[Phlebology in German departments of dermatology. An analysis on behalf of the German Society of Phlebology]. / Phlebologie an deutschen Hautkliniken. Eine Bestandsaufnahme im Auftrag der Deutschen Gesellschaft für Phlebologie.

BACKGROUND: Phlebologic diseases have become extremely common and have major socio-economic impact. However, the percentage of dermatologists working in phlebology appears to be decreasing according to the data of the German Society of Phlebology (DGP). METHODS: To investigate the reasons for this development, we--on behalf of the DGP--sent a questionnaire to 120 German Departments of Dermatology in autumn 2012. RESULTS: In 76 returned questionnaires, the number of physicians with additional fellowship training in phlebology averaged 1.5; the average number of those who fulfill the criteria for training fellows in phlebology was 0.9. In 71.1 % of the departments there was a phlebologist. A special phlebologic outpatient clinic existed in 73.7 % of the departments. Sonography with Doppler (89.5 %) and duplex (86.8 %) was used as the most frequent diagnostic tool. For therapy, compression (94.7 %), sclerotherapy (liquid 78.9 %, foam 63.2 %, catheter 18.4 %), endoluminal thermic procedures (radio wave 28.9 %, laser 17.1 %) and surgery (especially crossectomy and stripping 67.1 %, phlebectomy of tributaries 75 %) were used. The average number of treatments was very heterogenous in the different departments. CONCLUSIONS: Phlebology definitely plays an important role in dermatology. Most departments fulfill the formal criteria for the license to conduct advanced training in phlebology. A wide spectrum of phlebological diagnostic and therapeutic procedures is available.

In vitro effects of alpha toxin from Clostridium perfringens on the electrophysiological parameters of jejunal tissues from laying hens preincubated with inulin and N-acetyl-L-cysteine.

The present report demonstrates the effect of alpha toxin from Clostridium perfringens on electrophysiological indexes of jejunal mucosa from laying hens pretreated with inulin and N-acetyl-l-cysteine (ACC), a mucolytic agent. In a first set of experiments, the effect of alpha toxin with or without pretreatment with ACC on the electrophysiological parameters was determined when jejunal tissues from laying hens were mounted in Ussing chambers. The short-circuit current remained unchanged when alpha toxin was added mucosally in the tissues whether pretreated with ACC or not. The change in the transmural tissue conductance (DeltaGt) was higher (P = 0.18) after 90 min exposure of toxin independent of pretreament with ACC. The effect of alpha toxin on DeltaGt became significant (P < or = 0.05) after 120 min of incubation. In the second set of experiments, the effect of alpha toxin on the jejunal tissues preincubated with inulin (0.1%) was investigated. The effect of toxin was also time dependent, and DeltaGt became significantly higher (P < or = 0.05) after 120 min of incubation independent of preinubation with inulin. Inulin did not influence the DeltaGt during the experimental period when compared with control tissues. In conclusion, alpha toxin from C. perfringens can impair the intestinal mucosal barrier. The effect is obviously not dependent on the presence of a mucolytic agent nor can it be affected by direct addition of inulin under in vitro conditions. Whether there is an effect of inulin after long-term supplementation in feeding trials or it is due to fermentation bacterial metabolites remains an open question.

Patterns of dissociation in clinical and nonclinical samples.

Research has consistently found elevated mean dissociation scores in particular diagnostic groups. In this study, we explored whether mean dissociation scores for different diagnostic groups resulted from uniform distributions of scores within the group or were a function of the proportion of highly dissociative patients that the diagnostic group contained. A total of 1566 subjects who were psychiatric patients, neurological patients, normal adolescents, or normal adult subjects completed the Dissociative Experience Scale (DES). An analysis of the percentage of subjects with high DES scores in each diagnostic group indicated that the diagnostic group's mean DES scores were a function of the proportion of subjects within the group who were high dissociators. The results contradict a continuum model of dissociation but are consistent with the existence of distinct dissociative types.

Reliability and validity of a brief patient-report instrument for psychiatric outcome evaluation.

OBJECTIVE: The authors describe the Behavior and Symptom Identification Scale (BASIS-32), a brief patient-report measure for psychiatric outcome assessment, and present the measure's factor structure and reliability and validity data. METHODS: Using the BASIS-32, interviews were conducted with a total of 387 patients shortly after their admission to the adult inpatient services of a private not-for-profit psychiatric hospital. Six months after admission, they received a follow-up questionnaire version of the instrument. RESULTS: Factor analysis of the instrument yielded five factors, on which subscales were based: relation to self and others, daily living and role functioning, depression and anxiety, impulsive and addictive behavior, and psychosis. Internal consistency of the subscales ranged from .63 to .80. Internal consistency of the full 32-item scale was .89. Test-retest reliability ranged from .65 to .81 for the five subscales. Concurrent and discriminant validity analyses indicated that the BASIS-32 ratings successfully discriminated patients hospitalized six months after admission from those living in the community, patients working at follow-up from those not working, and patients with particular diagnoses. Follow-up ratings indicated that the BASIS-32 is sensitive to changes in symptomatology and functioning. CONCLUSIONS: The BASIS-32 provides a brief, standardized assessment of symptoms and problems from the patient's perspective. The instrument can be used for outcome assessment with most psychiatric inpatients.

Are NMDA antagonistic properties relevant for antiparkinsonian-like activity in rats?--case of amantadine and memantine.

Amantadine (25, 50, 100 mg/kg), memantine (5, 10, 20 mg/kg) and MK-801 (0.05, 0.1, 0.2 mg/kg), all having NMDA channel blocking properties, were compared in three tests used for screening of antiparkinsonian agents in rats, namely: haloperidol-induced catalepsy, locomotor activity in monoamine depleted rats and rotation in rats with a unilateral substantia nigra lesion. Additionally, plasma levels of amantadine and memantine were assessed to gain an insight into the concentration ranges achieved at behaviorally active doses. Amantadine and (+)-MK-801 produced dose-dependent inhibition of haloperidol-induced catalepsy while memantine was less efficacious producing clear-cut anticataleptic action at a dose of 10 mg/kg only but failing at 20 mg/kg due to myorelaxant activity. All agents attenuated sedation in monoamine depleted rats with amantadine being the least and MK-801 being the most effective. The same rank order of efficacy was seen in inducing ipsilateral rotations in rats after a substantia nigra lesion. On the basis of the present study and published data, it can be assumed that the doses of amantadine, memantine and MK-801 showing antiparkinsonian-like activity in animals result in plasma levels leading to NMDA antagonism. However, in the haloperidol-induced catalepsy test the efficacy of amantadine was higher than memantine, while the opposite was true for rotation and reserpine-induced sedation indicating pharmacodynamic differences between both agents.

Correlates of dissociative symptomatology in patients with physical and sexual abuse histories.

Recent studies have demonstrated a high prevalence of sexual and physical abuse histories and high levels of dissociative symptoms in psychiatric inpatients. We examined whether severity, frequency, and age of onset of abuse correlated with subjects' levels of dissociative symptoms. Sixty-four women reporting a lifetime history of physical and/or sexual abuse were recruited from consecutive admissions to three wards of a psychiatric hospital. Subjects completed the Life Experiences Questionnaire (LEQ) and the Dissociative Experiences Scale (DES). Subjects' self-reports of severity, frequency, and age of onset of abuse were analyzed for correlations with DES score. More invasive sexual abuse was associated with more dissociation. Higher-frequency physical abuse was associated with more dissociation, but no conclusion could be drawn about the impact of frequent sexual abuse due to missing data. An inverse correlation was found between age of onset of abuse and degree of dissociative symptomatology. These preliminary findings are consistent with hypotheses linking more severe, more chronic, and earlier abuse to the greater development of dissociative symptoms. The findings further emphasize the importance of recognizing dissociative symptoms in the clinical setting, and of continued study into the effects of childhood trauma.

Validity of the Dissociative Experiences Scale in screening for multiple personality disorder: a multicenter study.

OBJECTIVE: The Dissociative Experiences Scale has proved a reliable and valid instrument to measure dissociation in many groups, but its capacity to distinguish patients with multiple personality disorder from patients with other psychiatric disorders has not yet been conclusively tested. METHOD: A discriminant analysis was performed to classify 1,051 subjects as having or not having multiple personality disorder. Another discriminant analysis was performed on a subgroup of 883 subjects more closely representing patients in a typical psychiatric facility in terms of base rates of dissociative disorders. A cutoff score of 30 was also used to classify subjects, and Bayes's theorem, which allows for the calculation of the positive predictive value and the negative predictive value of a screening test, was applied. RESULTS: According to discriminant analysis of the total study group, the scale's sensitivity was 76% and its specificity was also 76%; according to discriminant analysis of the more representative subgroup, the scale's sensitivity was 76% and its specificity was 85%. Use of the cutoff score of 30 produced similar results. Results of the application of Bayes's theorem showed that 17% of the subjects scoring 30 or higher would actually have multiple personality disorder and 99% of those scoring less than 30 would not have multiple personality disorder. CONCLUSIONS: These results indicate that the Dissociative Experiences Scale performs quite well as a screening instrument to identify subjects with multiple personality disorder. In addition, the consistency of responses to scale items across centers indicates that the symptoms reported by patients with multiple personality disorder are highly similar across diverse geographic centers. This consistency supports the reliability and validity of the diagnosis of multiple personality disorder across centers.

Gas chromatographic-mass spectrometric method for the determination of bifemelane in human plasma at therapeutic doses.

A gas chromatographic method with mass-selective detection for the determination of bifemelane in human plasma has been developed. The assay is based on a single hexane extraction and an efficient gas chromatographic separation on a capillary column. The assay has been validated and used to support clinical pharmacokinetic studies. The lowest limit of quantitation was found to be 1 ng/ml and allowed pharmacokinetic evaluation of the drug at doses down to 50 mg.

Case-based reimbursement for psychiatric hospital care.

A fixed-prepayment system (case-based reimbursement) for patients initially requiring hospital-level care was evaluated for one year through an arrangement between a private nonprofit psychiatric hospital and a self-insured company desiring to provide psychiatric services to its employees. This clinical and financial experiment offered a means of containing costs while monitoring quality of care. A two-group, case-control study was undertaken of treatment outcomes at discharge, patient satisfaction with hospital care, and service use and costs during the program's first year. Compared with costs for patients in the control group, costs for those in the program were lower per patient and per admission; cumulative costs for patients requiring rehospitalization were also lower. However, costs for outpatient services for patients in the program were not calculated. Treatment outcomes and patients' satisfaction with hospital care were comparable for the two groups.

Synthesis of cRNA probes from PCR-generated DNA.

We have compared RNA polymerase promoter activities in PCR-generated DNA fragments for use in the in vitro transcription of cRNA probes. Sense oligonucleotide primers, specific for the mouse acidic fibroblast growth factor gene, were synthesized with 5' extensions containing promoter sequences for the T7, T3 and SP6 RNA polymerase promoters. A common antisense primer was used with each of the promoter/aFGF primers to prepare PCR-generated DNA fragments (minigenes). In vitro transcription efficiency for each of these constructs was evaluated by incorporation of radioactivity into the cRNA products. We find that both the T7 and T3 promoters can direct the synthesis of cRNA probes of high specific activity from a PCR-generated DNA fragment, but that SP6 cannot. No detectable cRNA product was obtained using either T7 polymerase on the T3/minigene or T3 on the T7/minigene. Antisense cRNA probes, transcribed from minigene constructs were used for both Northern and in situ hybridization studies. A PCR-generated DNA fragment with RNA polymerase promoter sequences at each end provides a single template for synthesis in vitro of either sense or antisense cRNA probes.

Social perceptions of male and female extreme mesomorphs.

In this study, male and female university students in the United States were exposed to mesomorphic or nonmesomorphic stimuli as reflected by photographs of either male body builders and non-body builders or female body builders and non-body builders. Then they were asked to attribute various personality traits and sex-role behaviors to them. Subjects, irrespective of their sex, perceived male and female body builders as possessing more traditionally masculine and less traditionally feminine personality characteristics than male and female non-body builders. Also, male and female body builders were seen as possessing less socially desirable traits than non-body builders. As predicted, female body builders were perceived generally as being more likely to engage in traditionally masculine sex-role behaviors in their dating and marriage relationships than female non-body builders. Contrary to expectation, however, male body builders were not perceived as more likely to engage in higher levels of masculine sex-role behaviors than male non-body builders.

Adult development and symptomatology.

The purpose of the current study was to explore relationships between symptomatology and ego development in adults. To that end we studied patients presenting for treatment in an outpatient clinic of a major psychiatric hospital. We examined the relationship of ego development to intensity of subjective distress and type of presenting symptoms and hypothesized that with increasing development of ego functioning, subjective distress from all kinds of psychiatric symptoms could be better tolerated and coped with and, therefore, would be experienced as less severe. For the sample as a whole, ego development was significantly related to psychiatric symptoms and symptom severity in patterns predicted from theory. On all but two scales, symptomatology decreased significantly as ego development increased. We argue that the ego development model is useful in further exploring psychopathology during the adult years.

The reliability of abuse history reports: a comparison of two inquiry formats.

We compared patients' reports about histories of physical or sexual abuse in two independent formats: the standard psychiatric intake interview at admission for inpatient treatment, and a subsequent confidential self-report survey about various forms of early childhood trauma. For 92 consecutively admitted female patients, nearly all reports of abuse histories obtained in the intake interview were consistent with later reports obtained in the survey. However, findings of no abuse history obtained in the intake format were frequently inconsistent with reports obtained in the survey, which were twice as frequent as intake reports. Gender of the intake interviewer was not related to reporting. These data suggest caution in accepting at face value initial denials of abuse histories.

Dissociative symptoms in relation to childhood physical and sexual abuse.

Studies have reported high rates of childhood abuse in people with psychiatric illness. This study examined whether dissociative symptoms are specific to patients with histories of abuse. Ninety-eight female psychiatric inpatients completed self-report instruments that focused on childhood history of trauma, dissociative symptoms, and psychiatric symptoms in general. Sixty-three percent of the subjects reported physical and/or sexual abuse. Eighty-three percent had dissociative symptom scores above the median score of normal adults, and 24% had scores at or above the median score of patients with posttraumatic stress disorder. Subjects with a history of childhood abuse reported higher levels of dissociative symptoms than those who did not.

Ego development and treatment requests.

Ego development theory suggests that patients might differ in the forms of psychiatric treatment they find helpful, depending on the maturity of their ego functioning. In our study, 100 adults beginning outpatient psychiatric treatment completed the Sentence Completion Test of ego development and the Patient Request Form, which measures treatment modality preference. Ego development was related to treatment requests in patterns predicted from theory: higher ego stage patients were more likely to request insight therapy, while lower stage patients were more likely to request reality checks, social intervention, and triage. We argue that the ego development construct can help treaters match patients to treatment modalities that are compatible with their frames of reference.

Validity of record ratings of the Global Assessment Scale.

The Global Assessment Scale (GAS) is a comprehensive rating of psychiatric status that is usually based on face-to-face interviews. Validity has not been established for the use of the GAS when it is based on secondary sources of information about the patient, source of patient information, although secondary sources have been used for this purpose. The current study examined agreement between GAS ratings based on medical records and ratings based on face-to-face interviews. Results showed moderate agreement between the two sets of ratings, with the intraclass correlation-coefficient (ICC) equaling .62. Record-based (R)-GAS ratings were upwardly biased and were restricted in range when compared with interview-based (I)-GAS ratings. A case-by-case analysis showed that the disagreement could be accounted for by inconsistent documentation of the degree of functional impairment in the most severely disturbed patients. We conclude the following: If R-GAS ratings are used, designs should be modified to adjust for probable overestimated functioning of the most severely disturbed patients.