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Biomedical subjects

R H Adler

Publications and source records attributed to R H Adler.

At least 37 records · Page 2Linked to original sources
PubMed1997

How not to miss a somatic needle in the haystack of chronic pain.

Interviews with 18 male patients with predominantly psychogenic pain (DSM-III and DSM-III-R) and with 18 male patients with pain of mainly physical origin, consecutively admitted to a medical department, were rated by blinded and independent raters with respect to "symptom description," "manner of speech," "personality characteristics," "interviewer reactions," "interpersonal relationships," and "relationships at work." Patients with predominantly organic pain significantly more often described a clear localization of the pain symptom, used more sensory words for the description of pain quality; more often described discrete changes of pain intensity and periodicity; more often showed pain-intensifying factors dependent on movement and pain-decreasing factors; more often believed pain to be a symptom versus as a disease itself, and tended to have fewer difficulties in their interpersonal relationships than those with predominantly psychogenic pain (p < 0.05 for all factors, two-tailed Fisher's Exact test).

Adult↗
PubMed1997

A small and painful puzzle.

This case of osteoid osteoma is reported for two reasons. First, for its rarity and unusual location (it was diagnosed very late) and second because it demonstrates that the history of a painful condition leads to the correct diagnosis, and although clinical investigations may provide corroboratory evidence, they are certainly no substitute. A 23-year-old student experienced spontaneous nightly pain in the distal phalanx of his right hallux. The pain increased over 2 years but with a good response to non-steroidal anti-inflammatory medication. After 9 months X-rays showed a cystic lucency. The patient was seen by a number of consultants, but the diagnosis of osteoid osteoma was delayed. After surgery the diagnosis was confirmed histologically and the pain has not recurred.

Adult↗
PubMed1996

[Steps to integration or the fight with the Hydra "dualism"].

Dualism in medicine (making a sharp distinction between somatic and psychosocial features) is not based on human nature. Rather, it is the result of the development and training of the observer. A physician must be brought to realize this. For behind his every medical consideration and action lies a medical theory. Clinical examples are given, where the physician's lack of awareness of the limitations of his concept led to serious results for the patient. The author describes his own path through training and experience from dualism to an integrative biopsychosocial concept. Based on his own pain research, he shows how results depend on the concept followed. He insists that from the very beginning medical studies must be founded on a biopsychosocial model.

Aged↗
PubMed1996

[Are there psychological factors which lead to iatrogenic disorders?].

Behind iatrogenic disturbances caused by psychological factors lies the dependence of present day medicine on the reductionist scientific paradigm of the 18th century. The latter excludes psychological and social factors from the "scientific equation". Only absolute objectivity and neutrality in the observer, and the avoidance of personality and history in the patient, are held to be valid. The patient's individual reality, as influencing his individual physiology, is not considered. The results are errors in diagnosis (e.g. with patients suffering from chronic pain), abuse (including sexual) of women patients, and insufficient care of cancer patients. Psychological iatrogenic disturbances can be reduced by training medical students in biopsychosocial interrelations and by self-experience courses for physicians.

Countertransference↗
PubMed1995

[Is there a scientific alternative to alternative medicine?].

Despite the great progress which has been made in mainstream medicine, alternative medicine has become increasingly attractive. Alternative medicine seemingly encompasses psychic and social factors, it is supposedly holistic, but in fact it is mechanistic and reductionistic. It's attraction is based on the helplessness and the hopelessness of the patient and his physician, making them prone to cling to the magic power of alternative medicine theories. Mainstream medicine has supported the boom of alternative medicine by neglecting psychosocial factors, i.e. the doctor-patient relationship. If mainstream medicine integrates the doctor-patient relationship and studies it scientifically, its model will change from a biomedical to a biopsychosocial one, thus satisfying many of the patient's needs, which were so far neglected. The scientific alternative to alternative medicine is biopsychosocial medicine, which includes biomedicine as one of its three components.

Complementary Therapies↗
PubMed1994

[Theory of a human medicine and the role of complementary medicine].

Complementary (or alternative) medicine has gained so much public interest that physicians have to face and discuss this new phenomenon. We are, however, already strained by trying to find an easy answer to the initial question: 'To what is this medicine complementary or an alternative?' Complementary means 'additionally'. Prior to our understanding why a complementation is necessary we must clarify what has to be complemented: Theories, methods and criteria for the goals of academic medicine have to be defined before characteristics of a complementary medicine can be outlined. According to Strapanek and McCormick extraordinary claims call for extraordinary proofs. Such claims are expressed in alternative therapeutic concepts. We have to consider whether it is justified to ask for the appropriate proofs.

Complementary Therapies↗
PubMed1994

[Backache: state-of-the-art from a biopsychosocial viewpoint].

The state-of-the-art in the diagnosis and therapy of low back pain is presented from a biopsychosocial point of view. Among low back pain patients, those dominate in whom psychosocial factors play an eminent role. The early comprehensive (biopsychosocial) integrative diagnosis is essential for further development of the illness. Conversion pain, psychoprosthetic pain and pain-proneness are the most important concepts for establishing a round diagnostic assessment and realistic therapeutic measures.

Combined Modality Therapy↗
PubMed1992

High "need for control" as a psychological risk in women suffering from ischemic stroke: a controlled retrospective exploratory study.

The assumption is tested that women scoring high on dimensions of coping pattern termed "need for control," which underlies several of the components of Type A behavior, are at increased risk of ischemic cerebrovascular disease. Consecutively admitted patients to medical wards, nineteen with ischemic cerebrovascular disease, were compared with nineteen patients with non-arteriovascular disease and nineteen healthy females doing volunteer hospital work. "Need for control" was assessed by a psychometric test based on forty-five dichotomous items defining six unidimensional scales. The Bortner Type A behavior was filled out by the subjects and by their next of kin for an impression of the subject. In ANOVA the dimensions "work commitment, hard driving" (F = 6.87, p less than .002), "perfectionism, need for making plans" (F = 6.26, p less than .003), and "inability to withdraw from work obligations" (F = 3.89, p less than .02) differentiated the three groups in the expected direction. Duncan multiple range test resulted in very similar, significant findings, as did Bortner measures, filled out by a next of kin (F = 4.63, p less than .01). In all analyses, effects of age, current smoking, and coronary artery disease (CAD) were controlled. Our results suggest that high "need for control" defines a psychological risk in women suffering from ischemic stroke. Prospective studies should be undertaken. If they confirm our results, interventions aimed at modifying the "need for control" should be planned.

Adaptation, Psychological↗
PubMed1991

[Missed somatic disease: justified fear or chimera?].

The fear to miss the diagnosis of somatic processes in "functional" disorders and the ignorance of the positive criteria for the diagnosis of conversion (physical expression of conflicts) and of psychophysiological disorder (somatic symptoms and signs, accompanying affectivity) lead to diagnosing by exclusion of somatic disorders. Its consequences are extensive, damaging procedures and a postponement of a diagnosis which integrates somatic, psychic and social components by seven to eight years. Based on positive criteria, which had been collected by means of a bio-psycho-social approach to the patient, ten were diagnosed as suffering from conversion and 22 from psychophysiological disorders. Five years later the patients were reassessed. In none of the cases a somatic diagnosis emerged, which would have been responsible for the initial complaints five years earlier. The diagnoses "conversion" and "psychophysiological disorder" proved to be reliable over five years, if they were based on positive criteria. The fear to miss a somatic process turns thus into a chimera.

Adult↗
PubMed1991

Adjuvant, specific, active immunotherapy for resectable squamous cell lung carcinoma: a 5-year survival analysis.

In 1976 Stewart et al. (Annals of the New York Academy of Sciences 277:436-466) reported the effectiveness of adjuvant specific active immunotherapy of lung carcinoma in improving the postoperative survival of stage I lung carcinoma patients in a phase II study using lung carcinoma-associated antigen (TAA) and complete Freund's adjuvant (CFA). A phase III study was then designed by the authors to see the effects of specific active immunotherapy compared to the conventional management (no treatment) and to nonspecific immunotherapy. From 1976 to 1981, 85 patients with resectable (stages I and II) squamous cell lung carcinoma were entered into a randomized study: 1) control group; 2) specific immunotherapy group--three monthly doses of 500 micrograms of TAA emulsified with CFA; 3) nonspecific immunotherapy group--three monthly doses of CFA emulsified in saline. All the patients in the study received skin tests with 100 micrograms of the same TAA used for the immunotherapy. Recently, a 5-year follow-up of all the patients became available: The life table 5-year survival of group 1 was 34%, of group 2 was 75%, and of group 3 was 53%. The median survivals for the three groups were group 1, 38 months; group 2, 106 months; and group 3, 71 months. The difference was significant at P = .007 (Cox-Mantel test).

Adult↗
PubMed1990

Collis gastroplasty: origin and evolution.

In 1957 J. Leigh Collis published his innovative operation for treating the difficult problem of the irreducible hiatal hernia, esophagitis, and stricture. The design of the operation was based on the relatively primitive understanding of hiatal hernia and the newly emerging concept of reflux esophagitis. A variety of antireflux operations by different surgeons emerged over the years to follow. The original Collis gastroplasty has been subsequently modified with the addition of both partial and complete fundoplication procedures. The place of the modified Collis gastroplasty-fundoplication operations in today's approach to the problems of hiatal hernia and gastroesophageal reflux disease remains unsettled.

Gastroesophageal Reflux↗
PubMed1989

[Engel's "psychogenic pain and the patient susceptible to pain": a retrospective, controlled clinical study].

Engel's hypothesis of pain-prone patients having a distinct pattern of developmental psychosocial experiences was tested in a controlled design including four groups of 20 patients each: a) psychogenic pain, b) organic pain, c) psychogenic bodily symptoms, d) organic disease. On admission an open-ended interview, including childhood experiences was tape-recorded. Measures were taken to minimize observer-bias. Patients in group a) had, compared to the other groups, significantly increased prevalence of: "Parents, verbally and/or physically abusive of each other", "parents, abusive of the child", "child, deflecting aggression from one parent to the other onto himself", "parents, who suffered from illnesses/-pain", "parent of the same gender as the patient suffering from pain", "pain of patient and parent in the same location", "number of operations in adulthood", "disturbance of interpersonal relationships", and "disturbance of work life". Factor analysis produced two factors explaining 73% of the variance in group a): F1 ("Brutality-Overcompensation") was related to "duration of pain", F2 ("Submission-Inhibition") to "number of operations, accidents" in adulthood.

Guilt↗