Egger J

Quality of life outcomes in pregnancy and postpartum complicated by hypertensive disorders, gestational diabetes, and preterm birth

Health problems can develop during a pregnancy, turning it into a high risk. The aim of this study was to explore the influence of hypertensive disorders, gestational diabetes, and preterm birth as risk factors for health-related quality of life (HRQL) and depressive symptoms during late pregnancy and postpartum. A prospective, longitudinal study was performed with three assessments. Ninety women were recruited in the study including 29 controls. HRQL was measured using the WHO-QOL-BREF questionnaire. Depressive symptoms were assessed with the Edinburgh Postnatal Depression Scale (EPDS). Statistical analyses were performed using ANOVA and the chi-square test to explore HRQL and depressive symptoms between three pregnancy risk groups and controls. Women of the preterm group had statistically significant higher depression scores and lower HRQL scores on the physical domain during pregnancy than those without complications. Women with hypertensive disorders showed the second most depressive symptoms. Physical and global HRQL improved and depressive symptoms decreased significantly from late pregnancy and early postpartum period to late postpartum. Pregnant specific health problems, especially the risk for preterm delivery is associated with more depressive symptoms and decreased HRQL in pregnancy. Guidance and communication for these women is important. The counseling should be multi professional to reduce childbirth burdens.

The influence of personality traits on the subjective outcome of operative hallux valgus correction

We studied prospectively the influence of personality traits on the subjective outcome of a chevron osteotomy in 42 patients with hallux valgus. The mean age of patients was 48.3 (20–70) years. Personality traits were evaluated by the means of the Freiburg Personality Inventory (FPI-R). Three months postoperatively 37 patients were satisfied, and five patients not satisfied with the operative procedure. The preoperative AOFAS Score improved from an average of 48.7 (30–65) points to 87.9 (50–100) points. A comparison of satisfied and dissatisfied patients revealed statistically significant differences in the personality traits aggressiveness (p=0.003), extraversion (p=0.001) and health worries (p=0.04). The postoperative hallux valgus angle was 12.2±7.8° and 13.4±8.3° (p=0.74) among satisfied and not satisfied patients, respectively, and the intermetatarsal angle (I–II) was 7.4±2.5° and 7.6±4° (p=0.89), respectively. The results suggest that the patient’s subjective result after the operative correction may be influenced by some individual, personality profiles.RésuméNous avons étudié l’influence des traits de la personnalité sur le résultat subjectif d’une ostéotomie en chevron chez 42 malades avec hallux valgus. L’âge moyen des malades était de 48,3 ans (20–70). Les traits de la personnalité ont été évalués au moyen de l’Inventaire de Personnalité de Fribourg (FPI-R). A trois mois postopératoires 37 malades étaient satisfaits de la procédure opératoire, et 5 ne l’étaient pas. Le Score préopératoire AOFAS a été amélioré d’une moyenne de 48,7 (30–65) points à 87,9 (50–100) points. Une comparaison de malades satisfaits et non satisfaits a révélé des différences statistiquement significatives dans le caractère agressif des traits de la personnalité (p=0,003), extraversion (p=0,001) et inquiétude sur sa santé (p=0,04). L’angle de l’hallux valgus postopératoire était respectivement de 12,2±7,8° et 13,4±8,3° (p=0,74) pour les malades satisfaites et les malades non satisfaits, et l’angle intermétatarsien (I–II) était de 7,4±2,5° et 7,6±4° (p=0,89) respectivement. Les résultats suggèrent que le résultat subjectif après la correction opératoire peut être influencé par le profil de personnalité du malade.

Persönlichkeit und Stressbearbeitung bei Patienten mit funktioneller Dysphonie

The examination covers the personality of 20 functional dysphonics, 14 individuals suffering from organic voice disorders and a group of 20 control persons when exposed to stress and its working up. In examining the group of functional dysphonics a significant positive self-assessment regarding their personality with a clear tendency to restraint has become clear. In comparison with the control persons an intensified anxiety state in situations causing stress is the result. Thus the influence of life events has been shown to have an important effect on the etiopathogenesis of functional dysphonia.

Zur Psychogenese funktioneller Dysphonien

Psychogene Faktoren spielen in der Atiologie funktioneller Dysphonien zweifellos eine mitentscheidende Rolle. In der vorliegenden Untersuchung wird versucht, mittels eines empirisch-psychologischen Ansatzes eine Differenzierung psychogener und nicht psy-chogener Dysphonien anhand relevanter psychologischer Dimensionen vorzunehmen. Bei funktioneUen Aphonien konnte anhand mehrerer Dimensionen (Beanspruchung, Offenheit, Allgemeinbeschwerden, Bela-stungsfaktoren) eine psychologische Auffalligkeit im Vergleich zur Kontrollgruppe nachgewiesen werden und die Psychogenese somit nachvollzogen werden. Bei den funktioneUen Dysphonien dagegen ist dies nur partiell gelungen. Daraus kann geschlossen werden, dass bei funktioneUen Dysphonien nicht zwangslaufig psychogene Aspekte im Vordergrund stehen. Es konnte zu einer Uberschatzung der Psychogenese bei funktionellen Dysphonien kommen, da die psychologisch gut abgrenzbaren Gruppen der funktionellen Dysphonien und Aphonien manchmal unter einer no-sologischen Einheit subsumiert werden.

Ratio of marked and excised sentinel lymph nodes and scintigraphic appearance time in melanoma patients with negative sentinel lymph node

AIM Metastases can occur in up to 15% of all melanoma patients with negative sentinel lymph node examination (SN -). We retrospectively investigated the number of preoperatively marked sentinel lymph nodes (SNs) with lymphoscintigraphy and effectively surgically removed SNs in SN--patients with cutaneous melanoma >or=0.5 mm. Ratio of these parameters was calculated and impact of this ratio as well as impact of scintigraphic appearance time (SAT) on disease progression was studied. MATERIALS AND METHODS Data on 122 SN--patients--70 women (58%), mean age 56.5 years--were analyzed. Mean follow-up time was 58 months. RESULTS Mean tumour thickness of all patients was 2.3 mm. In 51 patients (42%) the number of SNs marked in lymphoscintigraphy was higher than excised in surgery, in 47 patients (38%) the same number as marked was excised and in 24 patients (20%) a lower number was marked than excised. Metastases occurred in 17 patients (14%) after a mean time of 24.8 months. Mean tumour thickness (5.4 mm) was significantly higher in these patients than in the other patients (p = 0.000). Ratio of marked and excised SNs had no influence on disease progression; the only parameter influencing outcome was tumour thickness (p = 0.000). Short SAT was significantly associated with higher tumour thickness (p = 0.004). CONCLUSION Our study indicates that, in routine clinical practice, it suffices to harvest the first SN, as the ratio of marked and excised SNs has no impact on disease progression.

Impact of Mental and Physical Stress on Blood Pressure and Pulse Pressure under Normobaric versus Hypoxic Conditions

Objective Hypobaric hypoxia, physical and psychosocial stress may influence key cardiovascular parameters including blood pressure (BP) and pulse pressure (PP). We investigated the effects of mild hypobaric hypoxia exposure on BP and PP reactivity to mental and physical stress and to passive elevation by cable car. Methods 36 healthy volunteers participated in a defined test procedure consisting of a period of rest 1, mental stress task (KLT-R), period of rest 2, combined mental (KLT-R) and physical task (bicycle ergometry) and a last period of rest both at Graz, Austria (353 m asl) and at the top station Dachstein (2700 m asl). Beat-to-beat heart rate and BP were analysed both during the test procedures at Graz and at Dachstein and during passive 1000 m elevation by cable car (from 1702 m to 2700 m). Results A significant interaction of kind of stress (mental vs. combined mental and physical) and study location (Graz vs. Dachstein) was found in the systolic BP (p = .007) and PP (p = .002) changes indicating that during the combined mental and physical stress task sBP was significantly higher under hypoxic conditions whereas sBP and PP were similar during mental stress both under normobaric normoxia (Graz) and under hypobaric hypoxia (Dachstein). During the passive ascent in cable car less trivialization (psychological coping strategy) was associated with an increase in PP (p = .004). Conclusion Our data show that combined mental and physical stress causes a significant higher raise in sBP and PP under hypoxic conditions whereas isolated mental stress did not affect sBP and PP under hypoxic conditions. PP-reaction to ascent in healthy subjects is not uniform. BP reactions to ascent that represents an accumulation of physical (mild hypobaric hypoxia) and psychological stressors depend on predetermined psychological traits (stress coping strategies). Thus divergent cardiovascular reactions can be explained by applying the multidimensional aspects of the biopsychosocial concept.

Psychological Stress and Immunological Modulations in Early-stage Melanoma Patients.

Mental stress may have a negative impact on the immune state of cancer patients, in whom immunologic surveillance is essential for survival. This study investigated the immunological response of 19 patients with early-stage melanoma and a matched control group undergoing the Determination Stress Test before surgery. Cytokine and chemokine levels and lymphocyte subpopulations were measured at baseline and post-stress test time-points. Following the stress test lower levels of interleukin (IL)-6 were observed in the melanoma group compared with healthy volunteers (p = 0.044). IL-10 increased significantly in the control group 30 min after the stress test (p = 0.002) in comparison with the melanoma group (p = 0.407). CCL5/Rantes decreased significantly in the melanoma group, whereas CD16/CD56+ natural killer cells increased in both groups, with a sharp decrease below baseline after stress in the melanoma group (p = 0.001). This pilot study shows an altered immunological response to stressors in melanoma patients.

Psycho-social aspects of functional dysphonia

The study was designed as a two-stage project. In the first phase a sample dysphonia patients were examined thoroughly in respect of important etiopathogenetic factors mentioned in the relevant literature. In the second phase presented here a total of 45 patients with functional dysphonia were examined by means of standardized questionnaires and a newly-constructed interview. The results were compared to a group of normals matched for age, sex and voice strain. As hypothesized, these results suggest that functional dysphonia is correlated with less openmindedness, intensive voice strain, an array of psycho-physiological complaints and psycho-social strain factors.

The coping process with illness in patients with cardiovascular or cerebrovascular diseases: a new survey: EKV.

The EKV is a survey constructed by the authors to get detailed information about the patients feelings, thoughts, attitudes, and plans when confronted with a severe organic (chronic) disease, especially with cardiovascular or cerebrovascular diseases. Starting from the actual situation the focus lies on the patients realization of consequences resulting from the illness-event for the organic, emotional-cognitive, familial, occupational and social aspects of life. Further topics are early and previous events or thoughts and the development of symptoms associated with the later outbreak of functional disorders or organic lesions which are treated now. Attention is also paid for the treatment situation in the past and at time and for the patients projections to future life: thoughts about the progress of his disease, expected physical and psychical potency, occupational and leisure plans, partnership, familial and social life, illness-related changes in the style of life, expected satisfaction with life etc. The survey is to be used as a half-structured interview that takes 2 to 3 hours. It has already been tested, modified and now used on ca. 150 patients with different vascular diseases (pts. with myocardial infarction, coronary heart disease (angina pectoris), functional heart and circulatory disorders; completed stroke, prolonged ischaemic neurological defect, or transitoric investigation with the EKV are in preparation. Within a psychosomatic framework the survey gives a relevant overview and useful insight in the patients reality, his adapting and coping reactions, the meaning of the chronic disease for his self-conception and way of life, as well as possibilities or necessities for psychological interventions and other treatment aspects.

Autonomic Nervous Tone in Vitiligo Patients - A Case-control Study

In this cross-sectional, exploratory case-control study the vegetative arousal in vitiligo patients compared to an age and gender matched healthy control group was assessed. Forty-eight participants (24 outpatients with generalised vitiligo and 24 healthy controls) completed a test procedure consisting of an initial period of rest (R1), a defined mental stress task (the d2 test of attention), a second period of rest (R2) followed by an individually, age adapted physical stress task (bicycle ergometry) and a final period of rest (R3). Based on a continuously recorded electrocardiogram, heart rate variability, in particular high frequency (HF) and low frequency (LF) components were determined. Within the 3 periods of rest, vitiligo patients showed a higher vegetative arousal than controls, represented by the ratio of LF/HF which mirrors the sympatho-vagal balance (R1: p = 0.027; R2: p = 0.003; R3: p = 0.029). No differences between the 2 groups were found during the mental (p = 0.187) and the physical stress task (p = 0.773). The results suggest a higher vegetative arousal in vitiligo patients.