Search

Mental distress in medical learners and its consequent harmful effects on personal and professional functioning, a well-documented concern, draws attention to the need for solutions. The authors review the development of a comprehensive mental health service within a large and complex academic medical education system, created with special attention to offering equitable, accessible, and responsive care to all trainees. From the inception of the service in January 2017, the authors placed particular emphasis on eliminating obstacles to learners' willingness and ability to access care, including concerns related to cost, session limits, privacy, and flexibility with modality of service delivery. Development of outreach initiatives included psychoeducational programming, consultation services, and cultivation of liaison relationships with faculty and staff. Significant utilization of clinical services occurred in the first year of the program and increased further over the course of 4 academic years (2017-2021); with a 2.2 times increase in trainees served and a 2.4 times increase in visits annually. In the 2020-2021 academic year, 821 medical learners received services (for a total 5,656 visits); 30% of all medical students and 25% of house staff and fellows sought treatment in that year. In 2021, 38% of graduating medical school students and 27% of graduating residents and fellows had used mental health services at some point in their training. Extensive use of services combined with very high patient satisfaction ratings by medical learners within this system demonstrate the perceived value of these services and willingness to pursue mental health care when offered a resource that is cognizant of, and responsive to, their unique needs. The authors reflect on potential factors promoting utilization of services-institutional financial support, outreach efforts, and design of services to increase accessibility and reduce barriers to seeking treatment-and propose future areas for investigation.

Background: There is still controversy regarding the appropriate operative procedure of distal radius fractures. We reviewed a method of fracture stabilization, which combines the advantages of open fixation and closed reduction. The method is less complex than regular K-wire osteosynthesis. The follow-up treatment is similar to plate osteosynthesis. Methods: Without using any drill-device long K-wires are placed percutaneously in the distal radius. The result of the particular wire-placement is an isoelastic tension in the opposite direction of the common redislocations. This enables an early functional treatment. We reviewed 45 patients and determined the Castaing-Score and the loss of correction. Results: 88.9% showed excellent or good results. The average loss of correction of 2.84° is recognizable lower than within regular K-wire osteosynthesis. Complications are rare and comparable to other closed-reduction procedures. Conclusions: The study confirms the theoretical advantages of the described method and we recommend this technique.

In Australia the utilisation of clay in the construction of landfill liners has recently come under criticism either due to the difficulty in reproducing the laboratory results on site, or because of the potential for cracking of the compacted liner after construction. Realising that clay is weak in tension and given the possibility of certain areas of the liner being subjected to flexure, a testing program was undertaken to determine the effects of placement (compaction), moisture content and internal reinforcement on the potential failure of clay liners. In particular, this paper discusses the load carrying capacity and deformation sustained by compacted clay beams in flexure, and the improvement gained through the introduction of an economical reinforcement in the form of galvanised steel wire netting. Results obtained by flexural bending tests are discussed in detail, and the extent of improvement provided by galvanised wire netting is evaluated.

Two new CT techniques, dynamic multiscan and dynamic sequence, are introduced using examples from initial heart, liver, pancreas and kidney examinations. Dynamic multiscan provides reconstructed CT images at 0.1 sec intervals, permitting improved assessment of the perfusion phase in liver processes and aortocor-onary bypass studies. Dynamic sequence allows the examination of a single anatomical region by using rapid scan sequences with table feed. A single bolus administration of contrast medium is sufficient to display the enhancement of a mass in numerous tomographic planes, as demonstrated in the pancreas and kidney. Both methods raise hopes for improved early diagnosis of smaller masses in parenchymal organs. The decisive advantage of the new technology is the high economy made possible by the tremendous saving in contrast medium dosage.

Because of the possibility of life-threatening late complications by anastomotic aneurysms and the danger of their rupture, all patients in whom a coarctation of the aorta was resected and replaced by a vascular prosthesis must be followed up continuously for life. Their chest x-rays show-in addition to unequivocally normal or pathological findings-sometimes questionable variations of the aortic outline, which must be diagnosed definitely by further investigations. By means of computerized tomography, the suspicion of an anastomotic aneurysm can either be refuted or confirmed in almost all cases. Thus, the invasive examination by aortography, which is desirable before operation of an aneurysm, may be omitted in the group of unsuspicious patients. Out of 198 patients, who received a vascular prosthesis for correction of an aortic coarctation in the time from 1960 to 1980, 27 were examined by computerized tomography because of irregular findings in their chest x-rays. In 6 patients the suspicion of an anastomotic aneurysm was confirmed and could be proved by aortography and reoperation. In 21 patients an aortography could be omitted because of its unsuspicious findings by computerized tomography.

In individual cases the computed tomography renders possible the ascertainment of the coarctation of the aorta. Despite modified examination method (secondary section technique, continuous application of contrast medium) the reliability is insignificant. Therefore, the method cannot be recommended for the primary diagnostics of the coarctation of the aorta. The computed tomography is extraordinarily suited for the detection of aneurysms of anastomoses after operation of coarctations of the aorta. In 50 computed-tomographic examinations of 48 patients 11 times an aneurysm could be ascertained. This high proportion of late postoperative complications is above all to be traced back to the surgical suture material used in the sixties. There were only two falsely positive findings, in which cases also here relevant pathological changes were present. The computed tomography can more exactly than the aortography adopt a definite attitude to the question of the dissection of prostheses or to pseudoaneurysms.

51 patients with rheumatoid arthritis and high rheumatoid factors (mean titres 928) underwent examination for the demonstration of an extraarticular organ manifestation within the scope of the cooperation between the Department of Medicine of the Karl-Marx-University Leipzig and the Institute for Rheumatology of the Academy of Medical Sciences of the USSR in Moscow. The frequency of nodous rheumatism (about 60%) is comparable with the frequency of polyneuropathy. In 20% of the patients a systemic muscle atrophy, a hepatomegaly as well as a Raynaud-syndrome were stated. By means of skin biopsy in 28% perivascular infiltrates were found. Altogether in 6 patients (12%) a participation of the lungs and the pleura, respectively, could be proved. Only rarely a clinically manifest heart disease caused by the rheu-we we found an pericardial effusions in 3 cases. In systemic manifestation, such as myositis, participation of the eyes or vasculitis of the digital arteries with necrosis, were only sporadically to be established. Among 22 patients we found an pericardial effusions in 3 cases. In systemic manifestation in most cases increased parameters of activity were found. From the practical point of view apart from increased titers of the rheumatoid titres and circulating immune complexes (C1q-BT) increased concentrations of the C-reactive protein are prognostically significant. The presence of high rheumatoid factor titres alone as well as the isolated presence of rheumatic nodes must not always be connected with an unfavourable prognosis. When severe extraarticular manifestations are present a possibly early, intensive occasionally extracorporeal treatment is indicated.

The judgment of the function of the left ventricle is computer-tomographically possible using the ECG-regulated cardio-computer-tomography in a temporary resolution of about 0.1 sec. The qualitative and quantitative evaluation of the systolic and diastolic changes of the ventricle in patients with normal CT-findings, with idiopathic hypertrophic subaortic stenosis and with disturbances of motility in chronic ischaemic heart disease confirms the possible functional evidence known from literature. The quantitative parameters, in particular the systolic abbreviation of the axis, allow an estimation of the motility. The measurement of the thickness at the interventricular septum and at the lateral wall of the myocardium as well as the systolic abbreviation of the axis and the left-ventricular ejection fraction are essentially higher in the idiopathic hypertrophic subaortic stenosis than in the normal group. The values of the patients with disturbances of motility in the ischaemic heart disease were clearly below. The diagnosis of the idiopathic hypertrophic subaortic stenosis with response of the size of obstruction by the telesystolic and telediastolic pictures is possible in a high percentage. Sequelae of the chronic ischaemic heart disease, e.g. scars, become visible by a narrowing or an absence of the normal edge of the myocardium. Global and localized disturbances of motility are diagnosable by phase-referred systolic and diastolic ECG-regulated pictures.

It is reported on an at present 32-year-old male patient, in whom at the age of 30 years an excessive mediastinal lipoma was excised. For 12 years the cardiological diagnosis was not clear and could completely be clarified only with the help of the computed tomography of the heart.

Cardial and paracardial space occupations need a rapid, possibly non-invasive diagnosis. The echocardiography and the computer tomography are practically available. At the instance of 17 intracardial space occupations (4 solid tumours and 13 thrombi), which were found in a total number of 600 cardio-computer-tomographies, and several selected peri- und paracardial space occupations the high diagnostic significance of the computer tomography is demonstrated. With the computer tomography a standardized method independent of the investigator is available which in qualitative respect appears of the same value as to echocardiography in the diagnostics of the intracardial space occupations and in the peri- and paracardial space occupations the non-invasive method is the method of choice.