Umstimmungsvorgänge bei Facialisreflexen durch den Sympathicus und durch starke Reize

Zusammenfassung Durch Reizung des Sympathicus läßt sich keine charakteristische Änderung der Zeiterregbarkeit des durch Kondensatorreizung der Zunge ausgelösten Zungenkieferreflexe erzielen.Auch Ohrmuschelreflexe, die vom zentralen Stumpf des Nervus auricularis magnus oder des Nervus auriculo-temporalis ausgelöst werden, ändern sich unter dem Einfluß einer Sympathicusreizung meist nicht in eindeutiger Weise. Unter 7 Katzen war nur bei einer in wiederholten Versuchen regelmäßig eine Verlängerung der Chronaxie des Nervus auricularis magnus während der Sympathicusreizung zu beobachten.Starke Reize, welche die Ohrmuschel oder den Nervenstamm treffen, vor allen die Ligatur des Nervus auricularis magnus oder des Nervus auriculo-temporalis, führen zu einer lange anhaltenden Steigerung der Reflexe auf die mimische Muskulatur. Es läßt sich vorläufig noch nicht entscheiden, ob diese Steigerung der Reflexerregbarkeit nur auf einerzentralen Umstimmung beruht, oder ob dabei auch eine Umstimmung derperipheren sensiblen Nerven eintritt.Die Reizzeit-Spannungsbeziehungen der sensiblen Auricularisfasern verlaufen oft rein hyperbolisch, oft finden sich aber auch analoge Überkreuzungstypen, wie sie an den sensiblen Ischiadicusfasern beobachtet worden sind (Auersperg), doch sind diese Überkreuzungstypen am Nervus auricularis mitunter viel klarer ausgeprägt, da sich die Reizzeit-Spannungskurven hier oft nur auszwei Stücken von verschiedenem hyperbolischen Verlauf zusammensetzen, während am Ischiadicus Kurven erhalten worden sind, die unbedingt auf eine gegenseitige Durchkreuzungzahlreicher Einzelfaserkurven hinweisen.Die Erregbarkeit der einzelnen im Auricularisstamm vereinigten Fasern ist außerordentlich verschieden. Die beobachteten Chronaxien schwanken etwa zwischen 0,04 und 5 . Es ist nicht wahrscheinlich, daß diese langen Chronaxien geschädigten Fasern entsprechen.     

Anxiety,Depression, and Health-Related QOL in Patients Diagnosed with PAH or CTEPH

Background

Pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) are life-threatening diseases with a high burden of symptoms. Although depression, anxiety, and reduced health related quality of life (HRQOL) have also been reported, a comparative analysis which explores these traits and their underlying factors was lacking.

Methods

A retrospective analysis of depression, anxiety, and health related QOL was conducted using a Hospital anxiety and depression scale (HADS) as well as the SF-36 HRQOL questionnaire. Results from these tools were compared with haemodynamic and functional parameters in 70 PAH and 23 CTEPH outpatients from a German tertiary care center specializing in pulmonary hypertension.

Results

Although HRQOL was reduced in both cohorts of patients, individuals diagnosed with CTEPH scored lower in nearly all SF-36 parameters. Significance was noted in both “mental health” (p = 0.01) and “mental component summary score” (MCS) (p = 0.02). Depression was also more frequent in patients with CTEPH (56%) than in patients with PAH (30%), (p = 0.03). Overall, depression and anxiety correlated with most SF-36 scales in both PAH and CTEPH. In CTEPH, depression also correlated with the Borg Dyspnea Scale (r = 0.44, p = 0.01). These patients also had significantly lower pCO₂ levels than the PAH cohort reflecting more severe ventilation/perfusion mismatch. All other haemodynamic and functional parameters did not differ across the groups.

Conclusion

While both cohorts of patients suffer from a reduced HRQOL as well as depression and anxiety, decreases in mental health parameters are more pronounced in the CTEPH cohort. This suggests a strong effort to improve early detection, especially in dyspneic patients with classical risk factors for CTEPH and PAH and argues for mental illness interventions alongside routine clinical care provided to patients diagnosed with PAH or CTEPH.

     

Development of cardiovascular risk factors in patients after coronary artery bypass grafting with an in-hospital rehabilitation programme (WHO Stage I of Rehabilitation): 1-year follow-up

BACKGROUND: The purpose of this study was to evaluate the influence of an in-hospital (stage I of rehabilitation) individualized motivation programme for life-style change on the cardiovascular risk factors of patients after coronary artery bypass grafting (CABG). METHODS: 142 consecutive patients undergoing CABG because of coronary heart disease were divided into two groups. Group I received the usual care; Group II received the intervention (individual motivation programme). Medical variables concerning all cardiovascular risk factors and the current medication plan were evaluated on admission and one year after surgery. RESULTS: After 12 months significant reductions in systolic blood pressure (p = 0.002), LDL-cholesterol (p = 0.023) and triglyceride (p = 0.046) were found in the intervention group on comparison of the two groups. The HDL cholesterol improved in the intervention group and decreased slightly in the control group. Both groups showed an improvement in diastolic blood pressure, Body Mass Index, blood cholesterol and blood glucose values. The intervention did not show a significant influence on smoking and medication habits. CONCLUSION: An individualized motivation programme starting in the acute hospital may positively influence cardiovascular risk factors with ongoing success.     

Therapeutic temperature management after cardiac arrest and the risk of bleeding: Systematic review and meta-analysis

Aim

Prognosis after cardiac arrest in the era of modern critical care is still poor with a high mortality of approximately 90%. Around 30% of the survivors have neurological impairments. Targeted temperature management (TTM) is the only treatment option which can improve mortality and neurological outcome. It is so far unclear if bleeding complications occur more often in patients undergoing TTM treatment.

Methods

We conducted a systematic literature research in September 2013 including three major databases i.e. MEDLINE, EMBASE and CENTRAL. All studies were rated in respect to the ILCOR Guidelines and concerning their level of evidence and quality. We then performed a meta-analysis on bleeding disposition under TTM.

Results

We initially found 941 studies out of which 34 matched our requirements and were thus included in our overview. Five studies including 599 patients were summarized in a meta-analysis concerning bleeding complications of all severities. There was a trend toward higher bleeding in patients treated with TTM (RR: 1.30, 95% CI: 0.97–1.74) which did not reach significance (p = 0.085). Seven studies with an overall 599 patients were included in our meta-analysis on bleeding requiring transfusion. There was no significant difference in the incidence of severe bleeding with a risk ratio of 0.97 (95% CI: 0.61–1.56, p = 0.909).

Conclusions

The data included in our meta-analysis indicate that, concerning the risk of bleeding, TTM is a safe method for patients after cardiac arrest. We did not observe a significantly higher risk for bleeding in patients undergoing TTM.     

Readiness to change and therapy outcomes of an innovative psychotherapy program for surgical patients: results from a randomized controlled trial

Background

Readiness to change is a pivotal construct for psychotherapy research and a major target of motivational interventions. Our primary objective was to examine whether pre-treatment readiness to change moderated therapy effects of Bridging Intervention in Anesthesiology (BRIA), an innovative psychotherapy approach for surgical patients. This stepped care program aims at motivating and supporting surgical patients with mental disorders to engage in psychosocial mental health care.

Methods

The major steps of BRIA are two motivational interventions with different intensity. The first step of the program consists of preoperative computer-assisted psychosocial self-assessment including screening for psychological distress and automatically composed computerized brief written advice (BWA). In the second step, patients participate in postoperative psychotherapy sessions combining motivational interviewing with cognitive behavioural therapy (BRIA psychotherapy sessions).We performed regression-based moderator analyses on data from a recent randomized controlled trial published by our research group. The sample comprised 220 surgical patients with diverse comorbid mental disorders according to ICD-10. The most frequent disorders were mood, anxiety, substance use and adjustment disorders. The patients had a mean age of 43.31 years, and 60.90% were women. In a regression model adjusted for pre-treatment psychological distress, we investigated whether readiness to change moderated outcome differences between (1) the BRIA psychotherapy sessions and (2) no psychotherapy / BWA only.

Results

Multiple regression analyses showed that readiness to change moderated treatment effects regarding the primary outcomes "Participation in psychosocial mental health care options at month 6" (p?=?0.03) and "Having approached psychosocial mental health care options at month 6" (p?=?0.048) but not regarding the secondary outcome "Change of general psychological distress between baseline assessment and month 6" (p?=?0.329). Probing the moderation effect with the Johnson-Neyman technique revealed that BRIA psychotherapy sessions were superior to BWA in patients with low to moderate readiness, but not in those with high readiness.

Conclusions

Readiness to change may act as moderator of the efficacy of psychosocial therapy. Combinations of motivational interviewing and cognitive behavioural therapy may be effective particularly in patients with a variety of mental disorders and low readiness to change.

Trial registration

clinicaltrials.gov Identifier: NCT01357694.