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Biomedical subjects

W Langewitz

Publications and source records attributed to W Langewitz.

At least 19 recordsLinked to original sources
PubMed2005

Validation of TONOPORT V blood-pressure measuring monitor in adults.

A new automatic blood-pressure (BP) measuring device TONOPORT V was evaluated according to the International Protocol for Validation of Blood Pressure Measuring Devices in adults by the European Society of Hypertension. BP values measured by the TONOPORT V were compared to BP readings from two independent observers. A total of 33 patients (20 males, 13 females) provided systolic and diastolic BP readings in the normotensive, borderline hypertensive, and hypertensive range. Their age varied between 30 and 83 years, and their arm circumference between 23 and 36 cm. The device showed a mean (+/-s.d.) deviation from observer measurements of -0.7 (4.6) mmHg for systolic and -0.8 (4.4) mmHg for diastolic BP. The accuracy of the device did not vary according to BP values or other patient characteristics. The device passed all phases of the protocol and can be recommended following the regulation rules of the European Society of Hypertension.

Adult↗
PubMed2005

A quantitative analysis of anaesthetist-patient communication during the pre-operative visit.

Previous communication research in general medical practice has shown that effective communication enhances patient compliance, satisfaction and medical outcome. It is expected that communication is equally important in anaesthesia, since patients often suffer from anxiety and lack of knowledge about anaesthetic procedures. However, little is known about the nature of communication during routine anaesthetic visits. The present study of 57 authentic anaesthetic visits provides the first results on the structure and content of communication in the pre-operative setting using the Roter Interaction Analysis System (RIAS). Patient-centred communication behaviours of anaesthetists and the extent of patient involvement were particularly investigated. From the 57 pre-operative visits, 18 267 utterances were coded. The mean (SD) [range] duration of the visit was 16.1 (7.8) [3.7-42.7] min. Anaesthetists provided 169 (68) and patients 153 (82) utterances per visit (53.5% vs. 46.5%). Physician and patient gender had no impact on the distribution of utterances and the duration of the visit. Conversation mainly focussed on biomedical issues with little psychosocial discussion (< 0.1% of all anaesthetist utterances). However, anaesthetists quite frequently used emotional comments toward patients (7%) and involved them in the conversation. The use of facilitators, open questions and emotional statements by the anaesthetist correlated with high patient involvement. The amount of patient participation in anaesthetic decisions was assessed with the Observing Patient Involvement Scale (OPTION). Compared with general practitioners, anaesthetists offered more opportunities to discuss treatment options (mean (SD) OPTION score 26.8 (16.8) vs. 16.8 (7.7)).

Adult↗
PubMed1999

[Is self-management practical in bronchial asthma?].

The threat and uncertainty involved in an asthma attack reduce the quality of life for the patient. Life quality can be improved if the patient learns self-management principles. This is easy to learn and involves a simple procedure requiring the patient to refer to written instructions in the event of an asthma exacerbation. As a basis for treatment the patient needs to measure maximum peak flow, which can be done with an easy-to-use peak flow meter. A value above 80% of the personal best indicates that the treatment has been successful. By means of printed instructions in credit card format, the appropriate treatment for particular peak flow values and/or symptoms can be looked up and administered. So far there have been no self-management studies providing a definite answer on what interventions are effective and cost-effective. One clear result is that inhaled steroid therapy must be initiated early. Learning self-management patently leads to improvement in the patient's life quality and safety. In the long run this concept appears to be cost-saving with regard to days lost through sickness and hospitalization.

Anti-Asthmatic Agents↗
PubMed1999

Pharmacokinetics and pharmacodynamics of clomethiazole after oral and rectal administration in healthy subjects.

Clomethiazole, a sedative-hypnotic and anticonvulsant drug, has been successfully administered orally and intravenously, but in cases where either of these methods presents complications, rectal administration may represent a practical alternative. We sought to compare the single-dose pharmacokinetics and pharmacodynamics of clomethiazole after oral and rectal administration. Ten healthy adult volunteers were given 600 mg clomethiazole edisylate (corresponding to 390 mg clomethiazole base) in 2 capsules as a single oral or rectal dose in a double-masked, double-dummy, crossover fashion. Serum concentrations were measured up to 10 hours after administration using a specific high-performance liquid chromatography method. Computerized reaction-time measurement and visual analogue scales (VAS) were used to assess drug effects. Peak serum concentrations were significantly higher after oral administration (mean +/- SEM, oral 1.76 +/- 0.47 microg/mL vs rectal 0.48 +/- 0.14 microg/mL; P = 0.03) and appeared earlier (55 +/- 12 vs 89 +/- 11 min; P = 0.04). Area under the concentration-time curve values were similar after administration by both routes (oral 116 +/- 20.6 vs rectal 105 +/- 36.0 microg x min/mL), with a relative rectal bioavailability of 90% compared with oral administration. The objective pharmacodynamic effects on reaction time (increase of 104 +/- 26 vs 66 +/- 22 ms, oral vs rectal) and working speed (decrease of 132 +/- 38 vs 97 +/- 32 ms, oral vs rectal) were not significantly different. Subjective pharmacodynamic effects, as measured on the VAS, were comparable with both routes of administration. Clomethiazole was well tolerated, with a similar adverse effect profile for both routes of administration. The effects of rectal dosing of clomethiazole were similar to those of oral dosing but appeared to occur later. Our results suggest that rectal administration of a single 600-mg clomethiazole edisylate dose bears no safety risk. Therefore, rectal administration could be considered when neither oral nor parenteral administration is possible and a later onset of effect is not critical.

Administration, Oral↗
PubMed1999

Midazolam effects on prepulse inhibition of the acoustic blink reflex.

AIMS: The eye-blink response following sudden acoustic noise bursts is part of the startle reflex. The magnitude of the startle response can be attenuated by presentation of a weak stimulus before the 'startle-eliciting' stimulus (prepulse inhibition, PPI). PPI is a stable finding in awake humans but may be altered by anaesthetic drugs. We investigated whether the application of benzodiazepines altered the magnitude of PPI in healthy male volunteers. METHODS: In an open-label noncontrolled investigation, the effect of the benzodiazepine agonist midazolam on PPI was assessed in the absence and presence of the antagonist flumazenil. After an initial control period of 60 min three consecutive periods, each of 60 min, with progressively increasing concentrations of midazolam were studied (0. 02, 0.06, 0.14 mg kg-1 h-1 ). A final 60 min period during the administration of flumazenil (0.004 mg kg-1 h-1 ) and while the agonist was still present was also studied. Drug was administered intravenuously as a combination of bolus, 50% of total dose and continuous infusion over the 60 min period. Electromyographic (EMG) response of the right orbicularis oculi muscle was used to assess the startle response to noise bursts of 50 ms duration (95 dB(A)). Noise bursts were randomly preceded by nonstartling prepulses (800 Hz sinus, 50 ms duration, 65 dB(A), prepulse to noise interval 120 ms). The magnitude of PPI was calculated by dividing the EMG response to nonprepulsed stimuli by the response to prepulsed stimuli for each individual and period. Eleven subjects participated in the study, two of them were excluded from the statistical analysis because startle responses could not be reliably elicited (final sample size n=9). RESULTS: The magnitude of PPI was inversely related to the concentration of midazolam. This relationship was described by a sigmoidal Emax model, giving an Emax of 0.65+/-0.13, an ED50 of 33.9+/-10.9 ng ml-1 and gamma of 3.5+/-1.0. During infusion of flumazenil and in the presence of midazolam, the magnitude of PPI increased by 0.11 (95% CI, 0-0.22, P</=0.04), which is consistent with its mode of action as a benzodiazepine antagonist. CONCLUSIONS: In healthy male volunteers the magnitude of PPI varies according to agonism and antagonism of benzodiazepine receptors, suggesting that the assessment of PPI may be potentially useful to monitor the sedative effect of benzodiazepines in the clinical setting.

Acoustic Stimulation↗
PubMed1999

Effect of beta blockade with and without sympathomimetic activity (ISA) on sympathovagal balance and baroreflex sensitivity.

Beta blockers increase heart rate variability (HRV) and improve survival in coronary artery disease (CAD). The benefit of beta blockers with intrinsic sympathomimetic activity (ISA) in CAD still remains a matter of debate, and their effect on HRV has not yet been investigated. Therefore, we measured HRV, systolic blood pressure variability (BPV) and baroreflex sensitivity (BRS) under propranolol (PROP, without ISA, 160 mg q.d.), pindolol (PIN, with potent ISA, 15 mg q.d.) and placebo (PLA, q.d.) in 30 healthy subjects, aged 21-39 years, during controlled frequency breathing (0.30 Hz) in supine and tilt positions. PROP increased HRV in the high-frequency (0.15-0.40 Hz) band (PROP 7.4 +/- 1.0; PLA 6.9 +/- 1.4; PIN 6.8 +/- 1.0 ln MI2; P = 0.003), decreased BPV in the low-frequency band (at 0.1 Hz, Mayer waves) (PROP 0.6 +/- 0.7; PLA 1.3 +/- 1.1; PIN 1.2 +/- 1.2 ln mmHg2; P = 0.001) and enhanced BRS (PROP 14.6 +/- 9.5; PLA 8.0 +/- 6.8; PIN 8.7 +/- 6.8 ms mmHg-1; P = 0.001) in the supine position. After passive tilt, PROP decreased HRV in the low-frequency band (PROP 6.1 +/- 0.9; PLA 6.5 +/- 1.1; PIN 6.9 +/- 0.7 ln MI2; P < 0.001) and decreased Mayer waves (PROP 1.8 +/- 0.8; PLA 2.4 +/- 1.0; PIN 2.7 +/- 0.8 ln mm Hg2; P < 0.001). PIN increased the low-frequency HRV response, which is induced by passive tilt (PIN + 0.9 +/- 1.0; PLA + 0.3 +/- 1.3, PROP + 0.3 +/- 1.0 ln MI2; P = 0.026). Our results prove that beta-adrenergic blockade with potent ISA does not increase HRV, has no beneficial effect on autonomic balance and even exaggerates sympathetic responses to passive tilt.

Adrenergic beta-Antagonists↗
PubMed1998

[From perception to symptom--from symptom to diagnosis. Somatoform disorders as a communication phenomenon between physician and patient].

Patients with somatoform disorders probably constitute the largest diagnostic group in daily medical practice. A major communication problem forms the core of somatoform disorders: patients report about complaints which their physicians do not understand; there is no sufficient biological reason for the patient's symptoms. This article discusses the multifactorial origin of somatoform disorders, consisting of minimal physiological changes, the perception of bodily sensations, and their interpretation as symptoms (non-normal perceptions), as well as ensuing emotional and behavioral consequences. Concerning the communication problem, it is important to realize that patients normally present symptoms, whereas the underlying bodily perceptions and the explanatory models are rarely communicated to the physician. On the physician's side, symptoms presented by patients are subjected to his or her explanatory concepts translating symptoms into indicators of certain diseases. Thus, the information introduced into physician-patient communication by the patient has usually passed several cognitive circuits within the patient or between the patients and other significant conversation partners thus shaping its specific components. It is recommended that physicians try to trace back their patients' symptoms to bodily sensations and explanatory models in order to base their diagnostic and therapeutic reasoning on the same kind of information. Empirical evidence is presented to support the inter-dependence of the components of the model, on both the patient's and the physician's side. Therapeutic interventions based upon the model are presented.

Awareness↗
PubMed1997

[Difficult physician-patient relations--characteristics and possible solutions].

We have demonstrated that expectations of physicians and patients differ and, furthermore, that the mutual exchange of information is incomplete. We pointed to the problem of the observer's role explaining that differing subjective realities are common and not at all the exception. One possible approach to a common reality between physician and patient has been introduced by the role of the listening physician. It is also shown that necessary skills to communicate can be acquired by training. In the last paragraph studies are summarized which demonstrate that a partnership between physician and patient, especially during the exchange of informations and during search for a decision, influences behaviour and health of patients positively.

Communication↗
PubMed1997

Psychological and metabolic improvement after an outpatient teaching program for functional intensified insulin therapy (FIT).

To be the master of their disease and not its slave is the ultimate goal of many patients with diabetes. Intensified functional insulin therapy (FIT) helps to establish this goal by an intensive patient education: each patient learns in five small-group sessions how s/he reacts to standardized challenges of glucose homeostasis (e.g. 24 h fasting; physical exercise; various carbohydrate loads). We investigated in 43 patients with long-standing diabetes type 1 (mean age: 33 +/- 10 years; mean duration of diabetes: 15 +/- 10 years) whether FIT improves quality of life, influences metabolic control and doctor-patient relationship. The following instruments were used: diabetes specific quality of life questionnaire (DQOL), hierarchical distance and cohesion between doctor and patient (FAST), anxiety and depression (HAD). Pre and post intervention values were compared with paired t-tests. HbA1c and number of hypoglycaemic episodes were also assessed 1 year after FIT and 1 year prior to FIT. Metabolic control was improved: HbA1c in the year before FIT: 6.72 +/- 1.35; 4 months before FIT: 6.61 +/- 1.46; 4 months after FIT: 6.29 +/- 1.09 (P < 0.05 compared to 4 months before FIT); 1 year after FIT: 6.46 +/- 1.12 (n.s. compared to 1 year before FIT). Dissatisfaction with life decreases from 33.3 +/- 8.0 to 28.5 +/- 7.7 (P < 0.001). Moments free of disease-specific strain increase from 74.3 +/- 13.9 to 78.1 +/- 16.1 (P = 0.07). Hierarchical distance between doctor and patient decreases from 1.1 +/- to 0.6 +/- 0.8 (P < 0.001), cohesion increases from 9.3 +/- 1.5 to 9.9 +/- 1.1 (P < 0.001). Anxiety and depression both decreases significantly: anxiety, 6.5 +/- 3.3-->4.6 +/- 3.2 (P < 0.001); depression, 2.7 +/- 2.5-->1.5 +/- 1.6 (P < 0.001). The number of patients with severe hypoglycaemic episodes (level 4) decreases from five (11.6%) to one (2.3%) after intervention (P < 0.05). In conclusion, FIT enhances quality of life in diabetic individuals. It helps to establish a less hierarchical and closer relationship between patient and doctor as revealed by the FAST data. It should be emphasized that the psychological improvements are not achieved at the expense of less strict metabolic control.

Adult↗
PubMed1997

[Somatoform disorders and their therapy].

Somatoform disorders are frequent manifestations of psychosocial stress and present themselves in form of unexplained somatic symptoms. Diagnostics and treatment of somatoform disorders is mainly performed in order to uncover organic pathology. However, organic pathology could not be found, which leads to repeated investigations finally contributing to increase of health costs. Authors highlight pathogenesis of somatoform disorders, summarise the syndromes of this group of disorders and give recommendations as to management and treatment.

Diagnosis, Differential↗
PubMed1995

[Panic disorders in the emergency room].

Patients with panic disorder perceive physical symptoms which they interpret as dangerous phenomena; therefore, they normally seek help from physicians in somatic medicine and do not consult with a psychotherapist or psychiatrist. The combination of physical symptoms and catastrophic thinking induces such an intense feeling of anxiety that patients often visit an emergency unit. Thus, the prevalence of panic disorder is high among patients who seek help for heart symptoms within the setting of an emergency department (18%); in other clinical populations it may even be higher (patients with negative coronary angiography 33 to 59%, with irritable bowel syndrome 29 to 38%, with migraine headache 5 to 15%). Already in the emergency department it is possible to establish with the patient an understanding of the impact such catastrophic interpretations of basically benign physical changes have on the development of panic. This helps to avoid long-standing and expensive patient careers that have often been described in the literature. The present review includes a description of the cognitive model of the origin and the treatment of panic disorder as well as an overview of drug treatments with benzodiazepines and antidepressive drugs.

Antidepressive Agents↗
PubMed1994

Reduced parasympathetic cardiac control in patients with hypertension at rest and under mental stress.

The neurogenic component in the pathogenesis of essential hypertension has predominantly been analyzed with regard to the sympathetic part of the autonomous nervous system; the parasympathetic branch has largely been neglected. We investigated whether 54 normotensive (mean causal blood pressure [cBP]: 125 +/- 6/82 +/- 4 mm Hg), 41 borderline hypertensive (cBP: 134 +/- 8/90 +/- 5 mm Hg), and 34 hypertensive men (cBP: 152 +/- 13/101 +/- 5 mm Hg) without secondary target organ damage differed in parasympathetic cardiac control. Parasympathetic cardiac control was assessed via the amount of fast fluctuations (0.15 to 0.40 Hz; vagus band) and by the amount of respiratory-linked fluctuations (mean respiratory frequency +/- 0.03 Hz) in the power spectra of continuously registered interbeat intervals under the following conditions: mean of three rest phases with 10, 5, and 5 minutes' duration (REST); mean of two modes of a reaction time task with 10 and 5 minutes' duration (RTT); mean of 5 minutes' mental arithmetic plus noise (MA). Analysis of variance (ANOVA) shows that spectral energy in the so-called vagus band reveals the most prominent differences between blood pressure groups under all conditions: REST = normotensive, 2.70 +/- 0.31; borderline hypertensive, 2.55 +/- 0.33; and hypertensive, 2.43 +/- 0.43 (F[2.126] = 6.19; p < 0.01). RTT = normotensive, 2.41 +/- 0.35; borderline hypertensive, 2.19 +/- 0.33; and hypertensive, 2.17 +/- 0.46 (F[2.126] = 6.04; p < 0.01); MA = normotensive, 2.69 +/- 0.34; borderline hypertensive, 2.52 +/- 0.33; and hypertensive, 2.38 +/- 0.46 (F[2.126] = 7.04; p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

The integration of alternative treatment modalities in HIV infection--the patient's perspective.

The relationship between professionals representing conventional treatment (CT) and professionals representing non-conventional therapies (alternative therapy (AT) and/or psychotherapy (PT)) is usually characterized by mutual scepticism and mistrust, the overriding fear being that either side will evoke unjustified hopes or will provide false treatment. We investigated whether patients with HIV infection had unrealistic hopes in non-conventional treatment (non-CT), to what extent they use non-CT, and whether perceived benefit and harm differ between the two modes of treatment. We examined a sample of 100 patients with documented HIV-infection in the out-patient department using a self-developed questionnaire, the Hospital Anxiety and Depression Scale (HAD) and data concerning the HIV status. Fifty-six patients used AT and/or PT. Severity of HIV disease did not differ between users and non-users of non-CT. The most important reasons for the use of AT were 'strengthening the body and resistance; supplementing conventional therapy'. Users of non-CT rated the competence of CT lower than non-users in solving medical problems (VAS-scores 0-100: 65.5 +/- 17.6 vs 76.3 +/- 17.7; p = 0.003) and in solving emotional problems (VAS scores 0-100: 35.8 +/- 21.2 vs 48.2 +/- 28.9; p = 0.02). Users of non-CT were significantly more anxious 8.4 +/- 4.8 vs 5.5 +/- 4.6; p = 0.004) and more depressive (5.7 +/- 4.5 vs 3.7 +/- 4.5; p = 0.03) than non-users. Expectations and hopes did not differ between users of AT and non-users: main hopes were a delay of disease progression (76% vs 71%) and an alleviation of symptoms (78% vs 66%).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Post-vasectomy erectile dysfunction.

We investigated two groups of men with regard to vasectomy acceptance, and subsequent erectile dysfunction. Group I was a group of 45 men chosen at random from 254 vasectomized patients. Group II was a group of 18 men who, out of 180 patients treated for erectile dysfunction, attributed their dysfunction to previous vasectomy. We analysed the social background, motivation for vasectomy and postoperative changes of sexual life or behaviour of the partners. The partnership constellation, particularly the role of a predominant female partner seems to be an important feature for vasectomy acceptance. Low acceptance might cause erectile dysfunction.

Adult↗
PubMed1994

Sympathetic overactivity in subjects complaining of unexplained fatigue.

1. Theoretical and practical considerations suggest that in subjects complaining of fatigue, in the absence of evident organ dysfunction, an alteration in the autonomic nervous system might be present as a functional correlate. 2. Autoregressive spectral analysis of R-R interval variability from a surface ECG, was used in healthy control subjects (n = 24, age 45 +/- 4 years) and in subjects complaining of unexplained fatigue (n = 53, age 46 +/- 9 years) to obtain quantitative indices of the state of the sympathovagal balance, both at rest and during a mental stimulus (mental arithmetic), capable of enhancing sympathetic drive. Sympathetic and vagal modulations were inferred from the normalized powers of the low frequency and high frequency spectral components respectively. 3. We observed in patients, at rest, a prevailing low frequency component of R-R variability (patients low frequency = 73 +/- 11, control subjects 51 +/- 10 normalized units, P < 0.05). The responsiveness to mental arithmetic was reduced in patients as compared with controls. Systolic blood pressure variability did not differ. This suggested a selective imbalance in autonomic control of the sinoatrial node, characterized by sympathetic predominance as well as by vagal withdrawal, at rest. 4. The possibility of discriminating patients from control subjects on the basis of simple non-invasive functional markers might provide a better understanding of the mechanisms, clinical evolution and outcome of conditions such as the chronic fatigue syndrome, which lack ordinary evidence of disease, but comprise, as physiopathological correlate, a quantitative alteration of autonomic control.

Autonomic Nervous System↗
PubMed1994

Hypnosis and the allergic response.

In recent years our knowledge of the immune system and the pathogenesis of immune disorders has increased. There has been much research on the complex connections between the psyche, the central nervous system and the immune system and the effect of mood on disease processes. This paper reviews the evidence on the effects of hypnosis on the allergic skin test reaction, on allergies, particularly respiratory allergies and hayfever, and on bronchial hyperreactivity and asthma. Hypnosis, which is generally regarded as an altered state of consciousness associated with concentration, relaxation and imagination, and amongst other characteristics an enhanced responsiveness to suggestion, has long been thought to be effective in the amelioration of various bodily disorders. It has seemed that the state of hypnosis is capable of a bridging or mediating function in the supposed dualism between mind and body. There has been great variation in the experimental and clinical procedures such as type of hypnotic intervention employed, the training of subjects and the timing of the intervention. Also, variability in the type of allergen used and its mode of application is evident. But despite these limitations, many of the studies have shown a link between the use of hypnosis and a changed response to an allergic stimulus or to a lessened bronchial hyperreactivity. There is as yet no clear explanation for the effectiveness of hypnosis, but there is some evidence for an influence on the neurovascular component of the allergic response.

Asthma↗
PubMed1992

[Doctor-patient relationship--its quality and possibilities for improvement].

A review of the last decade's literature suggests that the doctor-patient relationship could be improved in three main respects: (1) Medical, social and psychological information is obtained incompletely or incorrectly. (2) A positive emotional relationship with the doctor is reported by the patient who has been able to talk about his own ideas, fears and expectations. The doctor rarely enquires about the latter and, if he does so, pays little attention to the reply. (3) Patients are not well informed about prior test results, prognosis or etiology. Concepts in social psychology afford valuable and practical hints in improving the doctor-patient relationship: checking on what the doctor and patient have said; a structured interview (use of a list of topics; open discussion of time limits); avoidance of yes/no type questions at the beginning; perceptions of patients' emotions; partnership-based approach. As a means of approaching the doctor-patient relationship on a psychoanalytic basis, Balint groups have proved of value.

Communication↗