Subkutane Kalzifikationen nach Strahlentherapie

Wir berichten über eine 75-j?hrige Patientin mit einem Sp?tstadium des kutanen Strahlensyndroms. Bei ihr wurde vor 32 Jahren postoperativ eine kombinierte Strahlentherapie bei einem Zervixkarzinom durchgeführt. Die aktuelle Vorstellung erfolgte wegen einer mit der 7,5-MHz-Sonographie und Magnetresonanztomographie verifizierten abszedierenden Entzündung der Kutis und Subkutis im Bereich des Bestrahlungsfeldes. Unter systemischer antibiotischer Therapie mit Cefotiam (Spizef) 2,0 g 3-mal tgl. i.v. war die Entzündung sowohl klinisch als auch magnetresonanztomographisch kontrolliert rückl?ufig. Als Nebenbefund fielen in der konventionellen R?ntgenaufnahme, 7,5-MHz-Sonographie, Computer- und Magnetresonanztomographie ungew?hnlich stark ausgepr?gte, teils groteske subkutane Verkalkungen im Bestrahlungsfeld auf. Diese Verkalkungen in der Subkutis dürften am ehesten radiogen bedingt sein.     

Neodymium:YAG laser anterior vitreolysis for Irvine-Gass cystoid macular edema

Twenty-nine consecutive patients with vitreous incarceration in the wound after cataract surgery and cystoid macular edema (Irvine-Gass syndrome) were treated with Nd:YAG laser anterior vitreolysis. Fifty-five percent (55%) achieved two or more lines of stable visual improvement; 17% improved but with fluctuating levels of vision and persistent edema; 28% failed to improve, half of them because of coexisting ocular pathology. Visual improvement was achieved an average of 3.5 months after treatment. Persistent macular edema was associated with several types of anterior chamber intraocular lenses.     

Snapping elbow caused by hypertrophic synovial plica in the radiohumeral joint: a report of three cases and review of literature

The snapping elbow caused by hypertrophic synovial radiohumeral plica is a rare form of lateral elbow impingement. In this article we report on hypertrophic radiohumeral synovial folds in three male patients, aged 54, 65 and 27 years. All three patients suffered isolated lateral elbow pain, painful snapping and unsuccessful conservative treatment over at least 5 months (range 5–9 months, mean 7.7 months) prior to surgical treatment. None of the patients had lateral epicondylitis, instability, osteochondrosis dissecans, loose bodies, arthritis or neurological disorders. Upon clinical examination the range of motion in the respective painful elbows was found to be normal in all three cases, but a painful snapping occurred between 80° and 100° of flexion with the forearm in pronation. While there were no pathologic findings in standard radiographs, magnetic resonance imaging (MRI) revealed hypertrophic synovial plicae in the radiohumeral joints associated with effusion in each of the diseased elbows. Arthroscopic examinations confirmed the presence of a hypertrophic synovial plica in all three radiocapitellar joints, and revealed a transient interposition and compression of the folds in the articulation from extension until 90°–100° elbow flexion, with replacement beyond 90° elbow flexion with a visible jump. Surgical management in all three cases comprised arthroscopic diagnosis confirmation and removal of the synovial plicae, leading to excellent outcomes at 6–12 months follow-up.     

The importance of physician listening from the patients' perspective: enhancing diagnosis, healing, and the doctor-patient relationship

ObjectiveThe research findings reported here describe the importance and various functions of physician listening according to patients.MethodsFifty-eight patients of the McGill University Health Centre were interviewed using a qualitative, interpretive design approach.ResultsPatients explained why listening was important to them and these findings were organized into three themes: (a) listening as an essential component of clinical data gathering and diagnosis; (b) listening as a healing and therapeutic agent; and (c) listening as a means of fostering and strengthening the doctor–patient relationship. The findings are presented along with a conceptual model on the functions of physician listening.ConclusionElucidating the multiple functions of listening in the clinical encounter from patient perspectives can assist physicians in improving their listening approach.Practice implicationsFor training purposes, we recommend that a module on listening should lead to a discussion not only about the skill required in listening attentively, but also to the values, beliefs, attitudes, and intentions of physicians who choose to listen to their patients. This teaching objective may be facilitated by future research that explores the concept of ‘authenticity’ in a physician's listening approach, which we argue is central to successful clinical outcomes.     

Faculty development: a ‘Field of Dreams’?

Objectives  Participants in faculty development workshops often comment that 'those who need faculty development the most attend the least'. The goals of this study were to explore the reasons why some clinical teachers do not participate in centralised faculty development activities and to learn how we can make faculty development programmes more relevant to teachers' needs.
Methods  In 2006, we conducted focus groups with 16 clinical teachers, who had not participated in faculty development activities, to ascertain their perceptions of faculty development, reasons for non-participation and perceived barriers to involvement. Content analysis and team consensus guided the data interpretation.
Results  Focus group participants were aware of faculty development offerings and valued the goals of these activities. Important reasons for non-participation emerged: clinical reality, which included volume of work and lack of (protected) time; logistical issues, such as timing and the central location of organised activities; a perceived lack of financial reward and recognition for teaching, and a perceived lack of direction from, and connection to, the university.
Conclusions  Clinical reality and logistical issues appeared to be greater deterrents to participation than faculty development goals, content or strategies. Moreover, when asked to discuss faculty development, teachers referred to their development as faculty members in the broadest sense, which included personal and career development. They also expressed the desire for clear guidance from the university, financial rewards and recognition for teaching, and a sense of 'belonging'. Faculty development programmes should try to address these organisational issues as well as teachers' personal and professional needs.     

Zellbasierte Therapie der Femurkopfnekrose

The goal of the therapy for necrosis of the femoral head in adults is the preservation of the femoral head and, therefore, avoidance of total joint replacement. Core decompression is known to reduce the intraosseous pressure and additionally provides the opportunity to introduce bioactive materials, substances and cells into the core tract. These include vascularized and non-vascularized bone grafts, allogenic and synthetic bone substitutes, osteogenic and angiogenic growth factors, as well as different progenitor cells. In particular, the use of cell-based strategies has great therapeutic potential and could play an important role in the treatment of femoral head necrosis in adults in the future. In this article, we summarize the existing clinical experience of current cell-based strategies for the treatment of femoral head necrosis in adults, and present a therapeutic approach using bone marrow stem cells (TRCs: tissue repair cells). in combination with a beta-TCP matrix.     

Successful interventions on an organisational level to reduce violence and coercive interventions in in-patients with adjustment disorders and personality disorders

Background

Self-directed and other violence as well as subsequent coercive interventions occur in a substantial proportion of patients with personality disorders during in-patient treatment. Different strategies may be required to reduce coercive interventions for patients of different diagnostic groups.

Methods

We specialised one of our acute admission wards in the treatment of personality disorders and adjustment disorders (ICD-10 F4 and F6). Patients are not transferred to other acute wards in case of suicidal or violent behaviour. Violent behaviour and coercive interventions such as seclusion or restraint were recorded in the same way as in the rest of the hospital. We recorded the percentage of subjects affected by diagnostic group and average length of an intervention in the year before and after the change in organisational structure.

Results

The total number of coercive interventions decreased by 85% both among patients with an F4 and those with an F6 primary diagnosis. Violent behaviours decreased by about 50%, the proportion of involuntary committed patients decreased by 70%.

Conclusion

The organisational change turned out to be highly effective without any additional cost of personnel or other resources.

     

A comparative trial of depot pipothiazine

Thirty-nine chronic schizophrenic patients were selected for a 12-month double-blind evaluation of the effectiveness of pipothiazine palmitate (PPT) and flupenthixol decanoate (FPX) in the maintenance management of their illness. Allocation was at random and, in order to allow constant injection intervals, the patients typically received every 2 weeks either 40 mg of flupenthixol decanoate or alternating injections of 100 mg of pipothiazine palmitate and placebo. At monthly intervals the patients were assessed using both a battery of rating scales (which included the Brief Psychiatric Rating Scale (BPRS), the Extrapyramidal Symptoms Rating Scale (EPS] and a general side-effects evaluation. At 3-monthly intervals they were also rated on the Comprehensive Psychiatric Rating Scale (CPRS) and the Zung Depression Scale. Haematological and biochemical tests were performed every 3 months. Both drugs provided good control of psychotic symptoms and side-effects were not troublesome. No substantial difference was detected on the CPRS and the Zung scales. There was a trend in favour of PPT on the BPRS survey, detectable at 6 months and reaching statistical significance by 12 months. We conclude that the PPT regime is at least as effective as the FPX treatment and probably more so. It is possible that even longer periods of control could be obtained with PPT.