First a number of aspects are mentioned that should be given special attention in the treatment of sex offenders. This is followed by a review of those treatment studies in which therapy was ...primarily either psychoanalytic or behavioral and which included a relatively large number of patients. Since the authors of the present study found that either a given treatment approach was indicated for a very limited group of patients only or the long-term outcome was poor, they developed an integrative approach for inpatient treatment of sex offenders. This approach includes behavior therapy, psychoanalytically oriented therapy and social therapy. The procedures are described briefly and the role of each is in the overall therapeutic concept pointed out.
The article reports on a ward with 12 beds which has been set up for emergency cases in psychiatry or for immediate intervention in case of a crisis experienced by a patient. In the theoretical part ...of this article, it is explained that crisis situations are present in most of the psychiatric emergency patients. The article then goes briefly into the fundamentals of therapeutic strategy in such patients: A therapy which helps to uncover hidden conflicts, the pros and cons of therapy focussed on conflict and on supportive measures; as well as a therapy which supports and promotes the ego. This is followed by a comparison of the ward with corresponding facilities in Germany and abroad and a description of their structure, their patients and their function within a psychiatric care system. The concluding part of the article is devoted to a description of the authors' initial experiences and impressions gained during their work with the ward patients, quoting several examples.
An unselected series of 100 psychiatric inpatient admissions were interviewed at admission by a psychiatrist using the German version of the PSE (Present State Examination), with a second ...psychiatrist as an observer. The diagnostic agreement between the two project psychiatrists was considerably higher than the agreement between clinicians and CATEGO, a computerised diagnostic system based on PSE data. The disagreements are discussed.
Polyethylene glycol (PEG)-based gut lavage solutions are safe and effective, but require consumption of large volumes of fluid. We compared a new 2 L solution of PEG plus ascorbic acid (PEG + Asc) ...with standard 4 L PEG with electrolytes (PEG + E) for bowel cleansing before colonoscopy to determine efficacy, safety, and patient acceptability.
Consenting adult inpatients scheduled to undergo colonoscopy were randomized to receive either 2 L PEG + Asc or 4 L PEG + E. Preparations were taken as split doses the evening before colonoscopy and the following morning. The PEG + Asc group took 1 L at each administration (i.e., total dose of 2 L). The PEG + E group took 2 L at each administration (i.e., total dose of 4 L). Bowel cleansing success was assessed via videotapes by independent, blinded raters. Statistical noninferiority was predefined as a difference of <15% in the lower limit of the 97.5% confidence interval for treatment difference. Patient views on the preparations were elicited. Adverse events were noted.
Successful gut cleansing was achieved in 136 of 153 (88.9%) cases of the PEG + Asc group and 147 of 155 (94.8%) cases of the 4 L PEG + E group (mean difference -5.9 -12.0-infinity). The difference fell within the predefined limit for noninferiority. Clinical and laboratory parameters showed no difference in safety profile. Patient ratings of acceptability and taste were better for the PEG + Asc group than for the PEG + E group (P < 0.025).
The combination of ascorbic acid and PEG-based bowel preparation reduces the volume patients have to drink without compromising efficacy or safety. The low-volume PEG + Asc preparation was more acceptable to patients, and should, therefore, improve effectiveness in routine practice.
ObjectivesThe Carcinoma of the prostate (prostate-CA) is considered the most common cancer among men in Germany with approximately 68000 cases annually. It is predominantly a disease of older men. ...However, the 5-year survival rate is about 91%. Causing factors are, as already mentioned, age, but ethnicity and weight seem to have an impact as well. This thesis aims to find factors that influence the survival of patients with prostate-CA. Design and MethodsOur study was not conducted hypothesis driven as well as retrospective and monocentric (Urologische und Kinderurologische Klinik, Universitätsklinikum Erlangen). Overall, we studied the big pathological influencing drivers using survival analysis with respect to tumour-specific survival and total survival. For each patient (n=2100) we tried to create a database, registering 38 different factors. Because of the incompleteness of our data (since our study is retrospective) we only analysed parameters, whose number of datapoints was greater than 200. Subsequently, this study discusses only significant attributes. Observations & ResultsHere, we were able to show, that influencing factors such as age, tumour size and infiltration in the surrounding tissue have a significant effect on the total survival as well as the tumourspecific survival in the Erlanger collective. Furthermore, we studied the quality of the surgery with respect to the resection margins and the status of the lymph nodes. An initially planned PSA(prostate specific antigen)-observational study had to be discontinued because the lack of responses of colleagues and the long observational timeframe (1977-2010). Moreover, we developed a nomogram, following the well-known Kattan nomograms. Hereby we identified the infiltration of the seminal vesicles and the tumour size T4 with infiltration in the surrounding tissue as independent factors for the survival in the Erlanger collective. The infiltration of the seminal vesicles was particularly striking. If necessary, further studies of the weighing should be conducted. ConclusionsOverall, we confirmed the current opinion in the field. We did not find new pathological influencing factors on the survival with prostate-CA. In the course of this study, the correlation to blood type proved not to be significant.
Individual characteristics of pathophysiology and course of depressive episodes are at present not considered in diagnostics. There are no biological markers available that can assist in categorizing ...subtypes of depression and detecting molecular variances related to disease-causing mechanisms between depressed patients. Identification of such differences is important to create patient subgroups, which will benefit from medications that specifically target the pathophysiology underlying their clinical condition. To detect characteristic biological markers for major depression, we analyzed the cerebrospinal fluid (CSF) proteome of depressed vs control persons, using two-dimensional polyacrylamide gel electrophoresis and time-of-flight (TOF) mass spectrometry peptide profiling. Proteins of interest were identified by matrix-assisted laser desorption ionization TOF mass spectrometry (MALDI-TOF-MS). Validation of protein markers was performed by immunoblotting. We found 11 proteins and 144 peptide features that differed significantly between CSF from depressed patients and controls. In addition, we detected differences in the phosphorylation pattern of several CSF proteins. A subset of the differentially expressed proteins implicated in brain metabolism or central nervous system disease was validated by immunoblotting. The identified proteins are involved in neuroprotection and neuronal development, sleep regulation, and amyloid plaque deposition in the aging brain. This is one of the first hypothesis-free studies that identify characteristic protein expression differences in CSF of depressed patients. Proteomic approaches represent a powerful tool for the identification of disease markers for subgroups of patients with major depression.
In Germany, analyses of clinical and laboratory features of patients with acute porphyrias are only available for hereditary coproporphyria (HCP) but not with other acute porphyrias, acute ...intermittent porphyria (AIP) and variegate porphyria (VP). The aim of the study was to analyze a large cohort of patients with particular focus upon quality of life aspects. Sixty-two individuals from separate families with acute porphyrias (57 AIP, 5 VP) were included into an observational study collecting biochemical, genetic, and clinical data. A questionnaire was designed to complete anamnestic information and to assess the influence on quality of life. Most frequent signs and symptoms or laboratory abnormalities were abdominal colicky pain, red coloration of urine, and hyponatremia. Depression or anxiety was reported by 61% or 52% individuals, respectively. Fatigue was mentioned as the most quality of life-limiting symptom. In 59/61 patients, mutations could be identified. 44% (20/45) had to be admitted to an intensive care unit. Heme arginate was used in 64% (29/45) of patients for treatment of acute attacks at least once and in 33% for long-term treatment with high frequency of administration. Serum creatinine values increased in 47% (7/17) of the patients with recurrent attacks. Our analysis confirms a substantial influence of the diseases on the quality of life on patients. Percentages of urine discoloration and intensive care unit admissions were much higher than in other reports. Long-term treatment with heme arginate requires careful monitoring of iron status and renal values.
PDF
