Patients with haematological malignancies show a restricted body image focusing on function and emotion.

The diagnosis of cancer threatens the psychological and bodily integrity. Based on this assumption, we aimed to explore how newly diagnosed patients cope with special regard to the body image (BI). In total, 40 patients (32 haematological malignancies) were assessed by questionnaires on mood, complaints, self-regulation and quality of life (QOL). The BI was assessed by the 'Body Grid' which reveals the constructs patients choose to characterize the body. The constructs were categorized using a model of six predefined categories comprising: emotion, control, activity, strength, function and appearance. Tinnitus sufferers and medical students served as comparison groups. Cancer patients showed significantly more anxious depression and a significantly lower QOL than controls. Their BI was restricted, focusing the functional status of body organs (e.g. opposing healthy vs. ill organs) as well as emotional aspects (e.g. trust vs. fear). The data convey fundamental psychological distress in newly diagnosed cancer patients. Restriction of BI and use of functional constructs may help to buffer the threat to body integrity. The emotional constructs reflect the existential impact. The data give a clear indication for the need for early psychosocial support which should aim at stabilizing the psychological and bodily integrity of the patient.

[Acute liver failure following the use of ecstasy (MDMA)]. / Akutes Leberversagen nach dem Konsum von Ecstasy (MDMA).

The use of "ecstasy" (Methylenedioxymethamphetamine) as a recreational drug is increasing in europe since the 1980's. Aside intended psychological effects the use of ecstasy can be followed by symptoms of intoxication; complications include toxic hepatic damage up to acute hepatic failure. This case-report is about a 17-year old female patient who regularly used "ecstasy" over a six-month period. Two days after the last use of "ecstasy", she reported to her general practitioner with nausea, vomiting, abdominal pain and jaundice. Within 10 days the patient developed acute liver failure. With criteria for liver transplantation fulfilled she was listed for orthotopic liver transplantation of high urgency which was carried out only one day later. Histological examination of the explanted liver showed evidence for a toxic fulminant hepatitis. After transplantation the patient made a full recovery and was released from hospital on day 26 after transplantation. At the first control after six months the patient was in good physical and nutritional condition, serological parameters were normal and ultrasound examination of the transplanted liver was unremarkable. The ethiopathology of "ecstasy"-induced hepatotoxicity, which can occur dose-independently with a symptom-free period from days to weeks after ingestion is not yet fully understood. Possible mechanisms of hepatic damage include influence of MDMA on body temperature regulation, harmful effects of the substance or further components of the "ecstasy"-tablets on the liver cell or a genetic vulnerability of some individuals against amphetamines and amphetamine derivates. There are no parameters existing which could predict the course and severity of "ecstasy"-induced hepatopathy. Especially in young patients with symptoms of hepatic damage frequent controls of clinical status and relevant laboratory parameters are of great importance. Patient transfer to a specialised centre should follow as early as possible; at the latest, when coagulopathy occurs.

[Validation of the new German translation version of the "Short Inflammatory Bowel Disease Questionnaire" (SIBDQ)]. / Validierung der deutschsprachigen Version des "Short Inflammatory Bowel Disease Questionnaire" (SIBDQ).

In the face of a hardly predictable course of illness--potentially effecting a severe diminution of daily activities--the quality of life (QOL) represents a chief outcome measure in the treatment of inflammatory bowel diseases (IBD). For the German-speaking area an economical disease-specific instrument measuring QOL has been missing, so far. Therefore, we translated and adapted the recently validated "Short Inflammatory Bowel Disease Questionnaire" SIBDQ (11). Bowel symptoms, systemic symptoms, moods, and social activities are represented by a total of 10 items. Along with this questionnaire 7 accepted instruments assessing QOL-components were administered to 125 outpatients (54 ulcerative colitis, 71 Crohn's disease) and 51 healthy controls. The psychometric properties are good. Consistency is alpha = .84, thereby slightly surpassing the Anglo-American SIBDQ (alpha = .78). Retest-reliability after 26 weeks is r = .60. Systematic covariations with accepted QOL-instruments give evidence for its convergent and discriminatory validity. Differences between groups (high vs. low inflammatory activity vs. healthy controls) substantiate its sensitivity. Thus, the German adaptation of the accepted SIBDQ supplies an economic, reliable, and valid instrument that proved able to assess clinically relevant differences in QOL in patients with IBD. We suggest that it should be used by its overall score rather than its subscales. The instrument is appropriate to be used in therapy outcome and evaluation studies. It allows international comparison.