[Inpatient psychoanalytic treatment of patients with structural ego disorders]. / Die stationäre psychoanalytische Behandlung von Patienten mit strukturellen Ich-Störungen.

Psychoneurotic and psychosomatic patients with severe personality disorders suffer from structural defects of their ego-functions and are in need of specific treatment techniques which can be supplied by the differentiated strategies of inpatient psychoanalysis. The experiences of a specific inpatient ward of the Psychosomatic department at the Central Institute of Mental Health in Mannheim are summarized whereby the use of the inward setting to initiate long term psychotherapeutic processes is emphasized. According to an integrative treatment concept various verbal and non-verbal modalities of experience and working through represented by different members of the therapeutic team co-operate within their well defined functions. The main task of the team is to identify the various splitting mechanisms of the patients with personality disorders and to combine all the walled off ways of experiencing and social behavior into a complete picture of his person. To this end close attention is payed to the dynamics within the group of the patients as well as with the group of the therapists. As a precondition the setting of the ward and its rules of conduct for inpatient group life have closely to be watched and the respective behavior of the patients and the team has to be monitored. We describe our setting, the time phases of treatment, the tasks of the different therapists, and explicitely emphasize sociotherapeutic aspects for the final therapy phase. At last, we mention special emotional difficulties waiting for therapists who work in this setting.

[Inpatient psychoanalytic treatment of sever personality disorders]. / Die stationäre psychoanalytische Behandlung bei schweren Störungen der Persönlichkeit.

Highlighting the development of in-patient psychoanalytical therapy the insufficiency of traditional therapeutical conceptions ("out-patient psychoanalysis in the hospital", "bipolar model of in-patient psychotherapy") in view of increasing numbers of patients with ego-structural disorders in psychosomatoses and borderline pathologies become clear. Their manifold splitting tendencies toward any conceptual distinction of the psychoanalytical session with its transferential processes on the one hand and the "actual" milieu of the ward on the other hand. This fact will be taken into account only by the integrative inpatient psychoanalytical therapy which contrasts the group of patients with the therapeutical team. Only this theoretical constellation may grasp the dynamic processes which the individual patient as well as the whole group of patients but also the individual therapist and his team are undergoing. On this basis interventions will become particularly effective. - The method is illustrated by a description of the setting and a casuistry. A necessary broadening in view of the patients' environment outside the ward and of the bounds of the procedure are described. - Summing up we can say that the integrative inpatient psychoanalytical treatment for the first time provides an approach to the group of severe personality disorders which up to now could not be treated and at best were exposed to an expert rating.

Thyroid hormone changes in obese subjects during fasting and a very-low-calorie diet.

Total fasting was compared with VLCD (1.28 MJ, 300 kcal/day; 56 g protein, 12 g CHO) in 14 euthyroid obese patients, selected as matched pairs, over a period of 28 days. The weight loss was significantly greater during fasting than during the VLCD (16.5 kg vs. 12.7 kg). The basal metabolic rate of (BMR) showed a significant decrease (25 per cent) during total fasting, but was unchanged with the VLCD. With both diets there was a transient increase in T4, FT4 and FT4I, and a tendency for TSH to decrease. There was a decrease in T3 and a transient increase in rT3. Nitrogen balance was attained in five of seven patients on the VLCD after four weeks.

Loss of weight, sodium and water in obese persons consuming a high- or low-carbohydrate diet.

Isocaloric 5.61 mJ (1,340 kcal) formula diets involving the isocaloric exchange of fat and carbohydrate were fed to 21 obese persons selected for sex, height, and weight before the start of the treatment and distributed over three groups. The weight loss observed during the carbohydrate-restricted diets was significantly greater than during the high-carbohydrate diet. After 28 days of treatment the weight loss recorded on the high-carbohydrate diet was 9.5 +/- 0.7 kg, as compared to 11.4 +/- 0.7 kg (p less than 0.05) on the corn oil-containing diet and 12.5 +/- 0.9 kg (p less than 0.01) on the butter-fat-containing diet. The weight loss achieved was not dependent on the type of fat administered (saturated vs. polyunsaturated). When calculated cumulatively, sodium excretion during the first 7 days was significantly greater on the low-carbohydrate diet, whereas after 28 days the total amount of sodium excreted was highest on the high-carbohydrate diet. Potassium excretion during the low-carbohydrate diets was significantly greater for as long as 14 days, but at the end of the experimental period the observed differences no longer attained statistical significance. At no time did the intake and loss of fluid and the balances calculated therefrom show significant differences. From the findings obtained it appears that the alterations in the water and electrolyte balance observed during the low-carbohydrate diets are reversible phenomena and should thus not be regarded as causal agents of the different weight reduction.

Studies on the extent of dietary fiber intake in West Germany.

By means of food diaries the volume of the average daily crude fiber and dietary fiber consumption and the percentage contribution of various groups of plant foods to the total dietary fiber consumption was determined in a group of 150 healthy subjects (89 males and 61 females) from four different occupational groups. It thus became apparent that the mean daily dietary fiber consumption was 22.0 +/- 5.5 g in the artisians and workers of a large industrial plant (group I), 24.8 +/- 8.4 g in students (group II), 21.7 +/- 5.5 g in teachers (group III), and 17.6 +/- 7.7 g in administrative employees (group IV). In groups I-III the mean daily dietary fiber consumption was significantly higher than in group IV. In 17% of the subjects, the mean daily dietary fiber consumption was < 15 g. The mean dietary fiber intake per 1,000 kcal (4.18 MJ) in groups II and III, 8.5 +/- 1.5 and 8.8 +/- 2.2 g, respectively, was significantly higher than in group I with a mean fiber intake of 7.2 +/- 1.4 g.

[Heart tumour in the right atrium: clinical recognition and therapeutical management (author's transl)]. / Herztumor im rechten Vorhof: Diagnostik und Therapie.

A 62 year old lady came to the hospital in cause of right heart failure. Right and left heart catheterization and cineangiocardiography revealed a tumour in the right atrium. Further angiographic investigations demonstrated a hypernephroma in the left kidney. The operation of both tumours was successful. Pathohistological examination confirmed the diagnosis of hypernephroma in the left kidney with metastasis into the right atrium.

Force velocity relations in vascular smooth muscle: the influence of pH, pCa, and noradrenaline.

The kinetics of vascular smooth musclw activity was studied by means of afterloaded isotonic contractions of the tetanized rat portal vein at varied pH (8.0-5.9), pCa (3.4-2.1), and during noradrenaline incubation (0.4 mug/ml). Under control conditions (pH 7.3, pCa 2.6) the following parameters of the force velocity relation were calculated: a of Hill's equation (relating to the isometric peak tension) = 0.36; b (relating to the actual muscle length) = 0.19 ML/s; VM Trelating to the actual muscle length) = 0.56 ML/s. Within the range of pCa between 2.0 and 3.2 the amount of force generation (= delta P) depended on the extracellular calcium level whereas the extrapolated velocity of shortening of the unloaded preparation (= VM) did not. Also pH changes between 8.0 and 6.8 as well as noradrenaline incubation at a pH of 5.9 affected delta P quite considerably, but VM only scarcely. At a pH of 6.3, however, VM was distinctly diminished, and a reduced calcium sensitivity of the ATPase was inferred from the shift of ED50 of extracellular calcium from 0.66 mM Ca at a pH of 7.3 to 1.56 mM Ca at a pH of 6.3 (P less than 0.0005). It is concluded from these results that the experimental conditions-pCa between 2.0 and 3.2, pH between 8.0 and 6.8, and noradrenaline added at a pH of 5.9-obviously change the intracellular calcium concentration which influences the number of activated interaction sites rather than the velocity of crossbridge movement.

Force velocity relationships in vascular smooth muscle. The influence of temperature.

Force velocity relationships of isolated vascular smooth muscle preparations were examined in the tetanized rat portal--anterior mesenteric vein by means of afterloaded isotonic contractions. Lowering of the temperature from 37 degrees C to 25 degrees C caused an average decrease of the follwoing parameters: maximal velocity of shortening at zero load from 0.51 to 0.28 muscle length/sec; maximal rate of tension increase (dT/dt) from 847 to 362 dyn/sec; mechanical tension developed at the maximum of dT/dt from 43 to 34% of the peak force generation; constant b of Hill's equation from 0.18 to 0.09 muscle length/sec. The latency was prolonged from 0.33 to 0.56 sec, and the time-to-maximum of dT/dt from 0.9 to 1.6 sec. Between 27 degrees C and 37 degrees C the following Q10 values were calculated: for the maximal velocity of shortening at zero load 1.56; for the maximal rate of tension increase 1.88; for the latency 1.63. No distinct influence of temperature could be observed on the extent of isotonic shortening at zero load (3.69 muscle length at 37 degrees C), on the extent of peak force generation (1107 dyn at 37 degrees C), and on constant a of Hill's equation (0.35 at 37 degrees C). It is concluded that parameters of contraction velocity in vascular smooth muscle depend on temperature, whereas the extent of contraction is independent of temperature. These findings are discussed in connection with the theory of the sliding-filament mechanism.