[Shift work from the viewpoint of the occupational health service].
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Biomedical subjects
Publications and source records attributed to W Werner.
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The results of a larger study of psychopathological disorders in relation to pre-operative and post-operative examined heart surgery patients, where the heart-lung machine was used, will be shown, to begin with, on 20 patients. Pre-operative examination showed quite clearly, among other things, that patients suppress obvious operation risks. General mental disorders were seen post-operative in 4 patients, and these were diagnosed as organic psychosis. A comparison between psychotic and other patients shows, among other things, that somatic predictors such as cerebral sclerosis and atrophy, or a cerebral trauma tend to promote post-operative psychosis. A releasing cause could be a cerebral hypoxia brought about by the extracorporeal blood circulation. In our opinion psychological factors can only be found in the contents of psychosis.
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214 patients who underwent cataract-extraction in 1973 were examined for systemic diseases. The average age of patients with (70%) and without (30%) general diseases was 67 years. The frequency of cardio-vascular and respiratory diseases corresponded to that observed in the general population of the same age. In contrast, the rate of diabetes mellitus was four times higher than to be expected statistically. The importance of an adequate clinical management of diabetic cataract patients is discussed.
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Especially in times when psychodynamic points of view in psychiatry seem the main focus of attention, one must not forget the primary somatic basis of many psychic disturbances. If such cases are not promptly diagnosed, there is a danger that appropriate therapy will be neglected. Since every imaginable type of psychic symptomatology can at times be organically caused, the organic point of view still is of immense practical value. In addition, this latter aspect is of great theoretical importance, because it illuminates the dynamic process not only of the symptomatic psychoses but also of the so-called endogenous psychoses. After a short review of alterations of consciousness as well as the presentation of a detailled case report, psychic disturbances, which at first glance appear not to be organically determined, are described and discussed.
80 strictly selected patients with chronic renal insufficiency with plasma creatinine values of 1.4--14.5 mg% were examined according to a fixed scheme to determine the presence of symptoms and signs of renal encephalopathy. The general cerebral symptoms complained of were headache in 33.4% of the patient material, dizziness in 30.3%, easy fatigability in 62.5%, giddiness in 18.8% and insomnia in 37.5%. The most prominent neurological findings were hyperactive deep reflexes in 30% and action tremor in 23.8%. The symptoms of organic brain syndrome were impairment of memory in 32.5%, weakness of concentration in 28.8% and lability of affect in 63.7%. Diffuse EEG abnormalities were found in 26.2%. While the clinical neuropsychiatric symptoms did not show any statistically significant correlation with the various internal medical data, a trend was observed in the greater number of pathological EEGs with an increase in the impairment of renal function. Furthermore, there was a statistically significant correlation, (alpha less than or equal to0.015) between the occurrence of pathological EEGs and the plasma creatinine and BUN values. It is remarkable that the patients with abnormal EEGs had a relatively low mean creatinine level of 5.89 mg%. The strict dietetic management of the patients is regarded as one of the deciding factors for the relatively low frequency of neuropsychiatric symptoms in the material studied.
80 strictly selected patients with chronic renal insufficiency with plasma creatinine values of 1.4-14.5 mg% were examined for clinical and electrophysiological signs of nephrogenic polyneuropathy. The motor symptoms complained of were cramps in 43.8% of the patients, "restless leggs" in 18.7%, muscular twitchings in 12.5%. It was emphasized that the first two symptoms do not always indicate the presence of polyneuropathy. 30% complained of paresthesias, 5% of "burning feet". The most frequent clinical finding was the impairment of vibration sense in the feet in 37.5% followed by diminshed appreciation of passive movement of the toes in 30%, weakening or absence of the ankle jerk in 23.8% and finally, weakening of the patellar reflex in 5%...
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In a strictly selected material of 80 patients, who were all outpatients of a special nephrological clinic, with chronic renal insufficiency with retention values of 1.4-14.5 mg% serum creatinine, an EEG was done besides thorough neurological and internal examinations. In 21 cases (26.2%) a pathological EEG in the form of background slowing and general dysrhythmia. There was a tendency to increase in pathological EEG findings in correlation with increase of the retention values. The patients with pathological EEG had on the average a creatinine value of 5.89 mg%, those without EEG findings had an average creatinine value of 3.98 mg%. The difference is statistically significant (alpha less than or equal to 0.015). It is notable that there is a statistical correlation (alpha less than or equal to 0.005) between the presence of pathological EEG and the motor conduction velocity of the peroneal nerve: only 12% of the patients with a conduction velocity of less than 43 m/sec had a pathological EEG while 60% of the patients with a conduction velocity of more than 43 m/sec had EEG findings. No statistical correlation were found between the EEG changes and other neurological and internal signs and symptoms, including cardiovascular findings like the blood pressure.
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