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This paper summarizes the results of a systematic literature search on three widely used psychosocial interventions for people with severe mental illness: psychoeducation for patients and relatives, social skill training and physical exercise. Based on this evidence, recommendations given in the S3 guidelines on psychosocial therapies in severe mental illness of the German Society for Psychiatry, Psychotherapy and Neurology (DGPPN) will be reported. Areas of future research are identified.

Since cartilage does not contain any blood vessels, diffusion is the most important transport mechanism for its supply. Although several methods are available for the measurement of diffusion, this study focuses exclusively on NMR methods. Besides the "classic" water diffusion, the diffusion behaviour of ions and polymers in cartilage is also described. In all cases, and at short observation times, diffusion is mostly determined by the water content of the sample. However, the variation of the observation time allows to obtain information also on the internal structure of cartilage. In addition, it is discussed to which extent the individual techniques allow conclusions with respect to degenerative joint diseases, and under which in vivo conditions they can be applied.

The pseudohalogenide sodium azide (NaN3) and the organometallic mercury compound merthiolate (sodium salt of ethyl mercurithiosalicylate) are commonly used as preserving solutions for biomaterials. In the present paper, these preserving solutions were compared for their efficacy in preserving porcine articular cartilage. For this purpose, porcine articular cartilage was incubated with phosphate buffer containing the corresponding amounts of NaN3 or merthiolate. Supernatants were assayed using NMR spectroscopy, and the content of soluble saccharides was determined using the dye Alcian blue. The results obtained clearly indicate that merthiolate is more effective than sodium azide. This makes the former a more suitable preserving agent for the storage of cartilage. A significant decrease in the lactate concentration, and enhancement of the acetate and the N-acetyl resonances indicate degenerative changes in the cartilage. However, when a large excess of sodium azide is used, its efficacy approaches that of merthiolate.

The influence of temperature on stored porcine articular cartilage was studied and the factors underlying degradation identified. For these investigations, specimens measuring 18 mm in diameter were punched out of the articularis humeri of juvenile pigs. These samples were investigated by MR microimaging immediately after preparation, and after storage for three days at +4 degrees C and -18 degrees C. Five smaller (3 mm) cylindrical specimens were then obtained and compared with one another using MR-spectroscopy, relaxometry and biochemical assays. From the experiments we conclude that all analytical methods--with the exception of MR microimaging--are capable of detecting changes in cartilage, and that it is not advisable to keep cartilage frozen, since marked changes, presumably at the cellular level, occur. Storage at +4 degrees C also requires the use of preserving chemicals, as otherwise, the polymers of the extracellular matrix degrade.

The results of studies concerning the mortality rates of both sexes are of great similarity in all industrial countries. For underdeveloped countries, little information is available, but analogue proportions can be supposed. In the nations of the industrialized world males have a significantly higher mortality rate, which shortens their life expectancy in comparison with that of woman. Since about 1970 a deceleration of this development has been observed. The diseases responsible for this fact are ischemic heart disease, lung cancer, accidents, and other traumatic incidences, but also infectious diseases. Concerning the origins of ischemic heart disease, the influence of sex hormones especially on the lipid profile are being discussed; nevertheless, for the enhanced coronary risk of males environmental and behavioral factors seem to be more important than biological reasons. As for carcinosis being a reason for the mortality of males, lung cancer is in the foremost position. Cigarette consumption, as well as the higher exposure to cancerogenic substances related to typically male professions, are held responsible for this. As for other types of cancer, environmental factors depending on gender are strongly considered as a reason for different rates of mortality. Furthermore, sociological explanations for these differing frequencies are being discussed. Occupational differences and the different positions held in working life by each gender are believed to be responsible for the higher rate of mortality among males. Also, risktaking behavior seems to be found more often among males, than among females. A variety of hypotheses based on genetics have been given to explain the different gender-specific rates of mortality, but none of them has yet been proven correct.(ABSTRACT TRUNCATED AT 250 WORDS)

Investigated were 12 aged stroke patients during and one-half year after treatment in hospital; interviews are compared with regard to stress, competence, and coping. The analysis shows that patients become aware of multiple restrictions after their release from hospital. We pointed out that rehabilitation should concentrate more strongly on normal life demands of the patients as well as on their psycho-social resources. A survey of some of the typical coping strategies is included, which could be considered during the rehabilitation process.

On the basis of results obtained from the study of mechanically induced potentials and pulsed 1H-NMR investigations of the condylar cartilage of the TMJ in vitro, the hypothesis is advocated that the internal regulation of condylar growth takes place with the aid of bioelectric signals. Reference in made to the importance of the studies for a future noninvasive diagnosis of condylar growth in the course of functional orthopedic treatment, using "dynamic" magnetic resonance imaging.

156 injuries by a stepladder are reported. In the whole of plunge injuries occurred with a stepladder we found 12%. The painters are involved in 34.6% in this kind of accident, apprentices in 5.8%. Most people were aged from 20-24 and the lower limb was more often injured than the upper limb. Fractures were present in 24% and we registered 48.8 days in which workers were unfit to work. Most patients (95.2%) obtained total rehabilitation.

36 patients with severe neurological diseases (craniocerebral trauma, cerebrovascular insufficiency, meningo-encephalitis, polyneuropathy, paraplegia, intoxication etc.) received for more than 3 months monosaccharides and polyols (Triofusin E 1000) and a 10-%-concentration of crystalline amino acids (Aminofusin L10% kohlenhydratfrei) via the parenteral route in combination with / or exclusively a nutrient-defined diet (Biosorb). Exclusive enteral nutrition was given preference if possible. Numerous laboratory parameters, as for example blood counts, "hepatic enzymes", electrolytes, trace elements, plasma proteins, lipids, urea and creatinine were determined once a week. Substitutions and secondary complications were registered in addition. Iron and plasma proteins had to be substituted most frequently. It could be proved that hypoferremia was caused by insufficient iron supply in case of exclusive/prevailing parenteral nutrition, incorrect application of the iron preparations, inflammatory complications with iron moving into the R.E.S., as well as malabsorption syndromes probably induced by bacteria. Inflammatory complications were also the major cause of protein deficiency syndromes (hypoalbuminemia). In case of relatibely often occurring diarrhea, however, it could clearly be proved that it was not induced by nutrition but was produced by a broad-spectrum antibiosis. Chronically persistent diarrhea with colitis-like colonic changes required enteral feeding with an oligopeptide diet (z.B. Peptisorb) via jejunal feeding tube. Nitrogen balances which were determined after more than 3 months of artificial nutrition formed the basis of a nutritional plan differentiated according to diagnostic groups and stages of disease.

Medical expert opinions about knee injuries are often complicated by lesions of some parts of joint-structures. The assessment of disablement has always to consider, the dimension (objective signs) and the case history. Wellknown anatomic variations are to note. In cases with measurable consequences of accident must be proved adequate traumas because of elasticity, tensile and breaking strength of the structures of the knee-joint. A scale for rating of bodily disability after severe knee-joint injuries is proposed from 5-10% to 30-35%.

The best therapeutic results after trauma are obtained by an optimal and possibly definitive primary treatment. In this case the in-patient and out-patient-treatment have to be a unity. The advantage of a mobile consultation service between highly specialized departments (neurosurgery, thoraxsurgery, blood vessel surgery) is referred to.

A numerically reproducible subdivision by higher and lower chances of survival is suggested in this paper, on the basis of discriminance analysis, for quoad vitam prognostication of patients with severe multiple injuries. The analysis was based on 90 patients with severe multiple injuries under intensive care. Ten severely polytraumatised patients, admitted to hospital from emergency ambulances were evaluated as controls. The subdivision mode prepared provided satisfactory separation and distinction. False assessments accounted for 5.5 per cent of all cases. In no case had survivors been grouped in the low-chance survival category.

In a multicentre study 15 physicians investigated the therapeutic efficacy and tolerance of Faktu suppositories and ointment (containing the active principle of Albothyl, a condensation product of m-cresolsulfonic acid and formaldehyde) in 585 patients with proctological affections. Highly satisfactory results were achieved in 486 patients (83.1%). The following were found to be the main indications: -treatment of wounds after proctological operations, -fresh and fissures, -bleeding internal haemorrhoids, -anal eczema and anal pruritus, -rhagades and perforated or prolapsed external haemorrhoids (perianal thrombosis). None of the investigators reported any persisting adverse side-effects. 16% of the patients complained of local discomfort of varying intensity such as pruritus, burning or irritation. The symptoms mostly appeared on commencement of the treatment and necessitated discontinuation of therapy in 5.3% only. The extremely favourable effect of Albothyl - the active principle of Faktu - is due to its unique mechanism of action: the markedly acid milieu of the substance. Furthermore the Faktu preparations do not contain any steroids and consequently they can be used without any misgivings over prolonged periods.

32 patients in a neurological intensive-care unit with severe disturbances of conscious or impaired function of the swallowing muscles had to receive artificial nutrition on an average of 164 days. They were nourished either parenterally, with the nutrient defined diet Biosorb in combination with parenteral nutrition, or exclusively via a feeding tube. Enteral nutrition was given preference over parenteral nutrition if justified under the clinical circumstances. A multivariable study was intended to investigate to what extent the respective type of nutrition and its individual components met the actual clinical requirements during such a long period. Moreover, the study was intended to demonstrate to what degree adverse factors influenced the different nutritional regimens and necessitated--in addition to infusion programs and dietetics--supplementary steps which might also be of use under completely optimized circumstances.