[Body dysmorphic disorder : Diagnostics and treatment in cosmetic dermatology]. / Körperdysmorphe Störung : Diagnostik und Therapie in der kosmetischen Dermatologie.

People with a body dysmorphic disorder (BDD) suffer from excessive preoccupation and anxiety about an imagined or to others a negligible defect in their appearance. They cannot bear to look at themselves, feel ugly, are convinced that their nose, their physique and their skin are disfiguring. The more concerned they become about their appearance, the more their attention is drawn to the ostensible blemishes and reinforces the impression of their own unattractiveness. Those affected do not consider themselves to be ill, but are convinced that it is a real physical defect which forces them again and again to stand in front of the mirror. Such patients may consult a dermatologist, some even a plastic surgeon, in order to get closer to their ideal of beauty, which perforce remains unattainable for patients because of a distorted perception of their body.

Manpower and portfolio of European ENT.

The aim of this study is to evaluate highly variable ENT manpower among European countries. A descriptive study design is used. Manpower in medicine is highly variable among European countries. EU and associated countries are keeping officially appointed representatives to the European Union of medical specialists--otorhinolaryngology section (UEMS--ORL section). UEMS--ORL section is running a working group for manpower in ENT collecting data regarding demographics and ENT manpower in European countries. These ENT manpower data are presented in this paper and compared to available data concerning manpower in European medicine in general. To further evaluate these huge differences, representatives of the particular countries were also asked to fill out a questionnaire concerning specifics of ENT healthcare in their country. Furthermore, typical tasks of ENT doctors based on the official UEMS logbook for ENT training were listed and could be rated regarding their frequency, performed in everyday routine of an average ENT doctor of the country. Divergences in doctors/inhabitants ratios were remarkable within European countries, but disparities in ENT manpower were even more so. The ratio of ENT doctors/inhabitants was the lowest in Ireland (1:80,000) and Great Britain (1:65,000). Greece (1:10,000), Italy, Czech Republic, Lithuania, Poland and Slovakia (1:12,000) were--at the time of the study--the countries with the highest density of ENT doctors. The EU average for 2009 was (1:21,000). The presence of non-surgical working ENT doctors was significantly associated with higher densities of ENT doctors, whereas the necessity of being referred to an ENT doctor (gatekeeping or similar measures) was not. Estimated average waiting times for an appointment in non-urgent, chronic conditions, respectively, diseases were highly variable and predominantly showed a significant correlation to the ENT doctors/inhabitants ratio in the investigated countries. But also for acute conditions like acute hypacusis, dysphonia and hemoptysis, significant differences correlating to the ENT doctors/inhabitants ratio in waiting times for an ENT appointment were found. Estimated frequencies of different ENT tasks in everyday routine were extremely diverse as well, however, without detectable correlations to the ENT doctors/inhabitants ratio. In countries like Great Britain, Ireland, Malta and The Netherlands ENT doctors are primarily seen and serving as surgeons. In most Central European countries like Germany, Austria, Czech Republic, Poland and Slovakia, ENT doctors aside of surgery are also dealing with high percentages of conservative medicine, which may include vast fields like the management of Allergology, Phoniatrics, Audiology, etc. In some countries ENT doctors are even playing a significant role in primary health care as well. These various portfolios of ENT may be one explanation for the huge difference in numbers of European ENT manpower.

Suction-generated noise in an anatomic silicon ear model.

The objectives of this study were to evaluate noise levels generated during micro-suction aural toilet using an anatomic silicon ear model. It is an experimental study. In an anatomic ear model made of silicone, the eardrum was replaced by a 1-cm diameter microphone of a calibrated sound-level measuring device. Ear wax was removed using the sucker of a standard ENT treatment unit (Atmos Servant 5(®)). Mean and peak sound levels during the suction procedure were recorded with suckers of various diameters (Fergusson-Frazier 2.7-4 mm as well as Rosen 1.4-2.5 mm). Average noise levels during normal suction in a distance of 1 cm in front of the eardrum ranged between 97 and 103.5 dB(A) (broadband noise). Peak noise levels reached 118 dB(A). During partial obstruction of the sucker by cerumen or dermal flakes, peak noise levels reached 146 dB(A). Peak noise levels observed during the so-called clarinet phenomena were independent of the diameter or type of suckers used. Although micro-suction aural toilet is regarded as an established, widespread and usually safe method to clean the external auditory canal, some caution seems advisable. The performance of long-lasting suction periods straight in front of the eardrum without sound-protecting earwax between sucker and eardrum should be avoided. In particular, when clarinet phenomena are occurring (as described above), the suction procedure should be aborted immediately. In the presence of dermal flakes blocking the auditory canal, cleaning with micro-forceps or other non-suctioning instruments might represent a reasonable alternative.

Sex differences in zonulin in affective disorders and associations with current mood symptoms.

INTRODUCTION: The bidirectional connection between the brain and the gut within psychiatric entities has gained increasing scientific attention over the last years. As a regulator of intestinal permeability, zonulin acts as a key player on the interface of this interplay. Like several psychiatric disorders, intestinal permeability was associated with inflammation in previous findings. METHODS: In this study we explored differences in zonulin serum levels in currently depressed (n = 55) versus currently euthymic (n = 37) individuals with an affective disorder. Further, we explored sex differences and possible influences on zonulin and affective symptoms like medication, age, body mass index, and smoking status. RESULTS: Serum zonulin was significantly higher in females than in men independent from affective status (z = -2.412, p = .016). More specifically, females in the euthymic subgroup had higher zonulin levels than euthymic men (z = -2.114, p = .035). There was no difference in zonulin serum levels in individuals taking or not taking a specific psychopharmacotherapy. We found no correlation between zonulin serum levels and depression severity. DISCUSSION: Increased serum zonulin levels as a proxy for increased intestinal permeability in women may indicate a state of elevated susceptibility for depression-inducing stimuli.

Discrimination of white matter lesions and multiple sclerosis plaques by short echo quantitative 1H-magnetic resonance spectroscopy.

Multiple sclerosis (MS) plaques and age related white matter lesions (WML) are of similar morphological appearance on T2 weighted MRI. Therefore their differentiation is sometimes crucial. Proton magnetic resonance spectroscopy ((1)H-MRS) adds metabolic information to conventional imaging and may help to distinguish inflammatory MS plaques from vascular related WML. This study was performed to evaluate the metabolite pattern in MS plaques and WML. 15 MS patients, 14 elderly individuals with WML and 16 controls were investigated by conventional MRI and short echo quantitative (1)H-MRS (TE: 30ms, TR: 3000ms). The mean metabolite concentrations in normal control white matter (NCWM), MS plaques and WML were: t-NAA: 8.96 mmol/l (SD: 0.93) vs 6.79 mmol/l (SD: 1.99) vs 7.18 mmol/l (SD: 1.41); Cho:1.66 mmol/l (SD: 0.4) vs 1.49 mmol/l (SD: 0.45) vs 1.46 mmol/l (SD: 0.34); PCr:5.64 mmol/l (SD: 0.83) vs 4.9mmol/l (SD: 1.3) vs 4.95 mmol/l (SD: 0.86); myo-Ins: 4.57 mmol/l (SD:1.05) vs 6.34 mmol/l (SD: 2.03) vs 4.5 mmol/l (SD: 0.96). t-NAA reduction in MS plaques and WML was significant compared with controls (p

Silent haemoglobin variants and determination of HbA(1c) with the HPLC Bio-Rad Variant II.

AIMS: To evaluate the determination of HbA(1c) with an automated high performance liquid chromatography (HPLC) method in patients with clinically silent haemoglobin variants. METHODS: HbA(1c) values were determined with the ion exchange HPL Bio-Rad Variant II using the high resolution beta thalassaemia programme in patients with silent haemoglobin variants, namely: Hb Graz, Hb Sherwood Forest, Hb O Padova, and Hb D. RESULTS: All of these haemoglobin variants caused additional peaks in the chromatograms. No clinically useful HbA(1c) results were produced for patients with Hb Graz and Hb Sherwood Forest, the results for the patient with Hb D were too low, but the results for patients with Hb O Padova were acceptable. CONCLUSIONS: The development of this automated HPLC method modification with high resolution mode aids the identification of interference caused by the described clinically silent haemoglobin variants in HbA(1c) determination.

[Personality profile and psychic deviations in offenders examined for psychiatric-forensic appraisal]. / Persönlichkeitsprofile und psychische Abweichungen bei psychiatrisch-forensisch begutachteten Straftätern.

Personality is one factor within the multidimensional structure of conditions involved in the development of an offender. The aim of this study is to contribute to a better accuracy of discrimination of risk factors and prediction of delinquent behaviour. For psychiatric-forensic opinions, social, forensic and psychiatric history as well as type of the last offence and its course for adjudged delinquents (n=128) was recorded. For determining personality structure, the "Freiburger Personlichkeitsinventar" (FPI-R) and the "Fragebogen zur Erfassung von Aggressivitatsfaktoren" (FAF) was used. Psychiatric diagnosis was based on criteria of ICD-10. Using a hierarchical cluster analysis including the dimensions of the FPI-R, three personality profiles could be separated. First offenders and re-offenders could be discriminated by family environment and age at the first delict. The importance of classification for risk estimation of delinquent behaviour and its significance for providing forensic opinions is discussed.

Body fat distribution of overweight females with a history of weight cycling.

Weight cycling may cause a redistribution of body fat to the upper body fat compartments. We investigated the distribution of subcutaneous adipose tissue (SAT) in 30 overweight women with a history of weight-cycling and age-matched controls (167 normal weight and 97 overweight subjects). Measurements of SAT were performed using an optical device, the Lipometer. The SAT topography describes the thicknesses of SAT layers at 15 anatomically well-defined body sites from neck to calf. The overweight women with a history of weight cycling had significantly thicker SAT layers on the upper body compared to the overweight controls, but even thinner SAT layers on their legs than the normal weight women. An android fat pattern was attributed to overweight females and, even more pronounced, to the weight cyclers. The majority of normal weight women showed a gynoid fat pattern. Using stepwise discriminant analysis, 89.0% of all weight cyclers and overweight controls could be classified correctly into the two groups. These findings show the importance of normal weight maintenance as a health-promoting factor.