2 is a useful contrast medium to visualise the extrahepatic biliary system before performing an external-internal biliary drainage in biliary obstruction. Unnecessary intraductal manipulations may be reduced.

Carbon Dioxide↗

PubMed1997

[Stent implantation and balloon dilatation in the treatment of stenosis and obstruction of the lacrimal apparatus].

PURPOSE: To evaluate treatment of epiphora caused by obstructions of the nasolacrimal duct system with balloon dilatation and stent implantation. MATERIAL AND METHODS: 28 dacryocystoplasties were performed in 20 patients with complete (n = 7) or incomplete (n = 13) obstruction of the nasolacrimal duct system. RESULTS: Dacryocystoplasty was technically successful performed in 26 cases (93%). Recanalisation was not achieved in two patients with complete obstructions. 17 patients showed complete or partial resolution of epiphora during follow-up of up to two years (clinical success 85%). Complete reobstruction occurred only in one patient 9 months after balloon dilatation and recanalisation was not possible. CONCLUSION: With a technical success rate of 93% and a clinical success rate of 85% dacryocystoplasty is a non-operative alternative for treatment of epiphora caused by obstructions of the nasolacrimal duct system.

Adult↗

PubMed1997

[Oral contrast media in CT: improvement by addition of guar?].

PURPOSE: To evaluate the additional effect of guar with iotrolan as an oral contrast medium. METHOD: In a clinical double-blind randomised study a viscous iotrolan (11.2 mg iodine/ml)/guar (4 g/l)-suspension was compared with aqueous solutions of pure iotrolan (11.2 mg iodine/ml) and meglumine ioxithalamate (12 mg iodine/ml). The contrast media were evaluated according to filling, distribution, transit time, artifacts, radiodensity, patient acceptance and side effects. RESULTS: The addition of guar delayed the transit time of the contrast media. Consequently a more homogeneous filling of the bowel with fewer artifacts was observed in comparison to the aqueous contrast media. The results of the pure iotrolan solution were comparable to meglumine ioxithalamate, except for a higher radiodensity in the distal small intestine. The colon showed a better filling with non-viscous contrast media in the given time frame. Pure iotrolan had the best patient acceptance. Two patients considered the iotrolan/guar-solution impossible to drink, the other 18 patients found taste and consistency just about acceptable. CONCLUSION: In spite of the discussed advantages, due to a less subjective acceptance the guar/iotrolan solution is not suitable in routine-diagnosis, unless taste and consistency are greatly improved. Individual use is recommended in selected cases and long-term examinations.

Administration, Oral↗

PubMed1997

[Callus distraction for progressive lengthening of the capitate bone after resection of the lunate bone in stage III lunate malacia. Surgical technique and 1 year results].

Inspite of the excellent subjective judgement and functional results of Graner's operation in case of Kienbock's disease stage III, this technique is rarely used nowadays because of its high rate (20 to 30%) of disturbed fracture healing due to impaired blood supply. To avoid the risk of complete devascularization in the capitate region, we are using the callotaxis lengthening technique of Ilizaron, carrying out a segmental shifting. After percutaneous temporary SC- or STT-arthrodesis with the scaphoid in the horizontal or high position, the lunate is completely resected using a dorsal approach. Osteotomy of the capitate is carried out at the corpus-collum interval in order to disturb a minimum of the vascular supply to the bone. Seven to ten days postoperatively, distraction is started with a rate of 1 min/day. The desired distraction length is accomplished, when the capitate articular surface fits perfectly into the curvature of the proximal row articular surface. In order to reduce or prevent soft tissue related complications during the consolidation period, the external distractor is replaced by two percutaneous Kirschner-wires. The consolidation period takes twice as long as the distraction period. Since November 1993, fourteen patients presenting a stage III Kienböck's disease have been treated by this new technique. The operative technique, postoperative care, as well as the potential and real complications are described and illustrated by one clinical case.

Adult↗

PubMed1997

[Stress on the radiocarpal joint. CT studies of subchondral bone density in vivo].

Most concepts about the mechanism of load transmission through the radiocarpal joint have been mostly acquired from the study of cadaveric specimens. Apart from this, however, it is possible to derive direct knowledge about the actual mechanical conditions of a joint from certain morphological parameters, particularly by analysis of the subchondral mineralization. CT-osteoabsorptiometry (CT-OAM) has provided a non-invasive investigative tool by which the distribution of subchondral mineralization within the radiocarpal joint can be determined. Seventeen wrist-joints in healthy young subjects were investigated by means of CT-OAM, and the results evaluated both topographically and quantitatively. In most cases, two density maxima were found on the articular radial surface, one corresponding to the scaphoid and one to the lunate. These matched the positions of pressure peaks described in reports of research on mechanical models. The density maximum on the articular surface of the radius opposing the scaphoid is, however, rather more dorsally placed, whereas that opposing the lunate lies palmar to the radioulnar midline. This explains the transmission of force to the forearm and the geometrical configuration of the joint components. On the other hand, our quantitative results do not confirm the existence of a generally greater degree of mineralization of either one of the joint compartments. We cannot confirm theories attributing transmission of the main force through either the scaphoid or the lunate. We assume rather that the type of stress indicated by the predominantly monocentric density maxima either on the scaphoid or the lunate surface of the radius, together with the equally balanced bicentric degree of mineralization, are to be regarded as physiological.

Absorptiometry, Photon↗

PubMed1997

[Results of surgical management of lunate malacia. A retrospective clinical study].

We investigated the results of 53 patients in a retrospective study after surgical treatment for Kienböck's disease. Surgery included shortening of the radius (35 cases), cancellous bone graft (four cases), pisiform transposition (two cases), Swanson prostheses (two cases), tendon interposition arthroplasty (one case), STT-arthrodesis (six cases), denervation of the wrist (one case), and wrist arthrodesis (two cases). The average follow-up was 43 months (minimum 12, maximum 84 months). Criteria for rating the results were subjective satisfaction and pain profile. Objective criteria were X-ray findings and range of motion of the hand and wrist. We paid particular attention to the economic consequences for the patients. Based on our own results and the results in the literature, we recommend bone-grafting in the early Decoulx stages I and II. In stages II and III, we recommend in cases of ulna-minus variance the shortening of the radius in combination with a bone grafting; in case of an ulna-zero variance, we have the possibility of a radius wedge osteotomy or a pisiform transposition. Stage III, especially IIIb according to Lichtman, is suitable for STT-arthrodesis. In stage IV, we recommend total wrist arthrodesis, the denervation of the wrist can be combined with all the other methods or as a salvage procedure prior to wrist arthrodesis.

Adolescent↗

PubMed1996

Depressive psychomotor disturbance, cortisol, and dexamethasone.

We examine the dexamethasone suppression test as a biological correlate of melancholia as defined by the CORE system, a scale for rating objective signs of psychomotor disturbance. Postdexamethasone cortisol concentrations and rates of nonsuppression were higher in CORE, Newcastle, and DSM-III-R defined melancholic groups. These differences, however, were no longer significant after partialling out the combined effects of age, dexamethasone, and basal cortisol concentrations. There was a significant correlation between the CORE (but not the Newcastle) scale and 8:00 AM postdexamethasone cortisol levels, which persisted after partialling out those same three covariates. Dexamethasone concentrations themselves were lower in CORE- and Newcastle-defined melancholics, though these were no longer significant after covarying for cortisol concentrations. Dexamethasone levels were also significantly inversely correlated with CORE and Newcastle scales. A significant correlation between CORE (but not Newcastle) scores and dexamethasone levels at 4:00 PM persisted after partialling out the effects of age and cortisol. These findings indicate an intriguing relationship between the CORE system as a dimensional construct for rating psychomotor disturbance, and both postdexamethasone cortisol and dexamethasone concentrations.

Age Factors↗

PubMed1996

Local muscle flaps of the second and third interosseus space for the treatment of osteomyelitis in the central metacarpal region.

Both experimental and clinical studies showed that muscle flap transposition is a reliable tool in treating chronic infections of the bone. The major advantage of local muscle flaps is the treatment with well perfused autogenous tissue without using any implants. The primary closure of the operation site and the cure of infection within four weeks allow a short immobilisation time. Nevertheless, the loss of muscle function with a possible functional and aesthetic defect in the donor site has to be accepted. The first dorsal interosseus muscle and the abductor digiti minimi muscle have been used successfully for the treatment of metacarpal osteomyelitis. Osteomyelitis in the central metacarpal bones cannot be treated with these techniques, because of their limited range. We present the muscles of the second and third interosseus space for local pedicled muscle flap transfer. The arterial network in this interosseus spaces and the vascularisation of the dorsal and palmar interosseus muscles allow to harvest muscle flaps with either proximal or distal pedicle. The loss of interosseus muscles in the second and third interosseus space is tolerable from a functional and esthetic point of view. Operative techniques are shown for the elevation of dorsal and palmar interosseus muscle flaps. Two cases of osteomyelitis in the central metacarpal bones, which were treated successfully with the new local interosseus muscle flaps, are reported.

Adult↗