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1.
Versicherungsmedizin ; 67(2): 82-6, 2015 Jun 01.
Artículo en Alemán | MEDLINE | ID: mdl-26281289

RESUMEN

A 54-year-old woman was referred to the psychiatric clinic with complex somatic whole-body complaints. In absence of organic findings, the diagnosis of somatoform disorder (somatization disorder ICD 10 F45.0) was made. Additionally, due to the typical appearance and chronically elevated IGF-1 (somatomedin C) concentrations, the critical diagnosis of acromegaly was postulated, although no hypophyseal adenoma was detected. The patient was variously assessed and 16 medical and rehabilitation opinions were given with regard to invalidity, particularly by orthopaedic and neurologic specialists. The results varied, even diametrically opposed. However, somatoform disorders or acromegalic appearance and possible medical consequences were not considered sufficiently. The case report encourages experts to deal with complex psychosomatic complaints objectively and unemotionally in medical opinions.


Asunto(s)
Adenoma Hipofisario Secretor de Hormona del Crecimiento/sangre , Adenoma Hipofisario Secretor de Hormona del Crecimiento/diagnóstico , Factor I del Crecimiento Similar a la Insulina/metabolismo , Trastornos Somatomorfos/sangre , Trastornos Somatomorfos/diagnóstico , Terapia Combinada , Conducta Cooperativa , Diagnóstico Diferencial , Evaluación de la Discapacidad , Testimonio de Experto/legislación & jurisprudencia , Femenino , Alemania , Adenoma Hipofisario Secretor de Hormona del Crecimiento/terapia , Humanos , Comunicación Interdisciplinaria , Persona de Mediana Edad , Trastornos Somatomorfos/terapia
2.
Schmerz ; 22 Suppl 1: 11-6, 2008 Feb.
Artículo en Alemán | MEDLINE | ID: mdl-18224348

RESUMEN

The association of migraine and depression has been confirmed in numerous studies and it has been suggested that both diseases influence each other in a bidirectional way. As the conventional antidepressants mostly aggravate a pre-existing depression, treatment of both is a demanding task and should be planned in an interdisciplinary setting with neurologists and psychiatrists experienced in pain management. The pharmacological therapy is mainly based on a modulation of the serotonergic and noradrenergic systems and non-pharmacological treatment is also incorporated. The number of drugs should be kept to a minimum but drugs effective in the treatment of both migraine and depression should be used. Current data favours the use of amitriptylin, although newer studies justify the use of venlafaxin and fluoxetin as second choice drugs.A combination of several antidepressants with acute acting antimigraine drugs can provoke potentially threatening side effects, however, these possible side effects should not lead to suboptimal treatment of patients with depression and concomitant migraine. The current data on the antimigraine effects of common antidepressants are reviewed and advice for the preventive treatment of migraine with concomitant depression is given. Additionally, hazardous interactions and preferable drug combinations are listed.


Asunto(s)
Amitriptilina/uso terapéutico , Analgésicos no Narcóticos/uso terapéutico , Antidepresivos Tricíclicos/uso terapéutico , Depresión/complicaciones , Depresión/tratamiento farmacológico , Trastornos Migrañosos/complicaciones , Trastornos Migrañosos/tratamiento farmacológico , Amitriptilina/administración & dosificación , Amitriptilina/efectos adversos , Analgésicos no Narcóticos/administración & dosificación , Analgésicos no Narcóticos/efectos adversos , Antidepresivos de Segunda Generación/uso terapéutico , Antidepresivos Tricíclicos/administración & dosificación , Antidepresivos Tricíclicos/efectos adversos , Antieméticos/uso terapéutico , Arritmias Cardíacas/inducido químicamente , Arritmias Cardíacas/diagnóstico , Estudios Cruzados , Ciclohexanoles/uso terapéutico , Interacciones Farmacológicas , Quimioterapia Combinada , Electrocardiografía , Fluoxetina/uso terapéutico , Humanos , Trastornos Migrañosos/prevención & control , Polifarmacia , Ensayos Clínicos Controlados Aleatorios como Asunto , Inhibidores Selectivos de la Recaptación de Serotonina/uso terapéutico , Factores de Tiempo , Clorhidrato de Venlafaxina
3.
Chronobiol Int ; 23(5): 1047-52, 2006.
Artículo en Inglés | MEDLINE | ID: mdl-17050217

RESUMEN

Seasonal distribution of birth rates was only recently described in patients with high-grade gliomas. We analyzed 501 cases from the database of a Regional Cancer Center in Bavaria to assess annual periodicity in the birth dates of glioma patients. Prior to analysis, the number of births per month was normalized [number of births x 100,000/total number of births in Germany] to obtain birth rates per month. The approximation of the time series data by a one-year cosine model found that the glioblastoma birth rate exhibits a statistically significant annual variation, with the peak rate in January. Vitamin intake, infections, and other as-yet-unknown factors and exposures during pre- and perinatal early life may contribute to the seasonality of birth rate in patients with brain tumors.


Asunto(s)
Tasa de Natalidad , Glioblastoma/epidemiología , Estaciones del Año , Ritmo Circadiano , Femenino , Alemania/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo
4.
Neuroimmunomodulation ; 13(1): 8-12, 2006.
Artículo en Inglés | MEDLINE | ID: mdl-16612132

RESUMEN

OBJECTIVE: During the last 2 decades, right/left hemisphere dominance was supposed to affect the immune system differently. Experimental and clinical observations indicate that the left hemisphere plays a crucial role in the development of the immune system. The true relationship between immune response and acute ischemic stroke laterality remains to be elucidated. METHODS: We studied acute right-handed stroke patients admitted to a single acute neurology department with a specialized stroke unit. Being part of our clinical protocol, blood samples were taken within the first 24 h after the onset of stroke symptoms. The medical record of each patient was reviewed, and demographic, clinical laboratory (key criteria: C-reactive protein, CRP, and white blood cell count, WBC) and neuroimaging information was retrieved. All data were presented descriptively, and bivariate test statistics, ANOVA (log-transformed data) or linear correlations were calculated. RESULTS: Fifty-six of the 187 patients admitted to our Stroke Unit between October 2003 and March 2004 with different stroke subtypes according to the TOAST criteria were retrospectively evaluated in order to characterize the impact of stroke laterality on immunoregulatory response measured by CRP levels and WBC. Correlation analysis revealed that left-sided ischemic stroke yielded a significantly higher correlation between CRP levels and WBC. Following left-sided stroke, a more marked variability in CRP and WBC was found compared to patients with right-sided ischemic stroke, although ANOVA did not show significant differences between immune response values as a function of stroke subtypes. CONCLUSIONS: We identified an association between stroke laterality and immunoregulatory response in patients with acute ischemic stroke. Left-sided stroke may be considered as a direct risk factor for infectious disease or immune deficits and should attract special attention. However, these preliminary results need be confirmed by controlled studies.


Asunto(s)
Isquemia Encefálica/inmunología , Corteza Cerebral/inmunología , Lateralidad Funcional/fisiología , Sistema Inmunológico/fisiología , Tolerancia Inmunológica/inmunología , Accidente Cerebrovascular/inmunología , Enfermedad Aguda , Adulto , Anciano , Isquemia Encefálica/sangre , Isquemia Encefálica/fisiopatología , Proteína C-Reactiva/inmunología , Proteína C-Reactiva/metabolismo , Corteza Cerebral/irrigación sanguínea , Corteza Cerebral/fisiopatología , Estudios de Cohortes , Femenino , Humanos , Huésped Inmunocomprometido/inmunología , Recuento de Leucocitos , Masculino , Persona de Mediana Edad , Neuroinmunomodulación/fisiología , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Factores de Riesgo , Accidente Cerebrovascular/sangre , Accidente Cerebrovascular/fisiopatología
5.
Curr Med Chem ; 12(24): 2915-21, 2005.
Artículo en Inglés | MEDLINE | ID: mdl-16305479

RESUMEN

The loss of cholinergic neurons, particularly in the forebrain, plays an important role in the pathophysiology of Alzheimer's disease (DAT). This concept has lead to the effective treatment of DAT by means of acetylcholine (Ach) esterase inhibitors. G-protein-coupled muscarinic acetylcholine receptors (mAchR) are classified in 5 subtypes, the M1 receptor stimulation and M2 inhibition being especially associated with cognitive skills. Modified cerebral muscarinic receptor profiles in patients with Alzheimer's disease in addition to loss of Ach releasing neurons help us to understand the pathophysiology of dementia and offer potential therapeutic approaches. Specific agonists and antagonists of muscarinic receptors are discussed as possible treatment options in DAT. Experimental results postulate a positive long lasting modulation of the pathological neuronal protein pattern in addition to their cholinomimetic effect.


Asunto(s)
Enfermedad de Alzheimer/fisiopatología , Receptores Muscarínicos/fisiología , Enfermedad de Alzheimer/tratamiento farmacológico , Humanos , Modelos Biológicos , Estructura Molecular , Agonistas Muscarínicos/química , Agonistas Muscarínicos/uso terapéutico , Antagonistas Muscarínicos/química , Antagonistas Muscarínicos/uso terapéutico , Receptores Muscarínicos/clasificación , Transducción de Señal/efectos de los fármacos , Transducción de Señal/fisiología
6.
Acta Physiol Hung ; 92(2): 139-46, 2005.
Artículo en Inglés | MEDLINE | ID: mdl-16268051

RESUMEN

Nineteen healthy volunteers were exposed to a standardized exercise test at sea level (SLa), at an altitude of 1700 m before (1700a) and after a moderate 10-day mountain training (1700b), with a final control four weeks later at sea level (SLb). Vital signs, blood lactate and arterial oxygen saturation were determined prior, during or after the exercise test. Whereas systolic blood pressure and heart rate at rest did not change substantially, diastolic blood pressure decreased at the final control (SLb, p<0.05) and oxygen saturation was significantly lower at 1700 m (1700a, 1700b, p<0.01). Lactate at rest increased from 1.16 (SLa) to 1.97 (1700a) mmol/l after acute exposure followed by a slight reduction after adaptation (p<0.05). The mean maximum lactate levels were as follows: 6.03, 10.56, 6.22 and 8.75 (p<0.01). The mean maximum performance increased during the study (225.6, 223.3, 231.6, 248.1 Watt, p<0.01). Lactate versus workload curves did not show a marked shift to the right. No significant changes of maximum heart rates during the exercise test were found. In conclusion, a sojourn at 1700 m provokes an increase of lactate levels with subsequent reduction after acclimatization and has a significant positive impact on the mean maximum performance after moderate mountain training.


Asunto(s)
Aclimatación/fisiología , Altitud , Prueba de Esfuerzo/métodos , Frecuencia Cardíaca/fisiología , Ácido Láctico/sangre , Adulto , Presión Sanguínea/fisiología , Femenino , Humanos , Masculino
7.
Acta Psychiatr Scand ; 112(3): 167-72, 2005 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-16095470

RESUMEN

OBJECTIVE: The aim of this review is to summarize all data on suicidal behaviour reported in the Bible and to discuss basic implications for medical ethical positions. METHOD: All books of the Jerusalem Bible, including the apocrypha accepted in the Catholic canon, were searched for all cases of suicide, attempted suicide and suicidal ideation clearly identifiable as such. RESULTS: The Bible including the apocrypha reports about 10 completed suicides and 11 cases of suicide attempt or ideation. The Bible considers human life as a divine gift but suicide per se is neither condemned nor approved. Those suffering from suicidal thoughts are treated with respect and support is offered. CONCLUSION: Theological teaching on suicide was influenced for centuries by the biased negative opinion of the early fathers of the church and scholastic savants, but these opinions are not substantiated by a thorough reading of the Bible.


Asunto(s)
Biblia , Investigación Empírica , Suicidio/psicología , Encuestas y Cuestionarios , Humanos , Intento de Suicidio/psicología , Teología
8.
Nagoya J Med Sci ; 67(3-4): 93-9, 2005 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-17375475

RESUMEN

The objective of our study was to assess the correlation of routine neuropsychological test results in elderly patients referred to a gerontopsychiatric ward. MMSEs, Clocktests (CT) and SKTs were performed in 94 patients (Age: Median = 74 ys, Range = 54-89 ys; 64 f, 30 m; MMSE < 25:45 and MMSE > 25:37) with mild to moderate dementia and evaluated retrospectively. Linear and multiple regression was used. The scores of all 3 tests used were reciprocally correlated (p < 0.05). Multiple regression analysis showed a maximum correlation of 0.87 and marked standardized beta values, if SKT was chosen as dependent variable. In conclusion, results of SKT, CT or MMSE in patients with dementia showed marked pairwise or multiple correlations and therefore it is not necessary to include more than two reliable tests in clinical psychogeriatric studies.


Asunto(s)
Demencia/psicología , Pruebas Neuropsicológicas/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Demencia/patología , Demencia/fisiopatología , Femenino , Evaluación Geriátrica/métodos , Humanos , Modelos Lineales , Masculino , Escala del Estado Mental/estadística & datos numéricos , Persona de Mediana Edad , Reproducibilidad de los Resultados
9.
Dtsch Med Wochenschr ; 129(51-52): 2788-9, 2004 Dec 17.
Artículo en Alemán | MEDLINE | ID: mdl-15605316

RESUMEN

The documentation of the normal psychiatric interview has been omitted in the ICD 10 classification. Particularly, psychiatric consultants have to deal with the practical problem of adequate classification of patients with normal psychopathology. To use unspecific codes or to omit the coding of the findings are no suitable solutions. Future revision of the ICD 10 classification should integrate the normal psychiatric interview.


Asunto(s)
Entrevistas como Asunto , Relaciones Médico-Paciente , Psiquiatría/métodos , Humanos
10.
Acta Physiol Hung ; 91(1): 67-72, 2004.
Artículo en Inglés | MEDLINE | ID: mdl-15334832

RESUMEN

Metoprolol is a widely used beta1-selective beta-blocker in hypertension and tachycardia. The influence on vital signs at rest and during ergometry (exercise heart rate or blood pressure, effect areas above baseline) was investigated in a pilot study with 18 healthy volunteers (mean age 29.1 years) by means of multiple and pairwise correlation analysis. At rest, the difference between predose and day 5 values were not associated with anthropometric characteristics. During ergometry for weight and height significant negative correlations were found corresponding to marked beta-values in the multiple regression models. Therefore heart rate decreases less markedly in slim persons which should be taken into consideration in exercise tests during metoprolol intake.


Asunto(s)
Antagonistas Adrenérgicos beta/farmacología , Presión Sanguínea/efectos de los fármacos , Prueba de Esfuerzo , Frecuencia Cardíaca/efectos de los fármacos , Metoprolol/farmacología , Antagonistas Adrenérgicos beta/farmacocinética , Adulto , Antropometría , Área Bajo la Curva , Presión Sanguínea/fisiología , Estatura/fisiología , Peso Corporal/fisiología , Femenino , Frecuencia Cardíaca/fisiología , Humanos , Masculino , Metoprolol/farmacocinética , Proyectos Piloto , Análisis de Regresión
13.
Nagoya J Med Sci ; 66(1-2): 31-8, 2003 May.
Artículo en Inglés | MEDLINE | ID: mdl-12848419

RESUMEN

The present study was designed to investigate the effects of a cross-choking-technique commonly used in Judo on visual acuity. In 156 Judokas, experienced in competition, visual acuity was examined before and after choking (Juji-Jime). The average age of the 46 female and 110 male subjects was 22.8 years (standard deviation 10.5 years). In all examined grades of distance (infinite, 0.55 m and 0.4 m), eye tests showed an improvement of visual acuity after choking on a highly significant scale. In quantitative terms, vision the far sight range was optimized more clearly than in the close ranges. The following mechanisms are discussed as possible causes of the present results: an increase of blinking frequency induced by stress, an optimized tear film covering the cornea, a stenopaeic gap induced by improved blinking, pupillomotor alterations and an improved cerebral processing of visual signals and information. From an evolutionary-biologic perspective, the benefit of this psychophysiological mechanism might consist in an improvement of visual acuity in moments of danger, approaching from a distance and, thus, better chances of survival.


Asunto(s)
Artes Marciales , Agudeza Visual , Adolescente , Adulto , Obstrucción de las Vías Aéreas/fisiopatología , Niño , Femenino , Humanos , Japón , Masculino , Modelos Biológicos
14.
Int J Clin Pract ; 57(2): 147-9, 2003 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-12661802

RESUMEN

There is no generally accepted treatment for tardive dyskinesia following intake of neuroleptics. Many compounds with effects on serotonine, GABA, cholinergic or dopamine receptors have been clinically useful. We report on a 71-year-old female patient suffering from orofacial tardive dyskinesia after treatment with haloperidol, which did not respond to monotherapy with antidyskinetic drugs. The syndrome disappeared almost completely within two weeks after a multidrug approach consisting of tetrabenazine, olanzapine and tiapride. A combination of antidyskinetic drugs should be considered in patients with severe tardive dyskinesia.


Asunto(s)
Antidiscinéticos/uso terapéutico , Antipsicóticos/uso terapéutico , Discinesia Inducida por Medicamentos/tratamiento farmacológico , Pirenzepina/análogos & derivados , Anciano , Antidiscinéticos/efectos adversos , Antipsicóticos/efectos adversos , Benzodiazepinas , Quimioterapia Combinada , Discinesia Inducida por Medicamentos/etiología , Femenino , Haloperidol/efectos adversos , Humanos , Olanzapina , Pirenzepina/uso terapéutico , Tetrabenazina/uso terapéutico , Clorhidrato de Tiapamilo/uso terapéutico , Resultado del Tratamiento
17.
Versicherungsmedizin ; 54(4): 176-8, 2002 Dec 01.
Artículo en Alemán | MEDLINE | ID: mdl-12491567

RESUMEN

2,825 cases of sudden deaths (2,669 men, 156 women) in sports-clubs between 1981 and 1999 were evaluated retrospectively by means of the cosinor method in order to detect a circannual distribution of occurrence. Deaths due to cardiovascular and traumatic events were additionally studied with regard to seasonal differences of frequency. The number of sudden deaths per month during a period of 19 years could be significantly fitted to a cosine model with a maximum in June, the absolute maximum value being observed in May (n = 317). In particular, accidents were more frequently found in spring and summer.


Asunto(s)
Muerte Súbita/epidemiología , Estaciones del Año , Deportes/estadística & datos numéricos , Adolescente , Adulto , Estudios Transversales , Muerte Súbita/etiología , Femenino , Alemania/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos
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