Functional results after CO2 laser surgery compared with conventional phonosurgery.

Treatment of benign vocal fold lesions by the use of the CO2 laser is discussed critically. The aim of the present prospective randomized study was to examine the post-operative functional results after laser phonosurgery in comparison to those after cold phonosurgery. In total, 44 patients with benign vocal fold lesions underwent surgery. Conventional cold phonosurgery was performed in 23 patients, and 21 patients were treated by laser phonosurgery. To determine vocal function, examinations were performed pre-operatively, on the second post-operative day, and one and four months post-operatively. The examinations included direct videolaryngoscopy, determination of maximal phonation, speech voice field as well as singing voice field. The results four months after surgery showed an improvement of vocal function in both treatment groups in comparison to the pre-operative findings. The improvement is only statistically significant after cold surgery.

[The Sceno Game in the course of time]. / Das Scenospiel im Wandel der Zeiten.

This article describes 50 years of working with the Sceno test, the first decades being in close cooperation with Gerhild von Staabs. After many years experience with the Sceno test in Swiss psychiatric hospitals over 1000 Sceno test games were conducted in the psychosomatic ward of the University of Munich Outpatient Department for Children and evaluated with a special record and slides. These were games carried out by children and adolescents with behavioral disorders, psychosomatic illnesses, and handicaps, in some cases by their mothers in an accompanying simultaneous analysis. Using the projective method the initial Sceno test, vulgar and original answers, key situations, repetition and memory compulsions were recorded. With 100 adults diagnosed as being schizophrenic Sceno tests with chaotic apparent order analogous to pictures painted by schizophrenics were observed. With adults and children with cerebro-organic damage we found an "organic play syndrom" in the game structure. Six medical dissertations dealt with the psychosomatics of children. Along with the depth psychology problems, in principle, the formality of the Sceno test set-up depending on age and development phase of the child also has to be taken into consideration. The Sceno test in its original form has proven itself to be up to date even today and requires only minor changes to some game elements, adapting them to the modern surroundings of children which means that a Sceno-R (Fliegner 1995) with 23 new game elements seems unnecessary. Psychodiagnostics and psychotherapy of our Sceno test game are based on the analytical method of Hans Zulliger and Anna Freud.

[CO2 laser versus conventional microlaryngoscopy in benign changes of the vocal cords]. / CO2-Laser versus konventionelle Mikrolaryngoskopie bei gutartigen Veränderungen der Stimmlippe.

BACKGROUND: Microsurgical treatment of benign vocal fold lesions as nodules, polyps, and Reinke's edema is a routine intervention in phonosurgery. After laser treatment of malignant neoplasms of the larynx has been accepted as a technical advance by most laryngologists, use of the laser has been also proposed for benign lesions. PATIENTS: Forty-four patients with a benign lesion of the vocal fold were randomized and operated conventionally or with the CO2-laser. Preoperatively, two days, one month, and four months postoperatively, the patients were queried about vocal problems and their subjective rating of their voice quality. Videolaryngostroboscopy was performed, the maximal phonation time was determined, and a phonetogram of the speaking and of the singing voice was registered. A phonetically balanced text and sustained vowels were registered on a DAT recorder and used for subjective rating by experienced listeners and electroacoustic analysis. RESULTS: All parameters showed worsening immediately postoperatively and an improvement later compared to the preoperative value. There was no statistical difference between conventional treatment and CO2 laser treatment. CONCLUSIONS: Microsurgical treatment of benign lesions of the glottis either by CO2 laser or by conventional surgery leeds to comparable results as seen in the final result.

[Child psychotherapy in medical practice and the clinic--15 years of the "Brühl Model"]. / Kinderpsychotherapie in ärztlicher Praxis und Klinik--15 Jahre "Brühler Modell".

Living in an industrial society places considerable stress on children and on adolescents, to which they react with behavioural disturbances and psychosomatic disorders. So far, physicians have been trained only insufficiently at universities with regard to psychotherapy, which means they cannot cope sufficiently with such problems if they are confronted with them in their clinical and practical work. Hence, a continuing education programme called the "Brühl Model" has been worked out which imparts knowledge on child psychology and child psychotherapy by means of three-year courses based on depth psychology. This corresponds to the "small-scale psychotherapy in medical practice" as conceived by J. H. Schultz and M. Balint. This educational programme has been largely adapted to the demands made at the Manheim Physicians' Congress in 1977 with regard to acquiring adequate proficiency in the subject of psychotherapy, and has been accepted by the German professional boards of physicians. 600 colleagues have since been undergoing this training during the past 15 years with success. The present seventh training course is now also open to the colleagues from the new German Laender of the former GDR.

Molecular structure of the multifunctional fatty acid synthetase gene of Brevibacterium ammoniagenes: its sequence of catalytic domains is formally consistent with a head-to-tail fusion of the two yeast genes FAS1 and FAS2.

The Brevibacterium ammoniagenes fatty acid synthetase (FAS) gene was isolated from a series of overlapping clones by both immunological and plaque hybridization screening of two independent gene libraries. From the isolated DNA a contiguous segment of 10,549 bp was sequenced in both directions. The sequenced DNA contained a very long (9312 nucleotides) open reading frame coding for a protein of 3104 amino acids and with a molecular mass of 327,466 daltons. Based on characteristic sequence motifs known from other FAS systems, seven different FAS active centres were identified at distinct locations within the polypeptide chain. Only one component enzyme, the 3-hydroxydecanoyl beta, gamma-dehydratase, has not yet been localized definitively within the gene. Translation is presumed to start from a GUG triplet located 25 nucleotides downstream of the transcriptional initiation site. There is a canonical Shine-Dalgarno sequence just before this start codon. Comparison of the B. ammoniagenes FAS sequence with those of other known fatty acid synthetases revealed a particularly high degree of similarity to the products of the two yeast genes, FAS1 and FAS2 (30% identical and 46% identical plus closely related amino acids). This similarity extends over the entire length of the genes and involves not only the primary sequences of individual component enzymes but also their sequential order within the multifunctional proteins. These data, together with those on the structure of other fatty acid synthetases, are interpreted in terms of a contribution of both primary structure and subunit cooperation to a conserved topology of functional domains common to all type I FAS complexes.

[Help for behaviorally disordered children and their families]. / Hilfen für verhaltensgestörte Kinder und ihre Familien.

1. A comprehensive survey is given on the divergence of opinions on child education in this century. 2. The aim of this survey is to find out the causes of children's behavioral disorders using psychoanalytical methods. 3. The factors of behavioral disorders occurring in families today are discussed. 4. Conclusions for psychoprophylaxis and -therapy of behavioral disorders of children are drawn. They describe the important roles of parents, pediatricians and psychologists and the social responsibilities of the family of a child suffering from a behavioral disorder.

[Power and helplessness in therapeutic care of children]. / Moc a bezmocnost v terapeutické práci s detmi.

The child is exposed to force, starting at birth, and force accompanies him through later life. Absence of force should thus start by gentle delivery in an operation theatre and be associated with the subsequent upbringing of the child. Trauma of separation in hospital is one of his most painful experiences. This led in the sixties to basic psychohygienic reforms in paediatric clinics, with unrestricted visiting times and admission of mothers to the department with the child. Force determines our lifestyle and penetrates via the mass media continuously into our families. Parents are therefore requested to alter their style of upbringing psychotherapists are requested to avoid any force used in aversive therapy by behavioural therapists or so-called "Festhaltetherapie" of autistic children. The number of disrupted families, demonstrated on the example of children of divorced parents indicates the tasks of "doctors as educators of children" (see Czerny). In an environment of soulles medicine based on apparatuses steady control of his activities are needed. The remedial teacher is an important assistant in paediatric hospitals. Psychological knowledge and experience can protect the doctor against abuse of force in therapy.

Identification and sequencing of cDNA clones for the rodent negative acute-phase protein alpha 1-inhibitor 3.

Rat alpha 1-inhibitor 3 clones were isolated by immunological screening of a lambda gt11 cDNA library prepared from rat liver poly(A)-rich RNA. The recombinant cDNA clones were identified by the absence of their immunoprecipitable products following hybrid-arrested in vitro translation. The size of the cognate poly(A)-rich RNA was estimated to be roughly 5000 residues. Approximately 16 h after induction of inflammation the amount of alpha 1-inhibitor 3 poly(A)-rich RNA decreases as shown by dot-blot hybridization and Northern analyses. The response of this negative acute-phase plasma protein to inflammation may therefore be considered to be at the pretranslational level. The characterized DNA constitutes an open reading frame of 225 amino acids followed by a canonical eucaryotic polyadenylation signal and a poly(A) tail. Sequence microheterogeneity, particularly in the 3'-flanking region was observed. An amino acid homology of 70% for alpha 1-inhibitor 3 with human and rodent alpha 2-macroglobulin emphasizes the evolutionary relationship of the macroglobulins.

[Long-acting traumas following hospitalisation (author's transl)]. / Lang wirkende Traumen nach Krankenhausaufenthalt.

The article reports on 50 children with hospital (operation) traumas presented many years later to the doctor or educational consultant because of disturbed behaviour basing on an anxiety neurosis combined with a symbiotic mother fixation. In these cases, there was a clear connection between the triggering traumatising event the the existing symptom pattern. Most of the children had been admitted during infancy once or several times to special wards without sufficient psychological care and with restricted visiting hours. Tonsillectomy and strabotomy, as well as equilibrating operations, have proved to the particularly traumatising, especially in infants. This is evident even after several years and shows up during psychodiagnostic examination. Children who have suffered an accident and are admitted to hospital in a state of shock, are particularly susceptible to the hospital separation trauma. Preventive and curative psychohygienic measures are described. The mother's presence in the hospital has always remained the most reliable protection, from the infant's aspect, in all danger situations, including hospitalisation.

[Psychohygiene in obstetrics. Rooming-in the nursing]. / Psychohygiene in der Geburtshilfe Rooming-in und Stillen.

The development of highly technical and highly computerized labour-rooms is contrasted by the mother's need for close personal contact with her baby and for close personal caring. If suitable conditions are to be created, the mother must be psychologically prepared for pregnancy and birth, the father must be admitted into the labour-room and rooming-in of mother and new born baby should be allowed. Breast-feeding is the beginning of the basic trust relationship (Urvertrauen) between mother and child. However, only 40% of the mothers continue breast-feeding after discharge from hospital and only 5,7% breast feed their babies for more than 3 months. The babies miss the intensive skin contact between mother and child that is so important for the child's development. This is confirmed by the experiences of the Offenbacher Modell" where mothers nurture their prematurely born babies. Psychohygienic methods with new born babies are related to diminuished infant mortality. In the Federal Republic of Germany, 105 maternity hospitals and wards allow mothers and new born babies to be together without restriction.