[Incorporation of multiple foreign bodies due to borderline personality disorder]. / Inkorporation multipler Fremdkörper bei Borderlinepersönlichkeitsstörung. Literaturübersicht und Fallbeschreibung.

BACKGROUND: Autoaggressive behaviour is one of the pathognomonic characteristics in patients with borderline personality disorder. Clinical symptoms of such behaviour can be the self-induced incorporation of foreign bodies. In the head and neck area, this form of autoaggressivity causes primary or secondary infectious complications with different clinical manifestations. Below follows a description of diagnosis, therapy and follow-up of such a case, comparing our own findings with the corresponding literature. CASE REPORT: A 24-year-old woman with manifest borderline personality disorder was referred to the Department of Maxillofacial Surgery after developing a swelling in the infra-auricular region. After antibiotic therapy failed to reduce inflammatory symptoms, local revision was performed including excision of two metallic foreign bodies. Comprehensive radiological evaluation identified multiple foreign bodies in the head and neck region and lower arms. A total of 76 metallic foreign bodies was removed surgically. During early surgical follow-up and subsequent psychiatric treatment, the patient incorporated new foreign bodies. DISCUSSION: The case reported represents a pattern of foreign body incorporation which is unusual based on review of the literature but characteristic for patients with borderline personality disorder. Diagnostics and therapy require an individual concept which only can be implemented in close co-operation with psychiatrists. Secondary clinical benefit derived from surgical diagnostics and therapy as well as the possibility of autoaggressive relapse have to be taken into consideration.

[Perioperative use of medical hypnosis. Therapy options for anaesthetists and surgeons]. / Perioperativer Einsatz von medizinischer Hypnose. Therapieoption für Anästhesisten und Chirurgen.

BACKGROUND: Surgical treatment of patients under local anaesthesia is quite commonly restricted by limited compliance from the patient. An alternative to treatment under pharmacological sedation or general anaesthesia could be the application of medical hypnosis. With this method, both suggestive and autosuggestive procedures are used for anxiolysis, relaxation, sedation and analgesia of the patient. PATIENTS AND METHODS: During a 1-year period of first clinical application, a total of 207 surgical procedures on a non-selected collective of 174 patients were carried out under combined local anaesthesia and medical hypnosis. RESULTS: Medical hypnosis proved to be a standardisable and reliable method by which remarkable improvements in treatment conditions for both patient and surgeons were achievable. CONCLUSION: Medical hypnosis is not considered to be a substitute for conscious sedation or general anaesthesia but a therapeutic option equally interesting for anaesthesists and surgeons.

[Evaluation of intraoperative standardized hypnosis with the State-Trait Anxiety Inventory]. / Evaluation des intraoperativen Einsatzes standardisierter Hypnose mit State-Trait-Angst-Inventar.

BACKGROUND: Surgical treatment under local anesthesia is commonly restricted by limited compliance of patients. Hypnosis may represent an alternative to sedation or general anesthesia. As the procedure demonstrated promising prospects during 1-year experience, the observed hypnosis-induced effects are now being evaluated in clinical studies. PATIENTS AND METHOD: The prospective study included 50 patients scheduled for dental surgery. All procedures were performed under standardized surgical conditions. The experimental group (n=25) received supplementary standardized tape hypnosis, whereas the control group received standard treatment (only local anesthesia). Individual and situative anxiety levels were determined by the State-Trait Anxiety Inventory (STAI). RESULTS: After simultaneous increase of preoperative state anxiety, anxiety levels in the hypnosis group showed a significant intraoperative reduction to baseline level, whereas intraoperative anxiety of the control group (n=25) remained unchanged. CONCLUSIONS: Hypnosis reduces intraoperative anxiety of oral and maxillofacial patients significantly. Further clinical studies on the use of hypnosis are considered useful.