Über den Lähmungstypus bei cortikalen Hirnherden

Ohne Zusammenfassung     

Kindesmord

Ohne Zusammenfassung     

Minoxidil and captopril in severe hypertension

Summary The antihypertensive efficacy of minoxidil and captopril was compared in 23 males with essential or renal parenchymatous hypertension refractory to conventional antihypertensive drug therapy. Following a pretreatment period the patients were randomly assigned to receive either minoxidil, 2.5 mg twice daily (n=12), or captopril, 25 mg twice daily (n=11). In patients with diastolic blood pressure >95 mmHg, doses of minoxidil and captopril were increased in 2-week intervals. Patients who maintained diastolic pressure >95 mmHg and/or those with intolerable side effects were switched over to the alternative substance. After a mean observation period of 12 weeks a significant decrease in systolic and diastolic blood pressure was observed (179/114 vs 148/92 mmHg in the minoxidil group; 176/111 vs 158/97 mmHg in the captopril group). The primary response rate was 75% in patients treated with minoxidil and 55% in those with captopril (not significant). After the change to the alternative substance two of the four non-responders on captopril and one of the two non-responders on minoxidil became responders. Side effects occurred significantly more often during minoxidil than captopril (p<0.05). The high efficacy of minoxidil and captopril in the treatment of severe hypertension refractory to conventional drugs was confirmed. Minoxidil lowered blood pressure slightly more than captopril, but it had a higher incidence of side effects than captopril.     

Life expectancy of diabetic patients undergoing vitreous surgery.

BACKGROUND: Patients with advanced diabetic eye disease are commonly in poor general health. In addition to the ocular status, life expectancy is an important factor in the decision whether and how to perform vitreous surgery. The present study investigates mortality and risk factors for survival in diabetic patients following vitrectomy. METHODS: The follow up of 332 consecutive patients who underwent vitrectomy for complications of diabetic retinopathy between 1990 and 1994 was studied retrospectively. Survival and risk factors for survival were analysed using the Kaplan-Meier life table method and for multivariate analysis the Cox proportional hazard model. RESULTS: The 5 year survival rate was 68%. Absence of heart disease was the most important predicting factor for survival. Fifty per cent of the patients with heart disease had died within 3.5 years. Patients without heart disease had a 5 year survival rate of 90%. Other significant, independent risk factors were age and presence of nephropathy. CONCLUSION: In diabetic patients undergoing vitrectomy the presence of heart disease indicates a poor prognosis for survival. This should be taken into consideration for indications and strategies in cases of vitrectomy.     

Risk factors for total and cause-specific mortality in human cardiac transplantation Prolonged extracorporeal bypass time: a high risk factor for rejection and infection

Data from the first 103 human heart transplantations in 100 recipients performed at a single centre from November 1983 to January 1990 were analysed to detect risk factors for overall and cause-specific mortality. Twenty-two patients died. Cumulative 1 year graft survival was 82% and 5 year, 68%. Acute and chronic rejection was the cause of death in 9 patients, disseminated infection in 8 and cancer in 3. One patient died from cerebral haemorrhage and 1 from acute cardiac failure. The mean observation time was 803 days (range: 1 – 2 308 days). Total follow-up was 226.6 graft years. Risk factors were analysed by univariate and multivariate methods. The type of immunosuppression regimen and recipient age above 50 years were independent risk factors for mortality. Histocompatibility mismatching (HLA-DR) and type of immunosuppression were independent risk factors for lethal rejection and a female recipient was an independent risk factor for lethal infection. Prolonged time on extracorporeal bypass was an independent risk factor for both lethal rejection and infection, and also for overall mortality. The impact of extracorporeal bypass time on rejection and infection is discussed, and the importance of prospective HLA matching in heart transplantation is stressed. The association between recipient female sex and infection remains uncertain.     

Krankheit, Arzt-Patient-Kontakte und Arbeitsunf?higkeit in einer Allgemeinpraxis

Zusammenfassung In einer Allgemeinpraxis wurden bei 314 Männern im Rahmen einer Vorsorgeuntersuchung die Häufigkeit von Symptomen der koronaren Herzkrankheiten (Fragebogen nachG. Rose) und einige Risikofaktoren erhoben. Gleichzeitig wurde die Anzahl der Arzt-Patient-Kontakte und die Dauer der Arbeitsunfähigkeit registriert und die Patienten in vier soziale Schichten eingeteilt. Es fand sich eine signifikante Zunahme der vegetativen Symptome und der Hyperurikämie (p<0,025) sowie der Anzahl der Raucher (p<0,01) mit abnehmender sozialer Schicht. Der gleiche Trend liess sich bei der Häufigkeit der Arzt-Patient-Kontakte und der Dauer der Arbeitsunfähigkeit zeigen (p<0,1). Bei Patienten mit vegetativen Symptomen fand sich eine mittlere Häufigkeit von Arzt-Patient-Kontakten von 7,2mal und eine Arbeitsunfähigkeit von 37,4 Tagen pro Jahr. Bei Patienten mit abnormem EKG-Befund lagen diese Werte bei 5,6mal bzw. 33,4 Tagen pro Jahr. Es bestand ein signifikanter Unterschied dieser Werte im Vergleich zu einer Kontrollgruppe.

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Disease, doctor-patient contacts and work incapacity in a general practice

Summary The frequency of Coronary Heart Disease symptoms (questionnaire fromG. Rose) and some risk factors were recorded for 314 men in a general practice as part of a preventive screening programme. Simultaneously the number of physician-patient contacts and the total days of work disability were registered. The patients were divides into four social classes. There was a significant increase of symptoms of autonomic nervous disorder and hyperuricemia (p<0,025) as well as the number of smokers (p<0,01) with descending social class. The same trend was found with the frequency of physician-patient contacts and the total days of work disability (p<0,1). Patients with vegetative symptoms showed a mean of 7,2 physician-patient contacts and a work disability of 37,4 days per year. For patients with abnormal ECG findings the rates were 5,6 contacts and 33,4 days of disability per year. There was a significant difference in these rates compared to a control group.

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Maladie, contact patient-médecin et incapacité de travail dans une pratique générale

Résumé A des examens préventifs qu'on a procédé chez 314 hommes dans le cabinet médical d'un médecin généraliste on a relevé la fréquence des symptômes des maladies cardiaques coronaires (questionnaire deG. Rose) ainsi que certains facteurs de risque. En même temps on a enregistré le nombre des contacts médecin-patient ainsi que la durée de l'incapacité de travail, et l'on a divisé les patients en quatre classes sociales. On a constaté qu'une augmentation significative des symptômes végétatifs, du taux d'acide urique (p<0,025) et du nombre des fumeurs (p<0,01) allait de pair avec les classes sociales inférieures. On a marqué une meme tendance en ce qui concerne la fréquence des contacts médecin-patient et la durée de l'incapacité de travail (p<0,1). Chez les patients ayant des symptômes végétatifs on a trouvé une fréquence moyenne de contacts médecin-patient de 7,2 fois par an et une incapacité de travail de 37,4 jours par an. Chez les patients ayant un résultat d'ECG anormal ces valeurs étaient 5,6 fois et 33,4 jours par an. Ces valeurs, comparée à celles d'un groupe de contrôle, montrent une différence significative.

     

Psychophysiological response specificities: a replication over a 12-month period

A sample of 58 students was subjected to four stress conditions (mental arithmetic, reaction time, free speech, cold-pressor test). Eight physiological variables (skin conductance, heart rate, pulse amplitude, Heather index, eye blinking, horizontal eye movements, respiration rate, blood pressure) and five psychological variables (self-rated anger, irritability, tenseness, motivation, indifference) were monitored. Proportions of variance in a three-factor ANOVA (subjects, situations, variables) accounted for by individual specific response patterns (ISR) amounted to 33-40% for physiological and 9-13% for psychological variables. Stimulus specific response patterns (SSR) accounted for 11-19% for physiological and 8-14% for psychological variables, and motivation specific response patterns (MSR) for 17% for physiological and 14-16% for psychological variables. About one-fourth of the subjects showed a rather stable ISR in physiological variables when tested again after two months, and about 14% when tested again after twelve months. Overall, the results replicated earlier findings from this laboratory.     

On the etiology of syndromes of dementia (author's transl)

Some new aspects of dementia are discussed. It is emphasized that the idea of dementia as a primary entity is obsolete. The following classification is proposed: dementia as a sign of a (still) unknown illness; dementia is a sign of a known, but not yet treatable illness and dementia as a sign of a known and also treatable illness. The differential diagnosis of the last group is described. Finally, some tests are proposed for the examination of demented patients to diagnose early treatable illnesses.