Wiener klinische Wochenschrift. Supplementum最新文献

In this paper the literature on placebo-controlled studies with Mianserin is being commented in view of the enclosed discourse "Placebo: Beyond pretense and nuisance variable." This paper's purpose is to enrich the understanding of the effect of a drug under everyday therapeutic conditions, an understanding, that derives from the physicians synthesis of personal uncontrolled observations of a drug's profile and the reported "mean-effect" in placebo-controlled studies.

In this theoretical paper the concept of placebo is being investigated within a field of tension: on one side the conventional understanding of "placebo", that is empirically inconsistent and scientifically and ethically unsatisfactory, and on the other side the upgraded concept of "aura curae" as suggested by the author, that appears to be less contradictory and also richer in heuristic potential and, conceivably, may be closer to the essence of "placebo" itself. This statement is being corroborated by six main arguments. The first three arguments are meant to weaken the conventional concept of "placebo": The first argument deals with the empirical inconsistencies of the traditional placebo concept; the second addresses the possible distortion of scientific conclusions drawn from a conventional "placebo-controlled" trial; the third argument deals with the ethical problems of "pretense" and of "withholding adequate medication". The following three corresponding arguments are put forward in support of the upgraded placebo-concept of "aura curae" (Latin: "air of care"; "unspecific healing context"). The fourth argument introduces the concept of "aura curae" itself; the fifth argument deals with two alternatives to the conventional placebo-controlled trial, namely the "placebo-integration" and the "value added efficacy"; the sixth argument concludes with a discussion of the ethical advantages of implementing the concept of "aura curae" in clinical and research practice. The purpose of this paper is to contribute to a comprehensive "healing context", that would better fit the patient's needs; i.e., in addition to the various traditional "therapies" of specific influence (biological and psychosocial), the "protherapeutic" and unspecific effects of the "aura curae" should be integrated into a systemic patient care.

260 patients with malignant disease received intravenous, intramuscular or intravesical hyaluronidase (H.) (Permease by Sanabo), 7,000 to 25,500 IU (10 to 30, 750 IU vials) or 200,000 IU (1 vial of H.) in addition to systemic or intravesical chemotherapy. Treatment was well tolerated except for 20 transient allergic episodes, 2 of which consisted in local symptoms at the injection site. Results are presented for 103 patients not responding to previous chemotherapy, 53 patients with primary and secondary brain tumours, and 51 patients with superficial bladder cancer. Adjuvant hyaluronidase was found to restore responsiveness in a large percentage of non-responders. The remaining systemically treated patients received H. together with their initial chemotherapy or with a modified cytostatic regimen. Intravesical H. in combination with mitomycin C was well tolerated and did not enhance mitomycin C plasma levels. In a randomized trial 5 of 23 patients with superficial bladder cancer receiving adjuvant intravesical mitomycin C alone developed tumour regrowth versus 1 of 21 patients receiving additional H. Adjuvant H. decreased 5-FU plasma saturation rates during arterial perfusion in colorectal cancer with metastatic spread to the liver, probably reflecting enhanced 5-FU extraction. Colorectal cancer stem cell assays with 5-FU showed a significant reduction of colony counts in the presence of H. Action mechanismus of hyaluronidase in malignant diseases are discussed, experimental data suggesting an effect of H. on immunologic events in malignant disease are presented.

Anterior chamber lenses sized correctly and positioned properly yield excellent results. Problems reported with anterior chamber implants are related to improper length/or lens placement to the scleral spur. In clinical routine examinations the "white to white data plus one mm" determine the overall length of an anterior chamber lens. However, variability of limbal anatomy causes great variations in estimations of corneal diameter. Approximation of corneal profile can be achieved by using ellipsoid or paraboloid functions. These data together with ultrasound measurements and keratometer readings serve as prerequisites for computations. For biometry an Ocuscan DBR 400-ST unit is used; the corneal refraction (r0) is measured with an automatic keratometer (Humphrey). The peripheral measurements are performed 13.5 degrees nasally and temporally (r1, r2). Using Euler's formula the horizontal radius is calculated (R0, R1, R2). Taking the constant epsilon 2 (epsilon 2 = r2-r0(2)/r2sin2 phi) the diameter can be calculated with the formula h = square root of (2ap-p2)(1-epsilon 2). Model A: two asymmetric halves are computed, the addition gives the corneal diameter (H = h1 + h2). Model B and C: only one symmetric half is computed, the double distance gives the corneal diameter (H = 2 h). The distance p is taken from biometry data; the distance from the anterior corneal surface to the posterior lens surface (ACD + LE) should be multiplied with the factor 0.32: p = (ACD + LE) 0.32. 250 eyes were examined comparing the optical data with the calculated results of our corneal model; the mean value for p was 2.4811 millimeter. Based on a control system the computer eliminated 35 eyes (14%). In the rest group of 215 eyes (100%) the difference to the optical measurements was not greater than +/- 0.25 mm in 181 calculations (84.2%). We noticed a tendency to predict too short internal diameters with external methods. Using optical measurements 1.25 millimeters should be added assuring correct position of the haptics. Using our computer-program for calculations of corneal diameter new anatomic conditions in eyes with abnormal dimensions may be detected.

In this report diseases of the Achilles tendon are discussed. First an anatomical survey of this region is presented including anatomical variations together with the results of the author's own investigations on corpses. Certain positions and insertions of the plantaris tendon with respect to the Achilles tendon may have pathological influence. Pathological aspects are discussed after a review of the physiology of the Achilles tendon, including functional and tensile tests. The clinical picture changes according to the location of the pathological disorder--tendon, paratenon, insertion and bursae--and whether the disease is acute or chronic. There are various reasons for degenerative changes in the tendon, which can even lead to rupture. Surgical and non-surgical treatment and their indications are presented. In conclusion treatment methods and their results for 36 cases are given.

Intramedullary osteosynthesis is preferred for shaft fractures of the long bones of the lower extremities because it generally results in early weight-bearing stability, allowing full function of the leg and rapid rehabilitation. Only transverse and short oblique fractures near the middle of the medullary cavity can be sufficiently stabilised using intramedullary nails alone. Additional stabilising aids such as cerclages or interlocking nails must be used for all other types of shaft fracture. There are no previous studies of stability that make a comparison between conventional intramedullary nails and interlocking bolts with or without cerclages. This paper set out to clarify therapeutically relevant questions in the light of a comparative study of stability. To this end a comparative experimental investigation was carried out using femora from human cadavers to determine whether or not either method of intramedullary osteosynthesis attained the stability of the intact bone. The study also set out to establish the relevance of the type of fracture, localisation and mode of fitting to the resulting stability of the osteosynthesis. A comparison was also made of the stability in the bone-implant complex of two different commercially available interlocking nails. Finally, the question was raised as to the clinical conclusions that can be drawn from the present investigation. The bone-implant complex represented by a fracture of the femur secured by an interlocking nail is a complex mechanical system. An optical measuring arrangement was developed so as to ensure that this system was not subject to any interference resulting from the method of measurement. This consisted of a laser light source which projected a beam of light parallel to the axis of the femur shaft across the fracture onto a mirror system attached to the bone. The rays of light reflected from the mirrors were recorded as dots of light on measuring screens. A load of up to 1000 N was gradually applied along the bearing axis, and the resulting changes in the position of the parts of the osteosynthesised fracture relative to one another indicated by the deviation of the beams of light. The axial tilt and rotation of the pieces of bone could be determined from the coordinates of the dots of light. The stability of nailed transverse femoral fractures (n = 6), short oblique fractures (n = 6), long oblique fractures (n = 6) and comminuted fractures (n = 6) was determined and compared with the deformation of intact femora. The stability of all types of osteosynthesis was several times less than that of the intact bones.(ABSTRACT TRUNCATED AT 400 WORDS)

The changes in psychiatric service concern the realm of psychiatric hospitals, the ambulant services, and the complementary services for chronic patients. Influencing factors are the number of patients and the incidence of illnesses and their fluctuations, the available possibilities of therapy and provision and their changes, social changes, influences of the spirit of the age, and political and financial factors. The change in all these areas is briefly presented. There exist relevant figures in the literature. They are critically discussed. The quality of psychiatric services has been altered several times. The change concerns also the patients, in which general factors are to be mentioned like higher longevity, an increased number of chronic patients, aging of the population and the resulting increase in the incidence of psychiatric disturbances.

Behavioural therapists increasingly take in account and apply scientific results and therapeutical methods of other branches of psychology. This has enlarged therapeutical possibilities. On the other hand the traditional techniques of behavioural therapy have found their way into many other schools of psychotherapy. Behavioural therapy and it's therapeutical efficacy has an impact on other schools of psychology and participates to a considerable degree in evaluation of therapeutical processes. In this procedure behavioural therapy undergoes a process leading to new ways out of the ordinary boundries of the traditional school of behavioural therapy. The behavioural therapy together with every other psychotherapeutic school reflects the social process and cannot be seen independently of changing social conditions.

Conceptually, brief-psychotherapy or focal therapy is distinguished from short-time-psychotherapy. The special importance of the first interview is pointed out. The underlying psychodynamics must be presented in which the triggering situation is of special importance. Differences to classical psychoanalysis are worked out. Finally, the domain of indications of brief-psychotherapy is discussed.