[Structural lag and room for possibilities in old age exemplified by central transitions. Initial results of a novel discipline trialogue between diaconal studies, psychology and theology]. / "Structural Lag" und Möglichkeitsräume des Alterns am Beispiel zentraler Transitionen. Erste Befunde eines neuartigen Disziplinentrialogs zwischen Diakoniewissenschaft, Psychologie und Theologie.

BACKGROUND: Although the need for interdisciplinary research is generally accepted in gerontology, such interdisciplinary communication is often limited to various combinations of psychological, sociological and biomedical scientific approaches. We argue that gerontology requires a continuous examination of novel disciplinary constellations to obtain a better understanding of aging in its complexity and to further develop this scientific field in its entirety. OBJECTIVE: The present study introduced and tested for the first time an innovative disciplinary trialogue, i.e. the combination of psychology, theology and diaconal studies. In particular, it is assumed that this combination can contribute to a more profound interpretation of the prominent concept of structural lag which is underresearched in gerontology. MATERIAL AND METHODS: The analysis of structural lag with another overarching concept, "room for possibilities", can provide a synergy-rich interpretation category for a range of challenges connected with old age. In this respect, three major transitions were selected to shed light on these concepts and examined by means of three focus group interviews: transition to retirement, need for long-term care in the private home context and transition to nursing home life. The data were evaluated using qualitative content analysis. RESULTS: The interdisciplinary-oriented evaluation of the interviews and the qualitative data analysis revealed the relevance of different perceptions of time in all three transitions. In addition, different dynamics in terms of the interplay of gains and losses as well as participation were found to be important for a better understanding of the three transitions. In particular, the subjective interpretation of the time remaining for living and the predetermined or self-selected time structuring of the daily routine were important factors for the perception of one's own potential. The results also underline a range of unused room for possibilities and the existence of structural lag for each transition. CONCLUSION: By the cooperation of the participating disciplines aspects of aging and their interdependence became visible. At the same time this pilot-like disciplinary trialogue revealed the challenges in combining interdisciplinary perspectives by the combination of empirical and hermeneutical methods.

Morphological and haemodynamic aspects of cerebral aneurysms.

4 patients with aneurysms of different size and location were examined by cerebral angiography, computed tomography, angio-computed tomography, magnetic resonance imaging and angiography, in order to demonstrate haemodynamic and morphological aspects of cerebral aneurysms. Turbulent flow within aneurysms could be shown by cerebral angiography and magnetic resonance angiography. In contrast MRI or computed tomography are necessary to visualize additional thrombosed parts. MRI is the method of choice to reflect the formation of thrombus, CT to show possible calcifications.

Comparison of magnetic resonance angiography, magnetic resonance imaging and conventional angiography in cerebral arteriovenous malformation.

10 patients with an AVM of the brain were examined by magnetic resonance angiography (MRA), magnetic resonance imaging (MRI) and conventional cerebral angiography (CCA). From MRA in 7/10 patients important information about vascular supply could be provided; in 3 patients, all with small AVM's it could be only suspected. CCA revealed the vascularisation of the AVM's in all patients and showed additional hemodynamic aspects better than MRA. With MRI in all cases the AVM could be diagnosed, but only the involvement of the main cerebral vessels could be demonstrated: however, MRI is superior to MRA and CCA in showing the nidus and the involved brain structures.

Neuro-Behçet: acute and sequential aspects by MRI and MRS.

Three patients with neuro-Behçet underwent MRI and MRS during acute illness. After therapy, MRI and MRS were performed in 3 and 1 patients, respectively. MRI revealed a marked improvement of the initial lesion in 2, a complete remission in 1 patient. MRS showed a reduction of the N-acetyl-aspartate (NAA)/phosphocreatine (CR) ratio within the acute lesion in all patients and a normalization in the follow-up spectrum of the examined patient.

[Ulcero-mutilating acro-osteopathy in hereditary neuropathies. Differential diagnosis and pathogenesis]. / Akroosteopathia ulcero-mutilans bei hereditären Neuropathien. Differentialdiagnostische und pathogenetische Aspekte.

Two patients, aged 51 and 70 years, had indolent ulcerations at the sole of the foot with destructive osteolysis in the bones of the feet, lesions characteristic of mutilating ulcerative acro-osteopathy. Patient 1, who had pes cavus, developed ulcerations on the balls of the feet along the second metatarsal bones, and patient 2 with pes equinovarus developed ulcers in the area of the calcaneus. Sock-like hypesthesia/hypalgesia from the toes to the ankles was present in both patients, and electrophysiological tests confirmed the presence of axonal sensory-motor neuropathy. Diabetes mellitus and alcohol abuse was excluded in both patient. Clinical findings, history and neurological disturbances in both patients identified the disease as hereditary sensory neuropathy (type I).

High resolution computed tomography of superior sagittal sinus-thrombosis and -abnormalities.

Ten patients with suspected abnormalities or thrombosis of the superior sagittal sinus were studied by high resolution computed tomography using a thin slice technique after bolus injection. In all patients good visualization of the sinus pathology could be achieved, which correlated exactly with the findings in the 7 angiographically controlled cases.

[Patients with transient ischemic attacks. Their cardiac status and its prognostic significance]. / Patienten mit transitorischer ischämischer Attacke. Ihr kardialer Status und seine prognostische Bedeutung.

In 51 consecutive patients with acute transitory cerebral ischaemia cross-sectional echocardiograms, 24-hour electrocardiograms (ECG) and exercise ECGs were recorded. The subsequent observation period averaged 13 (3-30) months. The echocardiogram was abnormal in 27 of 46 patients (58%). A holosystolic mitral-valve prolapse was found in eight: cerebral ischaemia recurred in five. There was no correlation between arrhythmias in the 24-hour ECG and renewed cerebral ischaemia. In addition to the 14 patients who--according to history and resting ECG--had already had a myocardial infarction, the exercise ECG revealed probably coronary heart disease in a further 11, i.e. half of the patients had coronary heart disease. Renewed attacks of cerebral ischaemia occurred in 13 patients during the follow-up period; four patients died, all of them also having had coronary heart disease. Because of the high prevalence of coronary heart disease (often previously undiagnosed) in the whole group, routine exercise ECGs are recommended for patients with transitory ischaemic attacks, protracted ischaemic neurological deficit or "minimal stroke", while 24-hour ECG monitoring does not seem essential. Randomized trials are needed to determine whether patients with cerebral ischaemia and echocardiographic evidence of mitral-valve prolapse should be treated prophylactically.

Lesions of high signal intensity at magnetic resonance imaging in vascular dementia.

Twenty-five patients with vascular dementia, 18 patients with senile dementia of Alzheimer type (SDAT) and 17 normal persons were examined by magnetic resonance imaging. Lesions of high signal intensity were always recognizable and were frequently very marked in patients with vascular dementia, while they were absent or mild in patients with pure SDAT and in non-demented patients without vascular disease. The possible nature of this disease as well as the role played in determining the type of dementia are discussed.

Follow-up of patients with proved occluded internal carotid artery. Clinical and angiographic correlation.

Patients with angiographically proven occluded ICA were subjected to a clinical follow-up. In about 25%, further ischemic attacks ipsilateral to the occluded ICA occurred. The pathogenesis of ischemia and the management of these patients is discussed.