An uncommon case of POLE mutated uterine carcinosarcoma - complemented by a review of literature.

Carcinosarcomas are high-grade endometrial cancers which enclose mesenchymal and epithelial differentiated components. The vast majority of these cancers belong to the p53 abnormal molecular subgroup and usually come with an unfavorable prognosis. POLE mutant carcinosarcomas are a rarity and only make up about 5% of this histologic subtype. Recent literature even suggests that this number is still an overestimation and the result of misclassification of undifferentiated or dedifferentiated endometrial cancers. Here we present a case of a 56-years old patient diagnosed with carcinosarcoma of the uterus. Hysterectomy, bilateral salpingo-oophorectomy with pelvic lymph node staging was performed and complete molecular workup of the tumor revealed an abnormal p53 expression as well as a pathologic POLE mutation. NGS was performed separately on the epithelial and mesenchymal component of this high-grade cancer and both components shared two identical POLE mutations, a known pathologic mutation, and a variant of unknown significance (VUS). This finding hints to a clonal origin of both histologic components of this tumor and supports conversion theory as mechanism of carcinosarcoma emergence. The cancer was correctly staged as FIGO 2023 Stage IAmPOLEmut and according to ESGO-ESTRO-ESP guidelines adjuvant chemotherapy no longer considered and our patient entered follow-up after a detailed discussion.

[Asthma management at the interface of general practice and hospital care]. / Asthma - Management an der Schnittstelle zwischen Hausarzt und einem Krankenhaus der Grundversorgung.

The aim of the study was to assess the management of patients hospitalised for asthma with regard to the recommendations of the German Airway League, and the communication between hospital doctors and general practitioners (GPs). All records of patients discharged with asthma or COPD (ICD9) between 1/1996 and 6/1998 were retrieved (n = 169) in one general hospital. All patients whose asthma had been known in admission and was given as a reason for hospitalisation in the discharge letter were selected (n = 93). Treatment prescribed by the patients' GPs before hospitalisation as well as diagnostic procedures and treatment in hospital and the recommendations in the discharge letter were reviewed. Additionally the GPs were questioned with case vignettes. Before hospitalisation, most patients had been treated with theophyllin (66 %) and inhaled betamimetics (62 %), only 44 % had received topical and 29 % oral steroids by their GP. In hospital, lung function assessment was performed in only 8 % of the patients and there was no monitoring of the peak flow. The most commonly prescribed drugs were theophyllin (94 %), mucolytics (94 %) and antibiotics (82 %). Half of the patients (47 %) were discharged without adequate anti-inflammatory baseline treatment. The discharge letters did not contain detailed recommendations on future asthma management. There seems to be room for improvement with regard to the implementation of the German Airway League's recommendations both in hospital and in general practice: Few patients received systemic or inhaled steroids, whereas theophyllin and antibiotics were prescribed routinely. In hospital, airway obstruction was neither measured initially nor monitored. Communication between hospital doctors and GPs seems to be insufficient.

The effectiveness of psychoanalytic psychotherapy: the role of treatment duration, frequency of sessions, and the therapeutic relationship.

This is an effectiveness study of treatment outcome that relies on patients' perception of their mental health during and after psychoanalytic psychotherapy. Ninety-nine outpatients attending the IPTAR Clinical Center (ICC) responded to the Effectiveness Questionnaire (EQ) adapted from that developed by Consumer Reports. Effectiveness is studied from various perspectives. Findings indicated (1) an incremental gain in effectiveness scores from six to over twenty-four months of therapy; (2) an incremental gain with greater session frequency from one to two or three weekly sessions; (3) facilitation of effectiveness by the experience of a positive relationship with the therapist; (4) an interplay between clinical syndrome and treatment conditions. A method giving clinical validity to the quantitative findings is described. Brief summaries of two recorded interviews reveal differential reconstruction of events that had occurred during treatment. The findings are discussed from the vantage point of two hypotheses: cognitive dissonance and internalization of therapeutic experience.

The preconceptual organization of emotion.

The suggestion is made that emotions organized on a preconceptual level are psychic constructs different in kind, as well as degree, from emotions organized on a more abstract conceptual level. For many people the regressive alteration in ego functioning that gives rise to these emotional constructions represents a characterological way of handling conflict. Emotions organized on a preconceptual level and rigidly maintained through primitive defenses ward off a host of fears ranging from castration to dedifferentiation. The shift from the preconceptual world of sensation to the conceptual world of abstraction complements the resolution of oedipal themes and is essential for free and easy movement between reality-based interactions and the imaginary experience of both self- and object representations in the transference. Structural and dynamic aspects of these emotional constructions are discussed and their relation to a person's experience of reality is explored through transference material taken from different points in an analysis. The problem of the analyst's use of concepts to refer to preconcepts is also discussed, as is the issue of enactments.