[Postgraduate training for specialists in psychiatry and psychotherapy. Problem-based learning - evaluation of a pilot project]. / Facharztweiterbildung Psychiatrie und Psychotherapie. Problemorientiertes Lernen - Evaluation eines Modellprojekts.

Problem-based learning (PBL) emphasizes the student's individual needs, their ability to solve complex clinical problems, and a professional attitude that facilitates communication among colleagues. Thus, PBL appears to provide a perfectly suitable didactic format for postgraduate training of medical specialties. To date, it is only rarely used in this area though. In a pilot project, we implemented PBL into the curriculum of postgraduate training in psychiatry and psychotherapy, and evaluated the program over a period of 12 months, using structured questionnaires. A total of 41 PBL courses were held, with 447 residents participating. Participants as well as tutors assessed 19 of 21 aspects as good or very good (5-point Likert scale, mean value >4). Overall, PBL was rated as highly suitable for advanced training (participants: 4.5±0.8; tutors: 5.0±0.2). The results of this pilot project suggest that PBL might be a useful element of multifaceted advanced training programs, strengthening their practical component and the applicability of knowledge in the daily clinical routine.

Diagnostic yield and safety of endoscopic ultrasound-guided trucut [corrected] biopsy in patients with gastric submucosal tumors: a prospective study.

BACKGROUND AND STUDY AIMS: Endoscopic-ultrasound-guided trucut needle biopsy (EUS-TCB) has not been adequately evaluated in patients with submucosal tumors (SMTs). PATIENTS AND METHODS: This prospective, uncontrolled study involving 49 consecutive patients with hypoechoic gastric SMTs (> or = 20 mm) evaluated diagnostic yield and 30-day morbidity of EUS-TCB, factors related to the success of EUS-TCB, and agreement between EUS-TCB and the surgical pathology diagnosis. Seventy-three percent of tumors were gastrointestinal stromal tumors (GIST). RESULTS: Tumor tissue adequate for diagnosis was obtained by EUS-TCB in 31 patients (63 %; 95 %CI 49 % to 75 %). In the remaining cases, EUS-TCB provided no tissue (n = 11) or an insufficient amount (n = 7). Logistic regression analysis showed that tumor location on the lesser curvature of the stomach was the only independent predictor of obtaining diagnostic material [odds ratio (OR) 7.4; 95 %CI 1.9 to 28; P = 0.004]. The experience of the endosonographer, the size of the tumor, and the location of the tumor relative to the long axis of the stomach were not related to the success of the biopsy. Agreement between EUS-TCB and surgical pathology specimens in respect of the diagnosis and CD117 status was high (0.9, standard error 0.31; and 0.95, standard error 0.16, respectively); however, there was no correlation between the mitotic index as determined on EUS-TCB and that determined on the surgical pathology specimen (correlation coefficient, 0.08). There were two severe septic complications in 52 procedures (3.9 %; 95 %CI 0.3 % to 14 %). CONCLUSIONS: The diagnostic yield of EUS-TCB in patients with gastric SMTs was moderate. Tissue samples were too small to reliably determine the mitotic index. Antibiotic prophylaxis should be considered because of possible septic complications.

[Curriculum and structure of modern medical education]. / Inhalte und Struktur des neuen Medizinstudiums.

The Medical Faculty of the University of Zurich compiles a fundamental restructuring of the Medical curriculum. Basic conditions represent the new Swiss Federal law for the education in medical professions (MedBG), heterogeneous implementation stages of curriculum reforms of other Swiss Medical Faculties of the medicine as well as efforts to improve mobility of students. The strategy of the curriculum reform is represented based on the principles decided by the Faculty. The authors demonstrate the corresponding organizational structures and give a future view focusing on aspects of the implementation and the dynamic adaptation of curriculum items.

[Cholecystolithiasis in the urban population of Poland]. / Kamica pecherzyka zólciowego w populacji miejskiej w Polsce.

Multicentre study was carried out in three regions of Poland aimed to assess cholecystolithiasis incidence in urban population and some potential risk factors of the disease. 10133 persons in five age groups, from 16 to 70 (6071 women and 4062 men) were examined. The examination consisted of questionnaire considered sex, age, weight, dietary habits, complaints, chronic drugs use, family history and in women number of pregnancies and deliveries as well as hormone therapy. The results obtained were analysed statistically with Chi 2 test. Cholecystolithiasis was found in 1411 persons (10.7%), among them 18% women (1083 women) and 8.2% men (328 men). Incidence rate was 180.5/1000 women and 82.0/1000 men. The obtained increase in percentage of cholecystolithiasis cases with age was statistically significant. No relation were found between the number of stones and sex of the examined persons. In 1480 persons (43.5%0 the disease was asymptotic. The studies did not prove the correlation between cholecystolithiasis in women and sex of the first child or oral contraception. Positive correlation was found between cholecystolithiasis in women, obesity, number of pregnancies and family history. In men age was most significant risk factor. Incidence of cholecystolithiasis in Poland, Western Europe and USA is similar.

[Value of cytologic examination in diagnosis of focal lesions to the liver and pancreas]. / Wartosc badania cytologicznego w diagnostyce zmian ogniskowych w watrobie i trzustce.

Four hundred fifty three percutaneous fine-needle biopsies (FNB) guided ultrasonically of the focal lesions to the liver and 418 to the pancreas were subjected to retrospective analysis. Biopsies were performed with the aid of real time ultrasound equipment ALOKA SSD-280. The needles of 0.7 and 0.8 mm in outer diameter were used for the aspiration. Smears were fixed with alcohol and stained with hematoxylin and eosin, and examined under light microscope. Specimens suitable for the examination were obtained in 97% of liver biopsies and 90% of pancreatic biopsies. Sensitivity of FNB in the diagnosis of hepatic and pancreatic carcinoma was 97% and 91%, respectively. Its specificity was 100%. ENB efficiency in the diagnosis of the focal lesions to the liver was 98% and in case of the focal lesions to pancreas -95%.

[Ultrasonographic images of liver neoplasms--comparison with histopathological findings]. / Obrazy ultrasonograficzne nowotworów watroby--zestawienie z histopatologia.

Ultrasound pictures taken in 100 patients with histologically confirmed primary of metastatic neoplasms of the liver were analysed retrospectively. The most frequent were hyperechogenic foci (43%). Hypoechogenic foci were found in 33% of the patients whereas mixed changes in the liver scans (hyper- and hypoechogenic) in 22%. Thirty seven per cent of the hyperechogenic foci were attributable to metastatic process. Hypoechogenic disorders were most frequently due to the primary cancer of the liver (20%). Mixed lesions were mainly produced by the cancer of large intestine and liver (41% and 27%, respectively). Metastases into the liver produced all three types of ultrasound pictures. The obtained results confirm the opinion that ultrasound picture of metastatic liver tumours is not suitable for the diagnosis of the type and origin of the neoplasm.