The versatility of median sternotomy in general paediatric surgery.

BACKGROUND: While common in cardiac surgery, median sternotomy (MS) is rarely required in general paediatric surgery. In the era of advancing endoscopic techniques, sternotomy is perceived as an extremely invasive incision, associated with prolonged postoperative recovery and significant morbidity. METHODS: We conducted a retrospective chart review of all children undergoing MS for non-cardiac indications between January 2007 and September 2012 and describe the pathology, number of ventilated days, duration of intensive care unit stay and analgesic requirements. RESULTS: Our experience over the past 6 years includes 14 children, aged between 8 months and 13 years. Indications for surgery included penetrating mediastinal trauma (1), anterior and posterior mediastinal masses (4), acquired tracheo-oesophageal fistulas secondary to button battery impaction (2), bronchial foreign bodies (2) and bilateral pulmonary metastases secondary to malignancy (5). The range of postoperative ventilation required was 0 - 34 days (median 1 day) and the range of duration of stay in the paediatric intensive care unit 1 - 39 days (median 4 days). Postoperative analgesia was provided with intravenous or oral paracetamol with or without the addition of morphine. All the children tolerated the procedure well with no sternotomy-related complications on follow-up. CONCLUSION: This review highlights the variety of conditions in which MS provides unrivalled access to the mediastinum and how well the procedure is tolerated by the paediatric patient, and emphasises the importance of sternotomy being within the armamentarium of access techniques of the general paediatric surgeon.

Physical exercise through mountain hiking in high-risk suicide patients. A randomized crossover trial.

OBJECTIVE: The following crossover pilot study attempts to prove the effects of endurance training through mountain hiking in high-risk suicide patients. METHOD: Participants (n = 20) having attempted suicide at least once and clinically diagnosed with hopelessness were randomly distributed among two groups. Group 1 (n = 10) began with a 9-week hiking phase followed by a 9-week control phase. Group 2 (n = 10) worked vice versa. Assessments included the Beck Hopelessness Scale (BHS), Beck Depression Inventory (BDI), Beck Scale of Suicide Ideation (BSI), and maximum physical endurance. RESULTS: Ten participants of Group 1 and seven participants of Group 2 completed the study. A comparison between conditions showed that, in the hiking phase, there was a significant decrease in hopelessness (P < 0.0001, d = -1.4) and depression (P < 0.0001, d = -1.38), and a significant increase in physical endurance (P < 0.0001, d = 1.0), but no significant effect for suicide ideation (P = 0.25, d = -0.29). However, within the hiking phase, there was a significant decrease in suicide ideation (P = 0.005, d = -0.79). CONCLUSION: The results suggest that a group experience of regular monitored mountain hiking, organized as an add-on therapy to usual care, is associated with an improvement of hopelessness, depression, and suicide ideation in patients suffering from high-level suicide risk.

[Treatment results from inpatient psychosomatic rehabilitation of Turkish migrants: a prospective study]. / Behandlungsergebnisse stationärer psychosomatischer Rehabilitation bei türkischen Migranten: Eine prospektive Studie.

Psychosomatic rehabilitation and the concluding social-medical assessment constitute a particular challenge. The aim of this study was to examine whether inpatient psychosomatic rehabilitation in the context of an integrated treatment concept, conducted in Turkish and German, is effective in the rehabilitation of Turkish migrant laborers, and what concluding socio-medical assessment results from this treatment. 195 Turkish patients--44 male and 151 female--received inpatient psychosomatic treatment for approximately 40 days. Sociodemographic, psychiatric and social-medical data were recorded, as well as Symptom Checklist (SCL-90-R) testing upon admission and discharge. A predominant number of patients were laborers, with a low level of primary education, who were afflicted with psychosocial problems and dissatisfaction with their workplace and who first came into psychosomatic treatment many years following the onset of their illness. Many of them had a clearly defined desire to retire. At the end of their admission, a significant improvement in almost all the scales of the SCL-R-90 was ascertained on the one hand, but on the other, adequate socio-medical results were hardly observed. The symptoms' improvement would confirm that the combination of service offerings in Turkish and German proved themselves. A portion of the patients (approx. 40 %) were classified subsequent to treatment as capable of working for 6 hours or more. Nevertheless, approximately approx. 75 % still sought to retire. Timely psychosomatic treatment could counteract chronification of the illness and the establishment of a steadfast desire to enter retirement, and consequently represent an improvement in the prognosis. Likewise, consistent psychosomatic training of physicians, as well as systematic prophylactic measures with the migrant laborers, should be considered.

[Treatment motivation and results of inpatient psychotherapy for women with depressive disorders: a prospective study]. / Behandlungsmotivation und Ergebnisse der stationären Psychotherapie bei Frauen mit depressiven Erkrankungen: eine prospektive Studie.

Whether the treatment results in inpatient psychotherapy are significantly influenced by the patient's motivation is a subject of discussion. The goal of this study was to assess whether the primary motivation for therapy in depressive women influences the results of psychotherapeutic treatment. In a prospective study, the monitored results from 64 female inpatients (32 who were highly motivated to enter therapy, and 32 who were minimally motivated) were compared to each other. The period of observation was six weeks. As instruments of assessment, the Fragebogen zur Therapiemotivation (FMP) (Questonnaire on Motivation for Entering Therapy) and the Beck Depression Inventory (BDI) were aministered upon admission; after the fourth and sixth weeks of therapy, the Veränderungsfragebogen des Erlebens und Verhaltens (VEV) (Questionnaire of Changes in Experience and Behavior) was administered as well. All patients who had applied for a pension were found in the group of less motivated patients and consolidated into a subgroup. The analysis was carried out according to the intent-to-treat principle. The variance analysis for the repeat measurements showed significant differences on all the FMP scales and on the BDI (all P< 0.001). The measurements with VEV likewise resulted in a significant difference (P< 0.01). The subgroup of "pension patients" showed significantly less change in all three of the above measurements. Patients with depressive symptomology who essentially are relatively highly motivated for therapy could profit significantly more from inpatient psychosomatic treatment than those who are less motivated. Establishing and developing motivation prior to inpatient hospitalization could possibly contribute to more efficient and cost-effective clinical treatment. Where legal proceedings pertaining to a pension are pending, relatively less motivated patients fare significantly worse not only in their motivational development for therapy, but also in their final treatment results. It should be noted, however, that the relatively small random sample, the restricted blinding, which was only partially possible, could have led to possible distortions.

Autobiographical memories in women remitted from major depression.

Several studies show that depressed people tend to overgeneralize when asked to recall autobiographical memories (AM); in particular, they respond with categoric descriptions. The authors sought to find out whether this tendency also occurs after remission from depression. Two groups of women who were not depressed at the time of the study were compared; only 1 group had a history of major depression. With an AM test, women in remission from major depression retrieved significantly more categoric descriptions when responding to negative cue words than women without a major depression in their biography. These findings support the assumption that AM is a correlate and a consequence of depression.

[Differences in the ratings of valence and concreteness for verbal concepts between depressive and nondepressive persons]. / Unterschiede in den Valenz- und Konkretheitsurteilen von Begriffen zwischen depressiven und nichtdepressiven Personen.

This study tries to reveal differences in the valency and concreteness ratings for nouns, verbs, and adverbs between depressive (N = 20) and nondepressive (N = 20) persons. For the valency ratings the results show significant differences between the two groups and between the syntactical categories as well as an interaction between the factors group and syntactical categories. For concreteness ratings we found a significant main effect for the group factor, a significant interaction between group and syntactical categories, and also a significant three way interaction between group, syntactical categories, and word valency. From these results it follows that, before conducting experiments in clinical psychology, one must establish the participants' representation of words that are used as stimuli. Otherwise, results could easily be misinterpreted as specific experimental results.

Infusional high-dose application of the calcium-channel-blocking and antiglutamatergic agent caroverine in the treatment of alcohol withdrawal (DSM-III-R 291.80).

In an open study, nineteen in-patients fulfilling the criteria for an alcohol withdrawal syndrome (DSM-III-R 291.80) were treated with intravenous caroverine (400 mg/12 h). Caroverine is a class B calcium-channel-blocker and antiglutamatergic agent with significant effects on the brain function. Caroverine exhibits competitive AMPA antagonism, and at higher concentrations, non-competitive NMDA antagonism. All rating scales showed a significant improvement from the start of the treatment throughout the whole study period (CIAW-Ar: P=0.0000; NGI 1: P=0.0000, NGI 2: P=0.0304; CGI 1: P=0.0000, CGI 2: P=0.0208, CGI 3: P=0.0003). The heart rate also stabilised from 111/min before treatment to 81/min after 12 h (P=0.0000). Caroverine was well tolerated, showed no sedative side effects, and no epileptic seizures were observed.

Multicenter double blind study of paroxetine and amitriptyline in elderly depressed inpatients.

Paroxetine is a phenylpiperidine compound which is a selective serotonin reuptake inhibitor (SSRI). Ninety-one hospitalised patients with a major depression (DSM-III) aged 65 and over from six Austrian and one German center were entered into the study, which compared the efficacy and tolerability of paroxetine versus amitriptyline. After 6 weeks both groups showed similarly good therapeutic results. In the paroxetine group, 64.3% of the patients had a 50% or more reduction of the HAMD total score compared to 58.1% in the amitriptyline group. Side effects were distributed similarly in both groups. Patients in the paroxetine group showed a higher incidence of anxiety and agitation; anticholinergic side effects were registered more often in the amitriptyline group.

[Computed tomography and the clinical picture of suicidal CO poisoning]. / Computertomographie und Klinik bei suizidalen CO-Vergiftungen.

Cranial CT is important to exclude the presence of a mass in the cavum cranii in case of an unclear suicide attempt, particularly a traumatic mass. It can be helpful also in cases of carbon monoxide intoxications.