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Einleitung: Das fruher haufig endemisch beobachtete Staphylococcal Scalded Skin Syndrome (SSSS) tritt heute nur noch selten auf. Durch eine hamatogene Aussaat von Staphylokokkentoxin Exfoliatin A (ETA) oder B (ETB) nach lokaler Staphylokokkeninfektion wird ein „Syndrom der verbruhten Haut“ mit disseminierter Blasenbildung verursacht. Fallbericht: Am 14. Lebenstag erkrankte ein mannliches Fruhgeborenes (30+5 Schwangerschaftswochen, 1065 g Geburtsgewicht) an einer perioralen Staphylodermie und wurde empirisch uber 6 Tage antibiotisch behandelt. Die Lasion heilte ab, allerdings zeigte sich nach einem symptomfreien Intervall am 26. Lebenstag ein Rezidiv. Trotz sofortiger intravenoser antibiotischer Therapie entwickelte sich binnen weniger Stunden ein Erythem mit schlaffer Blasenbildung, welche histologisch eine subkorneale Epidermisablosung zeigte. Durch Anderung und Erweiterung des Antibiotika-Regimes auf eine Kombinationstherapie aus Cefotaxim, Flucloxacillin und Clindamycin konnte das Fortschreiten der Exfoliation verhindert werden. Supportiv kamen eine Analgesie, parenterale Flussigkeitssubstitution und lokal antiseptische Masnahmen zum Einsatz. Die Erkrankung heilte folgenlos aus. Aus dem Primarherd konnte ein ETA-produzierender S.-aureus-Stamm isoliert werden. Als Ursache des fulminanten Krankheitsbildes wurde ein Mikrotrauma im Bereich des Naseneingangs durch eine nasogastrale Sonde vermutet. Diskussion: Das SSSS zeigt bei Fruh- und Neugeborenen eine hohere Inzidenz als bei alteren Kindern. Ursachlich hierfur konnten niedrigere Antikorper-Titer gegen Exfoliatine in Kombination mit einer verminderten Elimination der Toxine durch renale Unreife sein. Eine rasche Diagnosestellung sowie der rasche Beginn einer adaquaten antibiotischen Therapie sind unerlasslich, um Sekundarinfektion, Flussigkeitsverlust mit Elektrolytstorung, Tod oder eine endemische Ausbreitung zu verhindern.

ZusammenfassungDie in Deutschland verfügbaren modernen Antidepressiva bewirken zwar bereits jetzt eine deutliche Besserung der Symptomatik im Sinne einer „Response”, bewirken aber nur bei etwa 40% der Patienten im ersten Behandlungsansatz eine Remission der affektiven Symptomatik. Bei initialem Nichtansprechen führen auch Kombinationen, Augmentationen oder Wechsel (Switch) der Antidepressiva wiederum nur bei einem begrenzten Anteil von Patienten zur Remission, was noch nicht zufriedenstellt. Desiderate in der antidepressiven Therapie sind weiterhin der verzögerte therapeutische Effekt oder Nebenwirkungsprofile, die in einer längeren Behandlung Adhärenzprobleme bergen. Die am häufigsten verschriebenen Antidepressiva sind die SSRI. Der Begriff SSRI beruht auf dem begriffsbestimmenden Wirkmechanismus, indem alle Substanzen mit sehr hoher Affinität an Serotonin-Transporter binden und damit die Wiederaufnahme von Serotonin hemmen. Vortioxetin ist ein modernes Antidepressivum, das von der US-Zulassungsbehörde FDA und der europäischen Behörde EMA 2013 zugelassen wurde. Es besitzt ein neuartiges pharmakologisches Profil und gehört der Klasse sogenannter multimodaler Antidepressiva an: neben einer Hemmung des Serotonintransporters ist Vortioxetin v.a. ein Antagonist am 5-HT-1D-, 5-HT-3- und 5-HT-7- sowie ein Partialagonist am 5-HT-1B- und Agonist am 5-HT-1A-Rezeptor. Speziell dieses Rezeptorprofil könnte Vorteile im Nebenwirkungspektrum, v.a. bezüglich sexueller Dysfunktion, und bei kognitiven Funktionen sowie evtl. bei Angstsymptomen besitzen. Daher stellt die nun auch in Deutschland verfügbare Substanz Vortioxetin eine interessante Option dar.

Oxygen saturation and carbon dioxide values should be monitored during high-frequency jet ventilation (HFJV). Modern transcutaneous P𝒞𝒪2 (Ptc𝒞𝒪2) measurement allows the estimation of ventilation efficiency. We studied how tests of lung function could predict carbon dioxide elimination during HFJV. Lung function tests from 180 adult patients undergoing rigid bronchoscopy were analysed as factors affecting carbon dioxide elimination. The lung function test results showed a significant relationship with the efficiency of carbon dioxide elimination; the greatest impairment of carbon dioxide elimination was found in patients with combined abnormalities of lung function. Further factors associated with difficult carbon dioxide elimination were male gender and elevated body weight. Of the patients investigated, 72% had normal carbon dioxide elimination, whereas in 23% hypercapnia could be avoided only by increasing the driving pressure. The prevalence of abnormal preoperative lung function test results predicts (sensitivity 76%, positive predictive value 27%) impaired carbon dioxide elimination during jet ventilation and rigid bronchoscopy

Die Verhinderung eines Rezidivs ist das zentrale Therapieziel in der Behandlung der Schizophrenie. Jedoch erleiden schatzungsweise 75 % aller Schizophreniepatienten innerhalb von funf Jahren ein Rezidiv. Jedes Rezidiv kann das Krankheitsbild verschlechtern und das Risiko fur psychosoziale und berufliche Nachteile erhohen. Eine kontinuierliche und langfristige Behandlung kann dieses Risiko deutlich verringern. Limitierender Faktor einer kontinuierlichen Langzeittherapie ist allerdings die Medikamenten-Adharenz, die durch zahlreiche Faktoren beeinflusst wird. Naturalistische Studien haben gezeigt, dass Depot-Antipsychotika im Vergleich zur oralen Medikation konsistent ein besseres Outcome aufweisen, z. B. in Form einer reduzierten Rezidivrate und des Ruckgangs stationarer Aufenthalte. Auch zahlreiche Metaanalysen von randomisierten kontrollierten Vergleichsstudien von Depot-Antipsychotika vs. orale Formulierungen zeigen diese Vorteile, jedoch sind die Ergebnisse nicht in allen Metaanalysen konsistent. Ergebnisse aus kontrollierten Studien spiegeln die Gegebenheiten der taglichen Praxis nicht adaquat wider. In naturalistischen Studien zeigen sich die Vorteile von Depot-Antipsychotika deutlicher. Die vorliegende Ubersicht reflektiert die derzeitige Schizophrenie-Behandlung und diskutiert einen breiteren Einsatz von Depot-Antipsychotika anhand der verfugbaren Daten. Zudem werden Befurchtungen und Vorurteile von Arzt und Patient bezuglich Antipsychotika-Langzeittherapie mit Depotformulierungen erortert und Empfehlungen fur die Praxis ausgesprochen.

Background Dronedarone is a new antiarrhythmic agent that has only recently been approved for the therapy of atrial fibrillation (AF). Results regarding a broader spectrum of patients and experience accumulated in clinical practice are still very scarce. Therefore, we prospectively investigated the efficacy and tolerance of dronedarone in a real life setting. Methods and results The study included 191 patients (85 women) aged 63±9.9years with a history of paroxysmal or persistent AF. Follow-up time was 14.3±4.9months. In patients with persistent AF, sinus rhythm was restored using electrical cardioversion prior to dronedarone administration. Each patient underwent standard ECG on a daily basis during the first 4days of treatment, and on days 7, 30 and 90, resp. After that, the patients had a follow-up visit every three months. Creatinine, creatine kinase, and hepatic enzymes were closely monitored. Clinical history was meticulously taken at multiple follow-up visits. Dronedarone maintained sinus rhythm in 33.5% (95% CI: 27%–40%), and AF recurrence rate was high: 66.5% (95% CI: 60%–73%). Adverse effects occurred in 31.9% (95% CI: 27%–38%) of the patients and necessitated permanent discontinuation of dronedarone in 22% (95% CI: 17%–27%). Conclusions The results suggest that dronedarone may not be superior to available antiarrhythmic agents and caution against its use as a first line therapy in AF.

Die Analyse von Emotionsausdruck, Emotionserkennung und Emotionserleben hat in der Psychiatrie in vielen Studien Anwendung gefunden. Fur einige psychische Erkrankungen haben die Studien zu emotionaler Kompetenz wissenschaftlich und klinisch relevanten Erkenntnisgewinn erbracht, insbesondere fur das Verstandnis der Schizophrenie konnten wichtige Beitrage geliefert werden. Im vorliegenden Artikel wird die Datenlage zu Veranderungen in den Bereichen Emotionsausdruck, Emotionserkennung und Emotionserleben bei psychischen Erkrankungen (Schizophrenie, Depression, bipolare Storung, Borderline-Erkrankung) dargestellt, im Unterkapitel zur Schizophrenie wird zusatzlich auf die Emotionserkennung im Vorverlauf der Schizophrenie eingegangen.

Roxindole (5-Hydroxy-3-(4-phenyl-1,2,3,6-tetrahydropyridil-(1)-butyl)-indol) is a newly developed compound with a high dopamine autoreceptor agonistic potency at D2 receptors. Evaluation of roxindole for clinical purposes in psychiatric patients revealed that the substance has contrary to expectation merely negligible antipsychotic but considerable antidepressive effects. Interestingly it is nearly devoid of any side effects. To further characterize the endocrine effects, 1 mg roxindole was applied at 09:00 to 6 male volunteers and the effects compared to placebo. From 08:00 to 13:00 blood samples were drawn every 30 min. No effect on adrenocorticotropin and cortisol secretion was observed, neither mean plasma concentrations nor area values differed significantly. 90 min after roxindole administration an enhanced release of growth hormone could be observed, comparison of mean hormonal concentration revealed statistical significance (p < 0.05). Also the area values differed significantly (roxindole vs. placebo mean +/- SD 18.1 +/- 17.1 vs. 7.7 +/- 8.0 micrograms x h/l; p < 0.05). After roxindole also a pronounced reduction of prolactin plasma levels from 5.3 +/- 1.4 micrograms/l to 1.1 +/- 0.4 microgram/l within 150 min could be observed. Mean plasma concentrations (p < 0.05) and area values differed significantly (roxindole vs. placebo mean +/- SD 14.8 +/- 13.5 vs. 34.4 +/- 18.1; p < 0.05). Roxindole had no effect on blood pressure parameters and heart rate. The major findings of the present exploratory study are, that roxindole has potent effects on the facilitation of growth hormone secretion and the inhibition of prolactin release. Both findings are complementary and point also to interesting postsynaptic dopamine receptor agonistic effects.

Staphylococcal scalded skin syndrome (SSSS) was often endemic in the past but is nowadays rare. The hematogeneous spread of exfoliative toxins A (ETA) or B (ETB) produced by specific Staphylococcus aureus strains causes a scald-like eruption with disseminated bullous lesions.A perioral impetigo lesion occurred on day 14 of life in a preterm male infant (1,065 g, 30 weeks of gestational age). Empiric antibiotic therapy with cefotaxime and vancomycin was given for 6 days and led to complete resolution. A Staphylococcus aureus strain was isolated. After a symptom-free interval a relapse was noted on day 26 of life. Despite restarting the antibiotic therapy immediately the initial lesion expanded, and disseminated flaccid blisters on an erythematous base appeared within a few hours. On histological examination the cleavage was in the level of the granular layer. There was no mucosal involvement, and the Nikolsky I sign was positive. The antibiotic therapy was changed to a combination of cefotaxime, flucloxacillin and clindamycin which rapidly stopped progression of the exfoliation. Supportive therapy included adequate analgesia, parenteral rehydration, and application of local antiseptics. The preterm infant completely recovered. In the primary lesion an ETA-producing Staphylococcus aureus strain was isolated. Nasal microtrauma by a nasogastric tube was assumed to have caused the fulminant disease. At the same time, no other Staphylococcus aureus infections were seen in our Department of Neonatology.According to the literature, the incidence of SSSS is higher in premature infants and newborns than in older children. Possible causes include lower antibody levels against exfoliative toxins and renal immaturity. Rapid diagnosis and immediate appropriate antibiotic therapy are essential to prevent secondary infection, dehydration with electrolyte disturbance, death, and endemic spread.

Fall Bei einem 26 Jahre alten Patienten waren andernorts ein Hypopharynx-Divertikel reseziert und eine Myotomie des M. cricopharyngeus durchgefuhrt worden. Da zusatzlich eine A. lusoria vorlag und somit die Gefahr einer Gefasverletzung, hatte man sich fur einen transzervikalen Zugangsweg entschieden. In der Folge war es zu rezidivierender Fistelbildung durch die Hautwunde gekommen. Trotz 4-facher Nachoperationen kam es zu keiner Ausheilung. Der Patient wurde uns mit deutlicher Gewichtsabnahme sowie persistierenden retrosternalen Schmerzen vorgestellt. In der Osophagusmanometrie zeigte sich, dass immer noch ein deutlich erhohter Ruhedruck im oberen osophagealen Sphinkter bestand. Unter der Annahme, dass die Myotomie nicht vollstandig erfolgt war, entschieden wir uns, diese Masnahme im Rahmen einer Revision zu komplettieren. Der Pharynx wurde mit einer fortlaufenden Naht nach Conley verschlossen. Die Fistel heilte aus, es kam zu keiner erneuten Rezidivbildung.

The progress in sophisticated and complex operating methods for intrathoracic procedures demands reliable lung separation with the possibility of one-lung ventilation. Patients with thoracic traumas and pulmonary emergencies can confront any anaesthesiologist with the need for lung separating procedures. This review describes the contemporary procedures for lung separation. The special aspects of difficult airway management during one-lung ventilation and the indications for one-lung ventilation are described in detail. The pathophysiological changes during one-lung ventilation and strategies to avoid hypoxemia and to preserve adequate oxygenation are discussed.

OBJECTIVE In a prospective, randomised, double-blind study the effects of FiO (2) of 0,5 with CPAP and a FiO (2) of 1.0 without CPAP on oxygenation and pulmonary shunt during one-lung ventilation (OLV) were examined. METHODS In 20 patients undergoing thoracotomy (ASA II/III) two sequential ventilation methods were used during OLV: a) FiO (2) of 1.0 (OLV-100) and b) a FiO (2) of 0.5 in N (2)O combined with CPAP of 5 cm H (2)O to the non-ventilated lung (OLV-CPAP), whereby the sequence in 10 patients was OLV-CPAP followed by OLV-100; and the opposite in the remaining 10 patients. Operating conditions were graded by the surgeon. RESULTS OLV-CPAP was associated with a better oxygenation and a lower shunt compared to OLV-100 (paO (2) : 198 +/- 40 mmHg vs 181 +/- 38 mmHg; p < 0.05 and Qs/Qt: 30 +/- 6 % vs. 34 +/- 8 %; p < 0.01, respectively). The different sequence of the ventilation methods did not cause significant differences in the results. The surgical conditions were not impaired by the CPAP of 5 cm H (2)O. CONCLUSION The application of low FiO (2) with CPAP provided a better oxygenation and a lower pulmonary shunt during the OLV compared to high FiO (2) without CPAP.

ZusammenfassungDie Wirksamkeit der medikamentösen Rückfallprophylaxe in der Behandlung der Alkoholabhängigkeit wurde insbesondere für Acamprosat und Naltrexon nachgewiesen. Dennoch ist unklar, inwieweit eine pharmakologische Behandlung unabhängig von der individuellen Charakteristik des behandelnden Patienten wirksam ist. So stellt sich die Frage nach differenzierten Indikationskriterien. Aktuelle Studienergebnisse geben Hinweise darauf, dass Symptome wie Angst, Depression, somatische Störungen und Suchtdruck, aber auch typologische Differenzierungen hilfreich sein können, die Wirksamkeit der Behandlung abzuschätzen. Generell erscheint die pharmakotherapeutische Rückfallprophylaxe wirksamer bei Patienten mit einem frühen Beginn der Alkoholabhängigkeit, die auch nach Cloninger als Typ II definiert werden. Auf Basis der Typologisierung nach Lesch gibt es Hinweise darauf, dass Acamprosat insbesondere bei Typ I (+ II), Naltrexon eher bei Typ III und IV die Rückfallwahrscheinlichkeit mindert. Weitere, insbesondere prospektive klinische Studien unter Einbeziehung neurobiologischer und pharmakogenetischer Parameter sind nötig, um zu überprüfen, ob sich aus diesen Hinweisen differenzierte Therapieempfehlungen ergeben können.

Techniques to separate the airways to both lungs were employed in the laboratory by renowned physiologists like Pfluger and C. Bernard to study gas exchange. Pfluger's catheter, as used by Wolffberg in 1871 in the dog, essentially constituted an early example of endobronchial single lumen tube, and was to be the first airway separator introduced into man by Loewy and v. Schrotter in 1905 in experiments on circulation. As a variation of this device the carinal hook made ist appearance used by Hess in 1912 in rabbits. While the endobronchial catheters afforded airtight access to only one lung at a time for concomitantly studying ventilation in both lungs, a short tracheal cannula was combined with one introduced into the left main bronchus by Head in 1889, constituting as it were the prototype of double lumen (DL) tubes applicable to rabbits and turtles even. Werigo described 1892 a coaxial DL-tracheostomy cannula for dogs which construction principle was adopted in the first DL-bronchoscope used in man. In lung surgery during the 30s and 40s the ventilated lung was prevented from drowning by pus or secretions from the lung under surgery by sealing off ist main bronchus, either by endobronchial intubation or by a bronchial blocker inserted alongside the endotracheal tube. This principle gave rise to sophisticated devices, from the fixed combination of tube and blocker to the present-day tube housing a movable blocker. Remarkably, DL-intubation in its proper sense then was performed in bronchospirometry only. This technique was introduced by Jacobaeus upon suggestion of Liljestrand when dissatisfied with the restriction to sequential spirometry by customary bronchoscopic catheterization, relying on Frenckner's ingenious DL-bronchoscope. Rubber DL-tubes were developed by Gebauer 1939 and Zavod 1940 exclusively with bronchospirometry in mind, even E. Carlens primarily constructed his tube to improve this procedure. After its usage in over 100 bronchospirometries it was introduced for the first time in November 1949 for its familiar purpose: the resection of a tuberculous abscess in the right upper lobe. Once introduced into thoracic anaesthesia, the DL-principle so far fostered a wide variety of tube designs.

Relapse prevention in schizophrenia is a key aim in therapy. However, it is estimated that approximately 75% of patients with schizophrenia relapse within five years. Each relapse might worsen the disease and increase the risk of psychosocial and work-related disadvantages. A continuous long-term therapy is able to reduce this risk, but medical non-adherence, which is influenced by numerous factors, is a limitation. Naturalistic studies show that depot-antipsychotics compared with oral antipsychotics lead consistently to a better outcome, for example by reducing relapse rates or hospitalisation. Numerous meta-analyses of randomised controlled trials comparing oral versus depot-antipsychotics also show this advantages. However these results are not consistent in all meta-analyses. Results of controlled studies do not appropriately reflect the reality of daily practice. The advantages of depot-antipsychotics are shown more distinctly in naturalistic studies. The following review reflects the current therapy of schizophrenia and discusses adequately a broad application of depot-antipsychotics based on existing data. In addition, concerns and prejudices of physicians and patients against antipsychotic long-term therapy and depot-formulation are discussed and a recommendation is provided.

Background: Gas exchange during high-frequency jet ventilation (HFJV) for prolonged rigid bronchoscopy (RBS) is usually monitored by arterial blood gas analysis. Capnography of expired gases during brief HFJV discontinuation may be a reliable and noninvasive supplemental method. Capnography can be performed either for single breaths or with respiratory rate (RR) reduced to 10 . min -1 . The aim of this study was to demonstrate that capnography during short periods of HFJV discontinuation represents a reliable measure of PaCO 2 during prolonged RBS. Methods: We prospectively investigated 100 consecutive patients (75 male and 25 female) undergoing HFJV for RBS. HFJV was delivered through the rigid bronchoscope at the following settings: working pressure 1.2 bar, rate 100 . min -1 , F 1 O 2 0.99, t i /t tot 0.6. The light guiding channel ending at the distal tip of the rigid bronchoscope was used for gas sampling. Capnograms were assessed at 5 min intervals and compared to PaCO 2 from arterial blood samples drawn simultaneously. The accuracy of single breath CO 2 sampling was compared with sampling at RR=10 . min -1 . Results: Mean duration of RBS was 30±21 min. A significant correlation between capnography (PetCO 2 ) and arterial blood gas analysis (PaCO 2 ) was observed, being r=0.90 for the RR= 10 . min -1 method and r=0.91 for the single breath method. Mean difference between PaCO 2 and PetCO 2 was 0.37±0.2 kPa throughout the entire study period. No significant differences between single breath sampling or sampling at RR=10 . min -1 were observed. Conclusion: Capnography performed during short periods of HFJV discontinuation reliably and noninvasively reflects PaCO 2 during prolonged endoscopic procedures. Capnography during HFJV for RBS may reduce the frequency of arterial blood gas sampling, the duration of unmonitored intervals and costs.

Unter dem Oberbegriff Hoch-Frequenz Ventilation (HFV) findet sich eine heterogene Gruppe von Beatmungstechniken, denen allen eine mindestens 4mal hohere Beatmungsfrequenz gemeinsam ist, als sie bei normaler Spontanatmung vorliegt. Sie unterscheiden sich unter anderem durch den Frequenzbereich, welchen sie innerhalb des Spektrums von 60–2400 Impulsen pro Minute abdecken:„High Frequency Positive Pressure Ventilation“ (HFPPV), „High Frequency Jet Ventilation“ (HFJV),„High Frequency Pulsation“ (HFP),„High Frequency Jet Oscillation“ (HFJO), „Forced Diffusion Ventilation“ (FDO) und „High Frequency Oscillation“ (HFO) [2]. Der zweite Teil des Namens bezieht sich auf die stosweise Applikation von Beatmungsgas unter hohem Druck durch dunne und ungeblockte Leitungen in die nach ausen offenen Atemwege. Da relativ grose Gasvolumina durch englumige Leitungen und Dusen hindurchfliesen, werden die Gaspartikel auf sehr hohe Geschwindigkeiten beschleunigt. Dadurch entstehen die charakteristischen Stromungsgerausche, welche die Einfuhrung des ⊳ „Jet“-Begriffs begrundeten. Im Zusammenhang mit der Beatmungsfrequenz hat es sich eingeburgert, bei

Between 1986 and 1996, 16 infants and children less than 11 years of age (m = 11, f = 5) underwent resections for acquired or congenital tracheobronchial stenoses. During this period, various techniques of total intravenous anaesthesia (TIVA) were employed (midazolam, fentanyl, pancuronium; propofol, fentanyl, pancuronium). During the phase of dividing the airways, high-frequency-jet ventilation (HFJV) into the trachea or the main bronchi by 8-12Fr catheter(s) was applied for 10-75 min with driving pressures between 0.3-1.8 bar, frequencies between 100-200/min, I:E ratio between 1:4-1:1, and FjetO2 1.0. Catheter position was controlled visually, gas exchange was monitored by pulse oximetry and blood gas analysis. There were two incidents of transient hypoxaemia (paO2 less than 60 mmHg), and 4 cases of hypercapnia (paCO2 more than 45 mmHg). No complications due to the HFJV-catheter technique, such as barotrauma or aspiration were seen. All children were kept postoperatively on a ventilator due to swelling of the airway anastomosis. In 5 children ventilator treatment exceeded 7 days, 3 children were discharged tracheostomised. These observations serve to confirm that HFJV is capable of maintaining gas exchange during tracheal resection in infants and children, if the following prerequisites are met: 1. Tracheobronchial pathology suitable for poststenotic placement of jet catheter. 2. No respiratory impairment by parenchymal pathology. 3. Monitoring by continuous visual control of respiratory mechanics, pulse oximetry and blood gas analysis. Cardiopulmonary bypass should be applied if airway pathology precludes safe placement of jet catheters, or in the presence of parenchymal respiratory failure.

A method for the determination of β-endorphin and β-endorphin fragments in human plasma was developed. β-Endorphin-related peptides were extracted from plasma using octadecasilyl-silica cartridges. Extracts were subjected to re versed-phase high-performance liquid chromatography (HPLC). Extracts as well as HPLC column eluates were assayed using a multiple radioimmunoassay system; several antibodies directed against various distinct regions of the β-endorphin molecule were employed. Using this method, evidence for the presence of multiple β-endorphin fragments in the plasma of healthy young volunteers (under normal conditions) was obtained.

Several studies in clinical neuroscience have focused on the analysis of expression of emotions, identification of emotions and experience of emotions. These empirical studies produced certain insights into emotional competency in different mental diseases, most of them in schizophrenia. The current article gives a description of the scientific data about alterations in emotional competency in several mental diseases (e.g. schizophrenia, depression, bipolar and borderline diseases) and links the data, if possible, with clinical relevance with a special focus on emotional competency in prodromal schizophrenia.

Changes in time course effected by cortisol suppression and the relationship of these changes to the plasma dexamethasone concentration of suppressor and non-suppressor patients are described in this report on a combined pharmacokinetic-pharmacodynamic model. Thirteen depressed patients (8 suppressors and 5 non-suppressors) received an intravenous dose (1.5 mg) of dexamethasone. The drug-induced effect changes are found to lag behind, in time, the plasma drug level changes. To accurately relate the temporal relationship of effect changes to plasma dexamethasone levels, a pharmacodynamic model (sigmoid-Emax) was combined with a pharmacokinetic model that incorporated an effect compartment. The magnitude of the time-lag was quantified by the half-time of equilibration between concentrations in the hypothetical effect compartment and the plasma dexamethasone levels (t1/2keo). The t1/2keo of the nonsuppressing group was about 50% of that of the suppressing group, indicating that for a given plasma level the onset and termination of effect for the nonsuppressing group is about two times more rapid than for the suppressing group. Moreover, the model can estimate the effect-site concentration that causes one-half of the maximal predicted effect (EC50), a measure of an individual's sensitivity to dexamethasone. The receptor sensitivity (as determined from the EC50 ratio) of the suppressing group was about twice that of the nonsuppressing group.

Im Bereich von Anasthesie und perioperativer Versorgung lassen sich fur die Bronchoskopie 3 Indikationsfelder abgrenzen: Umgang mit schwierigen Atemwegen Umgang mit differenzierten Zugangen zu den Atemwegen Uberwachung und Unterstutzung operativer Verfahren (▸ Kap. 7)

Perforation of the oesophagus, as well as a pneumothorax are described as complications of the use of a nasogastric feeding tube. Clinical tests to determine correct placement are noted to be unreliable and the importance of radiological control, especially in the unconscious patient, ist stressed. The suspected diagnosis of oesophageal perforation should be verified without delay to immediately initiate conservative or surgical treatment.

To investigate the effect of dexamethasone dosage upon the outcome of the dexamethasone suppression test (DST) and the role of concurrent plasma dexamethasone concentrations, four different dexamethasone dosages were administered to 119 hospitalized depressed patients (0.5 mg: n = 12; 1.0 mg: n = 30; 1.5 mg: n = 42; 2.0 mg: n = 35). Independent of the dosage, dexamethasone plasma concentrations at 4.00 p.m. were lower in DST non-suppressors than in suppressors, although differences were statistically significant only for the 1.5-mg and 2.0-mg dosages. Our findings confirm recent reports that the actual plasma concentration of dexamethasone at 4.00 p.m. does not determine DST outcome.

In an open clinical trial the azepine derivative B-HT 920 was administered to patients with schizophrenia, paranoid type (according to ICD-9 and DSM-III criteria), in order to examine whether dopamine autoreceptor stimulation exerts antipsychotic effects. Twelve patients participated in the study and received the test drug orally for up to 28 days in a dose range from 0.3 to 1.2 mg/day. The following results emerged: in four patients a significant amelioration (reduction of initial BPRS scores by more than 50%) of psychotic symptomatology was observed; eight patients remained without improvement of psychopathology. Psychomotor activation was observed in seven patients, and prompted termination of the trial in two cases. No other marked adverse effects of B-HT 920 were noted, including EEG, ECG, and clinical chemistry parameters. As it was to be expected from the pharmacology of B-HT 920, plasma prolactin concentrations were significantly reduced two hours after oral application of a single dose of the drug. It remains to be clarified whether chronic treatment with B-HT 920 induces antipsychotic efficacy within as yet unidentified subsamples of schizophrenic patients. The observed activating effects of B-HT 920 may focus future investigative efforts toward study samples where negative symptoms predominate. In einer offenen klinischen Prufung wurden Patienten mit einer paranoiden Schizophrenie (nach ICD-9- und DSM-III-Kriterien) mit dem Azepin-Derivat B-HT 920 behandelt, um zu prufen, ob Dopamin-Autorezeptoragonisten antipsychotisch wirksam sind. Insgesamt zwolf Patienten nahmen an der Untersuchung teil, die, bis auf eine Ausnahme, mindestens sechs Monate medikationsfrei geblieben waren. Die Prufsubstanz wurde oral in einer Dosierung von 0.3 bis 1.2 mg pro Behandlungstag bis zu einer Dauer von 28 Tagen gegeben. Vier Patienten zeigten unter der Behandlung eine deutliche Besserung (Verminderung der initialen BPRSPunktsumme von 50%). Acht Patienten blieben ohne Besserung. Diese Ergebnisse sind in Ubereinstimmung mit klinischen Untersuchungen, bei denen Apomorphin niedrigdosiert verabreicht wurde. Eine psychomotorische Aktivierung wurde bei sieben Patienten beobachtet, die bei zwei Patienten so deutlich ausgepragt war, das die klinische Prufung bereits am Tag 1 abgesetzt wurde. Nebenwirkungen zeigten sich weder bei Beurteilung der extrapyramidalen Motorik noch bei EEG-, EKG- und klinisch-chemischen Parametern. Die Prolaktin-Plasmaspiegel waren jeweils zwei Stunden nach Verabreichung einer Einzeldosis erniedrigt. - Die Frage, ob eine langerdauernde Behandlung mit B-HT 920 bei bestimmten Formen der Schizophrenie antipsychotisch wirksam ist, konnte in dieser Studie nicht ausreichend geklart werden. Die beobachteten antriebssteigernden Effekte sollten in kunftigen Untersuchungen bei Patienten mit einer schizophrenen Minus-Symptomatik abgeklart werden.

A 26-year-old white male patient had undergone resection of a diverticulum of the hypopharynx and myotomy of the cricopharyngeal muscle elsewhere. A transcervical approach had been chosen owing to the presence of an arteria lusoria and the associated risk of vessel injury. The patient had subsequently had recurrent fistulas through the skin incision, which had not resolved despite four further operations. He presented in our department with significant weight loss and persistent retrosternal pain. Esophageal manometry revealed that resting muscle tone in the upper esophageal sphincter was still significantly elevated. Assuming that the earlier myotomy had not been completely successful, we decided to complete this operation as revision surgery. The pharynx was closed with a running suture using the Conley technique. The fistula healed, and there were no further recurrences.Complete and careful dissection of all muscle fibers back to the mucosa is essential, as well as complete removal of the diverticulum if this operation is to be successful when performed by the transcutaneous approach. Recurrent diverticula are not the only possible complication; persistent pharyngeocutaneous fistulas can also arise.

The initial results of planetary radar experiments carried out by the DLR in collaboration with American and Russian groups are presented. The case and future prospects for a planetary radar project in Europe are reviewed. It is shown that the necessary capability and technical facilities for crucial radar follow-up observations of near-Earth objects such as 1996 JA1 already exist in Germany.

The ability of naltrexone to increase hypothalamo-pituitary-adrenocortical (HPA)-axis activity was recently reported to be associated with its effects on the reduction of craving for alcohol. We now present data showing naltrexone to be more efficacious in female alcoholics. Since HPA-axis might be interpreted as a key mechanism of action that could explain the observed gender differences in the abstinence maintenance treatment of alcohol addiction.

The progress in sophisticated and complex operating methods for intrathoracic procedures demands reliable lung separation with the possibility of one-lung ventilation. Patients with thoracic traumas and pulmonary emergencies can confront any anaesthesiologist with the need for lung separating procedures. This review describes the contemporary procedures for lung separation. The special aspects of difficult airway management during one-lung ventilation and the indications for one-lung ventilation are described in detail. The pathophysiological changes during one-lung ventilation and strategies to avoid hypoxemia and to preserve adequate oxygenation are discussed.

In a prospective, randomised, double-blind study the effects of FiO (2) of 0,5 with CPAP and a FiO (2) of 1.0 without CPAP on oxygenation and pulmonary shunt during one-lung ventilation (OLV) were examined.In 20 patients undergoing thoracotomy (ASA II/III) two sequential ventilation methods were used during OLV: a) FiO (2) of 1.0 (OLV-100) and b) a FiO (2) of 0.5 in N (2)O combined with CPAP of 5 cm H (2)O to the non-ventilated lung (OLV-CPAP), whereby the sequence in 10 patients was OLV-CPAP followed by OLV-100; and the opposite in the remaining 10 patients. Operating conditions were graded by the surgeon.OLV-CPAP was associated with a better oxygenation and a lower shunt compared to OLV-100 (paO (2) : 198 +/- 40 mmHg vs 181 +/- 38 mmHg; p0.05 and Qs/Qt: 30 +/- 6 % vs. 34 +/- 8 %; p0.01, respectively). The different sequence of the ventilation methods did not cause significant differences in the results. The surgical conditions were not impaired by the CPAP of 5 cm H (2)O.The application of low FiO (2) with CPAP provided a better oxygenation and a lower pulmonary shunt during the OLV compared to high FiO (2) without CPAP.

We investigated the preference of Cave molly males to associate with a receptive or a non-receptive female while body contact was prevented but water-borne cues were allowed to reach the male. Both in light and in darkness, males did not prefer the receptive female. Water-borne chemical cues (pheromones) seem to be absent or they are not detected/used by males, respectively., Istraživali smo način na koji mužjak špiljske ribe Poecilia mexicana odabire receptivnu odnosno nereceptivnu ženku, pri čemu je tjelesni kontakt bio onemogućen, ali su čimbenici nošeni vodom mogli doprijeti do mužjaka. Niti na svjetlu niti u tami mužjaci nisu preferirali receptivne ženke. Proizlazi da vodom nošenih tvari (feromona) nema, ili ih mužjaci ne raspoznaju, odnosno ne koriste.