Scapular free flap as a good choice for mandibular reconstruction: 119 out of 280 cases after resection of oral squamous cell carcinoma in a single institution.

Microsurgical procedures for reconstruction after resection of head and neck tumours have become standardised and reliable. Among them, the scapular free flap is used less often, mostly to avoid excessive operating times. We hypothesise that complex reconstructions after resection of oral squamous cell carcinoma (OSCC) are successful even with time-consuming free flaps such as the scapular free flap. In this retrospective, single-centre study, we used the evaluation of medical records to investigate the postoperative outcome of microvascular reconstruction after ablative surgery of OSCC. Associations among the categorical variables were analysed using Pearson's chi squared test or Fisher's exact test. Among the continuous variables, the t test or Mann-Whitney U test were used as appropriate. For multivariate analysis, the logistic regression model was calculated. In the sample of 280 free flap reconstructions, we performed 142 radial forearm and 119 scapular free flaps. The American Society of Anesthesiology (ASA) score (p=0.006) and the duration of the operation (p=0.010) are independent factors which influence the need for operative revisions. The type of free flap is irrelevant for that. With 4.2% flap losses, scapular free flaps were successful; even in patients ≥ 70 years old (0 flap losses). Complex reconstructions after surgical resection of OSCC are successful even in aged patients. The scapular free flap is a good choice for mandibular reconstruction despite the time-consuming intraoperative repositioning of the patient. In an increasingly ageing group of patients, who have more vascular diseases, scapular free flaps could be a very successful alternative after ablative surgery of oral squamous cell carcinoma.

[Internet-based resilience training and prevention of mental disorders]. / Internetbasierte Resilienzförderung und Prävention psychischer Erkrankungen.

BACKGROUND: Resilience is associated with a positive and resource-oriented perspective. Therefore, it seems especially attractive for health promotion and prevention. In recent years, interventions to foster resilience have been increasingly developed, which train resilience factors and are mainly conducted in a face to face group format. OBJECTIVE: The question is raised what potential internet-based interventions (i-interventions) that train resilience factors have for health promotion and prevention. MATERIAL AND METHODS: Based on a narrative overview, the possibilities for i­interventions that train resilience factors for health promotion and prevention are investigated and the state of research is described. RESULTS: The effects of the i­interventions presented here, which aim at fostering resilience, on measures of mental health and well-being are heterogeneous and vary between low to high effects. Stronger evidence for the efficacy of these measures exists for more general i­interventions that also train resilience factors but are conceptualized for the prevention of specific disorders, such as depression or for stress reduction. DISCUSSION: Given the heterogeneous nature of intervention contents, theoretical foundations and therapeutic methods used, the heterogeneity of the evidence is discussed. In addition, perspectives for the further development of resource-oriented resilience interventions are outlined.

[Current concepts of resilience research]. / Aktuelle Konzepte der Resilienzforschung.

BACKGROUND: Stress-related mental disorders are the most prevalent and cost-intensive disorders of our time. On the other hand, the maintenance of mental health despite stressors, i. e. resilience, is a frequent phenomenon. Research on psychological resilience and its underlying mechanisms offers innovative possibilities for health promotion. It requires a consistent understanding of resilience and adequate methods of operationalization. OBJECTIVES: Modern concepts of the definition, operationalization and assessment of resilience as well as its implications for study designs in resilience research. MATERIAL AND METHODS: Analysis and discussion of current works and expert recommendations for the design of resilience research. RESULTS: Resilience research is undergoing a period of transition. Based on a new understanding of resilience as a dynamic and modifiable process, new approaches for operationalization and assessment were proposed. These include, for example, a transdiagnostic approach and the identification of resilience mechanisms, the consideration of stressor exposure in measuring the construct, and longitudinal cohort studies. CONCLUSIONS: In the upcoming decades, further profitable findings from current prospective longitudinal studies can be expected. One challenge for future resilience research consists in the continuous dissemination and implementation of the approaches described.

Intervention studies to foster resilience - A systematic review and proposal for a resilience framework in future intervention studies.

Psychological resilience refers to the phenomenon that many people are able to adapt to the challenges of life and maintain mental health despite exposure to adversity. This has stimulated research on training programs to foster psychological resilience. We evaluated concepts, methods and designs of 43 randomized controlled trials published between 1979 and 2014 which assessed the efficacy of such training programs and propose standards for future intervention research based on recent developments in the field. We found that concepts, methods and designs in current resilience intervention studies are of limited use to properly assess efficacy of interventions to foster resilience. Major problems are the use of definitions of resilience as trait or a composite of resilience factors, the use of unsuited assessment instruments, and inappropriate study designs. To overcome these challenges, we propose 1) an outcome-oriented definition of resilience, 2) an outcome-oriented assessment of resilience as change in mental health in relation to stressor load, and 3) methodological standards for suitable study designs of future intervention studies. Our proposals may contribute to an improved quality of resilience intervention studies and may stimulate further progress in this growing research field.

Naturalistic study on the effectiveness of psycho-oncological interventions in cancer patients and their partners.

BACKGROUND: There is evidence for the efficacy of psycho-oncological interventions (POI) in randomized controlled trials for cancer patients. Our objective was to explore, under naturalistic conditions (using propensity score matching), whether POI are effective to decrease anxiety, depression, distress and overall psychopathological symptoms within cancer patients and their partners. METHODS: This study was conducted in the Oncology and Hematology Center of a University clinic in Switzerland with a group of 186 patients and 117 partners. Outcome measures of mental health were the Hospital Anxiety and Depression Scale and the Symptom Checklist (SCL-9-K). Repeated-measures ANOVAs were used to analyze change over time and group effects between individuals with POI vs. without POI. RESULTS: Highly distressed patients and their partners participating in POI reported better mental health over time. Among moderately distressed patients, a decrease over time emerged in depression and distress independent of POI. No effectiveness of POI could be demonstrated in moderately distressed patients and partners. CONCLUSION: Most of the highly distressed patients receive additional POI and therefore conclusions about the efficacy of POI are difficult. For moderately distressed individuals, POI as implemented in Switzerland does not improve mental health in such patients and their partners, which may be caused by very time limited POI treatments. Studies with more intense POI treatments are needed.

[Frequency of vomiting after emergency abdominal surgery in a reference public hospital]. / Frequência do vômito após cirurgia abdominal de urgência em hospital público de referência.

OBJECTIVE: The objective of this study was to evaluate the frequency of the vomiting after urgency abdominal surgery in the Alagoas reference public hospital. METHODS: After approved in the Ethic and Search Committee of the Alagoas Federal University, the information was got in the medical records 24 hours after urgency abdominal surgery. Fisher test and chi-square with Yates correction were used do compare proportions assuming a 5% significance level. Was calculated 95% confidence interval to proportions when was possible. RESULTS: Were 100 patients, 85% men (85/100, CI 95% 0.78-0.92). The vomiting frequency was 25% without statistical difference between abdominal surgery after trauma and inflammatory acute abdomen (P=0.46). There was not statistical difference between anesthetic techniques (P=0.99). CONCLUSION: The general vomiting prevalence after the urgency abdominal surgery in the Alagoas reference public hospital was 25%.

Frequência do vômito após cirurgia abdominal de urgência em hospital público de referência / Frequency of vomiting after emergency abdominal surgery in a reference public hospital

OBJETIVO: Avaliar a frequencia do vômito após cirurgia abdominal de urgência em hospital público de referência no Estado de Alagoas. MÉTODOS: Após aprovação do Comitê de Ética em Pesquisa da Universidade Federal de Alagoas, os dados foram colhidos no prontuário médico 24 horas após a cirurgia abdominal de urgência. O teste de Fisher e o qui-quadrado com correção de Yates foram usados para comparar proporções. O intervalo de 95 por cento de confiança foi calculado quando possível. RESULTADOS: Foram 100 pacientes, 85 por cento homens (85/100, IC 95 por cento 0,78-0,92). A frequencia do vômito foi 25 por cento sem diferença estatística entre cirurgia abdominal após trauma e abdome agudo inflamatório (P=0,46). Não houve diferença estatística entre as técnicas anestésicas (P=0,99). CONCLUSÃO: A frequencia do vômito no pós-operatório de cirurgia abdominal de urgência em hospital de referência no estado de Alagoas foi de 25 por cento.

OBJECTIVE: The objective of this study was to evaluate the frequency of the vomiting after urgency abdominal surgery in the Alagoas reference public hospital. METHODS: After approved in the Ethic and Search Committee of the Alagoas Federal University, the information was got in the medical records 24 hours after urgency abdominal surgery. Fisher test and chi-square with Yates correction were used do compare proportions assuming a 5 percent significance level. Was calculated 95 percent confidance interval to proportions when was possible. RESULTS: Were 100 patients, 85 percent men (85/100, CI 95 percent 0,78-0,92). The vomiting frequency was 25 percent without statistical difference between abdominal surgery after trauma and inflammatory acute abdome (P=0,46). There was not statistical difference between anesthetic techniques (P=0,99). CONCLUSION: The general vomiting prevalence after the urgency abdominal surgery in the Alagoas reference public hospital was 25 percent.

[Distress among cancer patients and their partners in the first year after diagnosis]. / Psychische Belastungen bei Krebspatienten und ihren Partnern im ersten Jahr nach Diagnosestellung.

RATIONALE: Diagnosis of a malignant disease can cause serious psychological problems in patients as well as their intimate partners. AIM: This study investigated anxiety, depression, posttraumatic symptoms and feelings of guilt in patients and their partners segregated by sex. METHOD: In a clinical representative sample 248 cancer patients and 154 of their partners were assessed using standard questionnaires shortly after diagnosis and again six and twelve months thereafter. RESULTS: Cancer patients' female partners most frequently indicated psychopathology that required treatment (29% anxiety, 33% depression, 17% posttraumatic symptoms). CONCLUSION: Cancer patients' female partners are at high risk of developing psychopathology. Hence they routinely should be included in patient exploration and, if need be, referred to psychooncological treatment.

[Pathological changes in face and skull in acromegaly]. / Pathognomonische Veränderungen im Bereich von Gesichts- und Hirnschädel bei der Akromegalie.

31 patients (mean age 52.7 years) suffering from persistent symptoms of a growth hormone producing pituitary adenoma underwent both clinical and roentgenological examinations. The results of standardized x-ray analysis of the viscero- and neurocranium were compared with those of a group of 25 healthy subjects (mean age 42.1 years): Although several remarkable changes were observed, statistically significant changes of the facial skeleton could be found only in the lower jaw. The main contribution to its elongation was given by the chin prominence and the condyle. The findings in the neurocranium could be divided in symptoms of first and symptoms of second choice. With the help of these parameters, a score was established to facilitate interpretation of early signs of acromegaly in lateral skull radiographs. Two clinical symptoms found in our patient sample have not been mentioned before in literature about acromegaly: the so-called "hanging columella" and marked changes in diameter of the canalis mandibularis.

Typical changes in the viscerocranium in acromegaly.

31 patients (mean age 52.7 years) suffering from persistent symptoms of a growth hormone-producing pituitary adenoma underwent both clinical and radiological examination at least one year after transnasal extirpation of the tumour. The results of standardized X-ray analysis of the viscerocranium were compared with a group of 21 healthy subjects (mean age 42.1 years): Although several remarkable changes of the facial skeleton were observed, statistically significant changes could be found in the lower jaw only. The ascending ramus as well as the mandibular body were found to be elongated. The main contribution to the elongation was made by the chin prominence and the condyle. Two different growth patterns of the mandible could be determined; neither of them was pathognomonic for acromegaly. Due to overgrowth of the septal cartilage in 7 patients we found a so-called "hanging columella". In 16 patients the mandibular canal was widened and showed marked deviations in its diameter or a funnel-shaped mandibular foramen.

[Rhythm disorders in the rehabilitation phase after myocardial infarct]. / Rhythmusstörungen in der Rehabilitations phase nach Herzinfarkt.

45 patients with uncomplicated myocardial infarction and on no cardiac drugs underwent an exercise test and 24-hour monitoring 53 (range 22-80) days after the acute event before entering a 4-week rehabilitation program. These same tests were repeated 21 days later. Severe ventricular arrhythmias were registered in 14 patients (31%) while monitored on tape, in only 1 patient during exercise. Arrhythmias were more common in patients with ST-depression during exercise (38%) and in patients with reduced work capacity (42%). Non-smokers had no severe arrhythmias. The rehabilitation program had no influence on these findings. Arrhythmias after myocardial infarction correlate with work capacity and myocardial ischemia.

Cytomegalovirus strain differentiation by DNA restriction analysis.

The heterogeneity of CMV DNA obtained from standard strains and new isolates, including a vaccination strain (Towne 125), was investigated. The cleavage patterns produced by the restriction endonucleases Eco RI and Bam 1 revealed stable strain specificities of CMV. On the other hand, a remarkable homology of sequence-specific CMV DNA fragmentation was demonstrated. A CMV subtyping relevant to clinical questions seems to be improbable.

Evidence favoring the use of anticoagulants in the hospital phase of acute myocardial infarction.

Since the last comprehensive review of anticoagulation in acute myocardial infarction four additional randomized control trials have been reported. The overwhelming majority of all trials favored anticoagulation. Rates of thromboembolism were higher in the control, and hemorrhagic complications in the anticoagulated group. Pooling of all randomized control trials gives mean case fatality rates of 19.6% for the control and 15.4% for the anticoagulated group, a relative reduction of 21% (P less than 0.05 or less than 0.001, depending on the analytic method). Five of six randomized control trials reported "no effect" because the difference favoring anticoagulation was not statistically significant. However, sample sizes in these "negative" papers were too small to protect against missing a 21% reduction in true case fatality rate due to anticoagulation (beta greater than 0.10). All patients who present no specific contraindication should receive anticoagulants during hospitalization for infarction.