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Disturbances of cochlear microcirculation are among the most discussed causes of sudden sensorineural hearing loss. Increased levels of cholesterol and fibrinogen seem to act as risk factors for inner ear disorders. Fibrinogen/LDL apheresis greatly reduces the concentration of plasma fibrinogen thus leading to improved cochlear blood flow. In a retrospective case series remission rates of 152 patients suffering from sudden sensorineural hearing loss and resistant to former treatment were investigated after treatment with a single apheresis. Complete remission was reported in 11% of patients, partial remission in 43%. 37% had no change of hearing threshold and 2% reported a decrease in hearing. Rates of complete remissions decreased from 22% within the first 2 weeks after onset of hearing loss to 14% after 6 weeks. In the same period of time rates of partial remissions decreased from 33% to 13%. The present study shows that apheresis achieved complete or partial remission in 54% of patients even after unsuccessful treatment with another therapy and the therapeutic window lies by approximately 6 weeks.

Time-resolved X-ray Excited Optical Luminescence (TRXEOL) has been developed to investigate the optical properties of a green organometallic phosphor, tris(2-phenyl pyridine)iridium, Ir(ppy)3. Using time-gated measurements, we find that the characteristic luminescence band from a neat Ir(ppy)3 film is composed of a fast channel at approximately 534 nm and a slower channel at approximately 580 nm. The implication of this study and the applicability of the technique in the study of light emitting materials are noted.

To take advantage of the cytoadhesive characteristics of Wheat germ agglutinin (WGA) for improved particulate drug delivery, the interaction between WGA-grafted poly(D,L-lactic-co-glycolic acid)-microspheres and Caco-2 monolayers was investigated using bovine serum albumin (BSA) or glycine coated microspheres as a control. Covalent immobilization of WGA by the carbodiimide/N-hydroxysuccinimide-method on 4 microm microspheres yielded a surface density of 9.67+/-1.21x10(6) molecules/particle, whereas 0.22+/-0.04x10(6) WGA-molecules were bound by physical adsorption. After storage for 21 days in HEPES-buffer and treatment of the particles with 5 M urea, 86% of covalently linked lectin was still attached to the particles. At 4 degrees C the Caco-2 binding rate of both, WGA- and BSA-modified particles increased with addition of increasing numbers of particles until saturation was reached at 38150+/-1740 (WGA) or 12066+/-1195 (BSA) microspheres bound/mm(2) Caco-2 monolayer. Inhibition of Caco-2 binding of WGA-functionalized microspheres by chitotriose indicated for specificity of the interaction. As observed by confocal laser scanning microscopy, the fluorescein-loading of the particles was accumulated intracellularly after incubation of Caco-2 monolayers with WGA-modified microspheres contrary to glycine-grafted microspheres. Additionally, in case of WGA-functionalized microspheres the amount of cell associated fluorescein was 200-fold higher than that of the free solution. In conclusion, WGA-modified microspheres are expected to enhance intestinal transport of incorporated drugs due to cytoadhesion provided by the lectin coating.

A case report on a 43-year-old female patient with the longest chronic course of TTP known in the literature is presented. The results of comprehensive diagnostic investigations are described. In neuropsychiatric respect there exists a long standing bipolar affective disorder with a course showing a close association to this medical condition. This significant interaction is discussed in relation to the syndromal picture of the phasic bipolar psychosis and the various neuropsychiatric complications associated with recurrent cerebral thrombotic episodes.

Atrial fibrillation occurred in a 27-year-old patient with a history of globular cardiac enlargement since childhood. Because of the probable causal relationship between the preexisting heart disease-which was supposed to be an enlargement of the left atrium-and the rhythm disturbance, we recommended a surgical intervention. Cardiac surgery revealed a congenital aneurysm of the left atrial appendage which could be resected without any complication. Postoperatively, atrial fibrillation had returned to regular sinus rhythm. The bad prognosis with a high risk of systemic embolism is the reason why early cardiac surgery should be performed after diagnosis of this rare anomaly (20 reported cases) of the left atrium.

We have shown that while on the one hand interactional psychotherapy is based on the nosology of psychoanalysis, in the realization of its methods and techniques it is nevertheless clearly distinguished from the standard approach of psychoanalysis. We developed this specific therapeutic procedure to meet the needs of patients with ego-pathological phenomena, more and more of whom are now turning to the analytic psychotherapist and in whom psychoanalysts are also showing a more and more intensive interest. This is demonstrated by the work of Kernberg (1978), Kohut (1971) and Blanck and Blanck (1978), as well as that of Fürstenau (1977) and König (1975) in the German-speaking world. We perceive the interactional psychotherapy that we have proposed (Heigl-Evers and Heigl, 1973 and 1979) as a therapy for ego-pathogenic phenomena. It is indicated in the case of patients with this type of disorder in a certain phase, usually the initial one. If a patient succeeds, with the help of this treatment, in developing an ego state roughly equivalent to what Freud referred in 1937 as the normal ego and which he considered to be a prerequisite for psychoanalytic therapy, then it should be possible to treat the conflict pathology which is also usually present in such patients, using the classical repertoire of psychoanalysis according to the principle of interpretation.

We consider the depth psychologically grounded psychotherapeutic principle as being distinct from the principle of the classical psychoanalysis, on the one hand, and from the interactional principle derived from ego-psychology and ego-pathology on the other. In our attempt to more closely define the depth psychologically grounded principle we started out from the definition of a psychotherapeutic approach named depth psychotherapy in the so-called psychotherapy guidelines and additionally from an attempt at distinguishing this type of psychotherapy psychoanalysis by Loch. While the definition in the psychotherapy guidelines is at once a localization and a centration and therefore also a specification, Loch in the comparison of depth psychologically grounded psychotherapy and psychoanalysis merely observes differences in quantity, but not in quality. In differentiating the definition of a psychotherapy based upon depth psychology, we oriented ourselves on the intersection metaphor of the origin of neuroses. According to this metaphor, a necrosis manifests itself at a point where, in a manner of speaking, the vertical axis of the life history and the horizontal axis of the actual situation of an individual cross. The crossing signifies that latent pathogeneity with its origin in the life history may, under specific interpersonal conditions which, for their part, are mostly subject to specific socioeconomic and sociocultural conditions or both (pathogenic field), lead to a clinical manifestation. Latent neurotic conflicts are actualized in this way. When an actualized conflict of this kind can be distinguished the following possibilities for focussing on a therapeutic technique offer themselves: 1. The specific triggering (interpersonal) situation (situation of temptation and refusal) for the symptoms in question. 2. The pathogenous social fields, in which the triggering situation arose. 3. The actual interpersonal relationship between patient and therapist. The objective of this psychotherapy in the sense of a modification of the "triangle of insight" (Menninger; Menninger and Holzmann) consists in affording the patient an insight into the triggering (interpersonal) situation, into its inherent pathogenous social field, into the actual interpersonal relationship between patient and therapist, and finally, into the connections existing between these components; in this manner a limited insight into basic internal conflicts can be reaches, and in addition to a diminishing of the symptoms a partial internal reorganization is attempted. The means of reaching this objective present themselves, on the one hand, in the setting, the therapeutic arrangement (neutrality and abstinence of the therapist, handling of the frequency and duration of the individual meetings, and, should the occasion arise, occasional inclusion of significant others), and on the other, in certain types of therapeutic interventions...

After introducing the terms "morality" and "ethics" as defined by Patzig, the discussion focuses on applying to the practicing of psychotherapy the guidelines for ethics in medicine formulated by Beauchamp and Childress, i.e. respect of the autonomy of the patient, the doctor's duty to prevent injury, the obligation to give assistance and the principle of fairness. In particular, it is pointed out that to hale respect for the autonomy of the patient, a thorough and patient inquiry concerning diagnosis, indication and therapy is necessary in order for the patient to develop intrinsic motivation based on insight into his condition and evaluation of the prognosis. In connection with the discussion of the nil nocere, reference is made to the therapist's duty to take a patient's various limits of tolerance into account. Emphasis is also placed on the psychotherapist's duty to "service" his own psychic apparatus with the help of continued education and in-service training, supervision and self-analysis. Applied to psychotherapy, the obligation to give assistance means encouraging the patient to go in the direction of greater autonomy which means the reduction of helplessness. In psychotherapy, problems of distributing resources fairly may be manifested in unjustifiably long waiting lists or in the form of patient selection carried out in a way that is not justifiable on medical grounds but based rather on a tendency to eliminate certain groups of disorders by using contra-indications that are basically rationalizations of countertransference reactions and which are not in keeping with the professional and personal identity of therapists.

Among other factors the prognosis of psychoneurotic and psychosomatic disorders depends upon how soon after the onset of the symptoms a specific psychotherapeutic treatment is initiated. A group of one hundred test subjects, selected at random from among the patients admitted for treatment at a special clinic, was used to determine the factors responsible for the duration of the so-called careers of these patients. Contrary to what was expected it turned out that particularly three factors correlate positively with a speedy admission to psychotherapy. Thus younger psychoneurotic or psychosomatic patients, patients who in their own conception consider their disorder to be psychogenic, and patients in whom psychic or psychosomatic complaints have caused an impairment of their function at work, are the ones who are admitted to psychotherapy relatively soon after the first manifestation of their complaints. It must be noted that none of these three factors is explanatory for any of the others.

We have attempted to demonstrate the importance of the concept of value testing set forth by Hartmann in 1960 in terms of both clinical practice and the theory of psychoanalysis. We use a case study to illustrate the way in which this subfunction of the inner reality testing ties in with the subfunction of signal guilt (the function of affect differentiation as one of the subfunctions of the perception of internal reality) and with the anticipation of the interpersonal effect of one's own behavior and the appropriateness of this behavior as subfunctions of judgment. In conclusion we discuss the suitability of the concept of value testing as a way of relating the psychoanalytic idea of the moral organization of action to the ethics of utilitarianism.