[The habitual anterior dislocation of the sternoclavicular joint--imaging functional diagnosis and functional morphology].
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Acromioclavicular Joint↗
Biomedical subjects
W Kaiser
Publications and source records attributed to W Kaiser.
The dynamics of sleep-like behaviour in honey bees.
At night, honey bees pass through a physiological state that is similar to mammalian sleep. Like sleep in mammals, sleep-like behaviour in honey bees is an active process. This is expressed most clearly in these insects by spontaneous antennal movements which appear at irregular intervals throughout the night and interrupt episodes of antennal immobility. Here we present a newly developed video technique for the continuous recording of the position and movements of the bee's antennae. The same technique was used to record head inclination and ventilatory movements. Despite the constancy of the ambient temperature, the magnitudes of antennae-related parameters, as well as head inclination and ventilatory cycle duration, displayed dynamic unimodal time-courses which exhibited a high degree of temporal covariance. The similarity between these time-courses and the nightly time-course of the reaction threshold for a sensory stimulus, investigated previously, indicates that, in honey bees, deepest "sleep" and least ventilatory activity occur at the same time (in the 7th hour of the rest phase).
Animals↗
[Long-term patients in supported housing after deinstitutionalisation--part V of the Berlin Deinstitutionalisation Study].
OBJECTIVE: In part IV of the Berlin Deinstitutionalisation Study, we reported a positive change in quality of life for 65 resettled patients one year after discharge. In this part, we investigated changes in a longer follow-up period. METHODS: A group of 66 patients discharged into supported housing was assessed one and five years after baseline. Quality of life, needs for care, patients' assessment of treatment, re-hospitalisation and characteristics of care were studied in a control-group design. RESULTS: After five years, 61 % of the patients continued to live in highly staffed settings (mean staff-patient-ratio: 1 : 3.5). Eleven percent had moved on to independent living and 16 % had returned into an institutional setting. Standard mortality ratios were 4.4 (all causes of death) and 62.5 (2 suicides only of schizophrenic patients). After one year patients (n = 20) showed a significant increase in satisfaction with their living situation and more social contacts. Over the longer period of time, there were also favourable changes, which failed to reach statistical significance (n = 24). Average length of inpatient stay per year of the illness was decreased significantly at both follow-ups. CONCLUSIONS: Interpretation of the findings is difficult because of the small sample size and selection effects. Most of the former long-stay patients appear able to live in the community with a significant decrease of time spent in hospital. Whilst patients were particularly satisfied with their accommodation at one year follow-up, this did not lead to a generalised improvement in subjective quality of life and other subjective criteria in the long term. In line with other recent studies on community mental health care one may conclude that small case loads alone do not have major beneficial effects. Further research should evaluate more systematic and targeted models of mental health care in the community in general and of supported housing in particular.
Adult↗
Endoleaks after endovascular repair of aortic aneurysm: are they predictable?-initial results.
PURPOSE: To evaluate the predictability of endoleak. MATERIALS AND METHODS: Thirteen women and 60 men (mean age, 69.8 years) underwent transfemoral insertion of endoluminal stent-grafts for treatment of aortic aneurysms. Follow-up included helical computed tomography (CT) at 3-month intervals. In the cases of endoleak, angiography also was performed to document the number of leak sites, their size and position, the feeding artery, the size of the aneurysm, the amount of thrombus, and the visualization of the lumbar arteries and inferior mesenteric artery. These data were correlated (Student t test) with the probability of endoleak. RESULTS: A total of seven (10%) endoleaks were identified at CT in 68 patients. The feeding vessels were lumbar arteries in three cases, the inferior mesenteric artery in three cases, and the median sacral artery in one case. Of all factors, only the number of lumbar arteries visualized preoperatively (P <.005) had a significant correlation with probability of endoleak. In 71% (five of seven patients) of the cases of lumbar endoleak, four lumbar arteries were patent, whereas among the 61 patients with successfully repaired aneurysm, only eight (13%) had four patent lumbar arteries. Endoleaks were never found in the primarily thrombosed sections of an aneurysm. CONCLUSION: Prediction of endoleaks with absolute certainty remains elusive. The single correlating risk factor identified from the data was patency of four or more lumbar arteries visualized preoperatively at CT.
Aged↗
Quality of life in first-admitted schizophrenia patients: a follow-up study.
BACKGROUND: While most studies of quality of life (QoL) in schizophrenia have investigated long-term patients, relatively little is known about QoL early in the illness and how it changes over time. This study was conducted to investigate objective and subjective quality of life in first-admitted schizophrenia patients as compared to patients with long-term schizophrenia, changes between first admission and 9-month follow-up and predictors of changes. METHOD: Eighty-six patients were examined after first admission and 51 were re-interviewed at follow-up. Results were compared with samples of in-patients and out-patients with long-term schizophrenia. QoL was assessed using a German version of the Lancashire Quality of Life Profile. RESULTS: Although some objective QoL data were more favourable in first-admitted patients, subjective QoL was lower than in each of the other two groups, even when psychopathology and age were controlled for. On a group level, patients showed a slight improvement in subjective QoL, which was not statistically significant. Individual changes over time were not predicted by initial data, but were correlated with changes in anxiety/depression. CONCLUSION: Subjective QoL appears to be lower in first-admitted schizophrenics than in groups with long-term illness and, on a group level, it changes little within 9 months. On an individual level, changes in depressive symptoms need to be considered when interpreting changes in satisfaction with life.
Adult↗
Treatment of leaks after endovascular repair of aortic aneurysms.
PURPOSE: To evaluate leaks after the endovascular repair of aortic aneurysms and treat them with occlusive therapy. MATERIALS AND METHODS: Seventy patients (11 women, 59 men), aged 26-82 years (mean, 69.2 years), underwent transfemoral insertion of endoluminal stent-grafts for treatment of aortic aneurysms. Indications were traumatic pseudoaneurysms (n = 5) or arteriosclerotic aneurysms (n = 65). Aneurysms were thoracic (n = 5) or infrarenal (n = 65). To exclude the possibility of leaks, spiral computed tomography (CT) was performed at 3-month intervals. Patients with leaks that persisted unchanged longer than 3 months were referred for angiography and occlusive therapy. RESULTS: At CT, 21 leaks were identified in 17 of 70 patients (24%). Only 11 of those 17 patients (65%) had leaks identified with conventional aortography. Selective angiography, however, depicted all of these. Eighteen of 21 leaks proved amenable to occlusive treatment: surgery (n = 1), further stent implantation (n = 4), or embolization (n = 13). In one leak, spontaneous occlusion occurred after 3 months. Two leaks in either the iliolumbar or the median sacral artery were inaccessible; one remained untreated, and the other was unsuccessfully treated. Mean follow-up of occlusive therapy was 6.8 months (range, 2-14 months). CONCLUSION: Successful occlusion of perigraft leaks is feasible in most cases and can be performed without major complications.
Adult↗
Cognitive effects of antipsychotics in schizophrenia and relationship to quality of life.
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Antipsychotic Agents↗
[Quality of life in the course of deinstitutionalisation-- part IV of the Berlin Deinstitutionalisation Study].
As part of the Berlin Deinstitutionalisation Study, quality of life was assessed in 142 patients at two points of time. Discharged patients were reassessed one year after discharge. Patients who stayed in hospital were reinterviewed 1 1/2-2 years after the initial assessment. Discharged patients had more leisure activities, more often a "good friend", and more frequent social contacts. They were less often victim of a crime within the last year. In a cross-sectional comparison, they were significantly more satisfied with their life than patients who were still in hospital. In the latter group, only satisfaction with mental health improved significantly between first and second interview. Discharged patients became significantly more satisfied with their life in general, with leisure activities, with accommodation, and with mental health between initial assessment and follow-up. The findings demonstrate an improvement of quality of life in long-term hospitalised patients after discharge.
Adult↗
Abnormal motor cortex organization contralateral to early upper limb amputation in humans.
We performed both a functional magnetic resonance imaging (fMRI) study using single slice FLASH technique and an investigation with transcranial magnetic stimulation (TMS) in a 21-year-old patient. He had suffered a left upper extremity amputation at age 7. Anteflexion of the amputation stump produced an unusual, broad activation contralateral to the movement. TMS revealed an enlarged cortical motor output area of the deltoid muscle at the amputation stump. Application of paired magnetic stimulation demonstrated decreased intracortical inhibition (ICI). A T1-weighted image indicated a lack of the characteristic shape of the central sulcus contralateral to the amputation. In addition to previous functional studies, these new structural data suggest that maturation of the central sulcus develops in response to daily practice of the contralateral hand, possibly until adolescence.
Adult↗
Precautions against industrial accidents: experience in applying the Seveso II Directive in central and eastern European countries.
Adopted approaches to safety reports and internal emergency plans are described. Based on the provisions of the Seveso II Directive and on the achieved state of hazard prevention management of the respective enterprises in central and eastern European states, reports and plans were prepared. Although these states are no members of the European Union, the parties recognised the requirements of the Seveso II Directive as a working basis. In detail: Methodical experience in preparing safety reports and emergency plans include a methodology in the three main steps: Analysis of information on hazardous substances, hazard analysis including all plants, more specific hazard analysis for representative plants. Basic ways of forming scenarios are given. According to a procedure, various types of scenarios were usually taken into account. Based on the assessment of effects of a substance release, important conclusions can be drawn regarding the extent of danger prevention. In most cases, the structure of the described internal accident emergency plan turned out to be helpful. The programmed system DISMA (Disaster Management) which is widely used in Germany turned out to be a suitable tool for the internal as well as external emergency planning. An example of information to the population is described.
Accidents, Occupational↗
[Intraoperative blood requirements and allogeneic blood transfusion in cardioanesthesia. Data analysis of 7729 patients in 12 cardiac surgical clinics].
UNLABELLED: Allogeneic blood requirements in cardiac surgery shows a wide variation even for comparable procedures. The aim of the present study was to compare the intraoperative allogeneic blood requirement in defined cardiac operations among 12 cardiac centers in Germany. METHOD: A data set with 25 variables concerning the intraoperative course in adult cardiac patients with myocardial revascularization, valve replacement (aortic or/and mitral valve) or combined procedures was distributed to the participating centers. The data of all patients between January 1th 1998 and June 30th 1998 were included. Besides demographic data, the intraoperative transfusion of allogeneic and autologous blood, fresh frozen plasma and the concomitant hematocrit values were registered. Data were analyzed for all centers and separated for each center. RESULTS: The data of 7,729 patients were analyzed. The intraoperative allogeneic blood requirement was 0.6 +/- 1.3 units for all patients. It varied among the centers from 0.25 +/- 0.6 units to 0.97 +/- 1.6 units (P < 0.05). The percentage of patients receiving allogeneic blood was 27% and differed among the centers from 17% to 35%. Female patients were transfused in 53% (36-39%) compared to male patients with 16% (9-20%) (P < 0.05). The rate of autologous blood predonation varied from 0.5% to 23%. Patients without autologous predonation were transfused in 28% compared to 4% in patients with predonation (P < 0.05). In patients with autologous predonation the intraoperative transfusion of allogeneic blood was significantly reduced (0.1 +/- 0.39 vs 0.6 +/- 1.4 units, P < 0.05). However, some centers with a high percentage of autologous predonation also demonstrated a high rate of perioperative allogeneic transfusion. CONCLUSION: The incidence of allogeneic blood transfusion in cardiac surgery depends on the institution and not on the surgical procedure. A common threshold value of hemoglobin for the transfusion of blood trigger even for comparable procedures could not be detected among the centers. Especially in female patients, there was a wide variation in allogeneic blood transfusion. Autologous blood predonation reduces blood requirement significantly, however, it is practiced with variing intensity. The data set did not include information about transfusion regimen in the postoperative period, thus, these data do not allow to draw conclusions for the whole perioperative period.
Adult↗
Artifact processing during exercise testing.
In signal processing of exercise electrocardiograms (ECGs), artifacts are a recurring problem. It is still difficult to discriminate the ECG curves from artifacts, especially in exercise ECGs and particularly in the high exercise phase. We focused on the artifact problem and worked on two new topics: the Finite Impulse Response Residual Filtering (FRF) algorithm and the Intelligent Lead Switch algorithm. The FRF algorithm reduces the baseline wander and muscle noise in the ECG stream, with much less distortion of the QRS complexes. It subtracts a continuously updated median beat from the current ECG, filters the residual signal with a high-pass and a low-pass filter, and adds the median beat to the filtered residual signal. The Intelligent Lead Switch algorithm takes advantage of the redundancy of a multilead system (eg, standard leads), which is nowadays used during exercise testing. It selects the best leads for QRS detection and thus improves the heart rate calculation, ST segment evaluation, and arrhythmia classification.
Algorithms↗
[Short assessment of subjective quality of life. Application and results of a short form of the Berliner Lebensqualitätprofil (BELP-KF)].
The concurrent validity between the Berliner Lebensqualitätsprofil (BELP) and a new developed short form (BELP-KF) was tested in a sample of schizophrenia outpatients (N = 36) and turned out to be very high. The restriction to subjective quality of life questions did not lead to a greater halo-effect in the sense of an increasing similarity of single item values. Correlations with psychopathological symptoms were almost identical for both interview-versions. The same is true concerning the factorial structure of the satisfaction items which was nearly congruent. Two optional items on satisfaction with sexual life and with psychopharmacological treatment, which had been included into the short interview version, were attributable to an underlying general satisfaction dimension. Among 14 variables satisfaction with psychopharmacological treatment had the second highest factor-loading on the resulting general satisfaction factor.
Antipsychotic Agents↗
The impact of the interviewer-interviewee relationship on subjective quality of life ratings in schizophrenia patients.
Subjective quality of life (SQOL) ratings are usually based on interviews. This study examined in which way patients' ratings differ depending on whom they are interviewed by. SQOL was assessed in 78 schizophrenia patients in an out patient clinic and in sheltered living arrangements. Using patients randomly allocated to two interview situations: one group was interviewed by external researchers, the other group by their case managers. On average, more favourable ratings were elicited by case managers. Some of the differences were statistically significant and substantial in size. Yet, opposing differences were also found regarding some life domains in one group. It may be concluded that a significant impact of the interviewer-interviewee relationship on SQOL ratings may exist, but that it is not consistent, unidirectional and uniform regarding life domains and across different settings and samples.
Adult↗
[Discharge in inpatient care. Results of a survey. Postscript to part III of the Berlin Deinstitutionalization Study].
PURPOSE: 42 percent long-term patients from the Berlin Deinstitutionalization Study sample have been discharged to full-time institutional settings. METHODS: The questionnaires of a mail-survey covered features of 58 different non-hospital full-time institutional settings and care for a group of 125 long-term mental patients. RESULTS: The return rate was more than 70 percent. For 78 percent of the discharged former long-term inpatients the political goal of complete psychiatric care in the patient's home area has been reached, but only 20 percent live in smaller institutions of up to 40 places. CONCLUSIONS: The significance of other data of the survey does not exceed that of stock-taking and certain indications because of the selective data and the limitations of the method. There is an urgent need for further research in examining the quality of non-hospital institutional care for psychiatric long-term patients.
Adult↗
[Measuring changes in subjective quality of life in chronic schizophrenic patients].
Subjective quality of life in a group of chronic schizophrenia outpatients was assessed within 1 1/2 years (n = 50) and 4-6 weeks (n = 47) using the Berliner Lebensqualitätsprofil (German version of the Lancashire Quality of Life Profile). There had been no systematic therapeutic interventions meanwhile. Stability and constancy for the longer interval was similar to results in the general population. The statistics for the shorter interval justify in particular use of the profile's total score and general well-being for the measurement of change. In contrast to cross-sectional data and the longer observation period, no significant common variation between psychopathological symptoms and subjective quality of life could be found for the shorter period.
Adaptation, Psychological↗
Do different subjective evaluation criteria reflect distinct constructs?
Four subjective evaluation criteria--self-rated symptoms, subjective quality of life, self-rated needs, and patients' assessment of treatment--were examined to determine whether they reflect distinct constructs and to what extent they are correlated. The four criteria were assessed in 90 newly admitted schizophrenia patients, 170 long-term-hospitalized schizophrenia patients, 154 patients with alcoholism admitted for the short term, and 68 patients with alcoholism in long-term rehabilitation, using identical instruments. The four criteria show substantial intercorrelations, except for assessment of treatment in the two acute treatment groups. One general factor explains between 43% and 55% of the variance in each group. Factor scores are associated with observer-rated psychopathology and objective data. The four criteria overlap in different patient groups, except in the assessment of treatment in acute groups. The use of more than one subjective criterion should occur only with specific hypotheses. A better theoretical framework is needed to explain the differences between and interrelationships of subjective evaluation criteria.
Adult↗