Critical Role of 3D ultrasound in the diagnosis and management of Robert's uterus: a single-centre case series and a review.

A septate uterus with a non-communicating hemicavity was first described by Robert in 1969/70 as a specific malformation of the uterus. The condition is commonly associated with a blind uterine hemicavity, unilateral haematometra, a contralateral unicornuate uterine cavity and a normal external uterine fundus. The main symptoms are repetitive attacks of pain at four-weekly intervals around menarche, repeated dysmenorrhea, recurrent pregnancy loss and infertility. In this report, we review the disease, its diagnosis and treatment, and describe five cases of Robert's uterus. Three dimensional (3D) ultrasound (US) imaging was performed by the transvaginal route in four cases. In the fifth case of a 13-year-old girl, we avoided the vaginal route and magnetic resonance imaging (MRI) and 3D transrectal US yielded the correct diagnosis. The following treatment procedures were undertaken: laparoscopic endometrectomy, hysteroscopic septum resection, laparoscopic uterine hemicavity resection and total laparoscopic hysterectomy (TLH). The diagnosis and optimum treatment of Robert's uterus remains difficult for clinicians because of its rarity. A detailed and careful assessment by 3D US should be performed, followed by hysteroscopy in combination with laparoscopy, to confirm the diagnosis.

Changes of salivary estrogen levels for detecting the fertile period.

OBJECTIVES: Is the saliva test, Geratherm ovu control, as accurate as the established urinary luteinizing hormone (LH) test for detecting ovulation and the following the fertile period? STUDY DESIGN: The voluntary participants were 74 healthy women with regular menstrual cycles and not using any hormonal contraceptives. The women used Geratherm ovu control, a small plastic hand-held microscope, for detecting the fertile period. A drop of saliva from sublingual was put onto the lens of the microscope. Three results were possible: non-fertile (dot pattern), transitional and fertile (ferning pattern). The participants performed the saliva test from the 5th till the 22nd day of the menstrual cycle and noted the respective result in a table. In addition to Geratherm ovu control, the EXACTO test for determining urinary LH concentration and the time of peak fertility was also performed. RESULTS: Positive LH shows a sharp increase beginning on the 10th cycle day with a maximum on the 17th cycle day. The curve for positive saliva and questionable positive saliva (one curve) is almost parallel with the curve for positive LH, reaching a maximum on the 16th cycle day. There is a high level of conformity for the same test results from the 5th (100%) till the 14th (84%) cycle day and from the 18th (80%) till the 22nd (96%) cycle day which corresponds to the pre- and post-ovulatory period. CONCLUSION: The saliva and the LH test both detect the fertile window of a menstrual cycle. Caused by the different hormones (estrogen for the saliva and LH for the LH test) leading to the respective positive test results, saliva turns positive 24h before LH. Consequently, the saliva test can be used as an ovulation test and help women maximize their chances of conceiving. There is also a high congruence between LH and saliva in the pre- and post-ovulatory period, indicating that the saliva test can also be used for contraception purposes.

Biocompatibility of Textile Titanium Nickel Implants with Fibroblast Culture.

The parameters of biocompatibility of titanium nickel implants of different design with fibroblast culture are studied. Colonization of textile and mesh implants with fibroblasts and tissue development depend on the size of mesh cells and thread diameter. Titanium nickel implants of different constructions do not inhibit the growth of fibroblast culture.

Impact of radical operative treatment on the quality of life in women with vulvar cancer--a retrospective study.

OBJECTIVES: For patients undergoing vulva surgery the quality of life (QoL) is generally accepted as an important outcome parameter in addition to long-term survival, mortality and complication rates. Less radical operative treatment can reduce morbidity and thereby improve quality of life. This study focuses on outcome in terms of QoL in patients comparing wide local excision (WLE) with radical vulvectomy and waiver of lymphonodectomy (LNE) with inguinofemoral lymphonodectomy. METHODS: In a retrospective single-center study from 2000 to 2010, 199 patients underwent surgery for vulvar cancer. To assess QoL, the EORTC QLQ-C30 and a tumor-specific module questionnaire were sent to all patients in the follow-up period. RESULTS: Women who underwent WLE have a superior QoL with regard to global health status and physical, role, emotional and cognitive functioning than those who underwent radical vulvectomy. Less radical surgery also implies less fatigue, nausea/vomiting, pain, insomnia, appetite loss, diarrhea and financial difficulties. After radical vulvectomy 89% of patients have sexual complications. CONCLUSION: Radical operative treatment, such as radical vulvectomy, causes deterioration in the QoL of these patients. An individualized, less radical surgery must be the aim in the treatment of vulvar cancer.

Tissue reaction to a titanium-nickelide mesh implant after plasty of postresection defects of anatomic structures of the chest.

We studied morphological features of the regenerate formed after postresection defect plasty of the pericardium, diaphragm, and thorax with a mesh implant made of nanostructural titanium-nickelide threads. The newly formed tissue grew through the implant with the formation of an integrated tissue regenerate ensuring anatomic and physiological restoration of this area.

A human challenge model for dengue infection reveals a possible protective role for sustained interferon gamma levels during the acute phase of illness.

Dengue has recently been defined by the World Health Organization as a major international public health concern. Although several vaccine candidates are in various stages of development, there is no licensed vaccine available to assist in controlling the further spread of this mosquito borne disease. The need for a reliable animal model for dengue disease increases the risk to vaccine developers as they move their vaccine candidates into large-scale phase III testing. In this paper we describe the cellular immune responses observed in a human challenge model for dengue infection; a model that has the potential to provide efficacy data for potential vaccine candidates in a controlled setting. Serum levels of sIL-2Rα and sTNF-RII were increased in volunteers who developed illness. Supernatants from in vitro stimulated PBMC were tested for cytokines associated with a T(H)1 or T(H)2 T-cell response (IL-2, TNF-α, IFN-γ, IL-4, IL-10, IL-5) and only IFN-γ was associated with protection against fever and/or viremia. Interestingly, IFN-γ levels drop to 0 pg/mL for volunteers who develop illness after challenge suggesting that some mechanism of immunosuppression may play a role in dengue illness. The human challenge model provides an opportunity to test potential vaccine candidates for efficacy prior to large-scale phase III testing, and hints at a possible mechanism for immune suppression by dengue.

Impaired body image in patients with multiple sclerosis.

OBJECTIVE: Despite the growing research on body image disturbances in chronically ill patients, reports of such disturbances in patients with multiple sclerosis (MS) are scarce. The aim of this study was to assess the occurrence of different aspects of body image disturbances in patients with MS, taking into account the disability status as well as depressive symptoms. MATERIALS & METHODS: Forty patients with MS and 28 healthy controls were investigated with questionnaires assessing attractiveness/self-confidence, accentuation of external appearance, worries about possible physical deficits, sexual problems, vitality and depressive symptoms. In MS patients, medical parameters like the expanded disability status were assessed too. RESULTS: In comparison with healthy controls, the MS patients, being although only mildly disabled and in a quite stable mood, reported significantly higher worries about physical deficits, described a significantly worse body appraisal and significantly more sexual problems. While female MS patients predominantly suffered from worries concerning physical deficits and feelings of being less attractive, sexual problems were of particular concern in male MS patients. CONCLUSIONS: Even mildly impaired MS patients who are not markedly depressed have to deal with problems of body image. Improvement of body image perception in MS patients taking gender-specific differences into account represents a promising area of future psychological research.

[Quality of partnerships in patients with tinnitus]. / Die Qualität der Partnerschaft von Tinnituspatienten.

BACKGROUND: Chronic tinnitus can massively impair the quality of life of patients affected with this disorder. Whether the constant ringing sounds and head noises heard by the sufferer have a stressful effect on the individual's partner has not been investigated so far. PATIENTS AND METHODS: A total of 32 members of the Tyrolean tinnitus self-help group suffering from chronic tinnitus and their partners with whom they shared a common household for a minimum period of 2 years underwent psychological investigation with regard to their subjectively experienced tinnitus-related stress, the quality of their partnership, emotional support they received, style of communication with their partners, and depression. RESULTS: Our results show that it is not the extent of subjective tinnitus that is associated with impaired partnership quality, but rather the extent of tinnitus-associated depression. CONCLUSIONS: The results suggest that in clinical practice, less emphasis should be placed on the dynamics of family and partnership aspects and more attention should be paid to the possible presence of symptoms of depression and their treatment.

Association of factors influencing health-related quality of life in MS.

As results regarding associative demographic and disease-specific factors on health-related quality of life (HRQoL) in patients with multiple sclerosis (MS) are partially inconsistent and contradictory, we reinvestigated this question on a large Austrian MS dataset. Patients received a questionnaire covering demographic and disease-specific characteristics and the Nottingham health profile (NHP) for assessing HRQoL. In order to estimate the risk for suboptimal HRQoL, adjusted odds ratios were calculated from logistic regression models including gender, age, expanded disability status scale (EDSS), disease course, disease duration and walking ability as covariates. The EDSS was the only factor contributing to both physical and mental dimensions (P < 0.001), whereas disease course, gender and age showed a significant effect on all physical, but not consistently on mental dimensions. The regression models fitting better for physical than for mental dimensions, clearly indicate a lack of explanation of demographic and disease-specific factors in these dimensions of HRQoL.

Effects of psychological group therapy in patients with multiple sclerosis.

OBJECTIVES: The aim of this pilot study was to evaluate a psychological therapy program used in the treatment of multiple sclerosis (MS) and including cognitive/behavioral strategies, relaxation training and physical exercise. MATERIAL AND METHODS: The participants were 29 patients with MS recruited from an outpatient unit; 14 patients were assigned to the 7-week psychological therapy group (one session per week), the remainder formed a control group. Before and immediately after the course of therapy and after a 2-month follow-up, the participants completed a series of questionnaires measuring factors such as depression, anxiety, coping and body image. RESULTS: Compared with the control group the therapy group showed long-term improvements in depressive stress coping style and a short-term improvement in "vitality and body dynamics". CONCLUSION: Further studies should investigate the differential effects of specific units of the therapy program and how the short-term improvements in "vitality and body dynamics" could be maintained for longer periods.

Long-term improvements in cognitive performance through computer-assisted cognitive training: a pilot study in a residential home for older people.

The aim of the present pilot study was to investigate the effects of computer-assisted cognitive training on aging-associated memory deficits, information processing speed, learning, and interference tendency in older people. Residents of a home for older people (15 women, four men; mean age 83.5; range 75-91) participated in a 14-week computer-assisted cognitive training program. The Niirnberg Aging Inventory and the California Verbal Learning Test were administered prior to the program, immediately after the program and after a period of five months to assess the effectiveness of the cognitive training. After the cognitive training program there were significant improvements in primary working memory and also secondary working memory (for verbal and visual stimuli), on parameters of information processing speed, learning and interference tendency. Improvements in the last two cognitive parameters were maintained five months after completion of the training program. The present study indicates that computerized cognitive training programs can be used in older people to achieve long-term improvements in some important aspects of fluid intelligence. It is suggested that computers could be employed more extensively to prevent and treat cognitive deficits in older people.

Efficacy of an EMG-biofeedback therapy in fibromyalgia patients. A comparative study of patients with and without abnormality in (MMPI) psychological scales.

OBJECTIVE: The aim of the present study was to investigate the efficacy of EMG-biofeedback in female fibromyalgia patients with and without abnormality in the MMPI. METHODS: According to their MMPI profile out of a total of 24 patients, 12 patients were classified as 'psychologically abnormal' (at least one scale with a T-score higher than 70) and 12 as 'normal'. In a quasi-experimental setting, all patients underwent EMG-biofeedback therapy (12 sessions, twice weekly), after a waiting period of six weeks. Clinical symptoms (pressure point sensitivity, secondary symptoms), subjective pain dimensions as well as quality of life were assessed before and after the waiting period, immediately after the biofeedback training and at a three month follow up. RESULTS: Within the 'psychologically abnormal' patients primarily depressive, hypochondriacal and hysterical symptoms were found. Statistical evaluation showed that 'psychologically normal' patients experience long-term relief from pain measured in terms of pressure point sensitivity; vitality and mental health. 'Psychologically abnormal' patients, on the other hand, showed improvements in all the measured parameters (clinical symptoms, sensory and affective pain components, quality of life) after EMG-biofeedback. Long-term improvement, however, was observed only in pressure point sensitivity and the sensory pain dimension. CONCLUSION: The results suggest, that assessment of FM-patients should not only consist of commonly used ACR diagnostic criteria but should also include psychodiagnostic criteria, as these may co-determine treatment outcome. One approach to treating FM patients with additional psychological abnormality might be combining EMG-biofeedback that enhances self-efficacy with psychotherapy that helps patients to become aware of their basic psychological problems.

Phenotypic correction of diabetic mice by adenovirus-mediated glucokinase expression.

Hyperglycemia of diabetes is caused in part by perturbation of hepatic glucose metabolism. Hepatic glucokinase (GK) is an important regulator of glucose storage and disposal in the liver. GK levels are lowered in patients with maturity-onset diabetes of the young and in some diabetic animal models. Here, we explored the adenoviral vector-mediated overexpression of GK in a diet-induced murine model of type 2 diabetes as a treatment for diabetes. Diabetic mice were treated by intravenous administration with an E1/E2a/E3-deleted adenoviral vector encoding human hepatic GK (Av3hGK). Two weeks posttreatment, the Av3hGK-treated diabetic mice displayed normalized fasting blood glucose levels (95 +/- 4.8 mg/dl; P < 0.001) when compared with Av3Null (135 +/- 5.9 mg/dl), an analogous vector lacking a transgene, and vehicle-treated diabetic mice (134 +/- 8 mg/dl). GK treatment also resulted in lowered insulin levels (632 +/- 399 pg/ml; P < 0.01) compared with the control groups (Av3Null, 1,803 +/- 291 pg/ml; vehicle, 1,861 +/- 392 pg/ml), and the glucose tolerance of the Av3hGK-treated diabetic mice was normalized. No significant increase in plasma or hepatic triglycerides, or plasma free fatty acids was observed in the Av3hGK-treated mice. These data suggest that overexpression of GK may have a therapeutic potential for the treatment of type 2 diabetes.

["...not dangerous, but nevertheless frightening". A program against stigmatization of schizophrenia in schools]. / "... nicht gefährlich, aber doch furchterregend". Ein Programm gegen Stigmatisierung von Schizophrenie in Schulen.

OBJECTIVE: Evaluation of a brief school programme providing information about schizophrenia to high school students. It was investigated whether the programme changed the students' attitude towards this target group and whether information given by a patient affects the results. METHODS: 114 high school students (6 school classes) took part in the programme: 57 students were informed by a psychiatrist and an afflicted person (group A), the other 57 were informed by a psychiatrist and a social worker (group B). The students' attitude towards schizophrenics was assessed using a vignette of a fictitious class-mate suffering from schizophrenia (according to DSM criteria) and by questionnaires assessing the students' emotional and cognitive reactions and their social distance towards the person described by the vignette. RESULTS: Only in group A (psychiatrist and afflicted) there was a significant improvement regarding the emotional reaction (reduction of fear, increase in positive emotions) and a significant decrease in social distance. Moreover, students no longer associated psychiatric illness with being "crazy". In group B (psychiatrist and social worker) these changes could not be observed. There was even a significant increase in describing patients with schizophrenia as dangerous. CONCLUSION: As high school students themselves consider their level of knowledge about psychiatric illness as low, information about this topic should be given more attention than is currently done (also from a preventive point of view). For such information to be effective and to affect students' attitudes positively, it appears necessary that students have the opportunity to get in contact with a person affected by psychiatric illness. For changing attitudes it is also essential how information is presented.

Body image of women with rheumatoid arthritis.

OBJECTIVE: Physical disabilities generally cause severe disturbances in a patient's body image perception. The aim of the present study was to investigate different aspects of body image, including sexual dissatisfaction, in women with rheumatoid arthritis (RA) in relation to their subjective impression of handicap. METHODS: Forty women with RA were investigated using a series of instruments: Strauss and Appelt's questionnaire for assessing one's body (1), the body perception scale of Paulus (2), and an interview focusing on appearance, worries about health and sickness, and sexual dissatisfaction. In addition, clinical parameters and the subjective extent of morning stiffness were documented, and patients with a high degree of morning stiffness were compared to patients with a low degree of morning stiffness. RESULTS: In contrast to patients with a low degree of morning stiffness, patients with a high degree of morning stiffness worried significantly more about their bodies (p < or = 0.05) and reported significantly more problems in sexuality (p < or = 0.05). CONCLUSION: Our results suggest that morning stiffness plays a very important role in how severely a woman feels herself to be handicapped. Severely handicapped women have to deal with anxieties about health and have sexual problems. Physicians should not shy away from addressing these issues and in severe cases psychological therapy should be initiated.

Effect of cannabis use on cognitive functions and driving ability.

BACKGROUND: Neither experimental nor epidemiologic approaches have so far given definitive answers to the question of the potential effect of cannabis on driving ability. METHOD: To shed more light on this topic, we conducted a placebo-controlled double-blind study including 60 healthy volunteers (a negative urine drug screening test was prerequisite). On the first day, baseline data were obtained from a physical examination and a psychological test battery for the investigation of visual and verbal memory as well as cognitive perceptual performance. On the second day, subjects received a regular cigarette or one containing 290 microg/kg body weight of tetrahydrocannabinol. Physical and psychological assessments were performed immediately (15 minutes) after subjects smoked their cigarettes. Twenty-four hours later, physical and psychological examinations were repeated. RESULTS AND CONCLUSION: Our results suggest that perceptual motor speed and accuracy, 2 very important parameters of driving ability, seem to be impaired immediately after cannabis consumption.

[Electromyography biofeedback therapy in fibromyalgia]. / EMG-Biofeedback-Therapie bei Fibromyalgie.

Nineteen patients with fibromyalgia underwent a course of treatment with EMG-biofeedback (EMG-BFB) technique. On completion of treatment, there was a statistically significant lowering of sensitivity to pain at pressure points typical for fibromyalgia (p = 0.017), which could be observed also 2 months after completion of treatment. In addition, there was a reduction both in the affective (p = 0.04) and in the sensory (p = 0.007) components of pain. Furthermore, there was a statistically significant improvement in the accompanying disease parameters of sleep disturbance (p = 0.004) and head ache (p = 0.031). Since EMG-BFB training might contribute not only to a reduction of pain and muscle tension but also to an improvement of quality of life, it can be recommended as part of a multimodal pain therapy in fibromyalgia patients.

[Care of stroke patients by relatives--social support and coping strategies]. / Pflege von Schlaganfallpatienten durch Angehörige--soziale Unterstützung und Bewältigungsstrategien.

OBJECTIVE: To assess the coping ability and the social support of relatives looking after patients who have had a stroke. Of special interest was to ascertain how coping behaviour and social support differed between short-term (caring period of 3-6 months) and long-term (caring period longer than 2 years) carers. Differences in social networking between relatives and a control group (no caring tasks) were also assessed. SUBJECTS AND METHODS: A questionnaire based on the well-established "Berne coping forms" and another on social support were filled in by 20 relatives (18 women, two men; mean age 50.6 years) after a short-term caring period of up to 6 months and 20 relatives after a caring period longer than 2 years (14 women, six men; mean age 64.9 years) and a control group (27 women, 10 men; mean age 57.8 years). RESULTS: Among the total group of relatives the coping strategies (listed by order of importance) were: "passive cooperation", "acceptance", and "lending a hand". The short- and long-term carers showed no significant differences in these strategies. However, there were significant deficits in social support between the relatives and the controls as to practical support (P < 0.05), social integration (P < 0.01), social support received (P < 0.01), social burden (P < 0.01) and the caring persons (P < 0.05). There was no difference regarding social support between the short- and long-term carers. CONCLUSIONS: The results confirm the importance of social support for relatives who look after stroke patients. Every form of psychosocial help should be given at the time the patient is discharged to home care. This would require day clinics and short-term places in nursing homes.