[Characteristics and prevalence of painful coenesthesia in a pain clinic]. / Charakteristik und Prävalenz schmerzhafter Zönästhesien in einer Schmerzambulanz.

BACKGROUND: Coenesthesia, a rarely described symptom, is classified as schizophrenia according to ICD-10 and can occur independently of psychiatric diseases as a form of pain. The prevalence in chronic pain disorders is still unknown. The present study investigates the characteristics and psychological comorbidities of painful coenesthesia. MATERIALS AND METHODS: For the present study, all patients were pseudonymized and retrospectively analyzed qualitatively and quantitatively for existing coenesthesia. They were consecutively admitted, examined, and treated in the pain outpatient clinic of the University of Magdeburg over a five-year period (2013-2017). RESULTS: Of the 844 patients evaluated, 57 (6.7%) fulfilled the criteria of coenesthesia. The pain description may be rather bizarre if the patient is suffering from a psychiatric disorder, but it was also conspicuous by inappropriate localization for the pain description (tooth cramp instead of abdominal cramp). In our study, pain was mainly localized in the facial area (n = 35). Twenty-seven patients had no psychopathological abnormalities and 30 patients could be assigned an additional psychiatric diagnosis. In 23 patients, depression occurred as a psychological comorbidity. DISCUSSION AND CONCLUSION: Coenesthesia does not necessarily occur in connection or only with schizophrenia. Coenesthesia should be considered if the patient gives a bizarre description of pain, but also in common pain descriptions, such as burning, stabbing, cramping, or a feeling of pressure, if these are related to unusual locations (cramping tooth).

[Aspects of liaison psychiatry care of patients in a university pain clinic]. / Aspekte einer liaisonpsychiatrischen Betreuung von Patienten einer universitären Schmerzambulanz.

BACKGROUND: Owing to a rise of psychosomatic comorbidities, the treatment of psychological disorders, which may negatively impact prognosis and therapy, is increasingly becoming a focus of attention for pain outpatient clinics. AIM: This study investigates and discusses the advantages of liaison psychiatric care in a university pain clinic. METHODS: In this retrospective study, we investigated all patients who presented to an anaesthesiologically led pain clinic between January and June 2014. The psychiatric history was taken by the liaison psychiatrist of the pain clinic. RESULTS: In the period investigated, 485 patients were treated as outpatients. A psychiatric diagnosis was present 351 patients (72.4%). The distribution of the diagnoses was comparable with that of a consultation service. Adaptation and affective disorders dominated. The patients were preferentially treated with new generation antidepressants. CONCLUSION: The constant presence of a liaison psychiatrist allows for timely, specialised care of pain patients in terms of a multimodal therapeutic approach.

[The Risks of Perioperative Addiction to Benzodiazepines in the Elderly: What the Surgeon Needs to Know]. / Risiken perioperativer Benzodiazepin-Abhängigkeit beim alten Menschen - was der Chirurg hierzu wissen sollte.

BACKGROUND: In Germany, more than one million people use benzodiazepines on a regular basis. The majority of them is older than 60 years and take low-dose benzodiazepines for sleep disorders. This does not necessarily induce tolerance, but may result in problems such as falling, seizures or delirium if benzodiazepines are discontinued or taken on a long-term basis. Therefore, benzodiazepines can be associated with problems before, during and after surgery, in particular in the elderly. This narrative review aims to describe the clinical relevance for daily practice. KEY POINTS: 1. The high-dose use of drugs that induce addiction with possible parallel consumption of other drugs is clinically important. Even more relevant, however, is the large number of elderly people taking benzodiazepines periodically and in low doses for sleep disturbances. 2. Low-dose addiction of benzodiazepines is defined as daily use of less than 20 mg of a diazepam equivalent. 3. Short-acting benzodiazepines can promote addiction; long-acting benzodiazepines produce hangover effects. 4. During a hospital stay, rapid discontinuation induces withdrawal symptoms; continuous prescription may result in incidents and increases the risk of postoperative delirium. CONCLUSION: For the intake and continuous prescription there are four basic rules:Well-defined indication, correct dosage, short application, no sudden discontinuation.

[Pain therapy in patients with schizoaffective disorder and cancer]. / Schmerzbehandlung bei Patienten mit schizoaffektiver Psychose und Tumor.

We report on two patients with schizoaffective psychosis, cancer, and pain. However, it is not possible to make somatic or psychic disturbances alone responsible for the pain. In patients with current schizoaffective disorders, only administration of a combination of psychopharmaceutical and opioid agents is successful.

Prevalence of New Psychoactive Substances (NPS) and conventional drugs of abuse (DOA) in high risk populations from Paris (France) and its suburbs: A cross sectional study by hair testing (2012-2017).

BACKGROUND: The aim of the present study is to describe the prevalence of NPS and conventional DOA in Paris and its suburbs over a six-year period using hair testing approach. METHOD: Hair was sampled in patients admitted to different departments of Paris hospitals between 2012 and 2017. Two high-risk populations were mainly considered: 1) drug-dependent and 2) acutely intoxicated patients. Segmental hair analysis was performed by validated LC-MS/MS method to screen for DOA and 83 NPS. RESULTS: 480 patients (280 M/200 F, 15-70 years) were included. 141 patients tested positive for NPS (99 M/42 F; median age: 33). NPS prevalence was 29%, that of amphetamines, cocaine and opioids were 32%, 38.5% and 52%, respectively. 27 NPS were identified, 4-MEC and mephedrone (number of cases n = 24 each) were the most detected cathinones. JWH-122 (n = 1) was the only detected synthetic cannabinoid while ketamine (n = 104) was present in numerous NPS users (67%). 3-fluorofentanyl (n = 1), furanylfentanyl (n = 1), N-ethylpentylone (n = 2), pentedrone (n = 2), mexedrone (n = 1), methcathinone (n = 3), 6-APDB (n = 2), TFMPP (n = 2), 2-CE (n = 1), 3,4-MD-αPHP (n = 1) and dextromethorphan (n = 27) were identified for the first time in hair. Users were found to have more than one NPS in 53% of cases, mostly in combination with conventional DOA. The number of detected NPS rose from 5 in 2012 to 42 in 2017. A broad range of hair concentrations (0.001-318 ng/mg) was found, but the low median concentrations seem to show an occasional exposure more than chronic use. CONCLUSION: NPS screening should be assessed in routine clinical practice, especially in high-risk populations.

Altered dendritic maturation and loss of GABA immunoreactivity of hippocampal neurons after prenatal exposure to chloroquine.

The aim of the study was to analyze the intrauterine and postpartal effects of Chloroquine on the dendritic maturation in the hippocampus and on the expression of GABA within hippocampal interneurons of the stratum moleculare. Fifty-nine brains of rat fetus on day 22 of gestation and 37 brains from rats from postnatal day P7 were examined. We found changes in the cytoarchitecture of hippocampal CA3 neurons on P7 day. Chloroquine treatment resulted in a significant increase of the length of the apical shafts, apical dendrites and basal dendrites of the CA3 neurons (p < 0.05) under doses comparable to serum levels reached during long-term therapy. Furthermore, an early reduction of GABA-expressing interneurons of the hippocampal striatum moleculare was observed.

Chloroquine effects on intrauterine and postnatal dendritic maturation of hippocampal neurons and on lipid composition of the developing rat brain.

The aim of the study was to analyse the intrauterine effects of Chloroquine on the dendritic maturation in the hippocampal region under considering of the lipid composition in brain tissue. 131 brains of rat pups from day 22 of pregnancy and 49 brains from offsprings from day 7 of life were investigated. The findings indicate changes in the geometric dendritic architecture of the CA3 neurons on the 7th day of life. The length of apical shaft, apical dendrites and basilar dendrites of the CA3 neurons showed a significant elongation (p < 0.05) under low doses of Chloroquine. Furthermore a early considerable formation of dendritic spines during the intrauterine period could be observed for CA1 spines at the day 22 p.c. A significant increase of the fatty acids, a reduced amount of sphingomyelines, cephalines and gangliosides was found. These results underline the fact of a mild toxic effect under a low dosis of Chloroquine in our model.

[Agranulocytosis and vasculitis in a cocaine addict: levamisole, the hidden culprit]. / Agranulocytose et vascularite chez un patient cocaïnomane: lévamisole ou l'autre poison caché

INTRODUCTION: Adulterants are compounds added to street drugs to increase profits for the seller. Levamisole, a veterinary antihelminthic agent, has become the most common adulterant of cocaine. The prevalence of levamisole in samples of cocaine is increasing. Levamisole can lead to neutropenia and to a dramatic vasculopathy and even vasculitis of small and medium-size blood vessels. CASE REPORT: We here reported the first French case of levamisole related toxicity, due to cocaine use in a 50-year-old man, revealed by fever and agranulocytosis, high titters of antineutrophil cytoplasmic antibodies (ANCA), anticoagulant and positive Coombs tests. Outcome was slowly favorable with exposition withdrawal. CONCLUSION: Clinicians should be aware that agranulocytosis or vasculitis or vasculopathy could be related to levamisole toxicity in individuals who use cocaine.

[Intraoperative oxygen consumption and organ function in liver transplantation]. / Intraoperativer Sauerstoffverbrauch und Organfunktion bei Lebertransplantationen.

Liver transplantation has become established as a reasonable and promising treatment option in terminal stages of liver diseases. Since there is no permanent artificial liver support available, primary "non-function" (PNF) of the graft is one of the most threatening complications. Therefore, an early and, if possible, intraoperative assessment of liver function is essential. Pathological changes in total oxygen consumption (VO2) are considered as an early indicator for the occurrence of PNF. Previously, PNF was analyzed using extensive calculations according to the Fick method, but since inauguration of the PhysioFlex anaesthesia device (Dräger, Lübeck, Germany), which is based on a closed anaesthesia circuit, continuous monitoring of oxygen consumption has become possible. The aim of the study was to investigate whether continuous VO2 monitoring using PhysioFlex allows immediate detection of pathological changes in graft function in the very early neohepatic phase of liver tranplantation. Therefore, 51 liver transplants were investigated at the University Hospital of Magdeburg with regard to a correlation between intraoperative VO2 values and ischaemic time periods of the donor organ and the postoperative liver function. A regular course of oxygen consumption was found in uncomplicated transplants and prompt liver function within normal ranges. PNF was not observed in any transplants. Changes in oxygen consumption were caused by early retransplants or by the delayed start of graft-based metabolism intraoperatively and transient diminished liver function found postoperatively, e.g., in pre-existing hepatorenal syndrome. In addition, VO2 indicated precisely the anhepatic and neohepatic phases during the course of liver transplantation. There was no correlation between the course of glucose content of the blood and the metabolic index of glucose and oxygen consumption or between both parameters and initial graft function. Furthermore, the duration of ischaemic time periods was not closely associated with oxygen consumption during the reperfusion phase. However, there was a correlation between intraoperative VO2 and postoperative bilirubin values, while a correlation between VO2 and GLDH as a further relevant parameter of postoperative graft function could not be confirmed, most likely because of the great variance in these values. In conclusion, the results suggest that changes in total oxygen consumption may, in part, be caused by changes in liver metabolism, depending on the various phases of liver transplantation. In addition, oxygen analysis allows monitoring of the critical phases of liver transplantation such as the anhepatic and early neohepatic periods with regard to immediate detection of early changes in graft metabolism. For routine use of this parameter, steady measurement of the mean value displayed on the PhysioFlex for selectable time periods would be helpful in addition to the continuous VO2 analysis, since there is a greater variance in the single VO2 values, which are documented by the anaesthesiologist, than in the online-detected and automatically calculated values of specific periods of transplantation.