[Opipramol (Insidon) in the treatment of somatoform disorders].
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Antidepressive Agents, Tricyclic↗
Biomedical subjects
W Maier
Publications and source records attributed to W Maier.
[Complications of endonasal paranasal sinus surgery--diagnostic and therapeutic consequences].
BACKGROUND: Functional endoscopic sinus surgery has been proven the therapeutic method of choice in surgical therapy of chronic sinusitis. On the other hand, endonasal sinus surgery may cause severe complications even when performed by a skilled surgeon. This is easily explained by the close vicinity of many functionally important structures to the operative site. CASE REPORTS: Three histories are reported that involve possible complications even in apparently simple cases. Diagnostic and therapeutic consequences are discussed. In a case previously diagnosed histologically as chronic unspecific sinusitis, an endonasal biopsy resulted in endocranial bleeding requiring neurosurgical intervention. Midline granuloma was found to be the correct diagnosis. Another patient was seen with a normal X-ray of the sinuses and solitary polypoid structure in his left nose. Polypectomy was planned and a CT scan was performed, which demonstrated a meningocele. Transfacial surgery was then performed to remove the meningocele. Another patient presented with a traumatic impression of the frontal sinus, and open reposition by transfacial surgery of the frontal and ethmoid sinus was planned. When CT scans revealed an uncovered optic nerve in the sphenoid sinus of the fractured side, we abandoned ethmodectomy and performed reposition of the frontal sinus as the only surgical procedure. RESULTS AND CONCLUSIONS: In this paper, we show typical complications of endonasal sinus surgery and strategies for avoiding them. If any complication occur, prompt treatment is required. Three groups of complications can be defined: perforation of frontobasal dura resulting in cerebrospinal fluid (CSF) fistula, severe bleeding, and orbital or optic nerve injury. When the surgeon discovers an intraoperative complication, possible consequences must be considered immediately to minimize side effects for the patient. A CSF fistula should be closed in the same procedure, and transfacial surgery may be necessary. Hemorrhage resulting from an ethmoidal artery may require frontoorbital surgery and ligation of this vessel. If retrobulbar hemorrhage caused by retraction of an ethmoid artery occurs, immediate intervention is necessary. Usually a transfacial approach, resection of the medial orbital wall and retrobulbar decompression are performed. In some cases lateral canthotomy may be the best way to drain haematoma and decompress the optic nerve. Subsequently, orbital revision and ligation of the retracted artery must be performed. Any delay can result in persistent visual loss. We conclude that the extranasal frontoorbital approach should be part of the residency training program in ENT departments. Any surgeon performing endonasal sinus surgery must be trained in transfacial emergency procedures, which should be part of anatomic preparations in teaching courses, thus avoiding severe damage in case of intraoperative complication.
Aged↗
[Is surgery of the inner nose indicated before tympanoplasty? Effects of nasal obstruction and reconstruction on the eustachian tube].
BACKGROUND: When tympanoplasty is to be done in a patient suffering from chronic otitis media, usually potential interactions between middle ear mucosa, Eustachian tube function, and the nose and nasopharynx are considered. Poor tubal function goes along with a diminished success rate of tympanoplasty. On the other hand, pathological findings in the nose or the nasopharynx are often said to be responsible for inadaequate tubal function. Consequently, many authors feel that surgery of the nose should be performed before tympanoplasty if septal deviation or hypertrophy of the conchae is seen in a patient with chronic otitis media. PATIENTS AND METHODS: In order to better understand interactions between nasal pathology and Eustachian tube function, we utilized a pressure chamber to examine 50 patients undergoing septoplasty and conchotomy. Besides insufflation tests (Toynbee, Valsalva), we performed dynamic tubal examination with the dual-impedance method. Active parameters (positive and negative residual pressure) and passive parameters (tubal opening and tubal closing pressure) were recorded as the chamber pressure was varied. The aim of our investigation was to test if surgery of the nasal septum and the conchae really improves tubal function, thus evaluating indications for septoplasty before tympanoplasty. In addition, we explored the early and the late consequences of nasal surgery on tubal function. This was done to find out the optimal postoperative period during which tympanoplasty could be performed following septoplasty. RESULTS: In many of the patients, insufflation tests were negative and dynamic tubal parameters were outside normal value range before surgery of the nose. One week after surgery, active and passive parameters and insufflation tests even deteriorated in the majority of our patients. Six to 8 weeks after surgery, we observed a tendency towards normalization of tubal parameters. This was significant for tubal closing pressure, but not for the other parameters. Whereas passive tubal parameters showed considerable improvement in many patients, there was no real improvement of active tubal parameters in most patients. This tendency was observed several months after surgery of the nose as well. Despite this improvement of passive tubal function, we did not observe a complete normalization of mean values even after 4 to 6 months. In several patients (who were satisfied with functional results of septoplasty) tubal parameters were even worse some weeks or months after nasal surgery, but this was not subjectively registered by our patients. DISCUSSION: We conclude from our data that dysfunction of the Eustachian tube frequently occurs in patients with deviation of the nasal septum and the conchae. Septoplasty and conchotomy worsen tubal function during the early postoperative period, lasting for at least one week. In a later period, improvement of tubal function may occur but in many patients no effects of nasal surgery on Eustachian tube can be measured. Thus, septoplasty before tympanoplasty cannot be generally recommended in all patients with septal deviation. We suggest that it may be useful in cases with severe nasal pathology or chronic infection of the nose or the nasopharynx, if this is accompanied by poor tubal function. We recommend analysis of Eustachian tube function before deciding on therapeutic management. Individual findings in the specific patient should be the leading criteria in all cases. If septoplasty and conchotomia are done, tympanoplasty should not be performed in the same session or in the early postoperative period, but several months after nasal surgery.
Acoustic Impedance Tests↗
Support for a chromosome 18p locus conferring susceptibility to functional psychoses in families with schizophrenia, by association and linkage analysis.
The action of antipsychotic drugs on dopamine receptors suggests that dopaminergic signal transmission may play a role in the development of schizophrenia. We tested eight candidate genes (coding for dopamine receptors, the dopamine transporter, and G-proteins) in 59 families from Germany and Israel, for association. A P value of .00055 (.0044 when corrected for the no. of markers tested) was obtained for the intronic CA-repeat marker G-olfalpha on chromosome 18p. The value decreased to .000088 (.0007) when nine sibs with recurrent unipolar depressive disorder were included. Linkage analysis using SSLP markers densely spaced around G-olfalpha yielded a maximum two-point LOD score of 3.1 for a marker 0.5 cM distal to G-olfalpha. Multipoint analysis under the assumption of heterogeneity supported this linkage-whether the affected pheotype was defined narrowly or broadly-as did nonparametric linkage (NPL). In 12 families with exclusively maternal transmission of the disease, the NPL value also supported linkage to this marker. In order to test for association/linkage disequilibrium in the presence of linkage, the sample was restricted to independent offspring. When this sample was combined with 65 additional simplex families (each of them comprising one schizophrenic offspring and his or her parents), the 124-bp allele of G-olfalpha was transmitted 47 times and was not transmitted 21 times (P=.009). These results suggest the existence, on chromosome 18p, of a potential susceptibility locus for functional psychoses.
Chromosomes, Human, Pair 18↗
Obsessive-compulsive symptom exacerbation following cortisone treatment.
We here report a case of obsessive-compulsive symptom exacerbation during cortisone therapy in an adult patient without organic brain disorder. Possible clinical and pathophysiological considerations are discussed.
Adult↗
Special feature: family-genetic research strategies for personality disorders.
Personality disorders (PD) might be considered as extremes of personality dimensions varying in the general population or as attenuated variants of major psychiatric disorders. Both personality variation and major psychiatric disorders have been shown in twin and adoption studies, to be influenced by genes. Hence, it is likely that personality disorders are also under genetic control. However, direct evidence for influential familial and genetic factors is scarce. Various research strategies in this area are described and current evidence is reported. Gene-oriented approaches seem to be particularly promising. This strategy is illustrated for personality disorders in obligate carriers of mutations in the fragile-X gene.
Female↗
Flow-dependent vasodilation in the coronary circulation: alterations in diseased states.
Flow-dependent vasodilation has been recognized to play an important role in the perfusion of the myocardium and the occurrence of myocardial ischaemia. In the past few years, the role of the endothelium in the regulation of coronary artery dimensions has gained a lot of attraction. Changes in coronary artery size are caused through the contraction and relaxation of the smooth musculature within the vessel wall. Vasoactive substances released from the endothelium play a crucial role in the regulation of vessel size and coronary vasomotor tone. During physiologic exercise, normal coronary arteries dilate, whereas stenotic arteries constrict. This abnormal behaviour of the stenotic artery has been associated with the occurrence of myocardial ischaemia, and has been thought to be either due to: endothelial dysfunction with reduced release or production of the endothelial derived relaxant factor (EDRF); an increased sympathetic stimulation during exercise; enhanced platelet aggregation with release of thromboxane A2 and serotonin; and/or a passive collapse of the disease-free vessel segment within the stenosis when blood-flow velocity increases during exercise. Thus, a diseased coronary endothelium may have a dramatic effect on the function of the coronary arteries, and may cause or contribute to the occurrence of myocardial ischaemia under high-demand situations, e.g. physical exercise or mental stress. Changes in flow-dependent vasodilation have been described in various disease states, e.g. hypercholesterolaemia, hypertension, diabetes mellitus, but also in valvular heart disease, heart failure and transplantation. Most of these alterations are due to functional changes of the endothelium, but vascular remodelling of the coronary arteries with thickening of the intima and an enlargement of the artery may affect these functional changes importantly.
Coronary Circulation↗
Docetaxel (Taxotere): effectiveness against Plasmodium falciparum in vitro and Plasmodium yoelii nigeriensis in vivo.
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Animals↗
Prevalence and recognition of anxiety syndromes in five European primary care settings. A report from the WHO study on Psychological Problems in General Health Care.
BACKGROUND: This study explored the prevalence, socio-demographic characteristics and severity of different anxiety syndromes in five European primary care settings, as well as medical help-seeking, recognition by general practitioners (GPs) and treatment prescribed. METHOD: The data were collected as part of the WHO study on Psychological Problems in General Health Care. Among 9714 consecutive primary care patients, 1973 were interviewed using the Composite International Diagnostic Interview. Reason for contact, ICD-10 diagnoses, severity and disability were assessed. Recognition rates and treatment prescribed were obtained from the GPs. RESULTS: Anxiety syndromes, whether corresponding to well-defined disorders or to subthreshold conditions, are frequent in primary care and are associated with a clinically significant degree of severity and substantial psychosocial disability. Their recognition by GPs as well as the proportion treated are low. CONCLUSIONS: Since people with subthreshold anxiety show a substantial degree of disability and suffering, GPs may consider diagnostic criteria to be insufficient. However, their awareness of specific definitions and treatment patterns for anxiety disorders still needs a lot of improvement both for patients' well-being and for the cost resulting from non-treatment.
Adult↗
Interventional cardiology in perspective: impact on cardiac rehabilitation.
Exponential evolution of percutaneous, catheter-based revascularization has modified traditional premises of cardiac rehabilitation. With increasing numbers of percutaneous transluminal angioplasty (PTCA) procedures relative to coronary artery bypass grafting interventions, the need for in-patient rehabilitation is declining; on the other hand, the need for life-style counselling within the framework of out-patient rehabilitation is increasing. Risk factor interventions are important to minimize and to retard the progression of the disease. Rehabilitation programmes offer exercise training, stress modification and life style counselling to reduce cardiovascular risk factors and to increase exercise capability. Since costs of out-patient rehabilitation seem to be lower than those of in-patient rehabilitation, a case may be made in favour of directing limited funds to additional interventions and to saving money by replacing in-patient rehabilitation with outpatient programmes after PTCA. The budget-holder has to make the choice.
Angioplasty, Balloon, Coronary↗
Intra- and interhemispheric electroencephalogram coherence in siblings discordant for schizophrenia and healthy volunteers.
Former studies had pointed to an increased electroencephalogram (EEG) coherence in schizophrenics, but it remained unsolved whether this deviation represents the premorbid state or is only a consequence of the current or previous schizophrenic episodes. To clarify this question, we tested the hypothesis that subjects at elevated risk also reveal higher coherences compared to healthy controls. For that, intra- and interhemispheric EEG coherences were investigated in untreated schizophrenics, their healthy siblings, and healthy controls. Differences were only found regarding the intrahemispheric coherences. Both in schizophrenics and, even though to a lesser degree, in their siblings significantly higher coherence estimates were found compared to the control group. The results are in accordance with the assumption that schizophrenia is predominantly a neurodevelopmental disease. Increased coherence might be assumed to be a vulnerability marker for schizophrenia reflecting maldevelopment of the brain before onset of the disorder.
Adult↗
Subject and informant variables affecting family history diagnoses of depression and dementia.
The aim of the present study was to evaluate subject and informant factors affecting the validity of the family history for dementia and depression. Relatives of patients and control subjects (n = 531) were interviewed directly. At least one 'significant' other provided family history information on every interviewed relative. The detection of dementia or depression based on the family history increased with the severity of the respective disorder. The likelihood of detecting dementia based on the family history increased in proportion to the subject's age. A lifetime diagnosis of depression in the informant improved the detection of this disorder in a relative. The presence of another psychiatric disorder in either the interviewed relative or the informant significantly increased the risk for false-positive diagnoses of depression. The present results demonstrate that family history information on depression and dementia is influenced by different proband and informant variables. On the basis of these results, we cannot recommend reducing thresholds for family history diagnoses.
Adult↗
Neuronal nicotinic acetylcholine receptor alpha 4 subunit (CHRNA4) and panic disorder: an association study.
Anxiety disorders have been reported to be associated with low-voltage EEG (LVEEG). Some cases with LVEEG (approximately 1/3) have been linked to chromosome 20q13.2q13.3. In the same chromosomal region, the gene for the neuronal nicotinic acetylcholine receptor alpha 4 subunit (CHRNA4) has been located. We therefore tested the hypothesis that polymorphisms in the CHRNA4 gene show an allelic association with panic disorder. We examined the allele frequencies of three different CHRNA4 polymorphisms in patients with panic disorder and in healthy controls. No significant differences in the allele frequencies of these three polymorphisms were noted. This study does not support an association between panic disorder and the CHRNA4 gene.
Adult↗
5-HT2A receptor and bipolar affective disorder: association studies in affected patients.
The aim of this study was to investigate the possible involvement of genetic variation in serotonin receptors in the aetiology of bipolar affective disorder. The 5-HT2A receptor gene was systematically screened for genetic variants by single strand conformation polymorphism (SSCP) methods in subjects with bipolar affective disorder. Four polymorphisms (two structural changes, Thr25Asn and His4 M52Tyr, and two silent polymorphisms, 102-T/C and 516-C/T) which had previously been found in patients with schizophrenia and control subjects were detected. No novel polymorphisms were found in patients with bipolar affective disorder. These polymorphisms were genotyped in a sample of 129 patients and 252 controls of German origin and 176 patients and 182 controls of British origin. No strong associations were found between any of these polymorphisms and bipolar affective disorder. Genetic variation at the 5-HT2A receptor gene does not play a major role in the pathogenesis of the disorder.
Alleles↗
Description of the Genetic Analysis Workshop 10 bipolar disorder linkage data sets.
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Bipolar Disorder↗
Selection bias during recruitment of elderly subjects from the general population for psychiatric interviews.
The aim of the present study was to determine and assess a possible selection bias in an epidemiologic investigation in the elderly. A stratified sample of 1305 probands aged 60-99 years was initially contacted by mail and then by telephone to obtain their consent to participate in a psychiatric interview. A liberal recruitment procedure led to interview participation of only 291 subjects. The proportion of younger, male, and married subjects participating in the study was greater than that of elderly, female, and single or widowed subjects. Subjects without a psychiatric lifetime diagnosis were more cooperative than those with a psychiatric disorder. The latter finding demonstrates the need to determine and assess the selection bias in psychiatric epidemiologic studies in elderly subjects.
Aged↗
The relationship between major and subthreshold variants of unipolar depression.
Recent epidemiological research in the general population and primary care demonstrated that a substantial proportion of disabling depressive syndromes do not meet the diagnostic criteria for major depression. This observation proposes less restrictive diagnostic definitions of depression. However, a gain in sensitivity may induce a substantial loss of specificity. A variety of diagnostic definitions of subthreshold depression has been proposed balancing both aspects. However, the less restrictive diagnostic definitions are, the lower the specificity. This report explores variants of subthreshold depression characterized by current and subsequent disability in a prospectively investigated sample of general practice patients (n = 400), recruited within the framework of the WHO study "Psychological Problems in Primary Care and a survey in the general population. Duration of episodes, recurrence and number of associated symptoms are the main diagnostic variables. Brief depression with multiple episodes per year (including recurrent brief depression as defined by ICD-10) is comparable to major depression by social disability and subsequent course in the sample under study.
Cost of Illness↗
Evidence suggestive of a locus on chromosome 5q31 contributing to susceptibility for schizophrenia in German and Israeli families by multipoint affected sib-pair linkage analysis.
Suggestive evidence for a potential susceptibility locus for schizophrenia at 5q31 was obtained in two family samples. Sample I consisted of 14 families with schizophrenia and revealed for the marker IL9 a lod score of 1.8 by two point lod score analysis. Sample II comprised 44 families including four from sample I and was ascertained in order to employ affected sib-pair analysis by identity by descent. A lod score of 1.8 around the marker D5S399 was obtained by multipoint analysis. The lod score remained positive, but decreased to 1.27 when the four families from sample I were excluded in order to use sample II as a statistically independent replication sample. We propose a susceptibility locus for schizophrenia with probably minor contribution in the pedigrees under investigation.
Chromosomes, Human, Pair 5↗