Konsiliarisch-psychiatrische versorgung eines Allgemeinkrankenhauses im zusammenhang mit stationärer kriseninterventio

Zusammenfassung In der vorliegenden Arbeit untersuchten wir die konsiliarisch-psychiatrische Versorgung eines großen Allgemeinkrankenhauses in Verbindung mit der Aufnahme auf eine Kriseninterventionsstation.Besonders interessierten uns Zusammenhänge zwischen der Häufigkeit des Auftretens von Suizidalität, psychiatrischer Krise und Übernahme von konsiliarisch-psychiatrisch untersuchten Patienten. Von insgesamt 6004 Patienten des Allgemeinkrankenhauses wurden in einem Zeitraum von 2 Monaten 227 (130 Frauen, 97 Männer) psychiatrisch untersucht. Am häufigsten wurden psychogene Reaktionen und Anpassungsstörungen (ICD-9: 308.0–309.9) mit 36.6%, am zweithäufigsten Suchterkrankungen (ICD-9: 303, 305.0, 304.0–304.9, 305.1–305.9) mit 26.8% diagnostiziert. In 90 Fällen lag eine psychiatrische Krise vor. Das Durchschnittsalter dieser Patienten war niedriger als das der Übrigen. Bei 91 Patienten fand man ein suizidales Syndrom. Es wurden 23 Patienten innerhalb und 7 nach Ablauf von 24 Std auf die Kriseninterventionsstation (KIS) übernommen.Mit Hilfe der Konfigurationsfrequenzanalyse (KFA) fanden wir 3 signifikante Typen: (1) Krisen-Patienten (N = 18), bei denen sowohl Suizidalitat, Krise und Ubernahme auf die Kriseninterventionsstation innerhalb von 24 Std zusammentraf; (2) typische Nicht-Krisen-Patienten (N = 111), bei denen keine der 3 Variablen bejaht wurde; (3) eine Gruppe (N = 48), die trotz des Vorliegens eines suizidalen Syndroms und einer aktuellen Krise nicht auf die KIS übernommen wurden.Bei der Gruppe von Patienten (N = 23), die eine angebotene Aufnahme auf die Kriseninterventionsstation ablehnten, bestätigte sich durch eine Nachuntersuchung nach Ablauf eines Jahres unsere Hypothese eines hohen Risikos.Die vorliegende Arbeit ist Herrn Prof. Dr. med. Wilhelm Feuerlein zum 65. Geburtstag gewidmet.     

Experimental study on drug therapy of “traction retinal detachment” after posterior penetrating eye injury in the rabbit

In an experimental study on rabbits, a standarized eye injury was created by using the pars-plana incision model. Subsequently, the effect of intravenous application of dexamethasone and penicillamine on traction retinal detachment was investigated. The two drugs were applied in varying concentrations and combinations (single and combined use in varying intervals), followed by a 3-month control period without medication. Clinical and histological findings showed that intravitreal instillation of 1.2 mg dexamethasone reduces the incidence of retinal detachment from 46% to 27%. Higher concentrations of dexamethasone, as well as the use of penicillamine or a combination of both substances, proved to enhance traction retinal detachment.     

p63 deficiency activates a program of cellular senescence and leads to accelerated aging

The p53 tumor suppressor plays a key role in organismal aging. A cellular mechanism postulated to drive the aging process is cellular senescence, mediated in part by p53. Although senescent cells accumulate in elderly individuals, most studies have relied on correlating in vitro senescence assays with in vivo phenotypes of aging. Here, using two different mouse models in which the p53-related protein p63 is compromised, we demonstrate that cellular senescence and organismal aging are intimately linked and that these processes are mediated by p63 loss. We found that p63(+/-) mice have a shortened life span and display features of accelerated aging. Both germline and somatically induced p63 deficiency activates widespread cellular senescence with enhanced expression of senescent markers SA-beta-gal, PML, and p16(INK4a). Using an inducible tissue-specific p63 conditional model, we further show that p63 deficiency induces cellular senescence and causes accelerated aging phenotypes in the adult. Our results thus suggest a causative link between cellular senescence and aging in vivo, and demonstrate that p63 deficiency accelerates this process.     

Procedure- and age-dependent hyperactivity in a new animal model of endogenous depression

We have replicated the findings of Mirmiran and colleagues that neonatal administration of the antidepressant clomipramine (CLI) to male rats results in hyperactivity in open-field tests in adulthood. We report that this effect does not reliably occur in a "Digiscan" activity device. The difference in effect between the two activity measuring devices may be due to more stress being present in the open-field test, and we propose that the CLI-treated rats may be more reactive to stress. This hypothesized enhanced reactivity to stress may be similar to the proposed vulnerability of depressed humans to stress. In addition, we have found that the open-field effect does not occur until the rats are at least 4 months old; this delayed effect may be analogous to the progressive onset of endogenous depression in humans.     

Reversible hepatic veno-occlusive disease in an infant after consumption of pyrrolizidine-containing herbal tea

Veno-occlusive disease was diagnosed in an 18-month-old boy who had regularly consumed a herbal tea mixture since the 3rd month of life. The boy developed portal hypertension with severe ascites. Histology of the liver showed centrilobular sinusoidal congestion with perivenular bleeding and parenchymal necrosis without cirrhosis. The tea contained peppermint and what the mother thought was coltsfoot (Tussilago farfara). The parents believed the tea aided the healthy development of their child. Pharmacological analysis of the tea compounds revealed high amounts of pyrrolizidine alkaloids. Seneciphylline and the corresponding N-oxide were identified as the major components by thin-layer chromatography, mass spectrometry and NMR spectroscopy. We calculated that the child had consumed at least 60 g/kg body weight per day of the toxic pyrrolizidine alkaloid mixture over 15 months. Macroscopic and microscopic analysis of the leaf material indicated thatAdenostyles alliariae (Alpendost) had been erroneously gathered by the parents in place of coltsfoot. The two plants can easily be confused especially after the flowering period. The child was given conservative treatment only and recovered completely within 2 months.     

Graduate education in health services administration. Integrating business with clinical perspectives

Health services administration continues to evolve in response to environmental changes in reimbursement, technology, demographics, and health care reform. These changes encourage further integration of business skills in health services, an emphasis which often conflicts with the perspectives of clinicians. The balance between business and clinical perspectives must be developed such that administrators and clinicians foster the survival and growth of their organizations while assuring comprehensive and quality health services to patients and the community. This paper describes education in health services administration, and uses a survey of one program's graduates to assess the usefulness of the current educational model in balancing business and clinical perspectives.     

Borna disease virus-induced hippocampal dentate gyrus damage is associated with spatial learning and memory deficits

In neonatally inoculated rats, Borna disease virus (BDV) leads to a persistent infection of the brain in the absence of an inflammatory response and is associated with neuroanatomic, developmental, physiologic, and behavioral abnormalities. One of the most dramatic sites of BDV-associated damage in the neonatal rat brain is the dentate gyrus, a neuroanatomic region believed to play a major role in spatial learning and memory. The absence of a generalized inflammatory response to neonatal BDV infection permits direct effects of viral damage to the dentate gyrus to be examined. In this report, neonatally BDV-infected rats at various stages of dentate gyrus degeneration were evaluated in the Morris water maze, a swimming test that assesses the rats' capacity to navigate by visual cues. Our data demonstrate progressive spatial learning and memory deficits in BDV-infected rats that coincided with a gradual decline in the estimated hippocampal dentate gyrus neuron density.     

Phototherapeutic keratoectomy (PTK) after keratoconjunctivitis epidemica

Background: Persistent and recurrent nummuli after epidemic keratokonjunktivitis (EKC) often lead to reduced visual acuity and increased glare. In spite of long-term topical steroid therapy nummuli often recur. We tried to treat persistent nummuli with phototherapeutic keratectomy (PTK). Patients: PTK with an excimer laser (193 nm) was performed in 13 eyes of 9 patients with nummuli. The nummuli were observed over 3–72 months (mean: 36 months). Preoperatively, the visual acuity was 0.1–0.9 (mean: 0.39 ± 0.22) and the brightness acuity test (BAT) was 0.05–0.5 (mean: 0.25 ± 0.15). Prior to PTK all eyes had been treated with local steroids several times for recurrent nummuli. Results: During the follow-up from 15 to 56 months (mean: 33 ± 11.5 ms), 11 eyes had an increase in visual acuity: 0.3–1.0 (mean: 0.63 ± 0.26). The reduction of glare was especially beneficial for the patients: 0.3–0,9 (mean: 0.55 ± 0.21). One patient had a recurrence of nummuli in both eyes 6 weeks after PTK. The subjective-induced spheric refractive change was − 2.5 D to + 2.0 D. The astigmatic error changed between − 2.0 D to + 1.5 D. Conclusion: PTK seems to be an effective method of treating persistent, recurrent nummuli after EKC. The low rate of recurrence of nummuli after PTK is remarkable.