Survival after lung transplantation of cystic fibrosis patients infected with Burkholderia cepacia complex.

Within the Burkholderia cepacia complex (Bcc), B. cenocepacia portends increased mortality compared with other species. We investigated the impact of Bcc infection on mortality and re-infection following lung transplant (LT). Species designation for isolates from Bcc-infected patients was determined using 16S rDNA and recA gene analyses. Of 75 cystic fibrosis patients undergoing LT from September 1992 to August 2002, 59 had no Bcc and 16 had Bcc (including 7 B. cenocepacia) isolated in the year before LT. Of the latter, 87.5% had Bcc recovered after transplantation, and all retained their pretransplant strains. Survival was 97%, 92%, 76% and 63% for noninfected patients; 89%, 89%, 67% and 56% for patients infected with Bcc species other than B. cenocepacia; and 71%, 29%, 29% and 29% for patients with B. cenocepacia (p = 0.014) at 1 month, 1 year, 3 years and 5 years, respectively. Patients infected with B. cenocepacia before transplant were six times more likely to die within 1 year of transplant than those infected with other Bcc species (p = 0.04) and eight times than noninfected patients (p < 0.00005). Following LT, infection with Bcc species other than B. cenocepacia does not significantly impact 5-year survival whereas infection with B. cenocepacia pretransplant is associated with decreased survival.

Coordination dynamics of circulatory and respiratory rhythms during psychomotor drive reduction.

A 0.15-Hz rhythm band in cutaneous blood oscillations in awake human subjects was studied in cardiovascular-respiratory time series of five subjects relaxing naïvely or practicing hypnoid relaxation (autogenic training, or AT). Time series analysis used nonlinear algorithms, time-frequency distribution (TFD), postevent scan (PES) method, and linear fast Fourier transform (FFT) algorithm. This 0.15-Hz rhythm band caused phase synchronization with respiration at 1:2, 1:1, and 2:1 integer number (n/m) ratios for extended periods. During wave epochs, the 0.15-Hz rhythm band was amplified, causing the 0.15-Hz rhythm band to also appear in interbeat intervals and arterial blood pressure fluctuations. If phase synchronization of the 0.15-Hz rhythm band with respiration was established at a 1:1 integer number ratio, it was maintained and resulted in consensualization of all cardiovascular-respiratory oscillations at this frequency. Simultaneous cardiovascular and respiratory oscillations at about 0.1 Hz did not affect the appearance of the 0.15-Hz rhythm band in the photoplethysmography (PPG) signal. Recent evidence suggests the emergence of the 0.15-Hz rhythm band and n/m phase synchronization to result from nonequilibrium phase transitions operational in the network of lower brainstem neurons and associated parasympathetic neuronal effectors. These findings corroborate our notion of the 0.15-Hz rhythm band as a marker of the trophotropic mode of operation.

[Psychological trauma in trauma medicine--the current status of psychological management of trauma victims in Germany]. / Psychotraumatologie in der Unfallmedizin--Zum Stand der psychischen Versorgung von Unfallopfern in Deutschland.

A clinically significant amount of accident victims display psychological disorders as a reaction to the trauma. Outcome studies on multiple trauma emphasize that life quality following severe accidental injury is influenced by early diagnosis and treatment of psychic co-morbidity. In a nationwide survey concerning the state of the art in in-patient treatment of injury patients conducted in Germany, every surgical ward was contacted and physicians were asked about their standard procedures of detecting and treating psychotraumatic complications. The results of the survey indicate that surgeons pay close attention to signs of psychological comorbidity and have good basic knowledge of psychotraumatic disorders. Nevertheless, there are structural deficiencies caused by the fact that only a few wards have staff specially trained in psychotraumatological care. Only a minority of patients is treated for psychotraumatic symptoms. In view of the high prevalence rates for psychotraumatic disorders in the aftermath of severe accidental injuries, the article discusses the need for psychic diagnosis and support as well as the necessary cooperative structures required in the model of Integrative Posttraumatic Acute Care.

[Concepts of anthropological medicine]. / Konzepte der anthropologischen Medizin.

Medical anthropology is the teaching of the ill human being, of being ill; anthropological medicine is the realization of this teaching in practice. This concept was first developed and assessed in the "Gestaltkreis" and in the Pathosophy (44), in Medicine in Motion (39), and in the Bipersonality (10). The four most important concepts are represented, which have their origin and aim in anthropological medicine: anthropological medicine, Balint-work, family-oriented medicine, and salutogenesis. These concepts are exemplified in the Aachen psychosomatic liaison model, the Aachen Balint cooperation model, and the Aachen model of psychosomatic care. We wish to portray the meaning of these resources for the medicine of the future, since they have proven to be effective, cost-saving, and easy to be handled. In the latter part of our presentation, we will document this point with a pilot study conducted in Israel and in our own clinic in Aachen.

[Psychosocial stress and utilization of medical services after coronary bypass operation]. / Psychosoziale Belastung und Inanspruchnahme medizinischer Leistungen nach koronarer Bypassoperation.

This study examines the relationship between psychosocial stress and social support before coronary surgery and the amount of health care utilization in a sample of 136 patients during postoperative hospitalization. The aim of the study is to test the hypothesis that there is a correlation between a high psychosocial stress profile and the utilization of medical care (so called high utilizers). The sample consists of 80.7% men and 19.3% women aged between 31 and 78 years (mean 64; sd 9.1). In this first data analysis psychosocial impact is assessed by anxiety, depression and social support (HADS-D, F-SOZU). Detailed somatic factors concerning severity of the illness, inpatient course and the utilization of health care (medication, technical examinations, consultations) are assessed by means of a documentation system. With regard to anxiety, depression and social support the sample is located within the normal range. In contrast to our expectations the results show that high scores of anxiety and depression as well as a low level of emotional support do not correlate significantly with an increased use of medication, the number of consultations and technical examinations. Furthermore no correlation has been found between the length of hospitalization and preoperative comorbidity as compared to the mentioned psychosocial stress variables. On the other hand the data analysis showed that about 30% of the patients during the postoperative period utilize about half of the total amount of the different medical treatments. In the postoperative period these high utilizers cannot be distinguished from the other patients, neither by sociodemographic variables nor by means of an increased psychosocial stress or severity of illness.

Medical findings and predictors of long-term physical outcome in anorexia nervosa: a prospective, 12-year follow-up study.

BACKGROUND: Patients with anorexia nervosa (AN) run a high risk of becoming chronically ill and of dying. In the acute phase of their illness they present with numerous physical and laboratory abnormalities. However, little is known about the long-term prognostic value of these findings or about the medical morbidity in large samples of consecutively treated patients in the long-term. METHODS: We evaluated 84 consecutive female patients with AN who were studied again an average of 11.9 years later. The ability of some of the laboratory data obtained at the initial examination to predict a fatal or chronic course was analysed by discriminant and multiple regression analyses. RESULTS: Abnormally low serum albumin levels (< or = 36 g/l) and a low weight (< or = 60% of average body weight) at the initial examination were variables best able to predict a lethal course. In addition, high serum creatinine and uric acid levels predicted a chronic course. Most of the initial abnormal laboratory findings were reversible with a normal food intake. At a 12-year follow-up 67% of the chronic anorexic patients and 27% of those in the good/intermediate outcome group (compared to 8% morbidity in normal controls) presented with medical co-morbidity, in particular osteoporosis and renal disease. The standardized mortality ratio was 9.6. CONCLUSIONS: Laboratory findings obtained at the initial examination may be helpful in predicting a fatal or chronic course of AN. An evaluation of the long-term outcome of eating disorders should include an assessment of the medical co-morbidity.

[Treatment and responsibility ethics in dealing with severely ill and dying patients--discussion stimulation]. / Handlungs- und Verantwortungsethik im Umgang mit Schwerkranken und Sterbenden--Anregungen zur Diskussion.

As we are approaching the end of this century, the implicit axiom which addresses the question of responsibility within the new territory of collaborative medical practising that was entered with high-tech medicine, has still to be put into new places. As for ethical theories, there is no such thing as a no mans land. All reflections will reach sooner or later the limits of language, and so will reflections on the ethics of action and the ethics of responsibility. According to Ludwig Wittgenstein we call running up against the limits of language ethics. In clinical psychosomatic medicine interacting with those who are severely ill and those who are dying everything is enmeshed: religion and philosophy, medicine, technology and language. For the ethics of action this is represented e.g. by a collective search for a consensus in clinical-psychosomatic case conferences. By the reassurance through others we can relate when being active to two imperatives by H.Y. Förster (1984): firstly, if you wish to understand, learn to act! Secondly, act always in a fashion that will open up new possibilities. In ethics of responsibility we can relate to the inheritance of monotheistic religions, upon the God of Israel and to tolerance.

[Outpatient or inpatient treatment? Analysis of indications in psychosomatic medicine]. / Ambulant oder stationär? Analyse der Indikationsentscheidungen in der Psychosomatik.

This is an empirical study of the criteria which indicate inpatient or outpatient treatment. The two essential elements to the process of indication are, firstly, the recommendation of the outpatient clinic conference and, secondly, the preference of the patient. A specially developed test inventory was used for the statistical evaluation of one hundred case decisions of our outpatient clinic conference. As expected, the indication is not reduced to a one-dimensional schema but is the result of a complex process. Nonetheless, several characteristics can be identified, such as the length of the illness, any psychosomatic pretreatment, the recommendations of the first diagnostician and the patient's own wish for a particular type of treatment. In sum, this study is an example of a descriptive analytical approach for the differential research on indication. Such an approach could be of importance when discussing how to control quality of psychosomatic and psychotherapeutic treatments.

Superoxide production by human eosinophils can be inhibited in an agonist-selective manner.

This paper focuses on eosinophil activation and its selective inhibition. Superoxide anion (O2-) production by human eosinophils, an indicator of their activation, was induced by a variety of activators. Several compounds which are known to inhibit protein kinase C (staurosporine, K252a, sphingosine) inhibited O2- production induced by phorbol ester (PMA) but failed to inhibit O2- production induced by IgG coupled to Sepharose beads. Inhibition of O2- production by other agents (plasma-activated zymosan, fMLP, and leukotriene B4 (LTB4), was intermediate. By contrast, wortmannin, a compound which has been previously reported to inhibit O2- production in neutrophils via a protein kinase-independent pathway, potently inhibited O2- production in eosinophils which had been activated by IgG and by Platelet-Activating Factor but was virtually inactive against PMA-induced O2- production. Taken together, the results indicate that, as a minimum, there must be two pathways of induction of O2- production in eosinophils. Moreover, the intermediate levels of inhibition in cells which had been activated with serum-activated zymosan, FMLP, and LTB4 suggest that these agents may either be acting via both of these pathways or that yet other pathways may exist.

[Anxiety, the heart patient and the organization of psychosomatic medicine]. / Die Angst, der Herzkranke und die Organisation der Psychosomatik.

Using a simplified biopsychosocial model, it is possible to outline several aspects of the partly real, partly unreal anxieties of the patient with heart disease, also in connection with defense strategies. Questions regarding the formal introduction of psychosomatic medicine are raised exemplary findings in the area of heart transplants, resuscitation and denial aspects are mentioned. The medical-care system and the patient complement each other in perception and strategic handling of anxiety, partly in stabilized, partly in destabilized ways. The development of a future organisation of psychosomatic medicine must differentiate between consultant services, liaison services, working groups and independent departments. As in the analytical-therapeutical situation, the understanding of the function of defense strategies is the prerequisite to overcome the symptom, which - experienced or not experienced, expressed or not expressed - means anxiety both for patient as well as for those who work in institutions.

[Differentiation of the long-term effects of inpatient psychosomatic therapy of patients with anorexia nervosa]. / Differenzierung der Langzeitwirkungen einer stationären psychosomatischen Therapie von Anorexia-nervosa-Patienten.

In a catamnestic study of 103 anorexia nervosa patients treated at the university medical clinic in Heidelberg between 1970 and 1980, 51 patients were personally evaluated after 3, 6 years using a multi-dimensional system of criteria that covered 30 different symptom areas. There was a clear improvement with regard to constipation, vomiting, and the abuse of laxatives, various laboratory parameters, psychic symptoms, and vocational situation. Secondary amenorrhea, psychic suffering, and overly strong emotional ties to the family, however, were still found among two-thirds of the patients. Long-term success of treatment was found to correlate closely with an early age both for the onset of the disorder and for the beginning of treatment. Reduction of physical symptoms by the time of the post-examination was closely related to the extent of the family therapy carries out. In general, males appeared to benefit from treatment more than did female patients. Cluster analysis revealed that of four groups of patients studied, only one group could be called healthy; anorexia nervosa symptoms persisted to varying degrees in the other groups. Psychological testing using the PEF brought to light the following relationships: The greater the degree of illness at the time of the catamnestic study, the stronger the patient's tie to his/her own family, the greater the concern with physical appearance, the more achievement oriented, and the greater the aversion to playful activity.

[Changes in the cartilage of the rat knee joint caused by running stress--a contribution to arthrosis research]. / Veränderungen des Rattenkniegelenkknorpels unter dem Einfluss von Laufbelastung--ein Beitrag zur Arthroseforschung.

After running strain of Wistar-rats it is provable a small nonsignificant increase of the mean chondrocyte number per tissue area in the weight bearing cartilage of the medial femur condylus. Little foci of fibrillation and superficial localisated areas with loss of metachromasia are also visible in the cartilage. This tissue alterations appearing typical for a early phase of osteoarthrosis.

[Side effects of nonsteroidal and steroidal anti-inflammatory drugs on cartilage metabolism--facts from research and practice]. / Nebenwirkungen nichtsteroidaler und steroidaler antientzündlicher Pharmaka auf den Knorpelstoffwechsel--Erkenntnisse aus Forschung und Praxis.

On the base of experiments with laboratory animals and in the clinical practice existing results confirmed that steroidal and any non-steroidal antiphlogistic drugs have antianabolic and catabolic side effects on the connective tissue--and special articular cartilage metabolism. Biochemical and pharmacological investigations have shown that any of these drugs excert inhibitory effects on synthesis special of proteoglycans of ground substance in the cartilage. The use of such drugs in therapy of osteoarthrosis should be short-timed and limited to the treatment of patients with a so called activation of osteoarthrosis. For the long-term pharmacotherapy of osteoarthrosis should be used such antiphlogistic drugs without inhibitory side effects on the cartilage metabolism. The risk in occurrence of progressive articular cartilage damage in the therapy, special long-term therapy, with antiphlogistic drugs and the existence of pathological metabolic changes as a favourable factor for aseptic osteochondronecroses respectively as praearthrotic deformity is probably greater as in normal metabolic situations. The application of steroidal antiphlogistic drugs lead initial to good therapy results with reference to objective and subjective disease signs. These drug-therapy should be succombed an account of the severe negative side effects on cartilage metabolism (risk of osteochondronecrosis) a strict diagnosis and limited for the therapy of patients with rheumatoid arthritis (acute phase).

[Clinical psychosomatics: blood pressure regulation. Problem status from the systems theory viewpoint]. / Klinische Psychosomatik: Blutdruckregulation. Problemstellung aus systemtheoretischer Sicht.

The systemic aspect which integrates the family as a whole to the diagnostic and therapeutical process becomes more and more important in Clinical Psychosomatics. The development of a sound relationship between the hypertensive patient and his physician and the degree to which the patient is able to accept the drug treatment seem to be influenced not only by the personality structure of the individual patients but also by the interaction pattern of the whole family. The possible influence exerted by the special interaction patterns of the family on the chronification and/or replication of essential hypertension is shown by 1) the obvious negative non-verbal communication behaviour 2) the low intensity of verbal communication and 3) the high need of control, the setting of rigid bounds and a great inflexibility to solve the existing problems.

[Psychosomatic differentiation in patients following myocardial infarct]. / Zur psychosomatischen Differenzierung von Patienten nach Herzinfarkt.

An experimental study, based upon clinical impressions and theoretical considerations toward a differentiation of patients having suffered cardiac infarction, was employed to investigate the question of differentiation with regard to specific psychosomatic therapy. In conformity with other investigations it was observed that the patients with cardiac infarction could be classified into three groups. The theoretical considerations combined with the results from the experiments were the basis for the recommendation of specific therapeutic measures for each of the three groups: athletic group therapy for the more impulsive patients, single and group therapy for patients with regressive tendencies, combined group therapy in autogenetic training for sociable patients.