[Psychological treatments for pain in cancer patients : A systematic review on the current state of research]. / Schmerzpsychologische Interventionen bei onkologischen Patienten : Ein systematisches Review zum aktuellen Stand der Forschung.

BACKGROUND: In cancer patients, pain is one of the main symptoms and especially in the late stages of disease, these symptoms can be associated with considerable suffering. In psycho-oncology, preliminary psychological therapies targeting cancer pain have been tested; however, a systematic review of available interventions is lacking, especially considering their dissemination, evidence base, study quality, and the comparison with established treatments. Therefore, the aim of the current study is to systematically review the current research on psychological treatments for pain in cancer patients. MATERIALS AND METHODS: During May 2014, MEDLINE, PsycINFO, PSYNDEX, and CENTRAL databases were searched. Psychological treatments for pain in adult cancer patients studied in randomized, controlled trials (RCTs) and referring to pain as primary or secondary outcome were included. After examination for inclusion, structured data extraction and assessment followed. Data were synthesized narratively. RESULTS: In the review, 32 RCTs were included. Studies mainly referred to patients with breast cancer or patients in earlier stages of the disease. The methodological quality of included studies was heterogeneous. Most commonly, short interventions were delivered by nurses in out-patient settings. Interventions including education and relaxation techniques were utilized most often, followed by interventions with behavioral or cognitive components. CONCLUSION: A need for research persists regarding efficacy of current psychotherapeutic interventions, or the role of mediator variables (e. g., coping) on pain perception in cancer patients. Studies with high methodological quality which comprehensively and transparently report on interventions and designs are lacking.

Anatomy lessons in the Michelangelo' s works?

Michelangelo Bounarroti born in Italy and lived between 1475 and 1564. He had a vast knowledge inanatomy and it is confirmed by the perfection in which human  is represented in his works. This fact drawsthe attention of scholars from a variety of areas concerning the study of human body to be interested in his artworks. We discuss the possible presence of the representation of anatomical structures included in the worksof Michelangelo presented by several authors.

Calcification of the left internal carotid artery and itsimplications: a case report in human

During routine activities in the laboratory, a calcified segment of the left internal carotid artery was observedin a caucasian cadaver skull. The calcification extends from the cerebral segment to the cavernous segmentof the internal carotid artery. Some important diseases seems to be related with calcification of the internalcarotid artery, thus, the present study shall be important for health sciences and those who keep some interestin pathologies associated with calcifications.

Separating two components of body image in anorexia nervosa using fMRI.

BACKGROUND: Body image distortion is a key symptom of anorexia nervosa. In behavioral research two components of body image have been defined: attitudes towards the body and body size experience. Neuroimaging studies concerning own body image distortions in anorexia nervosa have revealed an inconsistent pattern of results and are constrained by the fact that no direct distinction between the different parts of body image has been made. METHOD: The present study therefore set out to investigate the neural correlates of two parts of the own body image using functional magnetic resonance imaging (fMRI): satisfaction rating and size estimation for distorted own body photographs in patients with anorexia nervosa and controls. RESULTS: Anorectic patients were less satisfied with their current body shape than controls. Patients further demonstrated stronger activation of the insula and lateral prefrontal cortex during the satisfaction rating of thin self-images. This indicates a stronger emotional involvement when patients are presented with distorted images close to their own ideal body size. Patients also overestimated their own body size. We were able to show complex differential modulations in activation of the precuneus during body size estimation in control and anorectic subjects. It could be speculated that a deficit in the retrieval of a multimodal coded body schema in precuneus/posterior parietal cortex is related to body size overestimation. CONCLUSIONS: We were able to find specific behavioral responses and neural activation patterns for two parts of body image in anorexia nervosa and healthy controls. Thus, the present results underline the importance of developing research and therapeutic strategies that target the two different aspects of body image separately.

[Which factors influence job satisfaction and motivation in an institute of radiology?]. / Welche Faktoren beeinflussen die Arbeitszufriedenheit und -motivation an einem Institut für Radiologie?

PURPOSE: As empirically shown, increasing job satisfaction and motivations correlates with reduced job fluctuation and costs of absenteeism in an organisation. To provide a motivating environment for employees becomes more important in the health-care system and thus also in radiology. The purpose of our study was therefore to evaluate job satisfaction of our team and to define important influencing factors. METHODS: For data collection, as standardized questionnaire was designed. As a result of a discussion in a focus group, 9 indicators characterizing job satisfaction and motivation were determined (four-point ordinal scale), in addition there were open questions as well as space for comments. The questionnaires were distributed to all employees at the institute during the study period 11/2005. It was assured in the study design that data analysis was anonymous. For statistical analysis, all replies were coded (scale 1-4) and transferred to an excel sheet. RESULTS: Rate of return was 92% (46/50). In general, employees enjoyed work (mean 3.37 +/- 0.5); no significant difference between physicians, technicians and other staff members were observed. Factors most important for personal motivation were good working climate (3.85 +/- 0.4), good reputation of the institute (3.56 +/- 0.8) and personal recognition (3.54 +/- 0.6). Wage raise (3.01 +/- 0.9) and bonus payments (3.11 +/- 0.9) were rated less important. Communication between groups of employees could be improved (2.78 +/- 0.7). When asked, which factors would improve motivation, common answer included teamwork and communication (n = 9), more participation in planning processes (n = 8), more appreciation (n = 7) and continuing education (n = 5). CONCLUSIONS: Profound knowledge of factors influencing job satisfaction and motivation of employees allows for the implementation of targeted strategies for continuous improvement.

Inactivation of pathogens in platelet concentrates by using a two-step procedure.

BACKGROUND AND OBJECTIVES: Platelet concentrates are contaminated with residual leucocytes and may also be infected with viruses and bacteria. We investigated whether these pathogens can be inactivated by a two-step procedure comprising photodynamic treatment in the presence of the phenothiazine dye, thionine, followed by irradiation with ultraviolet light (UV-B, wavelength range 290-330 nm). MATERIALS AND METHODS: Platelet concentrates were prepared from buffy coats. The concentrates were spiked with different viruses, bacteria and leucocytes, then illuminated with yellow light in the presence of thionine at dye concentrations between 1 and 5 microm and with UV-B at doses up to 2.4 J/cm2. The infectivity of samples and the viability of leucocytes were assayed before and after treatment. The influence of treatment on in vitro platelet function was also examined. RESULTS: The inactivation of free viruses in platelet concentrates by photodynamic treatment with thionine/light was significantly enhanced when it was followed by irradiation with UV-B. The inactivation of leucocytes and of bacteria by UV-B was improved when it was preceded by thionine/light. Sterile platelet concentrates were prepared from buffy coats infected with Staphylococcus epidermidis. Platelet function and the storage stability of platelet concentrates were only moderately influenced by the two decontamination steps. CONCLUSIONS: Photodynamic treatment in the presence of the phenothiazine dye, thionine, followed by low-dose UVB, has the potential to inactivate viruses, leucocytes and bacteria, which might contaminate platelet concentrates. Both treatments complement each other.

["Off-label" prescribing of drugs in the ambulatory care of children and adolescents]. / "Off-label" Verschreibung von Arzneimitteln in der ambulanten Versorgung von Kindern und Jugendlichen1.

BACKGROUND AND OBJECTIVE: Hospitalised children receive up to 90 % of their drug prescriptions without ("unlicensed use") or outside ("off-label use") the terms of their product license. As no data are available for pediatric outpatients in Germany, we determined "off-label" use in a representative cohort of children and adolescents. PATIENTS AND METHODS: We analyzed 1.74 million prescriptions, written from January 1 st through March 31 st, 1999, to 455 661 children and adolescents aged 0 to 16 years by 6886 specialists in pediatric, general or internal medicine. All prescriptions were covered by the public health insurance, Allgemeine Ortskrankenkasse, (AOK) Baden-Wuerttemberg. License status of 1 592 006 identifiable prescriptions comprising more than 10 000 differently branded drugs was determined in 5 age groups and in different groups of the Anatomical Therapeutical Chemical Classification (ATC). As reference documents for licensing status we used the "Fachinformation" (summary of product characteristics), the "Rote" and "Gelbe" Liste, respectively. RESULTS: 13.2 %, i. e. 210 528 of the 1.59 million prescriptions, were "off-label". 75 % of these "off-label" prescriptions were due to a lack of information on pediatric use in the summary of product characteristics. The highest "off-label" fractions were found in drugs topically used in eyes and ears (78.6 %), dermatological (57.9 %), cardiovascular drugs (55.2 %), drugs für musculoskeletal (45.2 %) and urogenital disorders (48.5 %) and antidepressants (36.6 %). CONCLUSION: "Off-label" prescribing in outpatient children is less frequent than in pediatric inpatients. Considering the high absolute number of prescriptions however, 13.2 % cannot be neglected. Doctors prescribing drugs for children and adolescents should be aware of their actual licensing status because of its medical and legal consequences.

Gastric stromal tumor--a rare cause of an upper gastrointestinal bleeding.

Gastrointestinal stromal tumors (GISTs) are rare neoplasms arising from connective tissue elements of the gastrointestinal wall. They show a great heterogeneity with respect to their histogenetic, morphologic and prognostic characteristics. GISTs are known with myoid, neural or mixed features of differentiation. Clinical findings are gastrointestinal bleeding, abdominal pain and weight loss. We report on the case of a 50-year-old male patient who presented with melena and acute anemia (hemoglobin 10.5 g/dl). Esophagogastroduodenoscopy revealed a broad-based, centrally ulcerated polypoid formation of 3 cm in the gastric corpus as the cause of the upper gastrointestinal bleeding. Multiple endoscopic biopsies were negative for neoplastic changes. Because of no tendency of healing after triple eradication therapy of Helicobacter pylori and following proton pump inhibitor medication, the patient underwent distal gastrectomy with gastrojejunostomy. GIST of combined smooth muscle and neural type was diagnosed by histological and immunohistochemical examination. The features with increased mitotic activity and cellularity were those of a borderline stromal tumor. 6 months after surgery the patient is well with no signs of residual malignancy. This case demonstrates that rare stromal neoplasms have to be taken into account in the differential diagnosis of gastrointestinal tumors even if endoscopic biopsies are negative for neoplastic changes. Because of the uncertain biological behavior of the GISTs an early surgical intervention is recommended.

Functional gastrointestinal disorders among soldiers in peacetime versus out-of-area missions.

Functional gastrointestinal syndromes are chronic disorders of the abdomen with an absence of organic findings. The aim of this study was to compare the frequency and symptomatology of functional abdominal syndromes in soldiers during an out-of-area mission versus during peacetime at home. We examined 124 soldiers who sought medical care for abdominal symptoms at the German Field Hospital Trogir, Croatia. The control group consisted of 113 soldiers who were referred with abdominal symptoms to the Central Hospital of German Armed Forces Koblenz, Germany. After excluding an organic disease, the diagnosis of a functional disorder was made. Fourteen percent of the Implementation Force soldiers had symptoms of a functional syndrome. At home, the frequency of functional gastrointestinal disorders was 50%, significantly greater than the rate during the out-of-area mission (p < 0.0001). We conclude that functional gastrointestinal disorders are more rare during out-of-area missions than during peacetime. They are probably as frequent away from home as at home, but "health care seeking" is less frequent under the stressful conditions of out-of-area missions.

[Acute renal failure due to hypercalcemia and peripheral polyneuropathy--rare manifestations of sarcoidosis]. / Akutes Nierenversagen auf dem Boden einer Hyperkalzämie und periphere Polyneuropathie--seltene Manifestationen einer Sarkoidose.

BACKGROUND: Sarcoidosis can involve many organs. Whereas lung and intrathoracal lymph nodes are most often effected, there are some rare manifestations as renal failure and neuropathy. CASE REPORT: A 57-year-old male patient was referred to hospital with dyspnea on exertion, hypercalcemia and acute renal failure after holidays in Southern Europe. The diagnosis of sarcoidosis with the extraordinary manifestations of a nephropathia based on hypercalcemia and a sensitive polyneuropathy was made. CONCLUSION: These findings suggest that an asymptomatic sarcoidosis can develop hypercalcemia with renal failure by increased ultraviolet exposure. Patients with sarcoidosis should avoid marked exposure to UV light.

[Asymptomatic diclofenac-induced acute hepatitis]. / Asymptomatische Diclofenac-induzierte akute Hepatitis.

HISTORY AND ADMISSION FINDINGS: After removal of an herniated intervertebral disc a 49-year-old man had recurrent pain in the lumbar region, treated with diclofenac and flupirtine. 4 months postoperatively he was referred to the author's hospital because of progressive rise in transaminase levels and in cholestasis parameters. Physical examination on admissions was unremarkable, except for jaundice. INVESTIGATIONS: Laboratory tests showed an increases in transaminases (GPT 769 U/l [normal: < 23 U/l], GOT 285 U/l [normal: < 19 U/l]) and in cholestasis-related values (gamma-GT 172 U/l [Norm 6-28 U/l], alkaline phosphatase 207 U/l [normal < 175 U/l], total bilirubin: 2.5 mg/dl [Norm < 1.1 mg/dl]). This corresponded to the histological finding of toxic damage to the liver parenchyma. Viral, autoimmune and metabolic causes had been excluded. DIAGNOSES, TREATMENT AND COURSE: The history as well as laboratory and histological findings indicated diclofenac-induced toxic hepatitis. The drug was discontinued and without any treatment all laboratory values returned to normal within 9 weeks. CONCLUSION: Diclofenac, a frequently prescribed non-steroid anti-inflammatory drug, is generally thought to be relatively safe. But it can produce toxic hepatitis which may be asymptomatic (but this patient was jaundiced) and may take an unforeseeable course. This should be taken account of by regularly monitoring liver functions.

A new rotational thrombectomy catheter: system design and first clinical experiences.

PURPOSE: To describe a new catheter for the percutaneous mechanical removal of fresh and organized thrombi, and to assess its efficacy and safety in vitro and in vivo. METHODS: The catheter consists of a coated stainless steel spiral that rotates at 40,000 rpm over a guidewire inside the whole length of an 8 Fr, single-lumen, polyurethane catheter, driving a dual-blade cutting crown. Abraded occlusion material is sucked into the catheter head through distal side holes and transported by the spiral into a reservoir at the proximal end. The efficacy of the device was tested in arterial models and fresh bovine carotid arteries (n = 72). In a clinical pilot study 10 patients (8 women, 2 men; mean age 70.6 +/- 10.1 years) with occlusions of the superficial femoral artery (2-12 cm, mean 5.8 cm), not older than 4 weeks, underwent thrombectomy with the new catheter. RESULTS: In arterial models and bovine cadaver arteries the catheter completely removed fresh thrombi. Occlusion material of higher consistency was cut into particles of 100-500 micron and transported outside. Thrombectomy was successful and vessel patency restored in all 10 patients. The ankle/brachial pressure index significantly (p < 0.0005) increased from 0.41 +/- 0. 18 before intervention to 0.88 +/- 0.15 after 48 hr and to 0.84 +/- 0.20 after 3 months. Two reocclusions occurred within 14 days after the intervention. CONCLUSION: Thrombectomy with the new device appears to be feasible and safe in patients with acute and subacute occlusions of the femoropopliteal artery.

Peroxisome subpopulations of the rat liver. Isolation by immune free flow electrophoresis.

Peroxisomes (POs) are a heterogenous population of cell organelles which, in mammals, are most abundant in liver and kidney. Although they are usually isolated by differential and density gradient centrifugation, isolation is hampered by their high fragility, sensitivity to mechanical stress, and their sedimentation characteristics, which are close to those of other major organelles, particularly microsomes. Consequently, until now only the so-called "heavy" POs with a buoyant density of 1.22-1.24 g/cm(3) have been highly purified from rat liver, whereas the other subpopulations also present in that tissue have escaped adequate characterization. The purification of these subpopulations has become an essential task in view of the functional significance of POs in humans, and the putative importance of peroxisomal subpopulations in the biogenesis of this organelle. Here we used an alternative novel approach to density gradient centrifugation, called immune free flow electrophoresis (IFFE). IFFE combines the advantages of electrophoretic separation with the high selectivity of an immune reaction. It makes use of the fact that the electrophoretic mobility of a subcellular particle complexed to an antibody against the cytoplasmic domain of one of its integral membrane proteins is greatly diminished, provided that the pH of the electrophoresis buffer is adjusted to pH approximately 8.0, the pI of IgG molecules. Because of this reduced electrophoretic mobility, IgG-coupled particles can be separated in an electric field from those that are noncoupled and hence more mobile. The IFFE technique has been recently applied for isolation of regular POs (rho = 1.22-1.24 g/cm(3)) from a light mitochondrial fraction of rat liver. We succeeded in isolating different subpopulations of POs by applying IFFE to heavy, light, and postmitochondrial fractions separated by differential centrifugation of a rat liver homogenate. The PO subfractions obtained differed in their composition of matrix and membrane proteins, as revealed by immunoblotting. This indicates that they indeed represent distinct subpopulations of rat hepatic POs.

[Bleeding from Dieulafoy's ulcer after argon-plasma laser coagulation of gastric angiodysplasia in Heyde's syndrome]. / Dieulafoy-Blutung nach Argon-Plasma-Koagulation einer Angiodysplasie beim Heyde-Syndrom.

HISTORY: A 75-year-old, pale-looking man with known severe valvar aortic stenosis and three-vessel coronary artery disease previously treated with two bypass grafts was referred for elucidation of anaemia before further coronary artery surgery. INVESTIGATIONS: In addition to chronic iron-deficiency anaemia (haemoglobin 9.5 g/dl) endoscopy revealed gastric angiodysplasia. Endoscopy of the colon was negative. DIAGNOSIS, TREATMENT AND COURSE: Argon-plasma laser coagulation (APC) for the angiodysplasia was performed twice. Although there were no complications at first, five days later tarry stools were noted and hypovolaemic shock developed. Emergency gastroscopy revealed a bleeding vessel stump (Dieufaloy's lesion) proximal to the APC-induced ulcer (stage Ib bleeding [Forrest's classification]). Epinephrine and fibrin glue were applied endoscopically. The patients died 20 days later of septicaemic and multiorgan failure, the result of left-heart failure with pneumonia. CONCLUSION: APC, usually described as being a low-risk procedure, can cause mucosal damage resulting in Dieulafoy's lesion. APC should therefore be carefully monitored.

[The coexistence of 2 different neuroendocrine tumors of the upper gastrointestinal tract and pancreas]. / Koexistenz von zwei unterschiedlichen neuroendokrinen Tumoren des oberen Gastrointestinaltraktes und des Pankreas.

HISTORY AND CLINICAL FINDINGS: A 41-year-old obese patient presented with cramp-like abdominal pain, watery diarrhoea with partly digested food particles, projectile vomiting and newly diagnosed diabetes mellitus. For the preceding 6 years he had been treated for recurrent gastric and duodenal ulcers. Although the fasting gastrin level was raised and Zollinger-Ellison syndrome suspected, computed tomography (CT), magnetic resonance imaging (MRI) and coeliac angiography at another hospital had failed to discover a tumor. INVESTIGATIONS: Biochemical tests were unremarkable except for an increased GPT concentration, slight fasting hyperglycemia and hypertriglyceridemia. The gastrin and chromogranin A levels were markedly elevated (15,590 pg/ml and 584.2 U/l, respectively). Gastroscopy revealed, in addition to multiple small duodenal ulcers, a round polypoid mass (diameter of 0.7 cm) lateral to the papilla of Vater, histologically an APUDoma. Endoscopic retrograde cholangiopancreatography (ERCP) revealed a 0.5 cm long compression of the duct of Wirsung in the region of the head of the pancreas. Liver metastases were excluded by magnetic resonance imaging and computed tomography. Endosonography showed a ca. 4 mm space-occupying lesion in the region of the body of the pancreas. Octreotide scintigraphy demarcated two foci at the level of the head of the pancreas (somatostatin-receptor positive). TREATMENT AND COURSE: After a pylorus-preserving partial duodenopancreatectomy with lymph node dissection N1/N2, histology confirmed a gastrinoma of the duodenum and a glucagonoma of the pancreas (pT3pN1pMx). Postoperatively the patient became symptom-free and both the blood sugar level and the tumor marker were normal. CONCLUSION: Combined ERCP, endosonography and scintigraphy are more sensitive than other radiological examinations (CT and MRI) in diagnosing and localizing neuroendocrine tumours of the gastrointestinal tract. Despite the low incidence of such tumours, the possible synchronous occurrence of several such tumour should not be ignored.