Physiological and psychological effects of imagery techniques on health anxiety.

Previous research has shown that intrusions are part of the psychopathology of mental disorders. Imagery techniques seem to be an effective treatment of negative intrusions. Since negative mental imagery is part of health anxiety, the present study investigated the impact of imagery techniques on health anxiety. A total of 159 students with elevated scores in a health anxiety questionnaire watched an aversive film concerning a cancer patient and were randomly allocated to one of three interventions (positive imagery, imagery reexperiencing, imagery rescripting) or the control group. The intervention lasted 9 min. Physiological data (heart rate and cortisol) as well as psychological measures, such as mood ratings, health anxiety scores, and intrusions, were assessed during the appointment, while psychological measures were assessed over a period of 1 week after the intervention. Cortisol levels changed over time depending on the intervention. Heart rate changed during the 9-min interventions as well, with the fastest decrease during imagery rescripting. Moreover, negative mood and distress decreased after the intervention, while intrusions were reduced 1 week after the intervention in all groups equally. The results suggest that imagery rescripting is a promising technique that seems to activate a process of deep elaboration. Therefore, it might be an adequate way to target health anxiety symptoms such as anxiety, intrusions, and avoidance or safety-seeking behavior. Further studies should focus on imagery rescripting in clinical samples with health anxiety and target individual intrusive images to increase effectiveness. Nevertheless, the development of a long-term explanatory model of rescripting is needed.

[Purple glove syndrome - a case report]. / Purple Glove Syndrom nach peripherer venöser Phenytoin Gabe - Ein Fallbericht.

The purple glove syndrome (PGS) is a soft tissue injury after peripheral intravenous phenytoin administration or oral overdosage. The incidence of PGS is described with 0-6%. Typical symptoms are purple discoloration, oedema, pain, and a decrease of range of motion. In severe cases PGS may lead to abscess, skin loss and compartment syndrome. The established treatment of PGS is immediate interruption of phenytoin injections, splinting, elevation, and close observation. In cases of severe complications (e. g., compartment syndrome), surgical intervention is necessary. The case of a 40-year-old female patient is reported who was transferred to our department 4 days after intravenous phenytoin administration and who underwent successful surgical revision.

[Alternative autologous breast reconstruction using the free microvascular gracilis muscle flap with horizontal skin island]. / Die alternative autologe Brustrekonstruktion mit dem queren Grazilislappen.

BACKGROUND: While free TRAM or DIEP flaps are still the most common techniques for autologous breast reconstruction, there are also other flaps which are suitable for patients who are not candidates for a TRAM/DIEP flap. In addition to the S-GAP or I-GAP, the transverse myocutaneous gracilis (TMG) flap is an excellent alternative. The tissue utilised is taken from the medial thigh and inferior gluteal area. PATIENTS AND OPERATIONS: We have performed 37 TMG flap operations on 23 patients since 2007. The indications were breast cancer, asymmetry of the breasts and capsular fibrosis. The average age of our patients was 47 years. Incisions are similar to those of a transverse thigh lift. The flap is nourished by perforators from the gracilis and its proximal dominant pedicle. The landmark ventrally is the greater saphenous vein and midpoint of the inferior gluteal fold on the dorsal side. Its size can go up to 30 x 10 cm. Recipient vessels are the internal thoracic vessels. The donor site is closed primarily. All of our patients are immobilised for 2 days and were instructed to avoid sitting for 2 weeks. RESULTS: 12 patients were reconstructed after breast cancer, 8 patients had a capsular fibrosis and 3 patients had an asymmetry. The follow-up period was 8 months. Mean operating time for unilateral reconstruction is 220 minutes, for bilateral reconstruction 325 minutes. The weight of the flaps varied from 220 to 440 grams. It takes approximately 30 minutes to harvest the flap. There was no flap loss. Some of the patients described a tight feeling on the thighs for 3 weeks. They described a hypaesthesia on the dorsal thighs. There was one delayed wound healing caused by haematoma. CONCLUSION: In our department, the TMG has become the most preferred flap for breast reconstruction besides the TRAM/DIEP. Especially slim patients with small breasts or a history of surgery on the abdominal wall are ideal candidates. The tissue from the medial thigh is very similar to the breast tissue. The constant vascular anatomy makes it easy to harvest the flap. The resulting scar is well hidden in the patients' underwear.

[Hereditary thrombophilia in free microvascular flaps--a case report]. / Hereditäre Thrombophilie und ihre Bedeutung für die freie mikrovaskuläre Gewebetransplantation anhand einer Falldarstellung.

Hereditary thrombophilia sums up a large number of haemostatic disorders, which cause thrombosis independently to external influences. The main cases of hereditary thrombophilias are the hereditary antithrombin defect, the activated protein C resistance, the hereditary protein C defect, the hereditary protein S defect, the antiphospholipid antibody syndrome, the hyperhomocysteinaemia, the increased factor VIII activity and the prothrombin-G20210A-polymorphism. We present a patient who was amputated in both breasts due to cancer. A bilateral microvascular TRAM-flap was planned as primary reconstruction on one breast and secondary reconstruction on the other breast. However in the operation the flap vessels revealed irreversible thromboses so that the intended reconstruction could not be completed in this operation. Postoperatively, a combined hereditary thrombophilia was diagnosed: heterocygote activated protein C resistance, antiphospholipid antibody syndrome and hyperhomocysteinaemia.

[Functional reconstruction of the radial articular surface after giant cell tumor]. / Funktionelle Rekonstruktion der Radiusgelenkfläche nach Riesenzelltumor.

Giant cell tumor is a benign locally aggressive tumor with a high tendency to recurrence, with a small rate of pulmonary metastases. In 90% of cases the tumor occurs in the long bones, especially near the epiphysis. A case of a 37-year-old female with a recurrent giant cell tumor of the distal radius including the radioulnar articular surface, successfully treated with a wide resection and reconstruction of the articular surface between the radius, scaphoid, lunatum, and ulna by an iliac crest graft, is reported.

[Surgical treatment of groin soft tissue defects]. / Chirurgische Therapieoptionen bei Weichteildefekten der Leiste.

BACKGROUND: Treatment of groin defects remains challenging due to their location and origin. Such defects commonly result from resection of tumours but can also occur after surgical or medical therapy. MATERIAL AND METHODS: From 2003 to 2005, 11 patients were treated with groin defects following radiation therapy and resection of lymph node metastasis, primary carcinoma, and sarcoma. Seven patients received wound closure with rectus femoris muscle flaps, and three had vertical rectus abdominis muscle flaps. One patient was amputated at the hip, and the defect was covered with dorsally pedicled muscle and skin flaps. RESULTS: All flaps healed primarily. There were no secondary infections or lymphorrhea. CONCLUSION: The flaps described here are well vascularised standard flaps which are easily harvested with no major donor site morbidity. They provide sufficient coverage for the groin, reduce long-term conservative treatment, hospitalisation, and problems such as scar contracture.

De novo mutation in the SCN5A gene associated with early onset of sudden infant death.

BACKGROUND: Congenital long QT syndrome (LQTS), a cardiac ion channel disease, is an important cause of sudden cardiac death. Prolongation of the QT interval has recently been associated with sudden infant death syndrome, which is the leading cause of death among infants between 1 week and 1 year of age. Available data suggest that early onset of congenital LQTS may contribute to premature sudden cardiac death in otherwise healthy infants. METHODS AND RESULTS: In an infant who died suddenly at the age of 9 weeks, we performed mutation screening in all known LQTS genes. In the surface ECG soon after birth, a prolonged QTc interval (600 ms(1/2)) and polymorphic ventricular tachyarrhythmias were documented. Mutational analysis identified a missense mutation (Ala1330Pro) in the cardiac sodium channel gene SCN5A, which was absent in both parents. Subsequent genetic testing confirmed paternity, thus suggesting a de novo origin. Voltage-clamp recordings of recombinant A1330P mutant channel expressed in HEK-293 cells showed a positive shift in voltage dependence of inactivation, a slowing of the time course of inactivation, and a faster recovery from inactivation. CONCLUSIONS: In this study, we report a de novo mutation in the sodium channel gene SCN5A, which is associated with sudden infant death. The altered functional characteristics of the mutant channel was different from previously reported LQTS3 mutants and caused a delay in final repolarization. Even in families without a history of LQTS, de novo mutations in cardiac ion channel genes may lead to sudden cardiac death in very young infants.

The relevance of intraoperative pressure and oxygen saturation monitoring during pulmonary artery banding in infancy.

Different methods have been used to define an effective and tolerable degree of pulmonary artery banding (PAB) intraoperatively. As the hemodynamic response determines the results, a reduction of risk could be expected by evaluating several selected parameters and adjusting the band accordingly. Between 1981 and 1986, PAB was performed in 12 infants, three with complex cardiac lesions and nine with complete atrioventricular canal defects. Pressures in the distal pulmonary artery, in a systemic artery or the aorta, and in a central vein were monitored, and oxygen saturation measurements in both great arteries were taken before, during, and after the procedure. Adequate, complicated, intolerable, and contraindicated constriction were recognized and shown on characteristic pressure traces and oxygen saturation shifts. The measurements provided an indirect but reliable indication of the change in intracardiac shunting, and predicted whether the banding would be hemodynamically tolerated. Postoperatively, ten of the infants improved significantly, especially the seven infants previously in a low cardiac output state. One infant died on the day of surgery from acute right heart failure (8% hospital mortality). The results suggest that hemodynamically controlled PAB is an effective palliative treatment with a lower risk than had been previously reported.

The experimental production of a persistent ductus arteriosus for testing catheter closure devices.

An experimental model was constructed to simulate a persistent ductus arteriosus (PDA) in infants. In 21 beagles (mean weight, 8.2 kg), a piece of subclavian artery was interposed between the main pulmonary artery and the aorta, thereby creating a large left-to-right shunt across the short, straight arterial pathway. There were no intraoperative complications. Three animals died postoperatively of stenosing tracheitis, pneumothorax, or bronchopneumonia. The model proved suitable for the serial testing of a new transvenous catheter closure procedure. Occlusion of the shunt was mandatory within a day after placement or severe heart failure would occur. Twelve animals with a released silicone double-balloon plug inside the vascular connection had a long-term follow-up of up to three years. Autopsy findings after the death of the animals at specified intervals revealed smooth ingrowth of the anastomoses and occlusion, by endothelialized fibrous tissue, of the pulmonary and aortic sides of the plugged experimental PDA within a month.

Transvenous double-balloon occlusion of the persistent ductus arteriosus: an experimental study.

A new method of transvenous catheter closure has been developed for closure of a persistent ductus arteriosus (PDA), especially in infants and children. The device consists of a 5F or 6F triple-lumen catheter which carries a detachable silicone double-balloon at the tip. After expanding the distal positioning balloon, the proximal occlusion balloon is placed in the PDA and filled to the required size with radiopaque silicone. As the silicone cures inside the balloon, a solid plug occludes the PDA after it is detached from the catheter. In 21 beagles a short segment of subclavian artery was interposed between the main pulmonary artery and the descending aorta, simulating a PDA. The procedure was tested on these models and proved to be suitable. Within one month the plug was covered with fibrous tissue at the pulmonary and aortic ends, thus ensuring permanent occlusion. The long-term follow-up extended for up to two years and confirmed the biocompatibility of the silicone plug.