Assessment of cardiovascular disease risk in patients with schizophrenia spectrum disorders in German psychiatric hospitals: results of the pharmacoepidemiologic CATS study.

PURPOSE: Patients with severe mental illness are at high risk for metabolic and cardiac disorders. Thus, monitoring of cardiovascular risks is imperative and schedules for screening for lipids, glucose, body mass index (BMI), waist-hip ratio and blood pressure have been developed. We intended to analyze screening for metabolic disorders in German patients with schizophrenia spectrum disorders in routine psychiatric care. METHODS: We included 674 patients with any F2 diagnosis in out- and inpatient settings and analyzed metabolic screening procedures as practiced under conditions of usual care. RESULTS: Except BMI (54 %), all other values were documented only in a minority of patients: waist circumference (23 %), cholesterol (28 %), fasting glucose (19 %), triglycerides (25 %) and blood pressure (37 %). We found evidence for less than perfect quality of blood pressure measures. The group of patients who met the individual metabolic syndrome ATP III criteria was comparable to the US CATIE trial. CONCLUSIONS: We conclude that frequency and quality of metabolic monitoring in German in- and outpatients settings are not in accordance with the respective recommendations. Similar to previous reports we found evidence for a high prevalence of metabolic disturbances in German patients with schizophrenia spectrum disorders.

Surgical management of complicated colonic diverticulitis.

BACKGROUND: Improvements in surgical techniques, advances in intensive care medicine and progress in the management of peritoneal sepsis have recently favoured colonic resection with primary anastomosis in the treatment of complicated diverticulitis. METHODS: Some 224 patients with complicated diverticulitis who had undergone surgery in the preceding 22 years were reviewed. Complications present on admission included acute phlegmon without pus formation (92 patients), paracolic abscess and/or localized peritonitis (99), diffuse purulent peritonitis (33), complete obstruction of the sigmoid colon (eight) and paracolic abscess complicated by fistula (27). RESULTS: The overall mortality rate was two (1 per cent) of 183 for resection with primary anastomosis, seven of 31 for Hartmann's operation and four of ten for the delayed three-stage procedure. The anastomosis was made by instruments employing the double-stapled technique in 130 patients and hand-sutured in 94. Reversal of Hartmann's operation was undertaken in only 31 per cent compared with 89 per cent for closure of the protective colostomy in patients with primary anastomosis. CONCLUSION: The Hartmann operation may be the most popular at present, but resection with primary anastomosis is the safest procedure for all stages of complicated diverticulitis, and reduces costs. There is no longer any clinical indication for the three-stage operation.

[Preventive ovariectomy in colorectal cancer]. / Die Problematik der prophylaktischen Ovarektomie beim colorectalen Carcinom.

Between 1975 and 1989 we carried out a total of 567 resections of the colon and rectum and performed a uni- or bilateral ovarectomy in 53 (9.3%) cases. Histopathological findings in the case of 41 (7.2%) patients were unremarkable whereas 8 cases (1.4%) revealed metastases of the colorectal cancer. In the case of 4 patients (0.7%) synchronous ovarian cancer occurred. According to the TNM-scheme primary tumors included T2 in 2 cases, T3 in 5 and T4 in 1 of the cases. Reported figures of ovarian metastases in colorectal cancer vary between 2.0 and 10.3%, we found 2.1% in our series. Prophylactic ovarectomy even in premenopausal patients is indicated if one or both ovaries show pathological findings on laparotomy since infiltrative growth of the tumor can be proved only histologically. In addition we performed bilateral oophorectomy on postmenopausal women as a method of preventing occurrence of other ovarian tumors.

[Combination therapy of malignant melanoma]. / Die Kombinationstherapie des malignen Melanoms.

Primary treatment of malignant melanoma should be surgical, with due consideration being given to certain peculiarities, including safety distance and radical lymphonodectomy in cases of lymph node metastasation. Adjuvant chemotherapeutic measures have failed to meet expectations in terms of adjuvant or palliative effects on healing. They have simply proved to prolong life with tumour presence.

[Recurrences after surgical treatment of achalasia of the cardia (author's transl)]. / Chirurgische Behandlung des Achalasierezidivs.

We observed 17 cases of so-called recurrences of achalasia of the cardia (10 times after preceding dilatation and 7 times after Heller's operation). For surgical treatment 16 of these patients underwent cardiomyotomy, using the transthoracic approach. In one patient who had cardiomyotomy plus fundoplication at the first operation an oesophago-gastrostomy became necessary. Three quarter of these patients had a satisfactory result when followed up. I case of recurrence the authors recommend to give priority to cardiomyotomy, rather than to dilatation or bougienage.

[Progress in functional gastric surgery for stomach ulcers]. / Fortschritte in der funktionsgerechten Magenchirurgie beim Ulkusleiden.

Different pathogenetic mechanisms lead to the formation of ulcers in stomach and duodenum. They must be taken into consideration, when selecting operative procedures. In the patient with duodenal ulcer we have with the selective proximal vagotomy a procedure at hand that in effective reduction of the secretion of the stomach and in preservation of the form and function of the stomach fulfills all criteria of a functional gastric surgery. At present in patients with gastric ulcers dominate still methods of resection with the aim of the removal of the ulcer and thus healing. The practicability and effectiveness of non-resecting methods is shown also in this case. But it should be controlled in larger clinical studies.

[The value of the symptom of dysphagia from the surgeon's viewpoint]. / Wertigkeit des Symptoms Dysphagie aus der Sicht der Chirurgen.

Dysphagia is the leading symptom in the most frequent and surgically most important disturbances of the passage of the oesophagus. Possibilities and results of the treatment are analysed on the basis of clinical material from the surgical clinic of Halle university. Nevertheless insufficient results in malignant tumours are opposite to favourable results of the operation in benign diseases (diverticles, achalasia, strictures). Measures for the improvement of the situation of treatment are discussed.

[Emergency endoscopy in acute upper gastrointestinal hemorrhage: Does the effectiveness justify the effort?]. / Notfallendoskopie bei akuter oberer Gastrointestinalblutung: Rechtfertigt der Nutzen den Aufwand?

On the basis of a common care of patients with acute upper gastrointestinal haemorrhage by internists, surgeons, and anaesthetists lasting several years advantages and disadvantages of emergency endoscopy are analysed from the standpoint of effectivity. High diagnostic ability, help in the decision concerning operative or conservative activity, the influence of the operative-tactic approach and the furthering influence on the close cooperation of the specialities are to be emphasized. Criteria of effectivity, such as mortality rates, duration of the stay in the hospital and frequency of relapsing haemorrhages underlie many factors of influence. They express results of therapy, to which emergency endoscopy may at present contribute only limitedly. The basic decision to medical activity -- active striving for a rapid, exact diagnosis or waiting when the diagnosis is uncertain -- does not inessentially influence the standpoint in the controversy about the emergency endoscopy.

[Blunt injuries of the abdomen in children (author's transl)]. / Die stumpfe Bauchverletzung im Kindesalter.

Out of 8 different hospitals 298 children suffering from blunt injuries of the abdomen were reported. 115 children had 141 different intra and/or retroperitoneal injuries of their viscera. Urgency and sequence of diagnostic measures being of highest importance for the destiny of the patient are evaluated.

[Alterations of abdominal vascularization (especially of the pancreas) after gastric resection (author's transl)]. / Veränderungen in der Vaskularisation des Oberbauches, speziell des Pankreas, nach Magenoperationen

Completing former examinations the paper deals with the influence of different methods of gastric operation on abdominal vascularization. Typical alterations found by selective coeliac and mesenteric angiography are demonstrated. They include deficiency of arteries, changes in calibre and in the course of the great vessels, alteration of the vascularization of the head of the pancreas. It becomes evident, that the various effects are subject to preoperative anatomical situation and different operative methods.