Pre-hospital discharge testing after implantable cardioverter defibrillator implantation: a measure of safety or out of date? A retrospective analysis of 975 patients.

AIMS: The present study evaluates the relevance and additional safety value of pre-hospital discharge (PHD) testing in patients with implantable cardioverter defibrillator (ICD) therapy. METHODS: From June 1998 to May 2009, 975 patients (830 male, 145 female) with ICD were screened retrospectively for failed PHD and analysed for its consequences, risk factors, and patient characteristics after successful intra-operative testing in the implantation procedure. RESULTS: Pre-hospital discharge testing procedure was performed in 809 cases. No serious adverse events (e.g. death, persistant ventricular fibrillation or ventricular tachycardia, stroke) occurred. The overall incidence of failed PHD was 1.4% (n = 11). The underlying mechanisms were defibrillation threshold failure in 9/11 cases and sensing failure in 2/11 cases. CONCLUSIONS: In this study predictors for PHD-failure are: (i) cardiomyopathy other than ischaemic or dilative, (ii) young age, and (iii) small or very large left ventricular end-diastolic diameter ( < 40 or > 65 mm). Particularly, (i) manufacture of device or leads, (ii) lead design, (iii) medical treatment, or (iv) gender have no significant influence on PHD failure.

[Socialpsychiatric and ethical reflections about prevention of schizophrenic disorders]. / Sozialpsychiatrische und ethische Uberlegungen zur Prävention schizophrener Störungen.

PROBLEM: In the last years there has been a shift from curative to preventive objectives in politics (prevention law) and medicine, by which socialpsychiatric practice also is affected. This requires a critical reflection about ethical, methodical and therapeutic problems of the prevention of psychological disorders--especially schizophrenic psychosis. ARGUMENTS: Studies dealing with the prodromal stage of schizophrenia point to a successful early detection and intervention. But also negative consequences like stigmatization and side effects by psychotherapeutic or pharmacologic interventions should be taken into account. CONCLUSION: Under critical consideration of the ethical principles of not causing harm, acting for the well-being and the person's right of self-determination prevention should play a larger role in psychiatry. Therefore further empirical studies about the efficacy of early detection and intervention are needed.

[Coenaesthesia after infection with Varicella zoster virus. The psychodynamic meaning of suffering a children's disease at adult age]. / Zönästhesie nach Varicella-zoster-Infektion. Psychodynamische Bedeutung einer Kinderkrankheit im Erwachsenenalter.

The case report is presented of a 33-year-old male who developed coenaesthesia after suffering from chickenpox. While central nervous involvement of the herpes zoster virus infection was not found, suffering a children's disease at an adult age proved an important psychodynamic factor for release of the coenaesthetic symptomatology.

Exciton exciton annihilation dynamics in chromophore complexes. II. Intensity dependent transient absorption of the LH2 antenna system.

Using the multiexciton density matrix theory of excitation energy transfer in chromophore complexes developed in a foregoing paper [J. Chem. Phys. 118, 746 (2003)], the computation of ultrafast transient absorption spectra is presented. Beside static disorder and standard mechanisms of excitation energy dissipation the theory incorporates exciton exciton annihilation (EEA) processes. To elucidate signatures of EEA in intensity dependent transient absorption data the approach is applied to the B850 ring of the LH2 found in rhodobacter sphaeroides. As main indications for two-exciton population and resulting EEA we found (i) a weakening of the dominant single-exciton bleaching structure in the transient absorption, and (ii) an intermediate suppression of long-wavelength and short-wavelength shoulders around the bleaching structure. The suppression is caused by stimulated emission from the two-exciton to the one-exciton state and the return of the shoulders follows from a depletion of two-exciton population according to EEA. The EEA-signature survives as a short-wavelength shoulder in the transient absorption if orientational and energetic disorder are taken into account. Therefore, the observation of the EEA-signatures should be possible when doing frequency resolved transient absorption experiments with a sufficiently strongly varying pump-pulse intensity.

[Erotomania and Frégoli syndrome. A case report]. / Liebeswahn und Frégoli-Syndrom. Eine Kasuistik.

A case report of a female schizophrenic patient is presented who showed a coincidence of erotomania and Frégoli syndrome with some interesting symptom constellations only rarely mentioned in the literature. Organic and psychodynamic factors were found in the etiopathogenesis of this disorder. A combination of psychotherapy and neuroleptic therapy was partly successful.

[Paranoia with late onset. Psychopathology and psychodynamics]. / Paranoia mit spätem Beginn. Psychopathologie und Psychodynamik.

We report on a 70-year-old man who suffered from persecutory delusions during the last 20 years. During first visits, he showed neither cognitive impairment nor Schneiderian first rank symptoms. Inpatient and day clinic treatment as well as further outpatient therapy led to reintegration into social life and trusting relationships between the patient and the therapeutic team, although the persecutory delusions still persisted. During following years, symptoms of cognitive impairment increased gradually and neurological symptoms could be observed. We present a psychodynamic hypothesis regarding the reported psychopathology and discuss alternative diagnoses and pharmacological treatment.