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Biomedical subjects

M Franz

Publications and source records attributed to M Franz.

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

Ultrasound measurements of the diameter of the fetal trachea, larynx and pharynx throughout gestation applicability to prenatal diagnosis of obstructive anomalies of the upper respiratory-digestive tract.

The purpose of the present study was to obtain normative data for the fetal upper respiratory tract by using high-resolution ultrasound techniques. Furthermore, we wanted to test the potential utility of the resulting normograms in diagnosing obstructive lesions of the trachea and oesophagus. Sonographic measurements of the diameters of the trachea, larynx and pharynx were obtained at well-defined planes from a prospective cross-sectional sample of 198 normal patients of known gestational age between 15 and 40 weeks' gestation. All measurements were performed during fetal apnea and in the absence of swallowing. The same measurements were also obtained from two cases with laryngeal atresia and three cases with oesophageal atresia, all of which were diagnosed prenatally. The data obtained were plotted on the constructed normograms. In normal fetuses approximately linear relationships existed between tracheal, laryngeal and pharyngeal diameter, on the one hand, and gestational age, on the other, with the measurements correlating significantly (p<0.0001) with gestational age. The linear regression coefficients (r2) for the tracheal, laryngeal and pharyngeal diameters were 0.66, 0.55 and 0.32, respectively. The 95 per cent prediction limits were also calculated. In fetuses with laryngeal atresia only the tracheal diameter was significantly higher as compared with that of normal fetuses. Data of the fetuses with oesophageal atresia showed that there were no changes in the upper airway anatomy. Our study provides normative data for the upper respiratory tract. In the prenatal diagnosis of obstructive neck anomalies the usefulness of the data would seem to be limited to those affecting the respiratory tract. Among the structures measured, only the trachea may prove to be of clinical significance.

Cross-Sectional Studies↗
PubMed1999

[Feelings without speech or speech without feelings? Further evidence for the decoupling hypothesis of alexithymia].

The theoretical background of the present investigation was the decoupling hypothesis of alexithymia, which presumes for alexithymic individuals a dissociation of psychophysiological indicators of emotion from verbal cognitive awareness of one's emotional state. To study alterations in reactivity to emotionally distressing stimuli in alexithymic individuals, 12 high-alexithymic and 14 low-alexithymic subjects (separated by TAS) out of a general sample of 54 were investigated. All subjects were exposed to cognitive (CPT) and affect inductive (film sequences) distress. During stimulus exposition electrodermal activity (spontaneous fluctuations) was recorded. After stimulus exposition the subjects assessed their emotional reaction towards the film sequences (DAS). Concerning electrodermal activity no differences were found between high and low alexithymics under cognitive distress. In any case a significant autonomous arousal was registered. However, only the low alexithymic subjects but not the high alexithymics showed a significant increase of spontaneous fluctuations as expression of autonomous arousal during presentation of affect inductive stimuli. The altered psychophysiological reactivity found in high alexithymics in contrast to low alexithymic subjects was revealed specifically for the processing of emotional qualified stimuli. However, there was no difference between the groups in cognitive self assessment of emotional response towards the film sequences. The findings are discussed with reference to neurophysiological and psychodynamic models and the decoupling hypothesis of alexithymia.

Adult↗
PubMed1999

A decade of spontaneous long-term course of psychogenic impairment in a community population sample.

BACKGROUND: Our epidemiological study demonstrates the spontaneous long-term course of predominantly psychosocially influenced ("psychogenic") disorders (neurotic spectrum disorders, personality disorders, stress reactions and somatoform disorders) in a representative community sample of the normal adult population of Mannheim, an industrial and university town in Germany. The natural spontaneous course of these disorders in a population sample over a long period remains largely unknown. METHOD: Beginning in 1979 (nt1 = 600) a random population sample was investigated three times over a mean period of approximately 11 years. The last follow-up study ended in 1994 (nt3 = 301). The follow-up sample was representative of the t1 sample. Psychodynamically trained and clinically experienced interviewers used a semi-structured interview and standardized clinical and psychometric instruments. Psychogenic impairment was assessed using a standardized expert rating (Impairment Score, IS). RESULTS: The mean sum-score of psychogenic impairment after 11 years exceeded the value at t1. The case rate (point prevalence, ICD diagnosis + clinical cut-off/IS) increased from 21.6% at t1 to 26.2% at t3 in the investigated follow-up sample. Intra-individual correlation of psychogenic impairment between t1 and t3 was high (r = 0.55). We found strong evidence for an unfavorable long-term course of psychogenic impairment and only a weak tendency (23.1%) for spontaneous remission of clinically relevant psychogenic impairment. Within a regression model clinical variables, childhood development conditions and personality traits at t1 predicted psychogenic impairment at t3. CONCLUSION: All clinical variables conclusively indicate an unfavorable spontaneous long-term course of psychogenic impairment. Together with the well-known high prevalence of psychogenic disorders in the normal population, this underlines the need for early therapeutic and preventive intervention.

Adult↗
PubMed1999

The fatigue strength of the interface between Ag-Pd alloy and hydrothermal ceramic.

OBJECTIVE: The purpose of this paper was to investigate the fatigue strength of a hydrothermal ceramic fused to Ag-Pd alloy. This study compared the values with those of other metal-ceramic systems previously reported by other authors. METHODS: This investigation was performed on 48 specimens made of Ag-Pd alloy frames (45 x 12 x 4 mm) on which the hydrothermal ceramic was fused (25 x 12 x 2 gmm). The specimens were divided into two groups. The first group of specimens was dynamically loaded immediately after casting and fusing, while the other group of specimens was thermocycled (1000 times at 0 degree C and 55 degrees C) before dynamic loading. The dynamic loading tests were carried out by using a modified three-point load method in a universal testing machine. RESULTS: The determined dynamic loading limit was up to 550 N for thermocycled, and up to 850 N for non-thermocycled specimens. These results are very respectable in comparison with other metal-ceramics. A statistically significant difference between maximal dynamic forces and number of loading cycles for thermocycled and non-thermocycled samples was determined. SIGNIFICANCE: From the data obtained in this study and current literature profiles, it is concluded that the tested metal-ceramic system is more durable than other metal-ceramic systems.

Hot Temperature↗
PubMed1999

[Not Available].

Under a psychoanalytic view, the etiological relevance of neurobiological modeis of obsessive-compulsive-disorder is discussed referring pharmacological and behavioral therapeutic options. From the beginnings of clinical psychoanalytic research, neurobiological correlates were considered for the understanding of obsessive-compulsive-disorder. However, within etiological psychoanalytic modeis those correlative biological markers have not the Status of monocausal independend variables. New biological findings regarding obsessive-compulsive-disorder can also be integrated in psychoanalytic concepts without renunciation of the significance of unconscious processes and an interaction oriented approach. Insight and Symptom oriented therapies are characterized with regard to necessary further research and to their complementary benefits.

Neurobiological modeis↗
PubMed1999

[Not Available].

Facing the increasing number of single-parent-families we investigated the impact of fathers absence within the first six years of childhood on psychic/psychosomatic impairment in later life. We used data from the Mannheim Cohort Study on the Epidemiology of Psychogenic (neurotic spectrum) Disorders for a comparison of extreme groups with a favourable or bad course of clinical impairment. In adition we performed regression analysis of the long term course of clinical impairment for the total follow-up sample (mean follow-up intervall 11 years, N=301) with psychometric, clinical and childhood variables. The absence of the probands father (> six months within the first six years of life) was a significant independend predictor of clinical impairment in later life, accompanied by clinical and psychometric variables. A significant and increasing impairment existed even in 73 of 125 older probands (birth cohort 1935), who missed their father in early childhood. The sociopolitical implications of these findings are discussed.

Childhood↗
PubMed1999

[The Dusseldorf short-term dynamic psychotherapy project (DKZP)].

Time-limited psychodynamic therapies in the outpatient setting are offered for a broad spectrum of psychogenic disorders. Meta-analyses prove their effectiveness mainly for neurotic disorders. We are interested in the suitability of the here applied CMP/SASB model (Tress et al. 1996) of psychodynamic short-term therapy for patients with psychosomatic and severe personality disorders. We extensively present the concept of Cyclic Mal-adaptive Pattern (CMP) in its clinically relevant parts as the core of psychogenic pathological developments. Particularly the introject, as the patient's attitude towards him- or herself, is of great importance for therapeutic change and its follow-up development. Within the DKZP (Duesseldorf Short-Term Psychotherapy Project), 36 male and female therapists, mostly interns at the local university clinic, treated 82 patients (m: 23/f: 59) with personality disorders (n = 26) and psychosomatic disorders (n = 31) as research groups and, in comparison, neurotic patients (n = 25) in a naturalistic design. 68 treatments have been completed so far, 11 patients have dropped out, the remaining 3 are still in therapy. Relevant research instruments are the Beeinträchtigungsschwere Score (BSS, an impairment score), Global Assessment of Functioning Scale (GAF), Cyclic Maladaptive Pattern (CMP), Symptom Check List (SCL-90-R), and Structural Analysis of Social Behavior (SASB) including process and content ratings, as well as the Intrex questionnaire. The treatments last 25 sessions. We carried out follow-up examinations after 6 months, 1 year, 2, and 5 years. Effect sizes for the whole sample by BSS and GAF are remarkably high, with further increase at follow-up interviews. Psychosomatic patients came off best, but personality disorders in comparison to neurotic patients profited surprisingly well. Effect sizes in self-rating (SCL and Intrex) were less high. However, in self-rating the changes of social functions are not sufficiently addressed. As a result, our form of focal therapy is well suited not only for neuroses, but also for psychosomatic disorders and personality disorders. An enlargement of the indication spectrum for this form of psychodynamic therapy to include these disorders is well founded and promising.

Adult↗
PubMed1998

Posttransplant hemolytic uremic syndrome in adult retransplanted kidney graft recipients: advantage of FK506 therapy?

BACKGROUND: Posttransplant hemolytic uremic syndrome (pHUS) is a rare but severe disorder that confers a poor prognosis on an allograft due to thrombotic microangiopathy. Immunosuppression with cyclosporine (CsA) is implicated as a significant risk factor for the development of pHUS. In early reports, it was hypothesized that immunosuppression with FK506 (tacrolimus) would avoid the development of pHUS. However, this initially supposed beneficial effect remains controversial, because pHUS associated with tacrolimus therapy has been published in some later case reports. This article aims to further evaluate FK506 with respect to the development and resolution of pHUS. METHODS: We describe the course of seven adult kidney graft recipients with pHUS, treated with FK506 either as initial immunosuppression for retransplantation or after discontinuation of CsA for resolution of pHUS. Work-up for pHUS was initiated when certain clinical features, such as hemolytic anemia, thrombocytopenia, and deterioration of graft function, were found. The diagnosis was confirmed by histologic examination of a renal allograft biopsy specimen (thrombotic microangiopathy). With the onset of pHUS, additional plasma exchange was performed in all patients. RESULTS: Two patients suffered from end-stage renal disease due to primary HUS and had a history of recurrent pHUS in previous renal transplants. In both patients, the attempt to regraft was only made because of the early optimistic reports using FK506. Despite initial FK506 therapy, both recipients developed pHUS again, leading to loss of graft function. Two additional kidney graft recipients with primary renal failure other than HUS also received FK506 as initial immunosuppression. One of them (loss of the first kidney graft due to CsA-induced pHUS) was successfully treated with FK506 for his second renal transplant. The other recipient, a patient in whom de novo pHUS had occurred in the first graft despite initial therapy with FK506, was treated with CsA for his second graft and again developed pHUS. The latter process, however, could be reversed by a switch to steroids and azathioprine. In all three patients regrafted for reasons other than pHUS, development of de novo pHUS was treated by CsA withdrawal and a switch to FK506; this approach was effective in two patients. CONCLUSION: Our results demonstrate that three of seven renal allograft recipients benefited from FK506 therapy for prevention or resolution of pHUS. Treatment or prophylaxis with FK506 can be considered advantageous in some patients with de novo pHUS, but FK506 fails to prevent recurrent pHUS in patients with primary HUS.

Adult↗
PubMed1998

Schizophrenia and anteroventral thalamic nucleus: selective decrease of parvalbumin-immunoreactive thalamocortical projection neurons.

This study was designed to examine possible anatomical changes of thalamocortical circuits in schizophrenics. Previous immunocytochemical studies have shown that parvalbumin, a calcium-binding protein, occurs in thalamocortical projection neurons, but not in GABAergic interneurons in the anteroventral thalamic nucleus (AN). Using parvalbumin-immunocytochemistry we investigated the densities of thalamocortical projection neurons in the AN of schizophrenic cases (n = 12) and controls (n = 14). The densities of all neurons in the AN were estimated by Nissl-staining. The majority of thalamocortical projection neurons in AN were identified by parvalbumin-immunoreaction. Significantly reduced densities of thalamocortical projection neurons were estimated in the right (P = 0.003) and left AN (P = 0.018) in schizophrenic subjects. The densities of all neurons in right and left AN were also diminished in schizophrenics; however, these decreases did not reach statistical significance. The reductions of parvalbumin-positive thalamocortical projection neurons were not correlated with the length of disease, this finding supporting the neurodevelopmental etiology of structural abnormalities in schizophrenia.

Adult↗
PubMed1998

Predicting extreme patterns of long-term course of psychogenic impairment: a ten-year follow-up.

This longitudinal study identifies predictors of course and etiologically relevant factors of psychogenic disorders. Since 1979, the Mannheim Cohort Project on the Epidemiology of Psychogenic Disorders has investigated neurotic spectrum disorders, personality disorders, stress reactions, and somatoform disorders in the normal population. Using these data, a cohort of probands suffering from moderate psychogenic impairment (N = 240; 121 men, 119 women) based on a representative sample of the urban adult population (N = 600; with cohorts 1935, 1945, 1955; gender distribution 1:1) of Mannheim, an industrial and university town in Germany, was followed up for almost 10 years. The cohort was investigated three times by psychodynamically trained physicians and psychologists. Tests were performed by means of cluster analysis. Different types of course of psychogenic impairment were identified. Both extreme types--the probands with the most positive and the most negative spontaneous long-term course--were investigated with regard to potential course-determining variables. Personality variables and conditions of early childhood development considerably influenced the spontaneous long-term course.

Adult↗
PubMed1998

[German version of the Snaith-Hamilton-Pleasure Scale (SHAPS-D). Anhedonia in schizophrenic and depressive patients].

The Snaith-Hamilton-Pleasure-Scale (SHAPS), introduced in English in 1995, assesses self-reported anhedonia in psychiatric patients. It has proven psychometric properties and advantages in applicability compared to other instruments assessing anhedonia. This study presents results of a systematic transcultural protocol translating the SHAPS into German (SHAPS-D). Quality of translation was confirmed on the one hand by bilingual reviewers with regard to equivalence in content and tone. On the other hand stable results were found in a test-retest-design crossing the English and German version with bilingual persons. SHAPS-D was obtained from schizophrenic (n = 50) and depressive (n = 33) patients and from healthy controls (n = 67). Results on applicability, internal consistency and relationship to depression, subjective quality of life, well-being as well as psychopathology indicate that the SHAPS-D is a useful and promising instrument in assessing anhedonia.

Adult↗
PubMed1997

Conventional versus atypical neuroleptics: subjective quality of life in schizophrenic patients.

BACKGROUND: The effectiveness of antipsychotic drugs against positive psychotic symptoms has been demonstrated in many studies, but their effects on quality of life have yet to be clarified. The impact of different neuroleptic therapies on the subjective quality of life of schizophrenic patients is evaluated in a cross-sectional open study. METHOD: During a four-month period a standardised quality of life interview for schizophrenic patients was applied on day 10 after admission; 33 patients on atypical neuroleptics (AAP) were compared with 31 matched patients on conventional neuroleptics (CAP). RESULTS: The AAP group had significantly higher scores in general quality of life as well as in different life domains: physical well-being, social life and everyday life. In separate comparisons of the AAP group, patients on clozapine and risperidone were found to have a higher quality of life score than patients on CAP or zotepine. CONCLUSIONS: The pharmacological profile of clozapine and risperidone may provide a basis for explaining the higher subjective quality of life found in this study. The lower quality of life of the CAP group may possibly be related to intrinsic effects of the conventional antipsychotics.

Adult↗
PubMed1997

Living on chronic hemodialysis between dryness and fluid overload.

The hydration state of a hemodialysis patient reflects the balance between fluid overload, normovolemia and underhydration. Since chronic volume overload enhances the cardiac mortality, and chronic underhydration carries the risk for dialysis-associated hypotension, treatment for the deranged water homeostasis of hemodialysis patients needs to focus on an accurate assessment of dry body weight. Non-invasive methods such as echocardiography of the inferior caval vein diameter (ICVD) or conductivity measurements are considered as reliable techniques to estimate the hydration state of hemodialysis patients. The value of biochemical parameters for an adequate assessment of dry body weight remains controversial. In our study we have determined cyclic guanosine 3'5'-monophosphate (cGMP) serum levels in 125 patients undergoing regular hemodialysis. Predialytic cGMP significantly decreased from 46.1 +/- 26.0 to 17.0 +/- 9.3 pmol/liter post-dialysis (P < 0.001). In 35 patients cGMP level after hemodialysis remained > 20 pmol/liter, but non of these patients displayed any clinical signs of fluid overload. In a group of patients with normal heart function (N = 29) additional sonography of the ICVD revealed normovolemia in 16 patients, underhydration in 5 patients and fluid overload in 4 patients. The respective post-dialytic mean cGMP level was significantly higher in the overhydrated group compared to normovolemic and underhydrated patients (25.3 +/- 10.8 vs. 14.7 +/- 6.4 and 11.4 +/- 5.3 pmol/liter, P < 0.02). However, there was no significant correlation between cGMP level and ICVD (r = 0.5, NS). We conclude that there is no single parameter to define the adequate dry body weight of a hemodialysis patient. Our own data demonstrate the limitations using cGMP, particularly in estimating underhydration. ICVD and bioimpedance offer non-invasive methods for both volume overload and underhydration, and seem to be reliable in the routine assessment of dry body weight.

Atrial Natriuretic Factor↗