[Intraoperative consulting. An easy addition to the surgical safety checklist for perioperative quality assurance]. / Intraoperatives Controlling. Einfache Ergänzung der Checkliste zur perioperativen Qualitätssicherung.

BACKGROUND: It has been proven that pre-operative and postoperative surgical safety checklists designed to improve team communication and consistency of care are useful tools to improve surgical outcome. The aim of this study was to investigate the effectiveness of intra-operative consultation (IOC) with regard to its feasibility. IOC comprises an assessment of definite pathways in the operative procedure by another surgeon present in the operating theatre in a consultative capacity during specific steps of the operation. METHODS: Between January and December 2008 a total of 2,004 operations were evaluated according the IOC. Data on the frequency of the feasibility of IOC and on whether IOC led to decisions influencing the course of the procedure were analyzed. RESULTS: A total of 1,369 IOCs were carried out including regular IOC in 1,102 cases (80%) and tactical IOC in 267 cases (20%). In 90 cases (7%) consultation resulted in minor changes and in 100 cases (7%) major clinically relevant revision of the operative strategy was deemed necessary. CONCLUSION: It was found that IOC is feasible in the majority of operations. In the case of tactical IOC a large number of treatment-relevant decisions are taken. This means that in the area of operative disciplines IOC represents a potential preventive strategy within the framework of quality management and a useful addition to the WHO checklist to improve safety in surgery.

[Family therapy as a component of routine management of schizophrenic patients. A report of experiences]. / Angehörigenarbeit als Bestandteil der Routineversorgung schizophrener Patienten. Ein Erfahrungsbericht.

Since 1993 we have been working with nine groups of relatives of schizophrenic patients who were admitted as inpatients to two different psychiatric wards at the Landesklinik Nordschwarzwald. We summarise our experience with the family groups as a part of the psychiatric care for schizophrenic patients. The concept of family groups combines psychoeducational aspects with the concept of "Expressed Emotion". The relatives valued the combination of information, discussion and exchange of experiences positively. The groups offer relief and support. The involvement of the relatives has proved useful in the treatment of schizophrenic patients at our institution and will be continued. Further studies designed to improve the efficiency and quality of family groups will be important for their general establishment in psychiatric care.

Cardiovascular effects of fluvoxamine and maprotiline in depressed patients.

In the choice of an antidepressant drug the clinician must often consider the presence of a cardiovascular comorbidity in depressed patients. In the present study the cardiovascular effects of fluvoxamine and maprotiline were compared in a double-blind trial in which the quantitative changes in ECGs were assessed before and during a 3-week treatment. A total of 33 patients (mean age 44 years; range 20-65 years) with major depressive disorder (RDC) who were free from clinically relevant organic diseases were investigated. After a 7-day wash-out period, a 3 week treatment phase was started with 200 mg daily of either fluvoxamine (n = 18) or maprotiline (n = 15). On days 0, 7, 14 and 21 a 12-lead standard ECG was performed and the drug plasma levels were determined. All ECGs were analysed in a blind fashion by an internist. Maprotiline caused a significant prolongation of the PR interval (P < 0.001) and of the QRS interval (P < 0.01) was well as an increase in heart rate (P < 0.001). The QTc interval was only tendentially prolonged (P < 0.10) and the P-wave duration and T-wave amplitude were not affected by maprotiline. No significant changes in ECG parameters were observed during treatment with fluvoxamine; and there was a nonsignificant trend (P < 0.10) for a lower heart rate during treatment. Blood pressure was not affected by treatment with either antidepressant. In both groups no significant correlations were found between ECG findings and the plasma levels of the drugs. Our results confirm that fluvoxamine in therapeutic dose causes no alteration in surface ECG regarding cardiac conduction and repolarization. Conversely, maprotiline caused a significant prolongation of atrioventricular and intraventricular conduction and a rise in heart rate. Although these effects were not clinically relevant in our sample of patients without overt heart disease, they should be taken into account when treating depressed patients with concomitant cardiac disease.

Acute and subchronic effects of low-dose bromocriptine in haloperidol-treated schizophrenics.

The effects of the acute (within 24 hr) and subchronic (21 days) addition of low-dose bromocriptine (2.5 mg/day) were compared to placebo in schizophrenic patients treated concomitantly with haloperidol. After 24 hr patients on bromocriptine (n = 15) showed a mean improvement of 29% in the total score of the Brief Psychiatric Rating Scale (BPRS) as compared to 14% in the placebo group (n = 15) (p less than 0.10). The acute improvement correlated negatively with bromocriptine plasma levels; patients with the highest reduction in BPRS score had the lowest plasma levels (between 50 and 150 pg/ml) at 60, 90, and 120 min after intake. The improvement in the bromocriptine group continued until the 10th day of the trial, when a nonsignificant increase in the total BPRS score took place. Analysis of Variance of the overall BPRS improvement during the 21 days revealed no significant difference between both patient groups. Our results give modest support to the idea of an acute antipsychotic response to low-dose dopamine agonists in neuroleptic-treated patients, but fail to support their clinical usefulness in the subchronic treatment of schizophrenia.

CT scans and neuroleptic response in schizophrenia: a multidimensional approach.

Structural brain abnormalities in schizophrenia have been reported in a number of studies using computed tomography (CT). However, the prevalence and the localization of the abnormalities vary widely among studies. These discrepancies might stem from clinical and demographic differences among samples, from the choice of the CT parameters, or from the use of different criteria to define abnormalities. In an attempt to overcome these difficulties, we studied 12 CT parameters in 30 schizophrenic patients and 30 sex- and age-matched controls, and evaluated the data simultaneously through multidimensional scaling (MDS). MDS offers a graphic representation in which subtle deviations in the different CT parameters can be detected, independently of predetermined criteria for the definition of abnormalities. MDS distinguished 13 patients from the controls as having deviant values in one or more CT parameters. Five of these patients were first-onset schizophrenics. Patients with deviant CT parameters showed significantly poorer response to haloperidol therapy over 3 weeks than did patients without deviant CT parameters. Our results suggest that the MDS approach might be useful in identifying more precisely patients with and without structural brain abnormalities.

Psychological correlates of functional secondary amenorrhoea.

15 women with functional secondary amenorrhoea and 15 controls (matched closely in age and educational status) were compared as to their knowledge of menstruation, their attitude towards those parts of the body likely to be associated with sexuality, and the amount of life events over the 6-month period preceding the onset of amenorrhoea, or an analogue time-span for control subjects. Comparison of means confirmed the research hypotheses: Knowledge of menstruation proved to be significantly lower and attitude towards sexuality-related body parts was significantly more negative in women with amenorrhoea than in control women (p less than 0.01 each). Also, in agreement with our expectations, subjects with amenorrhoea showed more problems in their partner-related sexuality than control subjects did (p less than 0.05), and had experienced more negative life events before the onset of amenorrhoea than the healthy group had over an analogue period of time (p less than 0.05).

Bulimia nervosa: sex role attitude, sex role behavior, and sex role related locus of control in bulimarexic women.

Thirty-four women with bulimia nervosa and 34 women without bulimarexic symptoms (but matched for age, weight, deviance from ideal weight, and educational status) were compared as to how liberated their attitude towards the woman's role in society (= their sex role attitude, SRA) and their actual own behavior as females (= their sex role behavior, SRB) were. The degree to which their general attitude towards sex role and their own sex role behavior differed from each other was also investigated. Experimental and control group were also compared concerning their sex role related locus of control (SRLC). SRA and SRB were significantly less liberated in the bulimarexic group than in the control group. In addition, the bulimarexic group showed a wide gap between their general attitude (SRA) and actual behavior (SRB) as to the degree of liberation. No such discrepancy was found in the control subjects. The sex related locus of control data showed that bulimarexic women had significantly higher external and fatalistic control, and lower internal control than the comparison subjects.

Synthesis of new polyamine derivatives for cancer chemotherapeutic studies.

Selected homologs, analogs, and acylated derivatives of spermine and spermidine, together with several heterocyclic and aromatic compounds containing a novoldiamine side chain, were prepared and evaluated biologically. Several compounds possessed activity against B-16 melanoma and human epidermoid carcinoma of the nasopharynx.

Secondary disulfonamides and secondary tetrasulfondiamides as proposed new biological alkylating agents.

Secondary disulfonamides and secondary tetrasulfondiamides were prepared for antineoplastic activity testing. For the disulfonamides, one alkyl series (n-butyl), three aralkyl series (benzyl, phenethyl, and phenpropyl), and one diaralkyl series (diphenpropyl) were prepared. Two series of tetrasulfondiamides were made from diamines, one in which the central methylene chain was varied from four to six and another using the tetrasubstituted sulfonyl derivative of xylylenediamine. Thirteen final compounds were synthesized. Ten of these compounds and four intermediates have not been reported previously. Preliminary screening results for the final compounds are given.

[Dichotic listening performance in children--development of a reliable test (author's transl)]. / Untersuchung Zur Dichotischen Hörleistung Bei Kindern--Entwicklung Von Testverfahren.

With a new developed and reliable dichotic test (one part monosyllable words, other part monosyllable digits) we could show a significant Right-Ear-Advantage (REA) in children from age six to eight. The determination of an auditory-dominance-index (DI)--in analogy to the DI of handedness by Schilling (1977)--made it possible to determine the different degrees of REA/LEA in individuals or groups. Within the near future the auditory-dominance-index could be an important measure in diagnosis and therapy of child development (i.e. discrimination of language features like phonematics, syntax, semantic, and their lateralisation within ages) as far as standard-scales for all-over-accuity and lateralisation will exist. Our test is the first step to do this.