Exfoliation syndrome related to sensorineural hearing loss.

BACKGROUND: To investigate the relationship between exfoliation syndrome and sensorineural hearing loss. METHODS: A prospective study was designed. Patients with evidence of ocular exfoliation syndrome (study group) and individuals without any clinical signs of exfoliation syndrome (control group) were selected. Cases and controls were chosen to have similar demographic characteristics. Study and control group subjects with a history of conditions affecting hearing function were excluded. Pure-tone audiometry was performed in all participants in both groups and hearing thresholds were measured at frequencies of 0.25, 0.5, 1, 2, 4 and 8 kHz (kilohertz) for each ear. RESULTS: A total of 69 subjects participated in the study. The study group included 47 subjects and the control group 22. There was no significant difference in mean age (P = 0.985) and gender (P = 0.378) between groups. Mean pure-tone hearing thresholds were significantly higher in study group at frequencies of 4 kHz (P = 0.004) and 8 kHz (P = 0.001), but not at frequencies of 0.25, 0.5, 1 and 2 kHz. The greatest difference in the comparison of mean hearing thresholds between study and control group was noted at 8 kHz. CONCLUSIONS: The above results are in accordance with previous studies and provide additional evidence of the association between exfoliation syndrome and sensorineural hearing loss at high frequencies. Particular effect was shown on the highest frequency of 8 kHz. These findings may support the systemic nature of exfoliation syndrome.

Acute pancreatitis associated with herpes simplex virus infection: report of a case and review of the literature.

Although a wide variety of infectious agents have been implicated in the aetiology of acute pancreatitis, their true incidence is unknown because they coexist quite often with other noninfectious causes. Acute herpes simplex viral pancreatitis is a rarely encountered entity in the literature. We report a patient who developed acute pancreatitis and hepatitis in association with herpes simplex virus infection as well as cholestatic syndrome because of compression of the intrapancreatic part of the common bile duct by the oedematous pancreatic head. Herpes simplex virus infection, although a rare entity, should be included in the conditions causing acute pancreatitis, when common noninfectious factors have been excluded and hepatic inflammation coexists. Diagnostically, a combination of serum amylase or lipase elevation, more than three times over the upper normal limits, as well as serologic evidence of the infectious agent should exist. Dilatation of the biliary tree is not invariably compatible with a biliary cause of acute pancreatitis.

[Interdisciplinary longitudinal curriculum "Medical Psychology, Psychotherapy and Psychosomatics." Experiences from the preclinical segment]. / Fachübergreifendes Längsschnittcurriculum "Medizinische Psychologie, Psychotherapie und Psychosomatik." Erfahrungen aus dem vorklinischen Abschnitt.

The departments of Medical Psychology, Psychosomatics and Psychotherapy developed an interdisciplinary longitudinal curriculum in order to coach medical students for the whole length of their medical education. Experiences from the first four undergraduate semesters are reported. 46 students (33 females, 13 males), mean age 22.3 +/- 2.6 years, attended 60 hours of interdisciplinary group sessions. Frequent motives to join the course were interest in psychosocial disciplines and relevant previous experience. The students expected to benefit from this project in their study, their future practice as a physician, and in their personal development. Important educational goals that could be attained were the adoption of a patient-centred view in medicine as well as strengthening of the students' critical capacities and sensitivity. The students especially appreciated the possibility of group discussions and the opportunity to participate actively in the course. Based on a critical review of the evaluation, the possibility of a transfer of our model is considered and perspectives for the future are developed.

Changes in cytokine production of breast cancer patients treated with interferons.

A clinical randomized study was performed on advanced breast cancer patients who were treated by interferons (IFN) beta and gamma in combination with hormonotherapy (Megace or Tamoxifen). Cytokine levels (IL-1beta, IL-2, IL-6, TNF-alpha, IFN-gamma) and sIL-2R of individual patients before, during (3 months) and after (6 months) therapy were evaluated and correlated to clinical response according to UICC criteria (responder patients-partial or Complete Response versus non-responder patients-Stable/Progression). Decreases in IL-1beta, IL-6 and sIL-2R were associated with clinical response to therapy versus increases in their levels which corresponded to progression of disease. A significant and dramatic increase in IFN-gamma levels was associated with a favourable response to therapy in the IFNs-treated patients, mainly in the group of Tamoxifen. Baseline levels of sIL-2R and of IFN-gamma were prognostic of clinical response and were found to be the most sensitive cytokine parameters for defining the clinical utility of the combination of IFNs and hormonotherapy in breast cancer patients.

[24-hour blood pressure decrease with nifedipine with a new galenic action]. / 24-Stunden-Blutdrucksenkung durch Nifedipin mit neuer Galenik.

OBJECTIVE: Testing of the blood pressure-lowering effect of a slow-release (24 hours) nifedipine preparation. STUDY DESIGN: Single blind, randomized placebo controlled, single cross-over test; duration eight days. PATIENTS: 18 inpatients with essential hypertension and a blood pressure of more than 160/95 mmHg. MEDICATION: A single 60 mg slow-release nifedipine tablet (Aprical long 60 mg) administered daily at 1800 hours. MEASURING PARAMETERS: Pulse and blood pressure measured after 3, 12, 15, 18, 20, 22 and 24 hours post-administration. RESULTS: Even 18 to 24 hours after administration, the systolic blood pressure was reduced on average by 20 mmHg, the diastolic pressure by 14 mmHg. In the case of the test substance, the percentage of blood pressures in the target range (less than 160/95 mmHg) was 40 percentage points (systolic) and 49 percentage points (diastolic) higher than in the case of placebo. In 15 patients, both systolic and diastolic blood pressure was maintained within the defined target range for 24 hours. Reflex tachycardia was not observed, while other side effects such as headache, flushing, hot flashes, and leg edema occurred only rarely. There was evidence that an evening administration of the drug had a favorable effect on the morning blood pressure increase.

[Verbal behavior and communication experience of psychosomatic patients in the first psychoanalytic interview in connection with the concept of "pensée opératoire']. / Untersuchungen zum Sprechverhalten und Kommunikationserleben von psychosomatischen Patienten im psychoanalytischen Erstinterview im Zusammenhang mit dem Konzept der "pensée opératoire'.

This pilot-study was concerned with differences in speech behaviour and communication as experienced in psychoanalytically oriented initial interviews. In line with the ideas of Marty, Fain, de M'Uzan, David and Sami-Ali, 38 patients were divided into 3 diagnostic groups according to the extent of "pensée opératoire" and the level of functioning of the psychic sphere in each case. The communication experienced was recorded with the help of a communication questionnaire developed in Giessen. The speech behaviour for the interview as a whole and in its development over time was registered automatically and record in 29 categories by the Giessen Speech Analyzer. The following results are reported: --The two groups with more extensive "pensée opératoire" (A1, A2) differed from the character-neurotic patients in 13 of the 29 speech categories registered. The differences between groups A1 and A2 were not significant. --The communication as experienced by the patients did not differ between groups, but the therapist experienced the patients from the 3 diagnostic groups differently. The information gathered from the therapist in the communication questionnaire agreed by and large with the data collected automatically. --For the development of the interview over time, characteristic changes in the frequency of various speech categories were found but these were in the main unrelated to the diagnostic groupings.

[Psycho-somatic considerations in surgical contraception (author's transl)]. / Psychosomatische Aspekte bei der chirurgischen Kontrazeption.

A group of 51 women who desired surgical sterilization were investigated by psychometry prior and after the operation. The results show that intra-psychic and inter-psychic factors need to be considered in the decision for surgical sterilization.

Libidinal cathexis and emotional growth in the analytical treatment of psychosomatic patients.

The paper deals with a form of analytical therapy in psychosomatics, which was developed and applied for many years in a model research ward. The therapeutic arrangement, or setting, was designed to make provision for all 3 elements of a person's make-up - his environment, his mind and his body. At the heart of the model is the therapeutic team, which offers the patient empathatic 'holding' and encourages his emotional growth. The members of the team have learned to offer themselves to the patient as a unit with a common inner attitude towards him. This means that they must first have worked out a unified approach, a hermeneutic structure, with which to understand him. Against the background of a special genetic conception of a mother's function for her child, the ward was turned into a setting that confronts the patient, in psychodramatized form, with a specific form of 'physical ambience'. In coming to grips with the team's physical, sensual presence, the patient is stimulated into developing a transference relationship to the empathizing, maternal father-figure, the 'père maternel'. In this way he can break loose from his clinging dependency on an 'omnipotent object', his dyadic partner, and, through internalizing the therapist both in his female and his male aspects, create a libidinal object in his inner world.

[Therapy-oriented research in psychosomatic medicine]. / Therapiebezogene Forschung in der psychosomatischen Medizin.

The author takes the view the patients with psychosomoatic disturbances show peculiarities in their psychic structure based on psychological ego defects. These typical characteristics are closely related to what is described as the "psychosomatic phenomenon" and the patient's resulting inability to give himself over spontaneously to the therapeutic process. The objectification of these clinical observations in patients taken from various branches of medicine is described. These studies support a number of hypotheses on aspects of the characteristic "lack" and have contributed to the development of a special theoretical model based on an object-psychological approach to understanding psychosomatic pathology. On the basis of this model the author developed a special analytically-oriented therapeutic method for the treatment of psychosomatic patients, which has proved itself in many years of application in a model research ward. Follow-up studies show that the positive therapeutic results achieved remained stable over a period of at least 4 years.

Pathological primary identifications and their effects on the psychosomatic economy of the individual.

The paper deals with the problem of the unstable psychosomatic economy and the patient's consequent susceptibility to psychosomatic disturbances. This goes back to a primary psychobiological defect in the sphere of his earliest identifications, which comes to the surface in emotional crisis situations. The term "Psychosomatic Phenomenon' is used to describe this basic disturbance in the patient's relationships, which can be observed in his interactions with the psychotherapist or interviewer, where it takes the form of a noticeable lack of fantasy, poor relationships and a reduced capacity for psychic experience and elaboration. The author's object-psychological approach has grown out of years of experience in the analytical treatment of hospitalized psychosomatic patients. A 'toxic environment' can be seen to have been a disturbing influence on the early development of the infant. A child whose mother herself knows no autonomy cannot develop its own fantasies through autoerotic activity and thus cannot build up a libidinal object in its inner world. The result is that such an individual is incapable of meeting the inevitable somatic disorganizations with differentiated reorganization processes and so has no defense against physical illness.