Psychosomatische Behandlungen bei HNO-Erkrankungen

The spectrum of psychosomatic diseases in the field of otorhinolaryngology covers reactive disorders brought on by excessive psychosocial demands, post-traumatic disorders following mental traumatization, purely psychological disorders brought on by personality development deficits or learnt false behavior, and multifactorial diseases with somatic correlatives and mental triggers. Psychosomatic medicine describes the interaction of physical and psychological processes. The central treatment method is psychotherapy. In Germany, the costs of psychodynamic psychotherapies and behavioral therapy are covered by the health insurance companies. The tasks of psychosomatic treatment in the field of otorhinolaryngology comprise differential diagnostics, basic psychosomatic treatment and the determination of differential indications for the respective forms of psychotherapy.     

Skin wound healing,ischemia-reperfusion injury and nerve regeneration: Similarities in the sequential events and molecular basis

Skin wound healing, ischemia-reperfusion injury and nerve regeneration are three important topics for the hand surgeon. The events and molecular basis for each of these three topics are very complex, and previous review articles have discussed each topic separately. The present review demonstrates and comments on the similarities in the sequential events and molecular basis among skin wound healing, ischemia-reperfusion injury and nerve regeneration.     

PEPTIC ULCER: PATHOGENSIS,HEALING AND ANTI-ULCER DRUGS

Abstract To investigate the possible absorption and deposition of bismuth or aluminium from agents used in the treatment of peptic ulcers, we have measured levels of bismuth and aluminium in the liver tissue of 15 patients undergoing elective liver biopsy and in the cerebrospinal fluid (CSF) of 15 patients undergoing elective myelography after administration of standard therapeutic doses of tripotassium dicitrato bismuthate (TBS), sucralfate or aluminium hydroxide for 1 month. Aliquots of liver or CSF were separated and levels of both aluminium and bismuth were assayed in each sample by atomic absorption spectrophotometry. The group who received TBS had significantly higher liver bismuth levels than the other two treatment groups, but there was no significant difference in CSF bismuth levels among the three groups. There was no significant difference in either liver or CSF aluminium levels among the three treatment groups. We conclude that tissue accumulation of bismuth may occur after short-course therapy with colloidal bismuth, although there is no evidence of CNS accumulation of bismuth in the present study.     

Acute haemorrhagic oedema of infancy, a benign variant of leucocytoclastic vasculitis

Acute haemorrhagic oedema of infancy (AHEI) is an acute leucocytoclastic vasculitis affecting infants and young children. It has a striking appearance of large purpuric skin lesions in a target-like pattern and marked oedema mainly on the face, auricles and extremities. In some patients there is mucosal involvement as well. We present five patients with skin lesions characteristic of AHEI with no visceral involvement and complete resolution within 7-14 days. In three of our five cases, histopathological examination was performed, and demonstrated typical leucocytoclastic vasculitis. Although sometimes confused with Schönlein- Henoch purpura, we suggest that AHEI should be regarded as a separate entity. Clinical criteria for diagnosis are proposed.     

Bone marrow examination before steroids in thrombocytopenic purpura or arthritis

Corticosteroids were used to treat two children with presumed idiopathic thrombocytopenic purpura and one with juvenile rheumatoid arthritis without examination of the bone marrow. Of the two with presumed idiopathic thrombocytopenic purpura, one had Fanconi's anaemia and the other may have had aplastic anaemia. The third child had acute lymphoblastic leukaemia. The diagnosis of Fanconi's anaemia was delayed. A diagnostic and therapeutic dilemma was caused in the second case. In the third, delayed diagnosis and, perhaps, compromised outlook resulted. These three cases re-emphasize the well aired caveats about the diagnosis of idiopathic thrombocytopenic purpura and juvenile rheumatoid arthritis and provide further support for the arguments of those who believe that if corticosteroids are to be used to treat such children, their bone marrow should be examined first.