Application of a Bayes Program for Classification of Coma

In previous investigations two additive 5-step scales (Guttman-scales) for »susceptibility to stimulation« and »reactivity« were developed. Both scales have proved very reliable for the measurement of levels of coma. Compared to usual examinations they entail additional effort. The present paper examines the possible prediction of scale-values, using neurological signs which are easier to obtain than the scale scores. A Bayes procedure was developed and. tested. Results from classification demonstrate that reactivity is highly predictable. Sequential selection of neurological signs, dependent upon their information-content leads to additional simplification of the diagnostic procedure. In contrast, susceptibility to stimulation can only be inadequately predicted from neurological signs.

Indikationsstellung für die zerebrale Angiographie. Entwicklung eines Bayes-Programms zur Entsclieidungsliilfe

Die Anwendung der zerebralen Angiographie bei Patienten mit raumfordernden oder vaskulären Hirnprozessen ist mit einer Reihe von Risiken verbunden. Es wurde ehi Bayes-Programm entwickelt, das den Arzt bei der Indikationsstellung zur zerebralen Angiographie unterstützen soll. In das Programm gehen nur Daten ein, die vor einer Angiographie relativ leicht erhoben werden können. Das Programm basiert auf der Auswertung von 328 Krankengeschichten von Fällen mit abschließend überprüfter Diagnose. Reklassifikationsergebnisse sowie weitere Daten über die Klassifikationsleistung demonstrieren die mögliche Verbesserung der Indikationsentscheidungen.

[Chronic complex tinnitus: does day care unit-based short-term psychotherapy help?]

BACKGROUND

Results of empirical research on the effectiveness of psychotherapeutic treatment of chronic complex tinnitus are still unclear and require further studies for clarification.

OBJECTIVE

The objective of this study is to investigate the effectiveness of multimodal treatment of patients with chronic complex tinnitus in a day care unit setting.

PATIENTS AND METHODS

In this prospective study, the effectiveness of an intense 5-day multimodal treatment delivered to 93 patients was assessed using a pre-post design. Tinnitus-specific effects were captured by the Mini-TQ-12 measurement instrument and psychiatric comorbidity assessed using the Brief Symptom Inventory (BSI). In statistical analyses, t-tests, χ(2) tests and Wilcoxon signed ranks tests were performed to determine statistical significance; effect sizes (ES) were calculated according to Cohen's d.

RESULTS

The pre-post difference in Mini-TQ-12 was highly significant in t-test (p < 0.001); the ES was small (ES = 0.45). In BSI, the pre-post difference in the Global Severity Index (GSI) as a global measure was also highly significant in t-test (p < 0.001); ES was small (ES = 0.40). Nonparametric tests (Wilcoxon test) confirmed these results.

CONCLUSION

This study demonstrates the statistically significant effectiveness of a multimodal therapeutic approach. Moreover, the results indicate that patients could benefit from more intensive therapeutic interventions.

Routine psychosocial distress screening in radiotherapy: implementation and evaluation of a computerised procedure

BACKGROUND

To implement distress screening in routine radiotherapy practice and to compare computerised and paper-and-pencil screening in terms of acceptability and utility.

METHODS

We used the Stress Index RadioOncology (SIRO) for screening. In phase 1, 177 patients answered both a computerised and a paper version, and in phase 2, 273 patients filled out either the computerised or the paper assessment. Physicians received immediate feedback of the psycho-oncological results. Patients, nurses/radiographers (n=27) and physicians (n=15) evaluated the screening procedure.

RESULTS

The agreement between the computerised and the paper assessment was high (intra-class correlation=0.92). Patients' satisfaction did not differ between the two administration modes. Nurses/radiographers rated the computerised assessment less time consuming (3.7 vs 18.5%), although the objective data did not reveal a difference in time demand. Physicians valued the psycho-oncological results as interesting and informative (46.7%). Patients and staff agreed that the distress screening did not lead to an increase in the discussion of psychosocial issues in clinician-patient encounters.

CONCLUSION

The implementation of a distress screening was feasible and highly accepted, regardless of the administration mode. Communication trainings should be offered in order to increase the discussion of psychosocial topics in clinician-patient encounters.

Quality of life following aesthetic plastic surgery: a prospective study

BACKGROUND

The objective of this study was the prospective evaluation of quality of life in patients undergoing aesthetic plastic surgery procedures. We examined pre- and postoperative changes in quality of life, and performed a comparison of our data with a representative random sample.

METHOD

228 patients agreed to participate in the present study. Measurements were taken preoperatively as well as 3 and 6 months postoperatively. One hundred and thirty two patients completed the three months postoperative evaluation (T1), 82 answered the 6 months follow-up evaluation (T2). The testing instrument included a standardised self-assessment test on satisfaction and quality of life (FLZ(M)), consisting of three modules: satisfaction with general life, health and appearance. Further, a postoperative complication questionnaire was used in order to evaluate the satisfaction with the surgical outcome and to estimate postoperative complications and side effects.

RESULTS

Significantly increasing values in two aspects of quality of life were found: health and appearance. Whereas the positive influence on health is persistent, there is a diminishing influence of appearance 6 months postoperatively. Although higher values for some of the individual items of the FLZ(M) modules of the norm data were found in comparison to our study group, a general preoperative lower level of quality of life of the aesthetic surgery patients could not be confirmed. Over 84% were satisfied or very satisfied with the aesthetic result. 85% would undergo the same treatment again and 94% of the patients would further recommend their operation. More than half of the study group did not report a decrease in physical fitness or reduced social contacts in the direct postoperative period.

CONCLUSION

Our study reveals that aesthetic plastic surgery increases most aspects of quality of life, especially regarding body satisfaction and health. It is very well tolerated by the patients and is therefore a recommended option.

Lebensqualität und Zufriedenheit nach Brustrekonstruktion

BACKGROUND

Nowadays, the array of methods for reconstruction of the female breast following mastectomy is vast. In this study, we investigate and compare quality of life after breast reconstruction and satisfaction with the results of two commonly used techniques (autologous tissue vs. expander/implant).

METHODS

Ninety-one consecutive patients who underwent breast reconstruction at a German clinic between 1996 and 2001 were included in the study. Patient satisfaction and quality of life were assessed retrospectively using self-evaluation questionnaires.

RESULTS

Patients were generally more satisfied with the outcome of the operation when autologous tissue was used. This was significant in the following areas: breast size, form, definition of the lower breast fold, softness of the breast, and symmetry of the breasts. In both groups the quality of life following breast reconstruction at least 2 years after the operation was equal to that of healthy women of the same age group.

CONCLUSION

Although patients were more satisfied with the results of autologous breast reconstruction, procedure choice did not affect quality of life.

Lebenszufriedenheit transsexueller Patienten nach geschlechtsangleichenden Operationen

BACKGROUND

More and more frequently, the registration of life satisfaction is being used to evaluate different medical treatments. So far, there have been only few such surveys on transsexuals (TS). Therefore, the aim of this study was to evaluate the general and the health-related life satisfaction of transsexuals after gender transformation operations.

PATIENTS AND METHODS

Forty patients took part in this German cross-sectional study. The Questions on Life Satisfaction Module (FLZ) and free questions on different aspects of the new gender identity were used as measuring instruments.

RESULTS

Of the TS studied, 85-95% were "very satisfied" or "satisfied" with the results of their gender transformation operation in respect to gender identity. The TS were significantly less satisfied (P>0.001) in overall "general life satisfaction" than the general population. In overall FLZ scores for "health-related life satisfaction", no differences were seen.

CONCLUSION

These data indicate a discrepancy between subjective satisfaction with new gender identity and current life situation, and they identify problems with life satisfaction.

Alters- und geschlechtsbezogene Betrachtung der Lebensqualität bei Mukoviszidose

BACKGROUND

Quality of life (QoL) becomes more important as primary criterion of quality management in time consuming therapy programs of chronic progressive diseases like cystic fibrosis (CF). Measuring weighted satisfaction of life allows to evaluate subjective aspects of health-related and general quality of life.

PATIENTS/METHOD

QoL of 254 CF-patients (age 16-45 years, mean 29.4 years, mean FEV1 62.5 % of the predicted, mean BMI 20.5) was evaluated with the Questions on Life Satisfaction (FLZ(M)), a multi-dimensional QoL questionnaire. QoL results of patients are compared with the QoL of a healthy population.

RESULTS

Subjective contentment in health-related life dimensions of German adolescents and adults with CF is significantly lower compared with healthy peers. Women with CF compensate their increased restriction in health-related dimensions by high satisfaction in the dimensions housing and partnership. Women with CF > 35 years have a risk for low life satisfaction, men of this age group are not restricted.

CONCLUSIONS

Therapy programs should take into account the subjective perceived QoL. Routine monitoring of QoL can indicate patients with special needs.

Le questionnaire de qualité de vie QLS-H© : validation de la version française chez les patients avec déficit en hormone de croissance et acquisition des valeurs de référence dans la population générale

The QLS-H(c) (Questions on Life Satisfaction- Hypopituitarism) is new a quality of life (QoL) self-administered questionnaire addressing the complaints of adult patients with growth hormone deficiency. The French version of the QLS-H(c) (16 items) has been psychometrically evaluated during a randomized, open label study comparing two strategies of growth hormone (GH) replacement therapy. Seventy-three patients were included and received an 8-month GH replacement therapy. QoL was explored at baseline, 4 and 8 months using the QLS-H(c) questionnaire and the Nottingham Health Profile (NHP) reference scale. Acceptance of the QLS-H(c) was excellent as 92% of the questionnaires were suitable for analysis. All the items demonstrated good selectivity. The homogeneity of the questionnaire was confirmed (Cronbach's alpha, 0.87). The external validity construct was assessed and confirmed using the NHP scores. Sensitivity to change was confirmed. Following an 8-month replacement therapy, the perception of the QoL assessed with the QLS-H(c) questionnaire was significantly improved, irrespective to the treatment strategy. Finally, redundant items of the questionnaire were removed. As a result, the final version of the QLS-H(c) contained 9 items. In a parallel study, reference data of the QLS-H(c) (9 items) were collected from a representative sample of 989 subjects from the French population. With these reference ranges, algorithms to calculate Z scores adjusted for age and gender were developed as a measure for the deviation of patients' scores from those of the general population, and also to evaluate changes along time. In summary, the French version of the quality of life QLS-H(c) questionnaire is a relevant, validated investigational tool for the evaluation and follow-up of an adult patient with growth hormone deficiency.

Psychological problems of cancer patients: a cancer distress screening with a cancer-specific questionnaire

The purpose of this study was to assess the psychological distress of cancer patients in a disease-specific manner as well as the demographic and medical variables that have an impact on the distress. Psychological distress was assessed with the Questionnaire on Stress in Cancer Patients revised version, which has been developed and psychometrically evaluated in Germany. It consists of items about 23 cancer-specific stress situations, which have to be answered in terms of relevance and amount of distress. A heterogeneous sample of 1721 cancer in- and outpatients was assessed. For the total group, the most important distress is the fear of disease progression. We consider between 23.4% (ca. of the upper gastrointestinal tract) and 40.9% (breast cancer patients) as highly distressed. The most distressed diagnostic subgroups are patients with soft tissue tumours and breast cancer patients. There are no global (general) stress factors, as the relevant demographic and medical ‘risk factors’ varied between the diagnostic subgroups. Cancer-specific distress questionnaires give a more precise insight into patients' experience than general or psychiatric questionnaires. They are not only used in large screening studies but also in routine medicine, particularly when the objective is to identify patients to whom psycho-oncological support is to be given.

Questions on life satisfaction (FLZM) in inflammatory bowel disease

BACKGROUND AND AIMS

When assessing quality of care the outcome in terms of quality of life (QOL) is of major significance. This study examined QOL in IBD outpatients and the contribution of individual expectations and various other factors including disease activity.

PATIENTS AND METHODS

The study included 306 outpatients with Crohn's disease and 109 with ulcerative colitis (UC). General and health-related QOL was quantified using the instrument Questions on Life Satisfaction(Modules). Disease activity was assessed by a questionnaire. Data were compared with a normal population sample.

RESULTS

Life satisfaction scores on general items and on health-related items were significantly lower than in a control sample (60.5+/-37.3 and 74.4+/-41.5, respectively) among both CD patients (54.3+/-33.2, 59.1+/-38.8) and UC patients (45.4+/-34.0, 52.1+/-40.7). Scores were significantly related to severity of disease activity. IBD patients attributed particular importance to health-related issues.

CONCLUSION

Both health-related and general life satisfaction is compromised in IBD outpatients, and health-related topics have major impact. Not surprisingly, inflammatory activity compromises QOL, which underlines the importance of anti-inflammatory strategies. The importance attributed to health-related features is higher in IBD patients than in the normal population.

A novel quality of life instrument for deep brain stimulation in movement disorders

OBJECTIVE

To develop a short instrument to examine quality of life (QoL) which specifically addresses patients with movement disorders treated by deep brain stimulation (DBS).

DESIGN

The instrument was developed within an existing concept of a modular questionnaire (questions on life satisfaction: "general life satisfaction" QLS(M)-A, and "satisfaction with health" QLS(M)-G), in which each item is weighted according to its relative importance to the individual.

METHODS

Items were generated by interviews with 20 DBS patients, followed by item reduction and scale generation, factor analysis to determine relevant and final questionnaire items, estimation of reliability, and validation based on the medical outcome study 36 item short form health survey (SF-36) and the EuroQol (EQ-5D) (data from 152 patients with Parkinson's disease, essential tremor, or idiopathic torsion dystonia, including 75 patients with DBS).

RESULTS

Initial questionnaires were reduced to 12 items for a "movement disorder module" (QLS(M)-MD), and five items for a "deep brain stimulation module" (QLS(M)-DBS). Psychometric analysis revealed Cronbach's alpha values of of 0.87 and 0.73, and satisfactory correlation coefficients for convergent validity with SF-36 and EQ-5D.

CONCLUSIONS

QLS(M)-MD and QLS(M)-DBS can evaluate quality of life aspects of DBS in movement disorders. Psychometric evaluation showed the questionnaires to be reliable, valid, and well accepted by the patients.

[Fear of progression in patients with cancer, diabetes mellitus and chronic arthritis]

Fear of an increasing disease progression (fear of progression) is among the main psychological stresses in patients with cancer, diabetes mellitus (type 1 and type 2) and chronic arthritis. The questions the study seeks to answer are: (1) Which are the main fears of these patients?, (2) How and in which circumstances in life do they occur?, (3) Which are the triggers of the fear? To answer these questions, a sample of 65 patients were researched through interviews. The results indicate that the predominant fears of cancer patients are the fear of dying and the unpredictability of the progression of the disease. Patients with chronic arthritis most frequently fear being physically dependent on someone else. The most common anxiety of diabetes patients are long-term complications. For all three groups of patients job-related fears cause a high amount of distress. These results contribute to the development of a standardised fear of progression questionnaire.

Development and psychometric properties of a disease-specific quality of life questionnaire for adult patients with growth hormone deficiency

BACKGROUND

Adults with growth hormone (GH) deficiency (GHD) may experience physical and psychological disturbances, which can affect their quality of life (QOL).

OBJECTIVES

To develop and validate a disease-specific module from the previously published QOL measure Questions on Life Satisfaction Modules (QLS(M)): the QLS(M)-H that specifically addressed the needs of patients with hypopituitarism. A second aim was for the questionnaire to be applicable across different cultural backgrounds in order to evaluate the efficacy of therapy in large, international clinical trials, thus providing additional clinical endpoints for these studies.

DESIGN

A preliminary German language version of the QLS(M)-H was developed from 26 semi-structured interviews of adults with GHD. The questionnaire was then independently translated into five other languages and applied in open, non-controlled, multicentre, longitudinal studies to patient (n=717) and normative populations (n=2700).

METHODS

A revised, nine-item version of the questionnaire was developed, based on previously defined criteria, and was evaluated for reliability and validity. Sensitivity to detect changes after GH replacement was also assessed.

RESULTS

The 16 items of the preliminary questionnaire were reduced to nine items on the basis of the correlation of items/factors from initial patient interviews. Psychometric analysis revealed the reliability of the nine-item scale. The Cronbach's alpha scores ranged from 0.81 to 0.89 and the test-retest correlations ranged from 0.76 to 0.88, all of which indicate reliability over time. Mean scores increased significantly during GH replacement therapy, with observed changes greater than those seen with the non-specific modules of the QLS(M), indicating the sensitivity of the scale.

CONCLUSIONS

The QLS(M)-H questionnaire is concise, easy to complete, and can be effectively applied across different cultural backgrounds. Psychometric evaluation of the questionnaire reveals that it is a valid, reliable and sensitive tool useful for assessing impaired life satisfaction in adult patients with GHD and also for monitoring the efficacy of GH therapy.

Monitoring Inositol-Specific Phospholipase C Activity Using a Phospholipid FlashPlate(R)

Inositol-specific phospholipase Cs(PLCs) are a group of enzymes involved in the signal transduction pathway of many plasma membrane receptor mediated events. We developed a modified solid surface to capture [(3)H] PIP(2) onto the Basic FlashPlate(R) in order to monitor PLC activity. Our results clearly demonstrate the utility of [(3)H] PIP(2)-Coated Phospholipid FlashPlate(R) microtiter plates for assessing PLC activity for HTS of receptor-coupled functional assays. The results show that PLC activity can be measured easily from a variety of sources including purified recombinant enzyme preparations, crude HL60 cell lysates and permeabilized A431 human carcinoma cells. Moreover, this format provides a surface comparable to that used for classical solution based radiolabeled mixed phospholipid micelle studies and illustrates the feasibility of this assay for measuring PLC activation in a variety of different drug screening assays.

[The effectiveness of the initial interview at a psychosomatic- psychotherapeutic outpatient unit]

In a cross sectional study of 1945 consecutive patients seen at a psychosomatic-psychotherapeutic outpatient unit between 1993 and 1995, we investigated how the therapists assessed the effectiveness of their work and what correlations there were with patient characteristics and with the way the therapists conducted the initial session. The therapists' ratings indicated that about two thirds of the patients benefited from the consultation. In the multivariate analysis of the data the most important determinants of effectiveness were found to be the patient's motivation, the ICD diagnosis, the patient's level of personality organisation and the reason for the consultation. In addition, we did a one-year follow-up of 260 patients to analyse the determinants that help patients to agree to the proposed treatment plan. Of the 235 patients for whom treatment was recommended, 174 (74%) actually began a treatment program. Our results show that a patient is more likely to accept the treatment recommendation if the therapist conducts the session in a certain way (e.g. provides detailed information) and helps the patient to find an appropriate therapist.

Illness-related distress: does it mean the same for men and women? Gender aspects in cancer patients' distress and adjustment

Gender differences were investigated in a sample of 149 married cancer patients (82 males, 67 females) undergoing outpatient chemotherapy. A cross-sectional design was used and evaluation included medical assessments and self-rating questionnaires. Tumour sites varied, and advanced stages of disease were predominant. Overall, the results suggest gender differences as well as some similarities. Although female patients reported symptoms and higher overall distress because of illness more frequently than male patients did, general satisfaction with life did not differ between genders, suggesting comparable adjustment. From the results of multivariate analyses physical impairment, such as older age, primarily explained female patients' distress, whereas men's distress was closely linked to their psychological condition. Men and women also differ in the way they make use of social support. Assessment of the distinctive aspects contributing to male and female cancer patients' distress could improve the provision of adequate support adapted to gender-specific requirements.

Psychological factors in functional gastrointestinal disorders: characteristics of the disorder or of the illness behavior?

OBJECTIVE

This study examines factors affecting the frequency of physician consultations by individuals with functional gastrointestinal disorders (FGD) in a group of subjects with functional dyspepsia or irritable bowel syndrome. Systematic selection of persons who were already seeing a physician for one of these problems was avoided by conducting an epidemiological field study rather than a clinical study.

METHODS

A representative sample of the German population (N=2201) completed a questionnaire that included, in addition to the criterion (number of physician visits in the past 12 months), items aimed at identifying the target group and questions about physical symptoms, illness behavior, living situation, personality features, and sociodemographic status (a total of 31 predictors).

RESULTS

Individuals with functional gastrointestinal disorders who consulted a physician for their gastrointestinal disorders and those who did not differed significantly, especially on psychological measures. The differences between these individuals and the general population were greater for the consulters than for the nonconsulters. Multiple regression analyses yielded nine predictors that explained 40.2% of the variance of the criterion. The best predictors of frequency of physician consultations were the duration of periods with symptoms and psychological factors, such as the severity of depression and the patients' views on the cause of their illness.

CONCLUSIONS

The psychopathology seen in people with functional gastrointestinal disorders is of two types: one is a characteristic of the illness itself and the other leads the individual to consult a physician. When gastroenterologists see patients with such disorders, they can assume that they may be dealing with a self-selected group of individuals with psychological stress. Psychological assessment would, therefore, be useful to determine whether a given individual with FGD might benefit from psychotherapy.

[Quality of life after complex tibial reconstruction]

58 patients following Gustilo IIIB open tibial fractures, treated by serial debridements, osteosynthesis and microvascular free tissue transfer were investigated after an average of 6 years. Assessment of life satisfaction was done by means of a proven valid and reliable test instrument (FLZ-"Fragen zur Lebenszufriedenheit"). Further specific questions on treatment satisfaction, aesthetic result, occupation and income were added to this questionnaire. Significant discrepancies of the items recreational activities, income, occupation and partnership, productivity, mobility and pain were evaluated in comparison to available data of healthy west german population. The calculated global index of life satisfaction and health differed significantly from the established index of west german population. Although specific aspects like aesthetic result, donor site morbidity, pain and even function were critically judged, 91% of the patients were satisfied with the long term result of the treatment. None of the patients thought that an initial amputation probably might have been a better solution. The postrehabilitation employment rate was 64%. Limb salvage of Gustilo IIIB fractures by means of a multidisciplinary treatment protocol is able to afford useful and satisfying long time results. However, an impairment of quality of life, at least in specific items has to be considered.

[Mutual stress and support in couples with one cancer patient]

Sources of distress and support were assessed in a prospective study covering 149 couples with a cancer patient on outpatient chemotherapy, with an overall equally high impact of disease. Distress levels in spouses were found as high as in patients, showing a moderate relation within couples. From multivariate regression analyses spouses' distress proved predominantly determined by characteristics of illness. When broken down according to gender, factors contributing to couples' distress varied. Couples' distress was found more closely related to each other with female patients, with spouses relying more on their ill wives, compared to couples with male patients. Whereas female patients' distress was determined by the degree of role limitations, male patients appeared more vulnerable to the psychological impact of illness. Though couples' estimated social support from various sources was estimated greatly helpful, no effects were found on patients' and spouses' distress, respectively. Conclusions in respect of family-oriented interventions are discussed.

[Needs and utilization of ambulatory psychosocial services by cancer patients--exemplified by the oncologic day clinic]

Needs and acceptance of specific psychosocial care was assessed in a longitudinal study of 224 patients. In an oncologic adult day hospital chemotherapy patients express the strongest need for information and social counselling. Assessment of the need for psychosocial care depends on the sex of the patients, their coping resources, the course of the disease and differs between patients and therapists. With the progression of the disease acceptance of "informal" short contacts demanding little initiative from the patients was higher than of psychotherapy. Conclusions for the ambulatory psychosocial care of cancer patients are discussed.

[Comparison of the quality of life after subtotal and total gastrectomy for stomach carcinoma]

OBJECTIVE

To compare quality of life after subtotal gastrectomy (STG) and total gastrectomy of various types, in view of the fact that, with T1 and T2 gastric carcinoma of intestinal type in the distal third of the stomach, subtotal gastrectomy is similar to total gastrectomy regarding the extent of lymphadenectomy and prognosis.

PATIENTS AND METHODS

Quality of life was measured by standardised questionnaires given to 36 patients after subtotal gastrectomy (22 men, 14 women; mean age 63 [27-79] years): general physical complaints (GPC); contentment with life (CL); psychosocial stress (PSS). The results were compared with those previously obtained in 58 patients with total gastrectomy (46 men, 12 women; mean age 63.4 [36-74] years) and oesophagojejunostomy (OJS) (n = 29) or oesophagojejunoplication and pouch (OJPP) (n = 29).

RESULTS

Weight loss of patients after OJPP was not significantly different from that of patients after STG, but it was significantly higher after OJS (13.5 +/- 8.6 kg; P < 0.0006). Patients with STG had significantly more general complaints (P < 0.05) and greater discontent with life (P < 0.05) than those with OJPP. Specific analysis of gastric complaints showed greatest dissatisfaction with gastrointestinal functions in patients after STG (P < 0.0004), less also after OJS compared with OJPP (P < 0.01).

CONCLUSIONS

Subtotal gastrectomy for gastric carcinoma has no advantages over total gastrectomy with oesophagojejunoplication and pouch as regards weight loss, gastrointestinal complaints, psychosocial stress and general contentment. The poor quality of life seems to have its functional correlate in increased intestino-oesophageal reflux with incompetent cardia and after Billroth II reconstruction.

[Need for psychosocial counseling--a comparison of women and men in East and West Germany]

The increasing use of psychosocial medical care by women has resulted in a wider range of counselling facilities for specific problems concerning women over the last few years. According to our survey including the population of both Western and Eastern Germany, however, there is no evidence that women have a greater need for counselling activities than men. Needs for counselling are more freely admitted by women than by men; counselling needs for so-called "women's problems" are more commonly observed in Eastern Germany, whereas male oriented problems predominate in Western Germany. The highest need for counselling exists in the field of "Health" and "Social Security".

[Partnership and pregnancy conflict]

101 men and women with a current pregnancy decision-making conflict or abortion and 31 couples without such a problem were asked about their living conditions, their childhood and their relationship. As conditions for the crisis the financial situation of the pregnant woman and the emotional bond with the significant other could be identified. While the conflict can be predicted through the current situation, the decision whether to abort the child or not depends upon internal and more individual processes. Important parts of these processes are the general commitment of the involved man toward a relationship, the compatibility of a child with the professional situation of the pregnant women and their relationship with their own mother. The last issue is combined with the pregnant women's trust in her own motherly competence.

[The quality of life after total gastrectomy for stomach carcinoma. Esophagojejunal plication with pouch versus esophagojejunostomy without pouch]

A group of 178 patients with total gastrectomy for gastric carcinoma were divided into two groups matched for sex, age, tumour stage and follow-up interval (29 pairs, 46 men and 12 women; mean age 63.4 [39-74] years) according to the type of reconstruction performed, oesophagojejunal plication with pouch or simple oesophagojejunostomy without pouch. Those with left-extended gastrectomy, follow-up period of 9 months or less, and local recurrence or metastasis were excluded. Quality of life was evaluated by means of three standardized questionnaires sent to all the patients: (1) general physical complaints; (2) satisfaction with life; and (3) psychosocial burden. Patients with pouch reconstruction declared more favourable results in 90 of the 94 questions contained in the questionnaire (96%) than the patients without pouch. Patients in the former group also had significantly fewer general physical complaints (P less than or equal to 0.05) and were significantly more satisfied with life (P less than or equal to 0.05) than those without pouch. Correlation analysis for the entire group (n = 58) indicated significant relationships especially between quality of life and postoperative nutrition and body weight. Technical surgical problems of total gastrectomy having largely been solved, the question of quality of life must increasingly determine the choice of treatment.

Measuring the quality of life: a comparison between physically and mentally chronically ill patients and healthy persons

The FLZ seems to be a suitable method for reliably measuring the quality of life of healthy persons and of patients, as well as differentiating between persons and groups. The concept of weighting satisfaction with the individual importance of each of the items and of measuring several dimensions seems to make sense in view of the data. The modified version of the FLZ is currently being employed in various hospitals. The assessment of a larger normative sample is being planned. QL shall then be differentiated from the construct mood and be compared to objective data. In addition, the sensibility to change of the questionnaire shall be tested in a process analysis.

Preprocessing in computed tomography picture analysis: a "bone-deleting" algorithm

A procedure for automatic deletion of extracranial parts and bone in computed tomography (CT) pictures is presented. Such a procedure is a prerequisite for many types of quantitative image analysis. The algorithm can delineate complex bone contours and is completely independent of information outside the skull. Special options allow, in addition, the deletion of calcified parts of the brain and of some artifacts. The program is implemented in a general program system (PICPRO) developed for CT image analysis and picture manipulation.