What kind of illness is anorexia nervosa? Revisited: some preliminary thoughts to finding a cure.

Two decades have elapsed since our publication of 'What kind of illness is anorexia nervosa?'. The question remains whether our understanding of anorexia nervosa and its treatment thereof has evolved over this time. The verdict is disappointing at best. Our current gold standard treatments remain over-valued and clinical outcomes are modest at best. Those in our field are haunted by the constant reminder that anorexia nervosa carries the highest mortality rate of any psychiatric disorder. This cannot continue and demands immediate action. In this essay, we tackle the myths that bedevil our field and explore a deeper phenotyping of anorexia nervosa. We argue that we can no longer declare agnostic views of the disorder or conceive treatments that are "brainless": it is incumbent upon us to challenge the prevailing zeitgeist and reconceptualise anorexia nervosa. Here we provide a roadmap for the future.

[Snowboarding. History--injuries--risks--new materials--tournament on-site services--prevention]. / Snowboarden Geschichte -- Verletzungen -- Risiken -- Materialneuigkeiten -- Wettkampfbetreuung -- Prävention.

Since the 1998 Olympic Winter Games in Nagano, snowboarding has been established as a popular winter sport for youth and adults. The most frequently affected body region reported in many studies on snowboarding injuries are the wrists accounting for more than 50% of severe injuries, especially in beginners. Wrist braces are effective in protecting snowboarding beginners against wrist injuries. Male snowboarders up to the age of 16 and female snowboarders over the age of 25 have a higher risk of injury. Snowboarders should not use ski boots and should be careful with rented equipment. Systems providing body and limb protection and also snowboard-specific helmets can reduce the injury risk for alpine racers, freestylers, and also freeriders. Snowboard training is important to prevent injuries especially for beginners, and icy slopes should be avoided.

[Choroid infiltration in myelodysplastic syndrome]. / Choroidales Infiltrat auf dem Boden eines Myelodysplastischen Syndroms.

BACKGROUND: Myelodysplastic syndrome is a clonal disease of the hematopoetic system characterized by insufficiency of affected bone marrow cell lines. After long-term course of myelodysplastic syndrome an acceleration towards acute myeloic leukemia is a frequent finding. Involvement of the eye is a well known phenomenon in acute leukemia or in blast crisis with chronic leukemias. Eye involvement in myelodysplastic syndrome showing its transition into acute myeloic leukemia however has been published in only few cases. CASE REPORT: We present a 70-year-old male patient suffering from myelodysplastic syndrome, complaining of an acute visual decrease to 0.05 in the left eye. Clinical findings, ultrasound and fluoresceine angiography were in accordance with choroidal infiltration. From the hematologic findings, the myelodysplastic syndrome had been in partial remission after chemotherapy without any sign of relapse or exacerbation. Only because of the ophthalmologic diagnosis, bone marrow aspiration was performed and revealed progression of myelodysplastic syndrome to acute myeloic leukemia. Prompt administration of chemotherapy and external radiation of the posterior pol of the eye led to complete resolution of the fundus lesion within 10 days and visual acuity recovered to 0.8. CONCLUSION: To the best of our knowledge this is the first patient with a choroidal infiltration as the initial sign of progression of myelodysplastic syndrome to acute myeloic leukemia. Realizing this possibility helps for an early diagnosis and rapid therapy which is so crucial in prolonging life.

[Uveitis masquerade syndrome in Gaucher disease. Causal treatment by alglucerase substitution therapy]. / Uveitis-Masquerade-Syndrom bei M. Gaucher. Kausale Behandlung durch Alglucerase-Substitutionstherapie.

BACKGROUND: Gaucher's disease, a sphingolipidose transmitted by autosomal-recessive inheritance, is caused by a deficiency of the lysosomal enzyme beta-glucocerebrosidase which is responsible for hydrolysation of glucocerebroside to ceramid and glucose. Thus glucocerebroside is accumulated in the reticuloendothelial cells of spleen, liver and bone marrow and pathognomonic Gaucher's cells are formed. CASE REPORT: In May 1997 a 42-year-old female patient presented with left-sided intermediate uveitis of unknown origin and decreasing visual acuity to perception of hand movements and intact projection of light since September 1996. To exclude a systemic disease a thorough medical examination--showing hepatoslpenomegaly, anemia, thrombocytopenia and bone lesions--was initiated and revealed advanced M. Gaucher (Type I) by bone marrow punction. Intravenous therapy with alglucerase was administered promptly. After five months of treatment vitreous opacities resolved almost completely and visual acuity increased to 0.7. CONCLUSIONS: The dramatic improvement occurred under treatment with alglucerase after no response to steroid treatment. Thus intermediate uveitis with severe vitritis can be interpreted as uveitis masquerade syndrome with M. Gaucher. To the best of our knowledge, this is the first case of M. Gaucher presenting initially as intermediate uveitis and showing successful clinical improvement during administration of alglucerase.

[Indications and surgical procedures in meniscus and capsular ligament injuries]. / Indikation und operative Verfahren bei Meniskus- und Kapselbandverletzungen.

The main aim in the treatment of meniscus injuries is the restoration of the meniscus by a primary suture. Partial resections of the meniscus should be done in a sophisticated arthroscopic technique. By the reason of relaxing of the joint's ligament should be repaired by operation. In spite of a larger "defect" bone-tendon-bone techniques are to prefer because of an improved long-term stability.

[Concomitant injuries after upper ankle joint dislocations]. / Begleitverletzungen nach OSG-Distorsionen.

Functional treatment with the Air Stirrup Ankle Brace recommended by C. N. Stover in 1979 can reduce pathological inversion of the ankle joint. In our retrospective study of 109 patients treated by this kind of ankle brace we found 96 patients (88%) with excellent results. Only 13 patients (12%) reported moderate to good results. To detect and characterize their painful conditions of ankles we did a clinical, radiological and MRI-Investigation. In only 2 cases we found a moderate instability after clinical investigation, anterior stress roentgenogram and talar tilt. By using the MRI-investigation 1.0 Tesla with a 512 x 360 Matrix we could find 10 cases with osteochondral lesions of the ankle. In 7 cases there was separated ossicle in the fibulotalar joint, in 1 case we detected a fracture of the processus anterior tali, in another case we could see a posttraumatic lesion of the talus and calcaneus with bone bruise and at least one osteochondral fracture of the distal tibia. The capability of the MRI to detect particularly osteo-chondral lesions of the talus and the tibiofibular joint was shown in 10 of 13 cases. Therefore we recommend to do an MRI-investigation on all patients after ankle sprain if there are painful conditions within the ankle after conservative treatment.

[Surgical management of shoulderblade fractures]. / Zur operativen Versorgung von Schulterblattbrüchen.

Fractures of the scapula are a domain of conservative therapy. In the majority of cases early restoration of function produces good results. Nevertheless there are types of fractures which should be reduced in open procedures and treated by an osteosynthetic method stable enough to ensure early mobilisation. A report of 5 patients is presented, 2 of whom showing severe, 1 light and the remaining 2 no concomitant injuries. Indications, access, choice of procedure and results are described.