Flash floods in the Tatra Mountain streams: frequency and triggers.

Flash floods represent a frequently recurring natural phenomenon in the Tatra Mountains. On the northern slopes of the mountain chain, located in Poland, ongoing and expected future changes in climate are thought to further increase the adverse impacts of flash floods. Despite the repeat occurrence of major floods in the densely populated foothills of the Polish Tatras, the headwaters have been characterized by a surprising lack of data, such that any analysis of process variability or hydrometeorological triggers has been largely hampered so far. In this study, dendrogeomorphic techniques have been employed in four poorly-gauged torrential streams of the northern slope of the Tatra Mountains to reconstruct temporal and spatial patterns of past events. Using more than 1100 increment cores of trees injured by past flash floods, we reconstruct 47 events covering the last 148 years and discuss synoptic situations leading to the triggering of flash floods with the existing meteorological and flow gauge data. Tree-ring analyses have allowed highlighting the seasonality of events, providing new insights about potential hydrometeorological triggers as well as a differentiating flash flood activity between catchments. Results of this study could be useful to design future strategies to deal with flash flood risks at the foothills of the Polish Tatras and in the Vistula River catchment.

[Functional somatic pain syndromes-nomenclature]. / Funktionelle somatische Schmerzsyndrome-Nomenklatur.

A significant number of pain syndromes to be found in all medical specialties, including pain therapy, can be ascribed to a group that according to the classification of the International Association for the Study of Pain (IASP) is referred to as "pain syndromes with dysfunctional etiology," or according to internal medical terminology as "functional somatic syndromes" (functional disorders), or based on psychiatric nomenclature as "somatoform disorders." Frequent syndromes exhibiting pain as the major symptom include fibromyalgia syndrome (FMS), irritable bowel syndrome (IBS), chronic pelvic pain (CPP), tension headache, chronic myoarthropathies of the masticatory system (MAP), and prostatodynia. It is important for practitioners of both somatic and psychosocial medicine to be aware of the terminology used in other fields and the frequency of comorbidities of the individual syndromes. To improve communication between somatic and psychosocial medicine as well as with patients, the authors recommend that pain therapists base their diagnosis on the ICD-10 classification and refrain from using a separate pain therapy nomenclature.

[Irritable bowel syndrome]. / Reizdarmsyndrom.

The prevalence of irritable bowel syndrome (IBS) ranges in all countries of the world between 6 and 25%, in Germany between 15 and 22%. The divergent rates of prevalence are mainly due to different definitions of IBS in epidemiological studies. In Germany, 20-50% of persons with IBS symptoms seek medical help. IBS patients produce high direct and indirect costs. The following psychophysiological mechanisms of IBS are presumed to be empirically validated: visceral hypersensitivity, postinfectious sequelae, psychiatric disorders, and psychosocial stress. Tricyclic antidepressant agents and psychotherapy (hypnosis, cognitive behavioral therapy, and psychodynamic therapy) are effective for treatment of IBS forms dominated by pain. In one controlled study, the combination of pharmacological therapy and cognitive behavioral therapy was superior to pharmacological therapy alone.

[Dysfunctional syndromes: their diagnostics and treatment]. / Diagnostik und Therapie funktioneller Schmerzsyndrome.

If a patient presents with symptoms of a functional somatic pain syndrome in the primary care setting, it is important to confirm the diagnosis based on a thorough history and physical examination including selected diagnostic tests to exclude somatic diseases with a similar clinical presentation. Important aspects of psychosomatic medicine in the primary care setting are to discuss the diagnosis, treatment options, and prognosis of the functional psychosomatic pain syndromes with the patient in detail. Patients who present with a functional somatic pain syndrome to secondary or tertiary care centers, should be screened for additional functional pain syndromes. A psychiatric-psychosomatic evaluation might be indicated. Based on criteria of evidence-based medicine, psychotherapy and/or tricyclic antidepressants seem to be the most promising treatment approaches for the functional somatic pain syndromes.

[Organization of pain therapy in surgery--comparison of acute pain service and alternative concepts]. / Organisation der Schmerztherapie in der Chirurgie. Akutschmerzdienst und alternative Möglichkeiten im Vergleich.

An acute pain service done by surgeons is one possibility for organizing pain therapy in surgical wards. To do this successfully, some preconditions must be kept in mind, such as 24-h presence, an integrated system of documentation, and teamwork between medical and nursing staff. Comparison of differently structured pain therapy in three different hospitals (with and without acute pain service) showed high levels of patient satisfaction with the pain therapies in all three hospitals. One of the preconditions for effective pain therapy in surgery is to formulate a concept which takes into account the specific situation of each hospital.

[Visceral pain--a neglected phenomenon in pain therapy and research?]. / Bauchschmerzen - ein Stiefkind der Schmerztherapie und Forschung?

The topic "visceral pain"is hardly covered in basic research and pain therapy. After low back pain, headache and musculosceletal pain is abdominal pain the 4th frequent chronic pain syndrome in the general population with considerable direct and indirect disease related costs.An interdisciplinary multimodal treatment of chronic abdominal pain syndromes is rarely practiced in clinical care.

[Percutaneous endoscopic gastrostomy (PEG). Course, nutrition and care in 233 consecutive patients]. / Die perkutane endoskopische Gastrostomie (PEG). Verlauf, Ernährung und Pflege bei 233 konsekutiven Patienten.

AIM: To evaluate the course, nutrition and care of PEG tubes on the basis of data collected from 233 consecutive patients. PATIENTS AND METHOD: Between 1.1.1990 and 31.3.1996, a total of 243 PEG tubes were implanted in 233 patients--56.5% male and 43.5% female--with an average age of 66.2 years. 57.3% had neurological, and 19.4% neurosurgical, diseases, 11.2% suffered polytraumatization or severe burns, and 8.2% had a malignancy. Patients stayed with the implanted tube on average 153 days, with neurological patients leading the field at 189 days. RESULTS: The overall complication rate was 14.5%, with the most common complication being local infection, which occurred in 5.4% of the cases. Severe complications were seen in 1.2%. One patient developed a necrotizing fasciltis, and in two others, migration of the tube was observed. 52.2% of the patients died with the tube still in place. In 33.6%, the PEG tube was removed after a mean of 82.7 days, when adequate oral nutrition again became possible. CONCLUSION: In this study, PEG proved an effective method for enteral nutrition over the middle-to-long-term in multimorbid and intensive care patients, as well as in those with malignant disease.

[Role of the surgeon in pain management in oncological surgery]. / Die Rolle des Chirurgen in der Schmerztherapie in der onkologischen Chirurgie.

Cancer pain patients need a causal therapy whenever possible. Often surgical treatment offers effective pain therapy (e.g. biliodigestive anastomosis in obstructive cancer). In addition, chemotherapy and/or radiation may be indicated. Simultaneous symptomatic pain management according to the guidelines for pain therapy in cancer pain should be started. In general, therapy of chronic malignant pain should follow the WHO schema for cancer pain. Surgery and medical pain therapy can reduce 96-98% cancer pain effectively.

[How much pain is tolerable? Target expectations of surgical patients for pain therapy]. / Wieviel Schmerz ist erträglich? Zielvorstellungen chirurgischer Patienten für die Schmerztherapie.

INTRODUCTION: Sufficient pain treatment is part of surgical therapy. One popular method of pain control is patient-controlled analgesia (PCA), which allows the patients to apply small doses of analgesics intravenously via a pump. Patient involvement in PCA requires an exact assessment of the patient's expectations as to the treatment of pain. METHODS: In a prospective study the patient's expectations of pain therapy were observed with respect to their disease and the actual intensity of pain during activities measured with a visual analogue scale (VAS). Fifty-three patients were involved, using a pain questionnaire. Healthy nursing staff (n = 44) served as a control group. RESULTS: Patients with benign (n = 29) or malignant (n = 24) disease showed no significant difference in the VAS scores accepted from patients as aim of successful pain therapy (25 points in the conservatively treated group and 27 points in the group of the operatively treated patients with malignant disease, 21 points in the operatively treated group with benign disease, and 18 points in the group suffering from chronic pain of benign causes). The aims for pain therapy showed no correlation with the actually felt pain intensity during movement. The control group of healthy nursing staff felt less actual pain during movement, but their expectations for sufficient pain treatment were not significantly different from the study patients (VAS 25.4 points).

[Laparoscopically guided reversal of Hartmann's procedure]. / Laparoskopisch assistierter Wiederanschluss nach Hartmann-Operation.

UNLABELLED: Morbidity and mortality after reversal of Hartmann's procedure following perforated sigmoid diverticulitis are high and the rate of intestinal restoration is low. AIM: To investigate whether laparoscopically assisted reversal of Hartmann's procedure is technically feasible and whether the laparoscopic procedure offers any benefit to the patient. METHOD: Nineteen patients were investigated. The postoperative course was followed prospectively. All patients were reinvestigated 9 months after surgery. RESULTS: Laparoscopic reversal of Hartmann's procedure was attempted in 19 patients. One patient did not want the laparoscopic technique. In two cases (11 %) conversion to the conventional technique was necessary; thus, 16 patients were operated laparoscopically. Median operative time was 114 (65-180) min. With the exception of three wound infections no immediate postoperative complications were noticed. Patients' convalescence was fast. First evacuation took place 3.3 (3-5) days after surgery, complete oral nutrition 3.6 (3-5) days after surgery. Duration of postoperative hospitalisation was 7.5 (5-12) days. One patient developed later a clinically significant anastomotic stricture which needed endoscopic dilatation. CONCLUSION: Laparoscopically assisted Hartmann's reversal is technically demanding but feasible. Postoperative morbidity is low, duration of hospitalisation short, convalescence fast. Thus, good arguments exist for performing reversal of Hartmann's procedures laparoscopically.

[Therapy of phantom pain with salmon calcitonin and effect on postoperative patient satisfaction]. / Phantomschmerztherapie mit Lachscalcitonin und Einfluss auf die postoperative Patientenzufriedenheit.

In this prospective clinical study we examined the intravenous application of salmon-calcitonin in eight patients with severe phantom limb pain (Visual Analogue Scale = 50-100). The patients presented at the Acute Pain Service (APS) section of the Second Department of Surgery, University of Cologne. Six of eight patients (75%) had no phantom limb pain after 10 days of intravenous treatment with salmon-calcitonin (maximum of five cycles of calcitonin infusion). Systematic follow-up examinations after 3, 6 and 12 months showed long-term success. Patient satisfaction was examined with a numeric rating scale (NRS 1-6) between the single infusion cycles. When patient satisfaction was low, the physician modified the time period or drug dosage between infusions. This study shows good or excellent results in patient satisfaction for six of eight patients (75%). A prospective randomized trial is required to verify the excellent results of intravenous salmon-calcitonin in a larger population. Alternative pharmacological and operative treatments of phantom limb pain are critically reviewed and assessed.

[The status of perioperative pain therapy in Germany. Results of a representative, anonymous survey of 1,000 surgical clinic. Pain Study Group]. / Situation der perioperativen Schmerztherapie in Deutschland. Ergebnisse einer repräsentativen, anonymen Umfrage von 1000 chirurgischen Kliniken. AG Schmerz.

To evaluate the status of perioperative pain management we mailed a anonymous postal survey to all 2,254 surgical departments in Germany. We received answers from 1,000 clinics (44.4%) which were representative related to their regional distribution. We asked the responsible surgeons to report their organizational structure and responsibilities for treating pain patients, the significance of the problem, their methods of measuring pain, and the usage of different analgesic drugs and methods. In 47% the surgeon and the anesthesist together had responsibility for adequate postoperative pain treatment; in 33% and 14%, respectively, it was the surgeon and anesthesist alone. Only 41% knew the interdisciplinary statement on pain therapy of the Professional Societies of German Surgeons and Anaesthesists from 1992. Although the importance of postoperative pain is globally acknowledged, only 19.1% of all departments had a written concept for pain treatment. Pain was measured in only 11% of the clinics mainly by using the visual analogue scale. Most surgeons relieve pain solely with systemic drugs. Regional analgesia was used by 18% only 51% of the surgeons decide on the choice and dosage of analgesic therapy on the ward; 33% admit that pain therapy often starts after complaints of the patient. 70% of all surgeons never participated in a congress on pain. We conclude that postoperative pain management in most German surgical departments still lacks effectiveness, adequacy, and organizational and scientific background.

[Efficacy of an Acute Pain Service--a controlled comparative study of hospitals]. / Effizienz eines Akuten Schmerzdienstes--Eine kontrollierte Krankenhausvergleichsstudie.

The efficacy of an acute pain service was prospectively evaluated on elective abdominal operations by comparing two surgical departments including a total of 498 patients. The patients of the clinic with an acute pain service reported less pain (at rest and in movement) pre- and postoperatively and received more analgetics. They had more appetite, lower sleep requirements and more independence. The patients' overall satisfaction was greater in the clinic with an acute pain service.

Sexual behavior and partner characteristics are the predominant risk factors for genital human papillomavirus infection in young women.

Risk factors for cervicovaginal human papillomavirus (HPV) infection were investigated in 604 college women. HPV was detected in 168 (27.8%) of the subjects by L1 consensus primer polymerase chain reaction, Southern blot hybridization, or both. Significant independent risk factors for HPV (P < .05) included age (odds ratios [ORs]: 2.6 for 21-23 years old and 1.6 for > 23, vs. < or = 20), ethnicity (ORs: 3.2 for black, 2.2 for Hispanic, vs. white/other), number of lifetime male vaginal sex partners (ORs: 4.5 for 2, 5.8 for 3 or 4, 10.3 for > or = 5, vs. 1), living with smokers (OR: 1.9), male partner's number of lifetime sex partners (ORs: 2.1 for 2 or 3, 3.1 for 4-10, 2.7 for > or = 11, vs. 1), duration of sexual relationship for > 12 months (OR: 0.6), and male partner currently in college (OR: 0.6). These data demonstrate that the predominant risk factors for genital HPV infection in young women are related not only to their own sexual behaviors but also to those of their male partners.