[Dyspnoea Due to Foreign Embolism after Percutaneous Vertebroplasty]. / Dyspnoe aufgrund eines Fremdkörper-Embolisats nach perkutaner Vertebroplastie.

HISTORY AND CLINICAL FINDINGS: Emergency admission of a 66-years-old man with right-sided and partly breath-dependent chest pain in the interdisciplinary emergency room. The complaints existed for several days and had a progressive character. Purulent expectoration and fever were negated. There was a history of COPD with occasional pulmonary exacerbations. Several weeks before the current event, community-acquired pneumonia had been treated with antibiotics. Moreover, the patient reported on multiple spine surgery procedures performed in recent months. INVESTIGATIONS AND DIAGNOSIS: In transthoracic echocardiography (TTE), detection of a foreign body (Palacos) in the right ventricle, which was confirmed to be a toothpick-like structure in the supplementary CT scan of the thorax and the transoesophageal echocardiography (TOE). TREATMENT AND COURSE: Foreign body extraction using right anterior mini thoracotomy. Subsequently, iatrogenic pneumothorax with bilateral nosocomial pneumonia and drainage. After short-term convalescence, renewed admission with bilateral pulmonary infiltrates. Under invasive ventilation, new left-sided pneumothorax was diagnosed, which was supplied with a Bülau drainage. Due to the detection of positive blood cultures, re-conducting of a TOE examination. Now first diagnosis of tricuspid valve endocarditis. Despite successful surgical biologic tricuspid valve replacement with an epicardial pacemaker electrode placement, the patient died approximately three quarters of a year after he became an emergency patient due to dyspnoea. DISCUSSION: The present case shows that a typical clinical symptom, associated with a previously known chronic illness, has to be reminded again and again of other and less common diseases. Even everyday diagnostic and therapeutic procedures are associated with a residual risk of possible complications.

[Process markers of the indications and termination sessions in inpatient psychotherapy: indicators for treatment success?]. / Prozessmerkmale des Indikations- und Abschlussgespräches in stationärer Psychotherapie: Indikatoren für den Behandlungserfolg?

Within a comprehensive research project investigating the outcome and process of inpatient longterm group psychotherapy, the initial and final interviews with the individual patients were video-tape-recorded and analysed using the Vanderbilt Psychotherapy Scales. The ratings of the interviews were related to self descriptions of the patients at the beginning of their psychotherapy, to the patients' perception of the group process during therapy and to the outcomes. In addition the characteristics of the initial and the final interviews were compared with each other. The results indicate process characteristics of the individual interviews to be a useful perspective to thoroughly describe the process and outcome of inpatient psychotherapy.