[Postoperative cognition disorders in elderly patients. The results of the "International Study of Postoperative Cognitive Dysfunction" ISPOCD 1)]. / Postoperative Störungen der kognitiven Leistungsfähigkeit bei älteren Patienten. Die Ergebnisse der "International Study of Postoperative Cognitive Dysfunction" (ISPOCD 1).

OBJECTIVE: Cognitive dysfunction is a known problem after operations and may be especially relevant in the elderly. The aim of this international multicentre study was to investigate short- and long-term cognitive dysfunction in elderly patients and to elucidate the relevance of hypoxaemia and hypotension as causative factors. METHODS: 1218 patients aged 60 years and older and scheduled for major non-cardiac surgery under general anaesthesia were investigated. Oxygen saturation was measured by continuous pulse oximetry before surgery and throughout the day of and the first 3 nights after surgery. Blood pressure was recorded every 3 minutes during the operation and every 15-30 min for the rest of that day and night. Cognitive testing was performed before and 1 week and 3 months after the operation. Cognitive dysfunction was identified with neuropsychological tests compared with controls recruited from the UK (n = 176) and the same countries as study centres (n = 145). RESULTS: Postoperative cognitive dysfunction was present in 25.8% of patients 1 week after surgery and in 9.9% 3 months after surgery, compared with 3.4% and 2.8%, respectively, of the UK controls. Increasing age and duration of anaesthesia, little education, a second operation, postoperative infections, and respiratory complications were the risk factors for early postoperative cognitive dysfunction, but only age was a risk factor for long-term postoperative cognitive dysfunction. Hypoxaemia and hypotension were not significant risk factors at any time. CONCLUSION: With this investigation long-term cognitive dysfunction could be proven definitively for elderly patients after major operations under general anaesthesia. No factors with prophylactic or therapeutic influence were detectable so that aetiology and pathophysiology of POCD could not be further determined.

[Some critical considerations on the status of the psychoanalytic discussion of bulimia]. / Einige kritische Uberlegungen zum Stand der psychoanalytischen Bulimie-Diskussion.

The most discussed psychoanalytic publications about bulimia and their central thesis are critically reported. Apparent is the accent of the very early childhood development, especially the earliest stages of mother-child-symbiosis in their pathogenic influence. Only some authors oppose with regard to conflicts of later stages of development in bulimic women. Personal clinical experiences and research data support the critique of the exclusive accent of early development. Rather adolescent developmental problems and particularities of female adolescence are stressed by the author.