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Journal Article 2009; 30(3): 409-413 PubMed PMID: 19855369 Citation  Keywords:  Activities of Daily Living, Aged, Dementia:drug therapy, Geriatric Assessment, Humans, Neuropsychological Tests, Psychiatric Status Rating Scales, Severity of Illness Index, Treatment Outcome,.   

BACKGROUND: An effort to share our many years of clinical experience.

OBJECTIVE: To predict the effectiveness of medication in advanced phases of dementia in the light of pharmaceutical economics and to find the most suitable alternative treatments.

METHODS: Use of 3 commonly available geriatric tests Mini-Mental State Examination (MMSE), Activity of Daily Living (ADL) and Instrumental Activity of Daily Living (IADL). Threshold values of these tests, after mathematical transformation to comparable values, enables calculation of the hypothetical Point of Reversibility Pr found on the range here called MEKO.

RESULTS: Estimated values of SD can be used to choose the most effective medical treatment.

CONCLUSION: Beyond the upper threshold of S(D), on the basis of the above mentioned method, continued medication is of dubious value....

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Journal Article 2009; 30(3): 363-367 PubMed PMID: 19855360 Citation  Keywords:  Aged, Cardiopulmonary Resuscitation:adverse effects, Critical Care, Female, Heart Arrest:mortality, Humans, Hypothermia, Induced, Intensive Care Units, Male, Middle Aged, Quality of Life, Retrospective Studies, Survival Rate, Treatment Outcome,.   

OBJECTIVES: Sudden circulatory arrest is most often of cardiac origin. Our aim was to evaluate circulatory arrest etiology and treatment strategies in patients after cardiopulmonary resuscitation (CPR) with persistent impairment of consciousness in relation to survival and the subsequent quality of life.

DESIGN: Retrospective analysis of patients after CPR treated according to the local protocol including mild hypothermia in the intensive cardiac care unit.

RESULTS: Over 2 years, we admitted 57 mechanically ventilated patients after CPR. 47 patients (82%) were resuscitated outside the hospital. In 33 patients (58%) the initial rhythm was ventricular fibrillation; in the remaining patients (42%) asystole/pulseless electrical activity. Urgent coronary angiography was performed in 36 patients and percutaneous coronary intervention in 25 of them. The admission APACHE II score was 32,4 +/- 3,4 with predicted mortality of 77,1%. The hospital survival rate was 54% and 47% of the patients were discharged home in a good state of health (Glasgow outcome score 4-5).

CONCLUSION: Our results suggest that comprehensive post-resuscitation care including therapeutic hypothermia and percutaneous coronary intervention in selected cases may have a positive impact on the prognosis of patients after CPR....

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Clinical Trial 2009; 30(3): 331-334 PubMed PMID: 19855355 Citation  Keywords:  Adult, Choline:immunology, Humans, Immunologic Factors:immunology, Lymphocyte Activation, Middle Aged, Multiple Sclerosis:diagnosis, Myelin Basic Protein:immunology, Peptide Fragments:immunology, Severity of Illness Index, Treatment Outcome,.   

: The efficacy of intravenous choline citrate infusions was investigated in 34 patients with multiple sclerosis (MS) by clinical evaluation and by monitoring of lymphocyte proliferation in vitro against fragments of myelin basic protein (MOG-35-55, MBP15-31, PLP 39-15) over a period of 12 weeks. Patients have been diagnosed with MS at least one year before entering the study and suffered from mild relapsing/remitting course to long-term chronic progressive disease. Twenty one patients exhibited positive lymphocyte proliferation to myelin fragments prior to treatment and were therefore selected for further studies. Choline citrate was administered with a dosage of 1200mg/ 2x week for a period of 3 months. This treatment resulted in a significant decrease of lymphocyte proliferation to neural fragments (MOG- 35-55, MBP15-31) in lymphocyte transformation test (LTT). There was no significant SI change of PLP Peptide (PLP 39-15) LTT found after treatment with choline citrate. During the 3 mo observation period, patients remained stable and no side-effects of the treatment were observed. In addition, some patients reported long-lasting improvement (less paresthesia and increase of muscle strength in lower extremities) which was demonstrated up to 3 years later. In one spectacular case a commercial pilot was able to return to duty again after treatment. This pilot was allowed back in to his position as a commercial flying cockpit member and is on duty for more than 4 yrs now....

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Journal Article 2009; 30(3): 284-299 PubMed PMID: 19855350 Citation  Keywords:  Cognitive Therapy, Exercise Therapy, Fatigue, Fatigue Syndrome, Chronic:therapy, Humans, Randomized Controlled Trials as Topic, Treatment Outcome,.   

: Benign Myalgic Encephalomyelitis (ME) / Chronic Fatigue Syndrome (CFS) is a debilitating disease which, despite numerous biological abnormalities has remained highly controversial. Notwithstanding the medical pathogenesis of ME/CFS, the (bio)psychosocial model is adopted by many governmental organizations and medical profes-sio-nals to legitimize the combination of Cognitive Behavioral Therapy (CBT) and Graded Exercise Therapy (GET) for ME/CFS. Justified by this model CBT and GET aim at eliminating presumed psychogenic and socially induced maintaining factors and reversing deconditioning, respectively. In this review we invalidate the (bio)psychosocial model for ME/CFS and demonstrate that the success claim for CBT/GET to treat ME/CFS is unjust. CBT/GET is not only hardly more effective than non-interventions or standard medical care, but many patients report that the therapy had affected them adversely, the majority of them even reporting substantial deterioration. Moreover, this review shows that exertion and thus GET most likely have a negative impact on many ME/CFS patients. Exertion induces post-exertional malaise with a decreased physical performan-ce/aerobic capacity, increased muscoskeletal pain, neurocognitive impairment, "fatigue", and weakness, and a long lasting "recovery" time. This can be explained by findings that exertion may amplify pre-existing pa-thophysiological abnormalities underpinning ME/CFS, such as inflammation, immune dysfunction, oxidative and nitrosative stress, channelopathy, defec-tive stress response mechanisms and a hypoactive hypothalamic-pituitary-adrenal axis. We conclude that it is unethical to treat patients with ME/CFS with ineffective, non-evidence-based and potentially harmful "rehabilitation therapies", such as CBT/GET....

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Case Reports 2008; 29(6): 871-873 PubMed PMID: 19112397 Citation  Keywords:  Abscess:complications, Anti-Bacterial Agents:therapeutic use, Cesarean Section, Female, Humans, Pregnancy, Pregnancy Complications, Infectious:drug therapy, Pregnancy Outcome, Treatment Outcome, Uterine Diseases:complications, Uterus:abnormalities, Young .   

: A 20 year old primigravida with a double uterus was admitted with a viable fetus in the right uterus and pus oozing from the left one. Management consisted of a regimen of intravenous antibiotics and intravaginal antibiotic tablets. Tocolysis was used to arrest imminent preterm labor. In the course of pregnancy IUGR was diagnosed. At 38 weeks of pregnancy a SGA baby boy of 2,440 g was delivered by cesarean section. The mother and the baby were discharged from the hospital in good general condition....

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Journal Article 2008; 29(6): 1038-144 PubMed PMID: 19112390 Citation  Keywords:  Acromegaly:blood, Adenoma:complications, Adult, Aged, Follow-Up Studies, Humans, Insulin-Like Growth Factor I:analysis, Male, Middle Aged, Pituitary Neoplasms:complications, Somatostatin:analogs & derivatives, Treatment Outcome,.   

OBJECTIVE: The aim of our study was to investigate the characteristics of acromegalic patients diagnosed at a tertiary University Hospital and to evaluate the results of the recommended treatment protocols.

PATIENTS AND METHODS: All our acromegalic patients were included (n=48; 27 women). Demographic, hormonal, visual and imaging data at diagnosis and during follow-up were recorded, as well as the treatments applied.

RESULTS: In 73.0% of the patients, acromegaly was due to a pituitary macroadenoma. From those under periodic surveillance, 68.2% underwent surgery and 36.4% had radiotherapy. At the time of the study 88.6% of the patients were receiving medical therapy, 28.2% of them as first-line treatment. Applying current criteria, only one patient was cured by surgery. Considering normal age and sex-matched concentrations of IGF-I as a control criteria, surgery resulted in disease control in 10% of the patients who had surgery, while medical treatment controlled the disease in 76.9% (P <0.05). Of those who receive medical therapy as first-line treatment, tumour size decreased in 45.5%, while in the rest no significant changes were observed during follow-up.

CONCLUSIONS: Not all centres obtain the results reported in the literature in terms of disease control and morbidity after surgical treatment of growth hormone-secreting tumours. It is possible that in some hospitals first-line medical treatment should be chosen, unless the patient has visual disturbances, as long as it is not clear that partial surgical removal of the tumour significantly improves response to medical therapy or reduces its costs....

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Journal Article 2008; 29(Suppl 1): 123-132 PubMed PMID: 19029877 Citation  Keywords:  Deep Brain Stimulation:adverse effects, Humans, Mental Disorders:therapy, Psychiatry, Treatment Outcome,.   

: Deep brain stimulation (DBS) is a reversible surgical procedure that involves stereotactic implantation of electrodes into the targeted brain regions, with a subcutaneously placed pulse generator powering the electrodes via one or two leads. The mechanism of action can be explained by the stimulation-induced modulation of impaired network activity. So far, the main use of DBS has been for neurological conditions, such as essential tremor, motor symptoms in Parkinson's disease, dystonia, epilepsy, and chronic pain. In psychiatry, case series and open studies indicate treatment efficacy of DBS in Gilles de la Tourette syndrome, treatment-resistant obsessive-compulsive disorder, and refractory major depression. Neuroimaging studies have confirmed the effects of DBS on the brain regions implicated in specific neuropsychiatric disorders. It is a well-tolerated method with relatively few serious side effects. Additional well-designed and appropriately powered controlled clinical trials are needed to conclusively establish the efficacy and safety of DBS and to identify the patient population(s) who may benefit most. Ongoing research with stimulation techniques may also significantly contribute to our understanding of major neuropsychiatric disorders....

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Historical Article 2008; 29(Suppl 1): 11-32 PubMed PMID: 19029876 Citation  Keywords:  Clinical Trials as Topic, Electroconvulsive Therapy:adverse effects, Ethics, Medical, History, 20th Century, Humans, Mental Disorders:therapy, Practice Patterns, Physicians', Psychiatry:methods, Treatment Outcome,.   

: Electroconvulsive therapy (ECT) is largely historical but is still in use. Modern psychiatry requires careful selection of patients in whom ECT will be performed. The indications for ECT treatment are limited, and the selection criteria should be strictly followed. The advantages and the disadvantages of the methods are discussed here. Despite the limitations, ECT seems to have real value in selected mental conditions in which it can even be considered a life-saving procedure....

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