Colon perforation following percutaneous nephrostomy and renal calculus removal

Two patients had colonic perforation as a result of percutaneous nephrostomy placement followed by track dilatation and renal calculus removal. We present the technical aspects of nephrostomy placement and stone removal, as well as the clinical diagnosis and management of these cases. Both patients recovered well with conservative therapy and required no surgical intervention. This report reviews the anatomic considerations for percutaneous nephrostomy in patients undergoing renal stone removal.     

Smoking, nicotine dependence and psychiatric comorbidity--a population-based study including smoking cessation after three years

BACKGROUND: Evidence suggests that nicotine-dependent smokers are at increased risk for psychiatric comorbidity but general population data that included the number of nicotine dependence and withdrawal symptoms according to DSM-IV, the Fagerstrom Test for Nicotine Dependence (FTND), somatoform disorders and the number of psychiatric diagnoses are rare. The goal of the present study was to analyse relationships of smoking and nicotine dependence with psychiatric disease and whether psychiatric disease predicts the sustaining of smoking after three years. METHODS: Cohort study with a random adult population sample in a northern German region (N = 4075) including a baseline measurement of ever daily smokers aged 18-64 (n = 2458), a first follow-up of the current smokers at baseline (n = 1552) after 30 months and a second follow-up after 36 months. Measures included DSM-IV diagnoses by the Composite International Diagnostic Interview, FTND, smoking cessation by interview. RESULTS: Current daily smokers showed higher odds of a substance use disorder other than nicotine dependence compared with never smokers (odds ratio, OR, 4.6; confidence interval, CI, 2.9-7.2), affective (OR 1.8; CI 1.4-2.5), anxiety (OR 1.6; CI 1.2-2.0) or somatoform disorder (OR 1.4; CI 1.0-1.8). DSM-IV nicotine dependence and the FTND were positively related with the number of psychiatric diagnoses. Psychiatric comorbidity did not predict the maintenance of smoking or quitting. CONCLUSIONS: Findings of increased rates of mental disorders among smokers and nicotine-dependent smokers in the adult general population are supported by this study. The number of nicotine dependence and withdrawal symptoms are related to mental disorders. In addition, somatoform disorders show relationships with smoking similar to relationships with depressive or anxiety disorders. The intention to stop smoking should be proactively supported among these comorbid patients.     

Relation among stage of change, demographic characteristics, smoking history, and nicotine dependence in an adult German population

BACKGROUND: The aim of this study was to provide evidence about the individual intention to quit smoking and accompanying characteristics in a country with a low amount of tobacco control (TC) provisions. METHODS: This study used a random sample of the population aged 18-64 in a German area to make a quantitative estimation of the stages of change to quit smoking among current smokers who had at least one quit attempt (n = 1075). RESULTS: The rate of those who did not intend to stop smoking (precontemplators) was 76.4%, that of those who intended to quit during the next 6 months (contemplators) was 17.0%, and that of those who intended to quit during the next 4 weeks was 6.6%. The three groups did not differ according to gender or age. Of those who had at least 16 years of education, more were contemplators than were those with fewer years of education. Among those who had somatic complaints or nausea from smoking, who had their first cigarette within 1 h or less after awakening, and who had more quit attempts, more were in the contemplation or preparation stage. CONCLUSIONS: Nicotine dependence may add to contemplating about quitting. The precontemplation rate was substantially higher than in samples from nations or states which show a large amount of TC provisions.     

Screening for mental health: validity of the MHI-5 using DSM-IV Axis I psychiatric disorders as gold standard

Short screening questionnaires for mental health are useful tools for research and clinical practice, e.g. they could play a major role in detecting patients with psychiatric disorders in primary care. The present study tests the validity of the five-item Mental Health Inventory (MHI-5) screening test using DSM-IV Axis I diagnoses as a gold standard and analyzes its performance in different diagnostic groups. A random sample was drawn from the resident registration office files in northern Germany. Personal interviews with a response rate of 70% were conducted. Of the sample, 4036 respondents filled in the MHI-5. DSM-IV diagnoses were assessed using the Munich Composite International Diagnostic Interview (M-CIDI). The area under the receiver operating characteristics curve (AUC) of 0.72 in identifying any DSM-IV Axis I disorder (except substance use) is not satisfying. The MHI-5 revealed best performance for mood (AUC: 0.88) followed by anxiety disorders (AUC: 0.71). Sensitivity and specificity were poor for somatoform and substance use disorders, especially in cases without comorbid mood or anxiety disorder. The power to detect mood and anxiety disorders of the MHI-5 was better for the 4-week compared with the 12-month diagnoses. The MHI-5 can be recommended to screen for mood disorders. Data have to be confirmed for primary care settings.     

肾康片质量标准的研究

目的：研究肾康片的质量标准并控制该制剂的质量。方法：用薄层色谱法鉴别了肾康片中的黄芪,山茱萸,桑寄生及丹参,用薄层色谱法限量检查屯该制剂中的乌头碱,用双波长薄层扫描法测定了该制剂中黄芪甲苷的含量。结果：乌头碱限量符合中国药典测定,黄芪甲苷的平均回收率为９７．５％,其ＲＳＤ为１．４３％。结论：本文的结果显示出这些方法可用于控制该制剂的质量,方法灵敏,简便,专属,准确。     

Cervical myelography: survey of modes of practice and major complications

A total of 68 major complications of cervical myelography were reported by 220 neuroradiologists in a mail survey. Two-thirds of the complications were attributed to cervical spine hyperextension and one-third to lateral C1-2 puncture. Narrow sagittal diameter of the spinal canal and severe cervical spondylosis were frequent contributing factors to hyperextension injury of the cervical spinal cord. Clinical and radiographic premyelography screening is suggested, with magnetic resonance imaging performed first in patients with spinal canal stenosis, severe spondylosis, and/or myelopathy of any cause. Neck extension should be minimal during myelography. All C1-2 punctures should be monitored with lateral fluoroscopy for accurate needle positioning and prevention of contrast medium injection into the spinal cord.