[Differences in the success rates of inpatient therapy for alcohol and illegal drug abusers. A Replication Study]. / Différence de réussite au traitement hospitalier entre dépendants à l'alcool et dépendants aux drogues illicites : une étude de reproductibilité.

INTRODUCTION: Irrespective of the type of psychotherapy used, the abstinence-oriented treatment of drug abusers is less successful than that for alcohol abusers. If, on the other hand, the two groups are parallelized in such a way that the patients are identical with respect to the five characteristics of gender, age, schooling, work situation and partner situation, then there is no difference between the success rates of the drug and alcohol abusers. The aim of this study is to determine whether this result can be replicated in another therapeutic institution. METHOD: Retrospective field study of 320 abusers of illegal drugs and 320 alcohol abusers who were treated with behaviour therapy. By combining the binary characteristics gender, work situation and age, the drug-dependent patients were divided into 23=8 groups, and the same number of alcohol abusers were randomly selected for each group. The scheduled period of inpatient treatment was 90 days for the alcohol abusers and 120 days for the drug abusers. Every week the patients had one session of individual psychotherapy and four to five group therapy sessions. According to the indications, the certified behaviour therapists implemented the following interventions including behaviour analysis, relapse prevention, cognitive therapy, self-management and behavioural family therapy. Comparison of the success rates was carried out using the Chi2 test, and changes in the psychological findings were tested with one-way variance analysis. RESULTS: There was no difference between drug and alcohol abusers with respect to the rate of therapy termination according to plan (around 80%). A total of 48% of the drug abusers and 41 % of the alcohol abusers who could be followed up had been continuously abstinent at the one-year catamnesis without a single relapse. There were also no differences between the two groups when it was assumed that the patients who could not be followed up had relapsed. In the case of both the drug and alcohol abusers the abstinence rate was highest in over-29-year-old employed men (57.6%; 48.4%). The abstinence rate was lowest in employed female drug abusers (27.8%) and young, unemployed female drug abusers (0%, n=11). DISCUSSION: What appears to influence the abstinence rate after inpatient treatment is not only the type of substance consumed but also sociodemographic characteristics. In addition to individually tailored therapy, our results confirm the importance of a highly differentiated presentation of the outcomes of therapy in the specialist literature. An average rate of abstinence (e.g. 30%) is insufficient to evaluate an intervention unless information is also provided about the patients for which the intervention is suitable and those for which it is not. In accordance with the Reproducibility Project, we consider replication studies essential in psychotherapy, even though in practice the considerable methodical requirements can only be partially fulfilled.

Frequency, histopathological findings, and clinical significance of cervical heterotopic gastric mucosa (gastric inlet patch): a prospective study in 300 patients.

The frequency and clinical significance of heterotopic gastric mucosa in the upper esophagus is not sufficiently known. Heartburn or dysphagia could result from mucin and/or acid production in this area. We undertook a prospective study in 300 patients with special attention of the endoscopist to this area. Moreover, clinical symptoms were determined by questionnaire before performing endoscopy. A total of 33/300 (11%) of patients had at least one histologically proven gastric inlet patch without gender or age preference. In 20/33 (61%) cases, the heterotopic gastric mucosa was classified as mixed type, in 8/33 (24%) as oxyntic, and in 5/33 (15%) as mucoid. Helicobacter pylori was present in none of the cases. There was no significant association to the presence of a hiatal hernia, reflux esophagitis, Barrett's esophagus, or gastric/duodenal ulcer. Moreover, there was no association to the reported grade of heartburn in the upper or lower part of the esophagus, recurrent hoarseness, or dysphagia. When thoroughly performed, heterotopic gastric mucosa is a quite frequent finding in endoscopy of the upper gastrointestinal tract. The presence of this gastric mucosa in the upper third of the esophagus seems to be rarely the cause of clinical symptoms and little prone to complications.

[The significance of psychotropic substance abuse and addiction in the treatment of psychosomatic rehabilitation patients]. / Die Bedeutung von Missbrauch und Abhängigkeit von psychotropen Substanzen bei der Behandlung von Patienten in der psychosomatischen Rehabilitation.

OBJECTIVE: The objective of this study is to investigate the influence of substance abuse and addiction as comorbid disorders on the treatment results of patients of a psychosomatic unit one year after their release. METHODS: In a prospective, non-randomized field study patients were asked by mail one year after finishing their treatment as part of a quality management endeavour. RESULTS: After one year patients with comorbid substance addiction did not improve in psychological tests whereas those with comorbid substance abuse or without any of these comorbidities showed significant improvements. CONCLUSIONS: Due to reasons to be studied further comorbid substance addiction seems to influence treatment outcome at least in psychological tests.

Retrograde amnesia: a study of its relation to anterograde amnesia and semantic memory deficits.

This group study of 24 amnesic patients and 40 control subjects examined the hypothesis that retrograde memory deficits result from a combination of two impairment mechanisms: (1) a deficit in the retrieval of contents that is related to dysfunctioning of the hippocampal anterograde memory system, and (2) a deficit in the storage and/or retrieval of contents that is related to concomitant neocortical lesions. Retrograde amnesia was evaluated with the use of new Famous Persons and Autobiographical Memory Tests. The postulated components of retrograde memory impairment were assessed using the Wechsler Memory Scale and a new Semantic Memory Test, respectively. Regression analyses showed that recent episodic autobiography was exclusively related to the hippocampal component, while memory for famous persons and childhood autobiography was related to the neocortical component. In the case of details concerning people of recent fame, both components were identified as independent determinants. The temporal gradient of patients' impairment at the Famous Persons Test was marked for detailed knowledge, but small for overlearned knowledge. The present results thus support the combination hypothesis. They conform to the view that the transition from a hippocampus-dependent to a neocortex-dependent mnemonic representation of new contents is mediated by reiteration, and occurs within 5-10 years.

[Follow-up and prognosis of early summer meningoencephalitis]. / Verlauf und Prognose der FSME.

Sixty-three patients with tick-borne encephalitis were studied for sequelae up to 5 years after the acute illness (median: 12 months, range: 1-44 months). Patients were examined clinically, by neuropsychological testing and by electroencephalography. The clinical presentation during the acute stage was as follows: Meningitis (M,n = 12), Meningoencephalitis (Me,n = 27), Meningoencephalomyelitis (My,n = 15), and Meningoencephaloradiculitis (R,n = 9). A total of 59 patients reported a neurasthenic syndrome after discharge, which correlated with the severity of the acute illness. Twenty patients were not able to work because of reduced stress tolerance, fatigue or an elevated emotional sensitivity, which lasted for 3 months at most. In some patients hypacusis (n = 7), severe dysarthria and dysphagia (n = 4) remained essentially unimproved for years following the acute illness. While in 8/9 patients with radiculitis paresis of the extremities improved well over months to years, improvement was quite limited in all patients with myelitis. In 41/55 patients, investigations by electroencephalography revealed normal findings even within months after acute illness. Persistent cognitive deficits were present only in 7/11 patients with a severe course of disease.

Cognitive procedural learning in amnesia.

This group study examined the role of residual declarative memory and task-specific cognitive abilities for cognitive procedural learning in amnesia. 20 amnesic patients and 40 control subjects were studied, using four new cognitive tasks, as well as the Tower of Hanoi and a Mirror Reading task. On the cognitive tasks, but not on Mirror Reading, the learning of amnesic patients was significantly impaired relative to controls. Between- and within-group differences in learning were found to be statistically related to cognitive abilities that are involved in the processing of the procedural tasks. In amnesic patients, significant effects of residual declarative memory on learning scores were not observed, but there was indirect evidence for a role of memory in two tasks. The analysis of the correlative relationship between absolute procedural task performances and cognitive abilities indicated a prolonged dependence on nonspecific intellectual abilities in amnesic patients, suggesting a retarded transition to more advanced stages of skill acquisition.

[Glucagon as an adjuvant to infusion cholecysto-cholangiography]. / Glukagon als Adjuvans zur Infusions-cholezystcholangiographie.

The effect of glucagon on the results of intravenous cholangio-cholecystography (IVC) was studied in a randomised trial on 246 patients. The injection of 1 mg. glucagon increased the speed of contrast excretion from the liver. This led to a significantly quicker demonstration of the gallbladder, with a tendency to more rapid filling of the biliary ducts. In patients with hyperbilirubinaemia there were somewhat fewer negative cholangiograms and significantly fewer negative cholecystograms. Considering the patients as a whole, the use of glucagon has the advantage of reducing the time taken for the examination and of a reduction of negative IVCs. Since glucagon has practically no side effects, our experience suggests that it can be recommended as an adjuvant to IVC. Improvements in IVCs are particularly significant since they are now only used for special indications.

[Behavior therapy of opiate dependence]. / Verhaltenstherapie der Opiatabhängigkeit.

Ten years ago an extensive behaviour therapy programme for the treatment of young opiate addicts was developed and tested, and shown through follow-ups extending over a period of two years to be successful. Some of the most important behaviour therapy procedures are introduced. A distinction is made between traditional methods which have been used since the beginning of the therapy programme and newer approaches in behaviour therapy, which in recent years have led to a broadening of the spectrum of therapy. In conclusion important areas for the treatment of opiate addicts in the future are dealt with, which make further improvements in the efficiency of therapy possible.

Preliminary clinical findings on the Kiel classification of malignant lymphomas.

In 75 patients with non-Hodgkin Lymphomas the influence of the histopathological form, as judged by the Kiel classification, on the epidemiology and prognosis of the disease was examined retrospectively. The different forms of the Kiel classification influence in a typical way the age specific incidence rates and the prognosis of the disease.

Proceedings: Prognosis of non-Hodgkin's lymphomas with special emphasis on the staging classification.

The prognosis of the non-Hodgkin's lymphomas is determined by 1. the pattern of origin and spread which can be demonstrated in a staging classification, 2, the histopathological type, and 3. the effectiveness and scope of the treatment methods, particularly radio- and chemo-therapy. In the following paper the Ann Arbor Classification, which was originally conceived of for both disease groups (Hodgkin's and non-Hodgkin's lymphomas), is discussed particularly with respect to the applicability and prognostic evaluation for the non-Hodgkin's lymphomas. The Ann Arbor Classification may in essence reflect the oncological characteristics of the non-Hodgkin's accurately; there are, however, a number of findings with qualitative and quantitative differences which defy integration into the Ann Arbor Classification. The qualitative differences consist of the differing lymphatic and extralymphatic origins and their consequence for spread and prognosis. The quantitative differences refer to the varying patterns of distribution of the different stages of spreading, whereby the dissemination stages in the non-Hodgkin's lymphomas are more dependent on the histological form than is the case with the Hodgkin's lymphomas, and thus must play a greater role in the prognostic evaluation and indication for treatment. Suggestions have been made for a modification of the Ann Arbor Staging Classification for the non-Hodgkin's lymphomas.

Prognostic significance of primary site after radiotherapy in non-Hodgkin's lymphomata.

In contrast to Hodgkin's lymphomata, non-Hodgkin's lymphomata originate in approximately a fourth of the cases in extranodal organs and sites. The prognosis of patients with primary extranodal organ involvement of the non-Hodgkin's lymphomata is similar to that of patients with primary lumph node involvement of the Hodgkin's and non-Hodgkin's lymphomata, dependent on the special spreading of the disease corresponding to the 4 stages of the Ann Arbor classification. This applies to the primary involvement of a single lymph node region (Stage I) or a single extralymphatic organ or site (stage IE) as well as to further stages of spreading within the lymphatic system (Stages II and III) including secondary localized involvement of an extralymphatic organ and site (Stages IIE and IIIE). The same qualitative dependence of the prognosis of Hodgkin's and non-Hodgkin's lymphomata on the spatial spreading, corresponding to the Ann Arbor concept, legitimizes, in spite of some quantitative differences, the application of the Ann Arbor classification system to all malignant lymphomata.