905 research outputs found
Somatoform disorders and GERD
No full textDas Ziel dieser Studie ist, bei Patienten mit gastroösophagealer
Refluxkrankheit somatoforme Störungen erstmals mit einem objektivierbaren
Messinstrument zu erfassen, und daraus Konsequenzen für die
Behandlungsstrategie zu ziehen. Dazu wurden 166 Patienten mit Sodbrennen und
Verdacht auf Gastrointestinale Refluxkrankheit untersucht. Im untersuchten
Patientengut standen 84 männliche 82 weiblichen Patienten gegenüber. Das
mittlere Alter der Patienten lag bei 58 Jahren, wobei der jüngste Patient 20
Jahre und der älteste 82 Jahre alt war. Vor und nach der Behandlung wurde zur
Erfassung der Lebensqualität der Gastrointestinale Lebensqualität Index nach
Eypasch (GILQI) verwendet. Das SOMS (Screening für Somatoforme Störungen nach
Rief) wurde eingesetzt, um Patienten mit psychologischen und emotionalen
Auffälligkeiten zu erfassen. Nach Abschluss der Diagnostik wurde das gesamte
Patientenkollektiv in drei Gruppen eingeteilt: Patienten in Gruppe AR-OP
wurden mit einer laparoskopischen Antirefluxoperation versorgt. Patienten in
Gruppe OP-MED wurde angeraten, bei Nachweis der Refluxkrankheit und
bestehender Operationsindikation PPI in adäquater Dosierung einzunehmen.
Patienten in Gruppe KOPI hatten eher eine milde Refluxkrankheit oder bei ihnen
wurde nach den diagnostischen Kriterien eine Refluxkrankheit ausgeschlossen.
Ihnen wurde angeraten, sich weiterer Diagnostik zu unterziehen und/oder es
wurde eine symptomatische Therapie der Oberbauchbeschwerden empfohlen. Es
konnte gezeigt werden, dass die Ausgangslebensqualität der Patienten mit
somatoformer Störung signifikant niedriger war als bei Patienten ohne diese
Störung. Durch eine laparoskopische Antirefluxoperation konnte die
Lebensqualität signifikant verbessert werden, unabhängig davon ob eine
somatoforme Störung vorlag oder nicht. Durch konservative Therapie wurde die
Lebensqualität in den beiden Gruppen OP-MED und KOPI stabil gehalten. Aufgrund
der deutlichen Verbesserung der Lebensqualität postoperativ sollte man
Patienten mit pathologischem Reflux und somatoformer Störung nicht prinzipiell
von einer Operationsindikation ausschließen, da sie nachweislich von einer
Operation profitieren können.To determine patients with gastroesophageal reflux disease (GERD) and
somotoform disorders with an objective measuring instrument and to assess
consequences for their medical treatment. 166 patients (84 male, 82 female)
with heartburn and suspicion of GERD were included in this study. Mean age was
58 years, the youngest patient being 20 years old and the oldest 82 years old.
Clinical diagnostics included interview, endoscopy, 24-h-PH metry and
esophageal manometry. To evaluate quality of life before and after surgery,
the Gastrointestinal Quality of Life Index (GIQLI) questionnaire was provided.
The Screening Instrument for Somatoform Symptoms (SOMS) was used, to determine
patients with psychological and emotional disorders. After completion of
diagnostic investigations the patients were allocated into 3 groups: patients
in group AR-OP were treated with laparoscopic antireflux surgery. Patients in
group OP-MED declined surgery and were advised to take proton pump inhibitors
in adequate dose because of proven GERD and indicated surgery. Patients in
group KOPI either had mild reflux symptoms or GERD was excluded by clinical
diagnostics. They were advised to undergo more diagnostic or to treat their
disorders with symptomatic therapy. Initial quality of life of patients with
somotoform disorder was significantly lower than quality of life of patients
without this disorder. Laparoscopic antireflux operation could significantly
improve quality of life, regardless of an existing somotoform disorder.
Conservative Therapy resulted in stable quality of life in the groups OP-MED
and KOPI. Due to the clear improvement of quality of life postoperatively,
patients with GERD and somatoform disorder should not be excluded from
surgery
Dr. Gerd J. Horten Professor of History - Concordia University Portland
No full textGerd Horten, author of the book \u27Radio Goes to War: The Cultural Politics of Propaganda during World War II\u27, discusses World War II propaganda and censorship. Recorded by Phil Sedgwick.
Video uploaded by Phil Sedgwick under Standard YouTube Licensehttps://commons.cu-portland.edu/humfacultymedia/1000/thumbnail.jp
Severity of GERD and disease progression
Full text linkThis is a pre-copyedited, author-produced version of an article accepted for publication in Diseases of the Esophagus following peer review. The version of record Fuchs, K. H., DeMeester, T. R., Otte, F., Broderick, R. C., Breithaupt, W., Varga, G. & Musial, F. (2021). Severity of GERD and disease progression. Diseases of the Esophagus, ?(?), ?. is available online at: https://doi.org/10.1093/dote/doab006Background - Many factors may play a role in the severity and progression of gastroesophageal reflux disease (GERD) since pathophysiology is multifactorial. Data regarding the progression of GERD are controversial: some reports of increased esophageal acid exposure (EAE) and mucosal damage were considered as evidence for a stable disease course, while others interprete these findings as disease progression. The aim of this study is to analyze a large patient-population with persisting symptoms indicative of GERD under protonpumpinhibitor-therapy and identify components characterizing disease severity and progression.
Methods - Patients with symptoms indicative of GERD were included in the study in a tertiary referral center (Frankfurt, Germany). All selected patients were under long-term protonpumpinhibitor-therapy with persistant symptoms. All patients underwent investigations to collect data on their physical status, EAE, severity of esophagitis, anatomical changes, and esophageal functional defects as well as their relation to the duration of the disease. Incidence over time was plotted as survival curves and tested with Log-rank tests for the four main disease markers. Multivariate modeling with COX-regression model was used to estimate the general impact of the four main disease markers on the time course of the disease. In order to elucidate possible causal relationships over time, a path analysis (structural equation model) was calculated.
Results - From the database with 1480 data sets, 972 patients were evaluated (542 males, 430 females). The mean age was 50.5 years (range18–89). The mean body mass index was 27.2(19–48). The mean time between the onset of symptoms and the diagnostic investigations was 8.2 years (1–50). A longer disease history for GERD was significantly associated with a higher risk for LES-incompetence. The mean duration from symptom onset to the time of clinical investigation was 9 years for patients with LES-incompetence (n = 563), compared to a mean of 6 years for those with mechanically intact LES (n = 95). A longer period from symptom onset to diagnostics was significantly associated with higher acid exposure. The pathway analysis was significant for the following model: ‘history’ (P P
Conclusion - LES-incompetence, the functional deterioration of the LES, and the anatomical alteration at the esophagogastric junction (Hiatal Hernia) as well as an increased EAE were associated with a long history of suffering from GERD. Path modeling suggests a causal sequence overtime of the main disease-parameters, tentatively allowing for a prediction of the course of the disease
Endogenous Fixprices and Sticky Price Adjustment of Risk-averse Firms
Full text linkA risk-averse price-setting firm which knows the quantity demanded at the status quo price but has imperfect information otherwise may choose not to change it although an otherwise identical risk-neutral firm would do so, provided the variance of the firm's subjective probability distribution over quantities demanded as a function of price displays a kink at the status quo. This is equivalent to risk aversion of order one. When no such endogenous fixprice exists, the size of price adjustment still tends to zero as risk aversion tends to infinity, and to any arbitrarily small menu cost there exists a degree of risk aversion so that the firm will not adjust.fixed prices, price adjustment, risk aversion, menu cost
"The European Commission as Corporate Actor? European Telecommunications Policy after Maastricht"
Full text linkTelecommunications in the past constituted a tightly regulated, nationally oriented policy field. In economic terms it was characterized by closed national markets and few transnational interactions. Telecommunications are now developing towards an international market with minimal national regulation. Among the factors that contributed significantly to these changes, bold actions by the European Commission have to be mentioned. The actions consisted of recommendations, directives, programs and other activities, such as supportive statements by the European Court of Justice. Contrary to what is very often hinted at, however, it is not to be expected that on the European level a central state authority will develop, that resembles the old national regulatory and institutional structures. Rather a complex system of multi level governance is coming into existence which features not very clearly specified competencies and a mixture of private, para-public and public institutions with shared responsibilities. The present paper will both try to analyze recent trends in European telecommunications policy as well as assess the role of the European Commission. With respect to the latter it will be argued that the conceptualization of the Commission as a corporate actor signifies an important step forward in analyzing the Commission, but it is still a concept that needs further clarification
Treating gastro-oesophageal reflux disease (GERD) with sense
No full textGastro-esophageal reflux disease (GERD) is a common disorder that affects an estimated 5 % to 7 % of the global population. Management of GERD often poses a number of challenges. In this article, the author presents a number of management modalities for this condition.peer-reviewe
Motilitätsstörungen der Speiseröhre im Alter: eine manometrische Analyse an Patienten mit und ohne GERD
No full textBackground/Aims : The impact of aging on esophageal motility is not completely understood. This study aims at assessing 1) whether degeneration of esophageal body motility occurs with age and 2) whether this development is influenced by gastroesophageal reflux disease (GERD).Methods: 326 consecutive patients with symptoms of GERD underwent a diagnostic work-up including a water-perfused esophageal manometry. Patients were divided by age: 17-39 years (group 1, n=75), 40-49 years (group 2, n=79), 50-59 years (group 3, n=64), 60-69 years (group 4, n=74), and >70 years (group 5, n=34). GERD was diagnosed if patients had erosive esophagitis at endoscopy, a positive pH-metry, or both. The amplitude of esophageal contraction waves 3 cm and 8 cm above the lower esophageal sphincter and the percentage of peristaltic contraction waves of the tubular esophagus were analyzed and correlated to GERD.Results: A normal esophageal manometry was found in 86.7%, 73.4%, 67.2%, 58.1%, and 55.9% (p<0.01) in groups 1-5, respectively. Esophageal contraction wave amplitudes were affected by age in patients positive for GERD only (p<0.01). Esophageal body peristalsis was affected by age (p<0.01) independent of the diagnosis of GERD. Conclusion: Aging is correlated to esophageal motor abnormalities. GERD has a significant impact on esophageal contraction wave amplitude, but not on peristalsis.Hintergrund: Schluckstörungen sind ein häufiges klinisches Problem älterer Patienten. Die Ätiologie der sogenannten Presbyphagie ist multifaktoriell. Unter anderem wird auch eine altersabhängige Verschlechterung der Speiseröhrenmotilität diskutiert. Manometrische Daten aus größeren Patientenkollektiven liegen zu dieser Fragestellung bisher nicht vor. Patienten und Methoden: 326 Patienten mit Verdacht auf gastroösophageale Refluxkrankheit (GERD) wurden mittels Ösophagogastroskopie, pH-Metrie und Ösophagusmanometrie untersucht. Die Patienten wurden je nach Alter in 5 Gruppen unterteilt: 17-39 Jahre (Gruppe 1, n=75), 40-49 Jahre (Gruppe 2, n=79), 50-59 Jahre (Gruppe 3, n=64), 60-69 Jahre (Gruppe 4, n=74) und älter als 70 Jahre (Gruppe 5, n=34). Kriterien der GERD waren eine erosive Ösophagitis oder eine positive pH-Metrie. Der Prozentsatz peristaltischer Kontraktionswellen sowie die ösophagealen Kontraktionsamplituden 3 und 8cm oberhalb des unteren Ösophagussphinkters wurden analysiert und mit dem Alter und der Diagnose GERD korreliert. Ergebnisse: Eine normale Ösophagusmanometrie fand sich in 86,7%, 73,4%, 67,2%, 58,1%, und 55,9% (p<0.01) der Patienten in den Gruppen 1-5. Der Prozentsatz peristaltischer Kontraktionswellen war bei allen Patienten - unabhängig von der Diagnose GERD - mit zunehmendem Alter reduziert (p<0.01). Die Amplituden der ösophagealen Kontraktionen waren nur bei Patienten mit nachgewiesener GERD altersabhängig reduziert (p<0.01). Schlussfolgerung: Mit dem Alter der Patienten sinkt der Prozentsatz peristaltischer Kontraktionswellen signifikant. Das Vorliegen einer GERD führt zusätzlich zu einer altersabhängigen ösophagealen Dyskontraktilität der distalen Speiseröhre
La place de la guerre de 1914-1918 dans l'histoire culturelle de l'Allemagne
No full textThe place of the 1914-1918 war in the cultural history of Germany, Gerd Krumeich.
Through his study of war accounts and memories, the author analyses the impact of the war experience on German culture in its individual as well as its collective aspects. That impact brought about the continuation and the diffusion of militarism and nationalism in much of the German society of the 1920s and 1930s.Krumeich Gerd. La place de la guerre de 1914-1918 dans l'histoire culturelle de l'Allemagne. In: Vingtième Siècle, revue d'histoire, n°41, janvier-mars 1994. La guerre de 1914-1918. Essais d'histoire culturelle. pp. 9-17
Differences in cerebral response to esophageal acid stimuli and psychological anticipation in GERD subtypes-An fMRI study
No full textBackground: To evaluate whether there are differences in the cerebral response to intraesophageal acid and psychological anticipation stimuli among subtypes of gastroesophageal reflux disease (GERD)
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