Sexual dysfunctions with antidepressive drugs--results of a physician survey

In a survey throughout Switzerland 7.455 general practitioners and psychiatrists were mailed a questionnaire addressing topics in sexual medicine with regard to antidepressant medication, 940 completed questionnaires (response rate 12.5%) were evaluated. 77.6% of the responders agree that knowledge in sexual medicine is important or very important. Only one half of the physicians judge their competence in sexual medicine as fair or good. There are differences in sexual history taking between general practitioners and psychiatrists; the latter addressing more frequently sexual medicine related questions. Sexual dysfunction before and during therapy with antidepressants is observed less frequently than reported in other studies. Only half of the physicians counsel their patients when sexual dysfunction occur during therapy. Treatment strategies of antidepressant induced sexual side effects are rarely seen. The results emphasize the importance of knowledge and competence in sexual medicine for general practitioners and psychiatrists, both showing interest in continuing education on this topic.     

Subendocardial infarction

To investigate the combination therapy of Western and traditional Chinese medicine on treatment of acute viral myocarditis, 48 patients were randomly divided into 2 groups. The 1st group consisted of 30 patients, receiving the combination therapy of Western and traditional Chinese medicine, including Astragalus membranaceus, taurine, coenzyme Q10 and antiarrhythmics, while the 2nd group consisted of 18 patients, receiving the conventional therapy, including glucose-insulin-potassium (GIK), coenzyme Q10 and also antiarrhythmics. RESULTS: The efficacy of combination therapy of western and traditional Chinese medicine was better than that of conventional therapy in improving the clinical manifestation, negative converting positive EVsRNA in peripheral leukocytes and controlling the premature beats. CONCLUSION: The combination therapy of western and traditional Chinese medicine was an effective method in treating acute viral myocarditis.     

How often is thrombolytic therapy of deep pelvic-leg venous thrombosis indicated?

BACKGROUND: For patients with deep vein thrombosis new thrombolytic regimes are being proposed and demand evaluation in controlled studies. We tested prospectively, how many patients in internal medicine are candidates for thrombolysis. PATIENTS AND METHODS: All available patients with the diagnosis of deep vein thrombosis (DVT) in lower extremities who were admitted to the service of internal medicine in a medium-sized hospital during one year were prospectively evaluated for the indication of fibrinolysis therapy according to the established criteria. RESULTS: A total of 62 patients were enrolled. Fibrinolysis was not proposed in 25 patients aged over 70 years nor in another 9 patients in whom the thrombosis was restricted to calf veins. Nine additional cases had a recurrence of DVT (n = 4) or a history of more than 14 days. Among the remaining 19 patients, fibrinolysis was not performed in 11 because of advanced malignomas (n =4) or other diseases (n = 3) with limited life expectance, enhanced probability of haemorrhage (n = 3) and obvious non-compliance (n = 1). Eight patients were offered thrombolytic therapy, but 5 of them denied consent after being comprehensively informed. CONCLUSION: Obviously by far most of patients admitted to internal medicine for DVT are candidates for standard heparin therapy only.     

Radiotherapy in veterinary medicine (review)

A review of the latest literature concerning the present level of radiation therapy in veterinary medicine is given. In a general section physico-technical as well as biological fundamentals are discussed. In the special part of the paper indications for a radiation therapy of dogs, cats and horses are stated. In this respect the basis for a decision is the TNM-classification into different clinical stages according to the directions of the WHO. Tumors of the hemolymphatic system are very responsive to radiation therapy. While epithelial tumors are sensitive, tumors arising from the mesenchymal tissues react less sensitive. Melanoma and osteosarcoma seem to be resistant to radiation therapy. Besides this, radiation therapy is often questioned by the tolerance of the normal tissue.     

Endocrine ophthalmopathy. Clinical symptoms, classification, diagnostic classification, indications for treatment (author's transl)

The clinical aspects and classification of "endocrine ophthalmopathy" were described. The clinical picture is of importance for the physician in nuclear medicine who is involved with the diagnosis and therapy of hyperthyroidism. In vivo and in vitro investigations in nuclear medicine regarding the classification of ophthalmic findings are derived from disturbances in control of the regulatory systems of the hypothalmas-pituitary-thyroid which are parallel to the ophthalmic processes. The clinical forms of endocrine ophthalmopathy and the thyroid findings which accompany it were systematized and an appropriate therapeutic procedure for the respective anomaly was described.     

Improved discriminative and evaluative capability of a refined version of Skindex, a quality-of-life instrument for patients with skin diseases

The placebo effect will have a growing importance in the field of nuclear medicine as the potentials for palliative therapy with internal sources are realized. It is important for nuclear medicine physicians and their colleagues to be familiar with the role of placebo responses in clinical trials, especially when such trials involve the subjective assessment of pain. A summary of the literature on the placebo effect in pain studies is presented in which traditional values for placebo responses are contrasted with more current thinking in the field. The few published double-blind studies of pain relief after treatment with radiotherapeutic agents are summarized specifically with respect to their cited placebo response.     

Psychologists in geriatric medicine: Results of a national survey.

51 physician directors of geriatric medicine fellowship programs were surveyed on their current and desired involvement with psychologists, perceived areas of expertise of psychologists, comparisons of psychologists with overlapping health care professions, and factors limiting involvement of psychologists in geriatric medicine. Results indicate that psychologists are quite involved in most geriatric medicine training programs and that directors of these programs welcome their greater involvement. Significantly, psychologists and psychiatrists are rated as similar in expertise in most areas of clinical practice. Neuropsychological assessment and family therapy are areas of psychologist expertise that are seen as especially valuable. Factors that may increase psychologist involvement in geriatric medical settings and the special importance of medical settings for the care of older patients are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A method of assessing retraction of a blood clot and spontaneous fibrinolysis and use of this method in evaluating the effects on infusion media on hemostasis

The results of a clinical observation of 30 patients with oral mucosa disease are presented in the article. All patients got "Tantum Verde" as a local treatment in the dose of 15.0 ml 4 times a day for 6 days. The efficiency of the medicine as a mean of symptomatic therapy of acute and chronic oral mucosa diseases is proved as well as prospects for its use both separately and for complex therapy of these diseases.     

Hypernatremia and hypertonic syndromes

Hypernatremia is the most common cause of hypertonicity in small animal medicine. Despite this fact, severe hypernatremia is an uncommon clinical entity in dogs and cats. The causes of hypernatremia are excessive water loss and increased sodium intake. Clinical signs are most often related to CNS dysfunction. Severe hypernatremia should be considered a life-threatening situation and treated as such. Initial fluid therapy should be given with care according to the rate of onset of hypernatremia, as deterioration of the animal's condition is a common sequela. The determination of the cause of hypernatremia and the treatment can be both challenging and rewarding. The other notable hypertonic syndrome in small animal medicine is hyperosmolar nonketotic diabetes mellitus. Judicious management of this disease with fluid therapy and insulin is the standard therapy. An understanding of the pathophysiology is essential to their diagnosis and appropriate medical management.     

Behavioural science and behavioural medicine.

A new field of endeavor for applied psychology is the development of behavioral medicine. One of its applications lies in rehabilitation therapy, in the study and use of EMG biofeedback for the treatment of the neuromuscular disorders of stroke hemiplegia. The background of this work is reviewed, and problems are outlined that require exploration (e.g., whether biofeedback works best in conjunction with physical therapy, what are the best techniques, and what kind of patient will respond). (French summary) (51 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychosomatic disease and the problem of causation

Despite its impressive rate of growth in the past decades, an increasing amount if dissatisfaction with the area of psychosomatic medicine is reflected in recent literature. The discipline's failures relate to concepts of pathogenesis and therapeutic application of research findings. These failures are explained as a necessary consequence of the philosophical tenet of mind-body dualism which underlies medical theory. It is urged that advocates of psychosomatic medicine give the concept of "holism" meaning at the most fundamental level by establishing a rational basis for theory, or else forsake this line of research for others which yield causal relationships conductive to effective therapy.     

Truth at the bedside in a historical overview

To tell the truth and withhold information were old topics in the history of medicine, whereas the term 'informed consent' appeared first in 1957. The historical development manifests different standpoints and central dimensions in the perspective of medicine as well as of theology, philosophy, arts, jurisprudence and psychology and with regard to diagnosis, etiology, prognosis and therapy. Physicians and patients are parts of their society and culture and are therefore depending on the dominant types of communication and concepts of health, disease and death.     

Further evolution toward effective therapy for acute ischemic stroke

The effective treatment of acute ischemic stroke remains an important goal of modern medicine and substantive advances are occurring. Recently, thrombolytic therapy with tissue-type plasminogen activator was approved for selected patients with acute ischemic stroke when therapy is started within 3 hours of onset. Streptokinase therapy for acute ischemic stroke has not been shown to be effective and is associated with an increased risk of hemorrhage, although it was not evaluated as early after stroke onset as tissue-type plasminogen activator. Various types of neuroprotective interventions are effective in animal models, but none has yet been proven effective in patients. In the future, combinations of thrombolytic and neuroprotective drugs may be used to attempt maximum rates of recovery after acute ischemic stroke. For combination therapy to achieve its maximum potential, patients with acute ischemic stroke will have to be carefully selected and treated.     

Arterial oxygen saturation over time and sleep studies in quadriplegic patients

Therapeutic nuclear medicine is rapidly developing as an additional treatment modality in oncology. Its unique characteristics are the systemic, yet selective delivery of radiation doses in target tissues, its non-invasiveness, the relative lack of immediate and late side effects, and the advantage that uptake and retention in the tumor can be pre-assessed by tracer studies. Many different tumor seeking radiopharmaceuticals are being used for therapy by different routes and a variety of targeting mechanisms. The current clinical role of radionuclide therapy is briefly reviewed, as well as more general aspects and considerations, such as mechanisms for tumor targeting, the choice of radionuclide labels, radiopharmacy, drug delivery, radiation protection, dosimetry and toxicity.     

Advances in hospice care

Hospice care developed in part as a reaction to the impersonal and technology-dependent end-of-life care offered by modern medicine. Unique approaches to care that emphasize interdisciplinary team management of troublesome symptoms and the promotion of quality of life as defined by the patient, are finding their way into all aspects of health care. Symptom control measures have expanded to include chemotherapy, radiation therapy, and multimodal therapies. Both the development of a unique knowledge base and advances in research have fostered the integration of hospice and palliative care into mainstream medicine.     

Highlights lecture of the European Association of Nuclear Medicine and the World Federation of Nuclear Medicine and Biology Congress, Berlin 1998. Where next and how?

Nuclear medicine benefits not only the people of developed countries but also those who are in developing or deteriorating countries. The combination of diagnostic imaging, tissue characterisation, function measurement and targeted therapy is powerful and cost-effective. This congress provides a sample of nuclear medicine's contribution to the world.     

An introduction to music therapy: helping the oncology patient in the ICU

Oncology and critical care patients have unique and complex problems. With the explosion of technology and advances in medicine, many intensive care units are seeing an increase in oncology patients. Intensive care units are stressful and frightening; music therapy is a noninvasive holistic approach to bridging the gap between oncology patients and intensive care units.     

Homeopathy: a field of work for the veterinarian

It is generally known that Homeopathy and other so-called alternative methods of treatment have recently been gaining acceptance. The profession of lay animal practitioner is no longer a rarity in Switzerland. For some, alternative medicine is one phenomenon among others in a saturated health market and thrives on the fact that classical medicine does not yet extend to all areas. For others, the search for alternatives corresponds to a justified demand by the practitioners and denotes an extension of the medical disciplines. The Workshop for Veterinary Acupuncture and Homeopathy (AGVAH) was founded several years ago by veterinarians in Switzerland. It represents the professional interests of its members and upholds their right to practice these forms of therapy. The ensuing debate between classical and alternative medicine questions not only the basis of Homeopathy and similar forms of medicine, but also that of scientific thought. The realization that any scientific approach has its limits can open a door to deeper understanding of traditional occidental medicine.     

The motivation to use complementary medicine healing methods. Study of a general internal medicine and orthopedic patient sample

436 patients from two different clinics of internal medicine and one orthopaedic unit were asked to fill a questionnaire on their attitude towards and use of alternative medicine. Of the 272 questionnaires returned, 235 could be used for analysis. 42.6% of all analysed persons confirmed use of alternative medicine. About half of them were motivated to do so by their nursing staff. Homeopathy was by far the most frequently used method. Persons who used alternative medicine were characterised by a distinct environmental awareness and regular sports activity. They had also often had positive experience of alternative methods in childhood. On the other hand, age, sex, education, duration of the treated disease and success of conventional therapy did not correlate significantly with the use of alternative medicine. An essential motive for the need to seek help by alternative therapists was the opinion that conventional forms of treatment would concentrate too much on the purely physical side of a health problem. All in all, users of alternative medicine did not seek confrontation with conventional medicine but rather sought a real complement to conventional forms of treatment.     

Guidelines for the diagnosis and treatment of chronic obstructive lung disease--effective and necessary

The independent practice of the art of medicine which doctors took for granted in the past has ended. With almost revolutionary speed, insurers, administrators and politicians have distributed the unique relationship between doctors and their patients. Treatment and diagnostic guidelines in different clinical entities have been based on the pillars of medicine - controlled studies and/or a common consensus among specialists and practitioners. These dynamic activities have enriched our knowledge and practice of medicine. However, only the continuing direct collaboration of physicians at all levels and constant adjustment to changing conditions make these guidelines applicable to the ever changing world of medicine. Chronic obstructive lung disease is one such clinical entity that requires uniform guidelines. Issues that have to be addressed are not only who belongs in this category but also what interventions, such as lateral chest radiographs, CT scans and sleep lab investigations, should be performed as well as the indications for costly therapies such as long-term home oxygen, alpha-1-protease inhibitor augmentation therapy and lung transplantations. Instead of looking at guidelines at straitjackets that limit excellence in the practice of medicine, medical associations should treat them as an opportunity to define their own quality standards. By doing so, the medical community would eliminate the influence of administrative directions or gatekeeper decisions, while patients and the whole population would greatly benefit.