[Quality of life among older informal caregivers of people with dementia]. / Lebensqualität älterer pflegender Angehöriger von Demenzerkrankten.

BACKGROUND: In Germany, informal caregiving becomes an increasingly important issue especially for people with dementia. Spouses often provide nursing care due to the limited daily living skills of people with dementia. This leads to a wide range of caregiver burden and decreased quality of life (QoL). Analyses on the relation between QoL and caregiver burden of older informal caregivers in Germany are rare. OBJECTIVE: The following research questions were assessed: (1) Does caregivers' QoL differ from that of the older general population?; (2) Which sociodemographic, health- and care-related characteristics affect caregivers' QoL? MATERIAL AND METHODS: For this study, two samples (aged 60 years and older) were recruited: informal caregivers (n = 119) and a representative sample of older non-caregivers in the general population (n = 1133). Linear regression analyses were applied to examine the effects of sociodemographic, health and care-related variables on the QoL of older informal caregivers of people with dementia. RESULTS: Older informal caregivers reported a significantly lower QoL compared to older non-caregivers in the general population. Especially the domains autonomy, activities in the past, the present and the future as well as intimacy were negatively associated with caregivers' QoL. CONCLUSION: The results of the study highlighted caregivers' need for assistance. Due to demographic changes, tailored support services should be based on older caregivers' needs.

Anaplastic thyroid carcinoma: Failure of conventional therapy but hope of targeted therapy.

BACKGROUND: Anaplastic thyroid cancer has a median survival between 1.2 and 10 months. The purpose of our study was to evaluate the outcomes of patients with anaplastic thyroid cancer in Ireland. METHODS: We carried out a retrospective analysis of the Irish National Cancer Database for patients with anaplastic thyroid cancer between 2000 and 2010. RESULTS: Of a total of 64 patients (40 women, 24 men), the median age was 69 years, and 29.7% of the patients had distant metastases. The overall median survival was 2.3 months and the 1, 2, and 5-year survival was 12.5%, 6.25%, and 4.69%, respectively. On univariate analysis age, sex, metastases at diagnosis, and multimodality treatment were statistically significant indicators of prognosis, and metastases at diagnosis remained statistically significant on multivariate analysis. CONCLUSION: These results correlate with the American Thyroid Association (ATA) guidelines, in which, when possible, multimodality therapy offers a survival advantage to a select group of patients. Novel therapies may offer the greatest hope for these patients. © 2016 Wiley Periodicals, Inc. Head Neck 38: E1122-E1129, 2016.

Emergency Health Care Use among Sociodemographic Groups of Children Presenting to Emergency Departments for Self-Harm in Alberta.

OBJECTIVE: To examine sociodemographic variations among children <18 years in (1) rates of self-harm visits to emergency departments (EDs) and (2) physician follow-up after the self-harm visit in Alberta. METHODS: A retrospective, population-based cohort (2002-2011) of ED visits for self-harm by individuals <18 years was conducted using administrative databases from Alberta, Canada. Individuals were grouped by First Nations status or type of health care premium subsidy (family receipt of government subsidy, human services program subsidy, no subsidy received). Visits from 104 EDs were summarized by crude and directly standardized visit rates (DSVRs) per 100,000 individuals. Kaplan-Meier estimates for median estimated time to physician follow-up were calculated with 95% confidence intervals (CIs). RESULTS: During the study period, visit rates decreased with the exception of children from families receiving government-sponsored program subsidy (DSVRs 163/100,000 to 250/100,000; p=0.032). First Nations children had disproportionately fewer follow-up visits compared to other children. The median time to follow-up for First Nations children was 39 days (95% CI: 32, 48) compared to 16 days for children from families receiving no subsidy (95% CI: 14, 19), who had the shortest follow-up time after an ED visit. CONCLUSIONS: Sociodemographic differences were evident in ED visit rates as well as the number of and time to physician follow-up visit. The disparities experienced by First Nations children in the follow-up period highlight an opportunity for culturally-grounded risk and needs assessment in the ED to determine and facilitate timely and appropriate follow-up care.

Laryngotracheal presentation of anaplastic thyroid carcinoma with squamous differentiation: seven cases demonstrating an under-recognized diagnostic pitfall.

AIMS: To describe a series of anaplastic thyroid carcinomas that mimicked primary head and neck squamous cell carcinoma (HNSCC) by virtue of both morphology and clinical presentation. METHODS AND RESULTS: Seven cases were identified in a 15-year period where a biopsy of an airway lesion that appeared to be squamous cell carcinoma was, in fact, anaplastic thyroid carcinoma. The tumours had squamous and/or spindle cell morphology, with only the squamous component being apparent in the airway biopsy. Some tumours arose within metaplastic (n = 3) or atypical (n = 3) epithelium, supporting the diagnosis of a primary mucosal tumour. Positive PAX8 (n = 5) and TTF-1 (n = 4) staining was identified. CONCLUSIONS: An endotracheal presentation of anaplastic thyroid carcinoma with squamous morphology may be misdiagnosed as a primary head and neck squamous cell carcinoma. PAX8 and TTF-1 expression are helpful in making the distinction, but the problem lies in suspecting a thyroid carcinoma in what appears to be a straightforward diagnosis of HNSCC.

Investigation of the impact of thyroid surgery on vocal tract steadiness.

INTRODUCTION: Subjective nonspecific upper aerodigestive symptoms are not uncommon after thyroid surgery. These are postulated to be related to injury of an extrinsic perithyroid nerve plexus that innervates the muscles of the supraglottic and glottic larynx. This plexus is thought to receive contributing branches from both the recurrent and superior laryngeal nerves. PATIENTS AND METHODS: The technique of linear predictive coding was used to estimate the F(2) values from a sustained vowel /a/ in patients before and 48 hours after thyroid or parathyroid surgery. These patients were controlled against a matched pair undergoing surgery without any theoretical effect on the supraglottic musculature. In total, 12 patients were recruited into each group. Each patient had the formant frequency fluctuation (FFF) and the formant frequency fluctuation ratio (FFFR) calculated for F(1) and F(2). RESULTS: Mixed analysis of variance (ANOVA) for all acoustic parameters revealed that the chiF(2)FF showed a significant "time" main effect (F(1,22)=7.196, P=0.014, partial eta(2)=0.246) and a significant "time by group interaction" effect (F(1,22)=8.036, P=0.010, eta(p)(2)=0.268), with changes over time for the thyroid group but not for the controls. Similarly, mean chiF(2)FFR showed a similar significant "time" main effect (F(1,22)=6.488, P=0.018, eta(p)(2)=0.228) and a "time by group interaction" effect (F(1,22)=7.134, P=0.014, eta(p)(2)=0.245). CONCLUSIONS: This work suggests that thyroid surgery produces a significant reduction in vocal tract stability in contrast to the controls. This noninvasive measurement offers a potential instrument to investigate the functional implications of any disturbance that thyroid surgery may have on pharyngeal innervations.

[Fibromyalgia]. / Fibromyalgiesyndrom.

Within clinical practice fibromyalgia is diagnosed according to the classification criteria of the American College of Rheumatology. The examination of the tender points is still to be standardized. By using additional diagnostic criteria fibromyalgia changes into a polysymptomatic syndrom with multiple functional and psychic symptoms. The prevalence of FMS is estimated to range between 1,3-4,8% in the general population. Relative hypocortisolism, sensory hypervigilance, adverse life experiences and psychiatric disorders are discussed as main pathophysiological mechanisms. There are no evidence-based guidelines of scientific societies for the management of fibromyalgia available. Patient education, medical training therapy, physical therapy (heat or cold) and relaxation therapy are recommended. There is a moderate evidence for the effectiveness of tricyclic antidepressants and aerobic training. The effectiveness of multicomponent therapy in fibromyalgia is still to be demonstrated.

Argon plasma coagulation in the treatment of tonsil remnants.

Tonsil remnants are a problematic outcome in a subset of patients undergoing tonsillectomy. Treatment options are rarely discussed in the literature. This is the first description of the use of argon plasma coagulation (APC) in this setting. APC is based on the principle of ionised argon gas creating a conductive plasma between an activating electrode and a tissue surface. We describe the usability and clinical efficacy of this modality in a group of six patients.

[Diagnosis and clinical signs of fibromyalgia]. / Diagnose und Klinik der Fibromyalgie.

According to the criteria of the American College of Rheumatology (ACR 1990) fibromyalgia can be classified as a complex of clinical symptoms. It is characterised by widespread muscle pain, and pain in at least 11 out of 18 defined so-called tender points. The widespread muscle pain must be present for at least 3 months. For the diagnosis of fibromyalgia many other rheumatological, neurological and psychiatric diseases have to be excluded; additional autonomic or functional symptoms are usual. Routine laboratory or radiological examinations yield normal results. From a pathogenetic point of view endocrine disturbances and psychosocial stress factors are found. In most cases the clinical course shows a slow development of generalised pain.

Randomized controlled trial comparing argon plasma coagulation tonsillectomy with conventional techniques.

Argon plasma coagulation (APC) is based on the principle of ionized argon creating a conductive plasma between an activating electrode and a tissue surface. To date, its use in tonsillectomy has not been extensively examined. The purpose of this randomized controlled trial was to assess the clinical efficacy of APC as a tool for this common surgical procedure. Forty patients were randomized into two groups--treatment A (conventional tonsillectomy, n = 20) and treatment B (APC tonsillectomy, n = 20). Trial end-points included a) operative time, b) intra-operative blood loss, and c) objective assessment of post-operative pain, by completion of a visual analogue pain score chart, over a two-week period. Thirty-one patients were available for analysis. There was a statistically significant reduction in the intra-operative blood loss with treatment B (p = 0.02). There was no statistical difference between both groups for the other outcome measures. First clinical experience with this treatment modality shows that it is an attractive alternative to conventional tonsillectomy and may offer possible benefits.

Effects of a non-ionic surfactant (Tween-80) on the mineralization, metabolism and uptake of phenanthrene in wheat-solution-lava microcosm.

Effects of a non-ionic surfactant (Tween-80) on the mineralization, metabolism and uptake of phenanthrene in wheat-solution-lava microcosm were studied using 14C-labeled phenanthrene. The mineralization and metabolism of phenanthrene were fast in such a system. At least 90% of the applied phenanthrene were transformed within 24 days. Only 0.3% of the applied 14C-activity were identified to be the parent phenanthrene. Most of the applied 14C-activity (70%) was recovered from wheat, in which ca. 70% were associated with wheat shoots (stems and leaves) and ca. 30% wheat roots. 33% and 20% of the applied 14C-activity had been constructed into wheat tissues of shoots and roots, respectively. The 14C-activity recovered in forms of CO2 and volatile organic chemicals (VOCs) was 12-16% and 4-5%, respectively. The major metabolites of phenanthrene were polar compounds (18% of the applied 14C) and only 2.1% were identified as non-polar metabolites. No phenanthrene was found in wheat shoots indicating that it could not be transported from roots to upper parts of the plant but in form of metabolites (mostly polar metabolites). Foliar uptake of 14C-activity via air in form of 14CO2 occurred. The presence of Tween-80 significantly enhanced the degradation of phenanthrene, which could be attributed to its increase of microbial activities in the system. Tween-80 also significantly (P < 0.05) reduced the phenanthrene level in wheat roots, which probably resulted from desorption of phenanthrene from root surface caused by the surfactant.

Computerized tomography-guided epidural blood patch in the treatment of spontaneous low cerebrospinal fluid pressure headache.

A 54-year-old woman suffering from migraine for 35 years was referred to the pain clinic with a changed pattern of headache that had developed over the last 6 weeks. The pain was located in the central forehead region; aggravation in the prone and immediate relief in the supine position led to the hypothesis of a spontaneous low cerebrospinal fluid (CSF) pressure headache. Cisternography revealed a cyst-like formation in the cervico-thoracic region, indicating cerebrospinal fluid leakage. Magnetic resonance imaging (MRI) myelography confirmed ventral leakage but failed to locate the exact site. Computerized tomography (CT)-guided epidural blood patching between T1 and T2 completely relieved the headache.

Transdermal fentanyl: little absorption in two patients with systemic sclerosis?

Two patients suffering from systemic sclerosis (SSc) were treated with the 25 micro/hr transdermal fentanyl patch for pain from either deltoid muscle tendinitis of the left arm or from ischemia of the left-hand thumb. When the medication was changed to either oral morphine or oral methadone, the effects did not correspond to the drug conversion table. These findings suggest that patients with SSc and other systemic skin diseases may be at risk for limited absorption of transdermal fentanyl. In contrast, no restriction of the absorption of transdermal testosterone was observed.

[Report of 2 cases of irreversible Horner syndrome after puncture of the internal jugular vein]. / Berich über 2 Fälle eines irreversiblen Horner-Syndroms nach Punktion der Vena jugularis interna.

Two cases are presented with irreversible Horner's syndrome after cannulation of the internal jugular vein during the intraoperative period. In the first case the cannulation succeeded only after several attempts. In the second case the cannulation succeeded the first time. All cannulations were performed by experienced anaesthesiologists. This means, that a strict indication for the cannulation of the internal jugular vein must be considered, because of the possibility of irreversible damage, even if the cannulation is performed by an experienced physician.

[Efficacy of low doses of heparin to postoperative changes of blood gases after abdominal surgery (author's transl)]. / Einfluss einer Low-Dose-Heparinisierung auf das postoperative Verhalten der Blutgase nach Oberbaucheingriffen.

Arterial hypoxaemia near critical values may occur during the postoperative period after surgery under general anaesthesia. Mainly alterations of ventilation/perfusion ratio seem to be the cause for this disorder. In this study we examined the effect of low-dose-heparin in improving pulmonary perfusion and consequently reduction of postoperative hypoxaemia. In 22 elderly patients both male and female we found no significant differences in oxygen tension compared to a control group of 19 patients. In both groups duration and degree of postoperative hypoxaemia were equal with minima on the first respectively second postoperative day. As in both groups there were no significant differences in other parameters further influencing oxygen supply--such as haemoglobin, haematocrit, pH and mean arterial blood pressure--we do not believe that disturbances of perfusion caused by microembolism are mainly responsible for postoperative hypoxaemia. Likewise low dose heparin seems to have no effect on postoperative hypoxaemia.

[Postoperative changes of blood gases after uncomplicated abdominal surgery in geriatric patients (author's transl)]. / Die postoperativen Veränderungen der Blutgase nach unkomplizierten Oberbaucheingriffen bei hochbetagten Menschen.

In 34 elderly male and female patients undergoing upper abdominal surgery under general anaesthesia we investigated duration and degree of postoperative hypoxaemia. In this study only patients with no signs and symptoms of pulmonary or cardiac diseases, verified by normal lung function--vital capacity and FEV1, X-ray and electrocardiographic findings were considered. Postoperative development was free of complications and temperature rises in all cases. The investigations showed occurrence of arterial hypoxaemia during the postoperative period with values near the lower limit where the organism must fall back on cardio-circulatory reserve mechanisms in order to avoid general hypoxydosis. Regarding the restricted pulmonary and cardiac capacity for adaptation and compensation in geriatric patients, we recommend to prolong the practice of O2-application for two or three hours over a period of 24 to 48 hours, especially in patients with postoperative complications such as prolonged gastric atony, temperature, haemorrhage or cardiac and coronary insufficiency. This prolonged application of oxygen by mask or nasal tube should go parallel to other physiotherapeutic measures.

Applied optics in crime detection.

FBI Laboratory applies a broad spectrum of scientific approaches to examination of evidentiary material recovered (luring FBI investigations. These facilities are also extended on a cost-free cooperative basis to all authorized law enforcement agencies throughout the United States. Accordingly, the physical evidence seen in the FBI Laboratory constitutes a highly representative sampling of evidentiary material encountered by, law enforcement agencies at all levels across the nation. Specific representative examples of the value of applied optics in this effort are described and illustrated in several forensic areas, including examination of documentary evidence, instrumental analysis, firearms and toolmarks examinations, and the like.