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1.
Herzschrittmacherther Elektrophysiol ; 30(2): 225-228, 2019 Jun.
Article in German | MEDLINE | ID: mdl-31049655

ABSTRACT

The therapy for heart failure in patients with uncompromised systolic ventricular function (HfpEF) is still challenging because there is an obvious lack of effective therapy options. Several of these particular patients are additionally presenting atrioventricular (AV) block. In these patients HIS bundle pacing could be a hopeful therapy strategy due to the option of an AV resynchronisation as illustrated in the following case.


Subject(s)
Atrioventricular Block , Bundle of His , Heart Failure , Cardiac Pacing, Artificial , Electrocardiography , Humans , Stroke Volume
2.
Nervenarzt ; 84(1): 55-64, 2013 Jan.
Article in German | MEDLINE | ID: mdl-22215217

ABSTRACT

BACKGROUND: The number of schizophrenic patients admitted to forensic hospitals according to section 63 of the German Criminal Code has increased continuously over the past years. Prior to admission to a forensic ward, two thirds of schizophrenic patients have been admitted to a general psychiatric institution at least once. Among other factors, forensic admission is seen as a consequence of insufficient pretreatment in general psychiatry. This study aims to identify differences regarding the history of treatment of forensic and general psychiatric patients diagnosed with schizophrenia. METHOD: The matched samples include 72 male patients from forensic wards and 72 male patients from general psychiatry diagnosed with schizophrenia. The history of psychiatric treatment was reconstructed by interviewing the patients as well as the outpatient psychiatrists and by analyzing these patients' medical records. RESULTS: Both groups showed similar risk factors, however, forensic patients had a higher number of previous convictions and were convicted more often for violent offences. Furthermore, the data indicate that forensic patients are less integrated into psychiatric care and showed a lower rate of treatment compliance prior to admission to a forensic ward. CONCLUSIONS: The results provide support for the arrangement of an intensive outpatient aftercare, especially for schizophrenic patients with comorbid substance abuse disorders and previous convictions for violent offences.


Subject(s)
Commitment of Mentally Ill , Patient Readmission/statistics & numerical data , Schizophrenia/epidemiology , Schizophrenia/rehabilitation , Schizophrenic Psychology , Adult , Commitment of Mentally Ill/legislation & jurisprudence , Comorbidity , Crime/legislation & jurisprudence , Crime/psychology , Crime/statistics & numerical data , Cross-Sectional Studies , Diagnosis, Dual (Psychiatry) , Germany , Humans , Interview, Psychological , Male , Middle Aged , Patient Compliance/psychology , Patient Compliance/statistics & numerical data , Patient Readmission/legislation & jurisprudence , Risk Factors , Schizophrenia/diagnosis , Substance-Related Disorders/diagnosis , Substance-Related Disorders/epidemiology , Substance-Related Disorders/psychology , Substance-Related Disorders/rehabilitation , Treatment Outcome , Violence/legislation & jurisprudence , Violence/psychology , Violence/statistics & numerical data , Young Adult
3.
Gene Ther ; 17(11): 1372-83, 2010 Nov.
Article in English | MEDLINE | ID: mdl-20535218

ABSTRACT

Several vaccination trials are evaluating the modified vaccinia virus Ankara (MVA) as a delivery vector in various clinical settings. In this paper, we present the reevaluation of a therapeutic vaccination trial in human immunodeficiency virus (HIV)-1-infected individuals treated with highly active antiretroviral therapy using MVA-expressing HIV-1 nef. Immunogenicity of MVA-nef was assessed using multicolor flow cytometry. Vaccine-induced polyfunctionality and proliferative capacity, which are associated with nonprogressive HIV-1 infection, were detectable by combining two immune assays. By means of short-term polychromatic intracellular cytokine staining, we observed a significant increase in polyfunctional Nef-specific CD4 T cells expressing interferon-γ, interleukin (IL)-2 and CD154 after vaccination, whereas changes in the quality of CD8 T-cell response could not be observed. Only the additional use of a long-term polychromatic Carboxyfluorescein succinimidyl ester (CFSE)-based proliferation assay revealed vaccine-induced Nef-specific CD8, as well as CD4 T cells with proliferative capacity. The correlation between vaccine-induced IL-2 production by CD4 T cells and the increase in proliferating Nef-specific CD8 T cells suggests a causal link between these two functions. These results highlight the importance of combining sophisticated immunomonitoring tools to unravel concealed effects of immunological interventions and support the use of the poxvirus-derived MVA vector to stimulate highly functional HIV-1-specific T-cell responses. However, the clinical benefit of these functional T cells remains to be determined.


Subject(s)
AIDS Vaccines/immunology , CD4-Positive T-Lymphocytes/immunology , CD8-Positive T-Lymphocytes/immunology , HIV Infections/immunology , HIV-1/immunology , Antiretroviral Therapy, Highly Active , Cell Proliferation , Genetic Vectors/genetics , HIV-1/genetics , Humans , Immunoassay , Interferon-gamma/metabolism , Lymphocyte Activation/genetics , Lymphocyte Activation/immunology , Vaccines, DNA/immunology , Vaccinia virus/genetics , nef Gene Products, Human Immunodeficiency Virus/genetics , nef Gene Products, Human Immunodeficiency Virus/immunology
4.
Nervenarzt ; 81(9): 1117-24, 2010 Sep.
Article in German | MEDLINE | ID: mdl-20076938

ABSTRACT

We assessed data concerning demographic, criminological and psychiatric characteristics of all patients with disorders of the schizophrenic spectrum, who were detained in the forensic psychiatric departments of Mecklenburg-West Pomerania, a federal state of Germany, in 2007. Of the 202 patients of both clinics, 45 suffer from a disorder of the schizophrenic spectrum assessed in ICD-10: F20-F29, which corresponds to 22%. This level is markedly lower than in other regions of Germany. But similarly to results assessed in other federal states of Germany and in Austria there is a high rate of pre-treatment in general psychiatric institutions. It remains a relevant task for general psychiatry to establish adequate interventions for hostile and violent psychotic patients, especially for those with a double diagnosis, history of delinquency and social decline.


Subject(s)
Commitment of Mentally Ill/statistics & numerical data , Forensic Psychiatry/statistics & numerical data , Hospitals, Psychiatric/statistics & numerical data , Psychotic Disorders/diagnosis , Psychotic Disorders/epidemiology , Adult , Female , Germany/epidemiology , Humans , Male , Middle Aged , Risk Assessment , Risk Factors , Young Adult
5.
Fortschr Neurol Psychiatr ; 77(2): 91-6, 2009 Feb.
Article in German | MEDLINE | ID: mdl-19221971

ABSTRACT

The aim of our study was to determine the development of the number of patients with schizophrenia in detention (section 63 German Penal Code) in North Rhine-Westphalia and the characterization of these patients. Patients with schizophrenia are examined, by using a standardized questionnaire answered by the attending psychiatrist or psychologist (n = 531). During the last 12 years the number of patients with schizophrenia in forensic-psychiatric hospitals has increased three times, whereas the number of patients with other diagnoses heightened only twofold. The patients with schizophrenia showed high rates of psychiatric comorbidities (substance disorders 73.9 %, personality disorders 17.2 %), previous inpatient treatments (78.3 % with a mean of 7.5 stays) and previous convictions (63.4 %). Almost half of these convictions (46.6 %) were violent offences (e. g. assault, homicide). Possible explanations for this development are discussed.


Subject(s)
Hospitals, Psychiatric/statistics & numerical data , Insanity Defense/statistics & numerical data , Prisons/statistics & numerical data , Schizophrenia/epidemiology , Crime/statistics & numerical data , Germany/epidemiology , Hospitals, Psychiatric/legislation & jurisprudence , Humans , Juvenile Delinquency/statistics & numerical data , Length of Stay , Mental Disorders/complications , Mental Disorders/psychology , Personality Disorders/psychology , Prisons/legislation & jurisprudence , Schizophrenia/diagnosis , Schizophrenic Psychology , Violence/statistics & numerical data
6.
Herz ; 24(2): 126-31, 1999 Apr.
Article in English | MEDLINE | ID: mdl-10372298

ABSTRACT

Chest pain following successful percutaneous coronary interventions is a common problem. Although the development of chest pain after coronary interventions may be of benign character, it is disturbing to patients, relatives and hospital staff. Such pain may be indicative of acute coronary artery closure, coronary artery spasm or myocardial infarction, but may also simply reflect local coronary artery trauma. The distinction between these causes of chest pain is crucial in selecting optimal care. Management of these patients may involve repeat coronary angiography and additional intervention. Commonly, repeat coronary angiography following percutaneous transluminal coronary angioplasty (PTCA) in patients with chest pain demonstrates widely patent lesion sites suggesting that the pain was due to coronary artery spasm, coronary arterial wall stretching or was of non-cardiac origin. As reported by the National Heart, Lung and Blood Institute PTCA Registry, 4.6% of patients after angioplasty have coronary occlusions, 4.8% suffer a myocardial infarction, and 4.2% have coronary spasm. The frequency of chest pain after new device coronary interventions (atherectomy and stenting) seems to be even higher. However, only the minority of patients with post-procedural chest pain have indeed an ischemic event. Therefore, the vast majority of patients have recurrent chest pain without any signs of ischemia. There is some evidence that non-ischemic chest pain after coronary interventions is more common after stent implantation as compared to PTCA (41% vs. 12%). This may be due to the continuous stretching of the arterial wall by the stent as the elastic recoil occurring after PTCA is minimized. In conclusion, chest pain after coronary interventional procedures may potentially be hazardous when due to myocardial ischemia. However, especially after coronary stent placement, cardiologists must consider "stretch pain" due to the overdilation and stretching of the artery caused by the stent in the differential diagnosis. Clinically, it is, therefore, important to recognize that in addition to ischemia-related chest pain other types of chest pain do exist with cardiac origin.


Subject(s)
Angina Pectoris/etiology , Angioplasty, Balloon, Coronary , Chest Pain/etiology , Coronary Disease/therapy , Stents , Angina Pectoris/physiopathology , Angioplasty, Balloon, Coronary/instrumentation , Atherectomy, Coronary/instrumentation , Chest Pain/physiopathology , Coronary Disease/physiopathology , Coronary Vasospasm/diagnosis , Coronary Vasospasm/physiopathology , Coronary Vessels/physiopathology , Humans , Risk Factors
7.
Circulation ; 98(24): 2656-8, 1998 Dec 15.
Article in English | MEDLINE | ID: mdl-9851949

ABSTRACT

BACKGROUND: Chest pain frequently occurs without any signs of ischemia within the first 24 hours after coronary interventions. To test the hypothesis that this pain may be due to local vessel injury ("stretch pain"), we performed a prospective study enrolling patients after PTCA, stent implantation, or diagnostic coronary angiography alone. METHODS AND RESULTS: A total of 145 patients after coronary angiography were evaluated by a validated questionnaire for quantifying postinterventional chest pain within 24 hours. To detect myocardial ischemia, all patients were evaluated with a 12-lead ECG and cardiac isoenzymes immediately after the procedure and the morning after. After stent implantation, 21 of the 51 patients (41.2%) developed chest pain, compared with 4 of the 33 patients (12.1%) undergoing PTCA and 6 of the 61 patients (9.8%) with a diagnostic angiography (P<0.001). Of these 31 patients who developed chest pain, only 3 (9.7%) felt that the pain was similar to previously experienced angina pectoris. The minimal lumen diameter after intervention was significantly larger in the stent group than in the PTCA group (3.14+/-0.75 versus 1.95+/-0.67 mm; P<0. 001). No patient had changes in the ECG compared with before intervention, but 3 patients after stent implantation had a rise in cardiac isoenzymes. No other major adverse cardiac events occurred until discharge. CONCLUSIONS: Nonischemic chest pain develops in almost half of all patients undergoing stent implantation and seems to be related to vessel overexpansion caused by the stent in the diseased vessel segment.


Subject(s)
Chest Pain/etiology , Myocardial Ischemia/complications , Aged , Angioplasty, Balloon, Coronary/adverse effects , Arteries/injuries , Coronary Angiography , Coronary Vessels/injuries , Female , Humans , Male , Middle Aged , Pain Measurement , Prospective Studies , Single-Blind Method , Stents/adverse effects , Time Factors
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