Biomedical subjects
Publications and source records attributed to W Maier.
CT findings of eight malignant hemangiopericytomas are presented. CT revealed well-circumscribed mass lesions in five cases, whereas three tumors showed invasive growth. Cystic areas were found in four hemangiopericytomas, and a dystrophic calcification was seen in one case. Following intravenously injected contrast material, all tumors demonstrated a distinct enhancement.
In a representative sample (n = 31) of patients with panic attacks and a cardiac anxiety syndrome, a prospective follow-up study after a 1-year interval was performed. At the follow-up assessment 33% of the patients were in remission, whereas the majority of patients had an unfavorable course. Avoidance behavior and female sexual status were found to be predictive for an unfavorable course. Within a matched-pair design controlled for age and sex, no difference between panic disorder with and without cardiac anxiety syndrome was observed in any psychosocial or psychopathological outcome variable. This result is an argument against the validity of the subtype cardiac anxiety syndrome.
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The assessment of endogenous depression by means of the Newcastle Scales (1965, 1971) has been validated by their correlation with biological findings in many previous studies. However, reliability and cross validation studies are lacking for these scales. We found the reliability of the Newcastle Scales to be sufficient or at least moderate in a sample of 70 inpatients with major depression. In order to cross validate both scales, the clinical classification according to ICD-9 and the assessment of the Newcastle Scales have been performed independently in a sample of 112 inpatients with Major Depressive Disorder (RDC). The rate of agreement between clinical diagnosis and classification according to the Newcastle Scales of endogenous depression is only fair. However, a modification of the diagnostic algorithm applied to the items of the Newcastle Scales I (1965) improves the rate of agreement considerably. The Newcastle Scale I turned out to represent a heterogenous concept without sufficient transferability. Modifications of both scales are proposed.
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A new system of positioning and adjustment facilities is presented for fractionated total-body irradiation with the use of compensators, consisting of a positioning plate provided with devices for translation and rotation, a lifting device installed in the irradiation room, a transport vehicle, an individually adapted foam bed for the patient, and a fine-adjustment holding device for the compensator. The method as well as the material used are described in detail. The system does not only allow an exact reproduction of patient's position and compensator adjustment, but also reduces the time of preparation.
In most marsupials, the angular process is inflected medially. By using an ontogenetic series of Monodelphis domestica, the development of this characteristic structure has been described. In contrast with the eutherian mammals, in marsupials there is retained a close connection between the dentale and the tympanicum and goniale; it is well known that these 2 elements of the middle ear are derived from the angulare and prearticulare of the reptilian lower jaw. At the neonatal stage, the dentale and tympanicum are both relatively vertically orientated; during the following 2 weeks, they take an increasingly oblique position, which is primarily caused by the rapid growth of the braincase. Only after the eruption of the first teeth, the ascending ramus of the dentale takes a more and more vertical position, whereas the angular process remains with its tip near the medioventral floor of the tympanic bulla. The bulla shows at this place a rectangular fenestra which is covered by a membrane of loose connective tissue; the tip of the angular process, which is always free of muscular insertions, maintains contacts with this fenestra throughout life. During juvenile and adult life stages, the process becomes somewhat removed from the fenestra for obvious reasons, but at a gape of about 40 to 50 degrees it inevitably must touch the "inferior tympanic membrane" and possibly also the tympanic ring. It is speculated that the relationship between the angular process and the tympanic bulla represents a specific form-function complex for sound transmission, which may be a modified retention from archaic mammalian conditions. Further details of the ontogenetic development of the tympanic region have been described which may be of some relevance for the evolutionary morphology of mammals: The tympanic process of the petrosal, which fixes the posterior end of the tympanic ring, is formed by 'Zuwachsknochen' (additional bone) but not by cartilage. The styloid process remains cartilaginous throughout life: its free tip ends in the lateral wall of the tympanic cavity and it is closely connected with the collum mallei and the posterior end of the tympanicum; it guides the chorda tympani and may therefore be homologous with the cartilage of Spence. The cartilage of Paauw is interpreted in terms of functional morphology. A model of evolutionary transformation of the dentale-tympanicum complex in mesozoic mammals in outlined on the basis of the ontogenetic findings in Monodelphis and other didelphid and dasyurid marsupials.
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With the percentage of prenatally diagnosed malformations rising, there is a growing need for the contribution of the pediatric surgeon regarding prognostic and therapeutic aspects for the unborn child. An important risk factor for the validity of any statement is the possible presence of undetected, associated malformations. In spite of all advantages prenatal diagnosis offers regarding carefully planned therapy, etc., doubt and uncertainty always remain.
No single ICD-9 category corresponds to panic disorder (DSM-III). To investigate whether patients with panic attacks can be identified by means of ICD-9, 97 patients with three panic attacks within 3 weeks were recruited from various medical centers, and were classified independently according to DSM-III and ICD-9. The ICD-9 diagnoses were scattered over a broad range of categories, and it was impossible to identify patients with panic disorder in this manner. Anxiety state, affective psychosis, and depressive neurosis were the most frequent ICD-9 diagnoses. The boundary between affective psychosis on the one hand and anxiety state and depressive neurosis on the other hand was validated by present and previous symptomatology and by cluster analysis. The boundary between anxiety state and depressive neurosis could not be validated in this way. Correspondingly, modifications of the ICD-9 classifications are proposed.
Diagnostic schedules for any psychiatric disorder should represent a coherent concept and demonstrate adequate construct (internal) validity and transferability. Testing fit to latent class models (e.g. by Rasch model fitting test), correspondence to these requirements can be assessed. Based on data from a sample of 173 depressed in-patients, diagnostic schedules for endogenous depression (melancholia) according to DSM-III and RDC are evaluated for their ability to fit the requirements listed above. According to the data presented, the set of DSM-III-criteria for melancholia represents a coherent concept; on the contrary, this is not the case for RDC-criteria. Furthermore, application of the diagnostic algorithm applied to the defining criteria according to DSM-III has been justified; again, this was not the case for the diagnostic algorithm according to RDC. However, a simple linear diagnostic algorithm emerges from our data.
Seventy-seven consecutively admitted inpatients with depressive syndromes were examined with the Present State Examination and classified according to eight different operational diagnoses of endogenous depression. All patients received a 1.5 mg dexamethasone suppression test (DST). Sensitivity, specificity and the corrected predictive values of DST nonsuppression (50 or more ng/ml at 0800 hr, 1600 hr, or 2300 hr), adjusted to a 50% prevalence of endogenous and nonendogenous depression, varied considerably depending on the diagnostic definition used. The highest predictive value (89.9%) was found with the Taylor-Abrams criteria (sensitivity = 43.9%, specificity = 95.0%), and the lowest predictive value (53.3%) with DSM-III (sensitivity = 37.7%, specificity = 68.1%). Eliminating the patients with dexamethasone levels of less than 2000 pg/ml improved the diagnostic specificity of the DST for most of the eight definitions of endogenous depression. This further indicates that plasma dexamethasone levels should be analyzed in studies designed to explore the diagnostic utility of the DST. A significant, chance-corrected association between DST nonsuppression and the diagnosis of endogenous depression was found with clinical diagnosis (according to the International Classification of Diseases), and for four out of eight operational diagnoses (Newcastle Scale I, Newcastle Scale II, Taylor-Abrams Criteria, and Vienna Research Criteria). For the other diagnoses (Research Diagnostic Criteria, DSM-III, Michigan Discriminant Index, and Hamilton Endogenomorphy Index), no significant association was found. The RDC criterion "early or intermittent awakening" was the only one out of 28 diagnostic criteria tested which was significantly associated with DST nonsuppression.
Operational diagnoses of endogenous depression have gained special importance for psychopharmacological research. The high reliability of operationally defined diagnoses is a prerequisite for sampling comparable patient group. The simultaneous application of competing categorical diagnostic system ("polydiagnosis") allows us to determine whether differences in research findings are due to differences in patient samplings. Furthermore, a dimensional classification of patients by means of a newly developed polydiagnostic scale (so called OPD scale) allows us to compare the diagnostic homogeneity of patient groups diagnosed as endogenous depression cases and to select extreme groups with high diagnostic homogeneity for comparing the distribution of variables under research in patients with endogenous and nonendogenous depression.
The classification of depressive disorders (subtypes of Major Depressive Episode--MDE) according to DSM-III is different in many respects from the classification according to ICD-9; the relevance of both diagnostic systems necessitates the assessment of their compatibility. In a sample of 173 depressed inpatients, both diagnostic systems are applied independently and the relationship between affective psychosis (endogenous depression) (ICD-9) and subtypes of MDE (DSM-III) is investigated. The resulting low rate of agreement between endogenous depression (ICD-9) and MDE with melancholia (DSM-III) can be improved considerably by a modification of the diagnostic algorithms applied in DSM-III. Furthermore, by combining the subtype or criteria of melancholia (DSM-III) and characteristics of course (recurrence, bipolarity) the ICD-9 diagnosis of endogenous depression can be simulated.
Several operational diagnoses (OPD) for endogenous depression have been proposed. However--though aiming at similar clinical concepts--the amount of association and agreement between different OPD is rather low. In this study the relationship between eight OPD (Research Diagnostic Criteria, DSM-III, Michigan Discrimination Index, Newcastle Scale I, Newcastle Scale II, Taylor-Abrams Criteria, Vienna Research Criteria, Hamilton Endogenomorphy Index) was assessed by applying latent trait analyses to the classificatory data of these eight OPD which were rated simultaneously in a sample of 173 depressive inpatients. According to these analyses six OPD (RDC, DSM-III, NCS-I, NCS-II, TAC and VRC) are tapping the same phenomenon. This latent trait represents compatible concepts of endogenous depression; it is strongly associated with the independently assessed clinical ICD-9 diagnosis of endogenous depression. The six OPD can be considered as items of a scale (so-called OPD-scale). The total scores of the OPD-scale represent a dimensional assessment of the decisiveness of the diagnosis endogenous depression. Coefficients and parameters of this new scale are presented.
One hundred and five of 395 patients with acute pancreatitis were surgically treated in our clinic from 1981 to 1984. Ninety three of these patients were examined with contrast enhanced computed tomography and/or ultrasound and were clinically assessed according to Ranson's objective criteria before operation. At operation, 77 patients showed necrotising pancreatitis and 16 showed biliary acute interstitial pancreatitis. Ninety per cent of the cases with extensive and 79% of those with minor necroses of the pancreas had been demonstrated with contrast enhanced computed tomography. Ultrasound failed to be diagnostic in 24% of the patients due to meteorism; the sensitivity of the diagnostic studies for pancreatic necrosis was 73% regardless of the extent of the process. Using the early objective signs, seven patients with acute interstitial pancreatitis were classified as having a severe attack, whereas 30 patients with necrotising pancreatitis were categorised as mild attacks. We conclude that the contrast enhanced computed tomography is an aid in deciding on conservative or surgical treatment in a case of acute pancreatitis. Ultrasound does not appear to be an adequate method for determining pancreatic necrosis. The early objective signs fail to sufficiently identify the necrotising form of acute pancreatitis.
A structured interview (PODI) for the polydiagnostic evaluation of affective and schizophrenic disorders is presented. The interview includes elements of the Structured Clinical Interview for DSM-III (SCID) and of the Present State Examination (PSE). The central idea of this interview is to break down complex criteria into their elements, to assess a wide area of such elements, and to recombine them by a computer program according to different algorithms that are included in a greater number of operational diagnoses. Reliability data will be presented which show sufficiently high kappa and Yule coefficients for a selected set of diagnostic criteria for depressive, manic and psychotic disorders. The applicability of the PODI was established in about 180 interviews.
The growing application of the polydiagnostic approach makes it necessary to examine the methodological problems associated with the simultaneous assessment of multiple competing diagnoses. This paper contrasts the method of nonstandardized consecutive judgement of nonintegrated criteria lists with the method of a structured polydiagnostic interview with integrated criteria lists. The comparison of two polydiagnostic studies using both methods of assessment confirms that the unstructured use of nonintegrated and consecutively judged criteria lists is biased by a halo effect. This halo effect leads to a reduction of differences between the classifications of competing operational diagnoses and influences the type of patient distribution along the diagnostic dimension. This finding is interpreted as an argument to switch over to integrated criteria lists applied on the basis of an unstructured clinical examination or a structured interview.