The "troubled" child from the existential analysis viewpoint

Fundamental principles of the "Logotherapy and Existential Analysis", which was founded by FRANKL and further developed by LANGLE, are examined from the view of the Clinical Child and Adolescent Psychology with regard to theoretical aspects as well as to their practice-oriented relevance for the Child and Adolescent Psychiatry and Pediatry. Applying the "existential analytic diagnostic scheme" central subject-matters of finding the purpose in life as personal and existential basic motivations are considered in the differential-diagnostic proceedings and permits--as demonstrated by examples--a holistic consideration of specific problems. The indication of a functional, counseling-attendant or psychotherapeutic intervention depends on the impairment in the dimensions of personal and/or existential meaning-frustration. Finally the significance of personal attitude towards differential diagnosis as well as towards the motivation for therapy is emphasized, a criterion non considered in actual versions of international diagnostic schemes as ICD-10 or DSM-IV.     

Evaluation of the dental status from he viewpoint of denture requirements in the adult population of Hungary]

Authors found a rather high number of missing teeth of the Hungarian population, whereas the claim of the patients to dentures is less than the capacity of the dental professionals. The percentage of the patients wearing fixed and/or removable dentures is only around 50% (mean value), in the aesthetically not disadvantageous cases (i.e.: classes 1/a; 2/a; Fábián-Fejérdy) only 30-40%, but in the aesthetically disadvantageous cases 70-80% (i.e.: classes 1/b; 2/a/1; 3; Fábián-Fejérdy). The percentage of the men wearing dentures is higher than the percentage of the men (61.9% and 44.9% respectively). Authors concluded that, the most important expectations of the patients to dentures are aesthetic. The injurious effects of not reconstructed missing teeth have minor effects on the patients motivation.     

Consequences of cholestasis from the hepatologist's viewpoint

Chronic cholestasis is associated with a variety of symptoms and dysfunction of most organs. Among them, jaundice and pruritus are the first to be recognized, usually prompting the patients to see a physician. Besides the skin, however, cholestasis also affects, inter alia, the metabolism of plasma lipids and fat-soluble vitamins, as well as bone and liver. In the following article the pathogenesis and therapy of metabolic disturbances and organ dysfunctions occurring frequently in patients with chronic cholestasis are discussed.     

Consequences of cholestasis from the pathologist's viewpoint

The present review summarizes extrahepatic obstructive cholestasis and its hepatic morphological sequelae. The first part focuses on early and late changes visualized in liver biopsies. In the second part, pathogenic mechanisms involved in liver fibrosis are discussed. A third section deals with the morphological differentiation of liver atrophy occurring in obstruction and secondary biliary cirrhosis. Biliary obstruction induces a wide array of typical early and late changes of liver morphology. They comprise the visible accumulation of bile in hepatocytes and macrophages, liver cell damage (cholate stasis; apoptosis), alterations of cellular organelles, cytoskeleton and junctions, portal tract edema with cellular infiltrates, ductular reaction, bile infarcts, bile extravasation and, in the later stages, fibrosis and partial nodular change. The pathogenesis of septal fibrosis appears to involve, besides fibroblasts, myofibroblasts probably derived from the Ito cell system. Myofibroblasts seem to closely follow proliferating ductules which, therefore, have a crucial role in hepatic tissue remodeling. There are considerable structural similarities between liver atrophy occurring in biliary and/ or portal vein obstruction and secondary biliary cirrhosis. In both situations partial nodular change ensues, but with preserved vascular relations. In addition, both changes are partially reversible in the early stages of the disease. Irreversible late stages of atrophy and secondary biliary cirrhosis are, therefore, maximum alterations of a similar, dynamic process, involving part of the liver in the first case and the whole organ in the second, depending on the level of obstruction.     

Perioperative problems posed by patients suffering from vascular diseases. The viewpoint of the anesthetist-resuscitator]

The presence of benign proliferative lesions is a risk factor for the development of cancer. However, only a subset of individuals presenting with benign lesions goes on to develop cancer. It is a major challenge of cancer research to identify those individuals at increased risk for this neoplastic progression. It has been suggested that individuals with inherent genomic instability may have a predisposition for cancer development. The hypothesis is presented that this genetic instability could be quantified through the analysis of apoptosis in biopsies of benign lesions. It is further conjectured that genetic damage-dependent apoptosis might serve as a prognostic indicator to identify individuals at increased risk for cancer.     

Pain management from the viewpoint of the anesthetist

In a pain clinic team the anesthetist has the knowledge and experience concerning the peripheral and central neural blockades. The value of the diagnostic, prognostic and therapeutic blockades is today under discussion. Patients with a chronic regional pain syndrome (CRPS) can find some relief with a series of somatic and sympatholytic blockades, which allow an aggressive physiotherapy. Epidural steroid injections are helpful in radiculopathic pain. In other types of pain (neuropathic, postherpetic, failed back surgery syndrome, abdominal, cervico-cephalgic, phantom limb pain und tumor pain) the spinal cord stimulation (SCS) and the intrathecal morphine pump are approved methods for intactable pain.     

Settlement fraud from the viewpoint of the defendant

When a physician by attempting to gain an illegal financial advantage for himself or another person damages the property of somebody in such a way that he produces or maintains an error under false pretense or distortion or suppression of facts, the physician is guilty of fraud. The attempt is a criminal offense. Following terms are discussed in this paper: illegal financial advantage, damage of property, intent, and status proceedings.     

Quality assurance from the viewpoint of the surgeon

The problem of global standardization, clinical documentation, and confidentiality of methods in quality control are discussed. It is concluded that conventional methods of quality assurance should be further developed in order to avoid investments into administration tools that have not yet proved any effectiveness worldwide. Future developments should be orientated to achieve benefits for the patient and to promote surgical excellence.     

Suicide in the Bible from the current psychodynamic viewpoint. "There Saul took a sword and fell upon it"

After a short introduction to psychoanalytical interpretation of literature in general and in the Bible, the stories of Samson and King Saul are examined on the basis of modern psychoanalytical aspects of suicidology (narcissistic theory, object relation theory, self psychology). Samson's beginning is hallmarked by the uncertainty of his parents, their megalomanic fantasies which are projected on the child. His relationships are characterized by violent emotions, intensive conflicts on intimacy and distance and also raging anger at insults and privation. In his suicide he fuses himself with the highly ambivalent primary object and destroys it at the same time he destroys himself. People with narcissistic personality are considered to be extremely suicidal especially in combination with the destructive potency of narcissistic anger.     

Health effects of airborne pollutants, particularly in swine confinement stalls, from the viewpoint of occupational medicine]

From the point of view of occupational respiratory medicine, an overview on potential health effects of airborne pollutants particularly in swine confinement houses is presented. Airway diseases are the most frequent occupational disorders among farmers in many countries around the world including Germany. Due to various methodological reasons, epidemiological studies in farming populations are more difficult to perform than among non-farmers. Major constituents of swine confinement dust include bacteria, endotoxin, mites, fungal spores, and animal dander. Gaseous pollutants include ammonia, methane, and hydrogen sulfide. In a variety of cross-sectional studies, high prevalences of respiratory symptoms and non-obstructive (and obstructive) bronchitis and Organic Dust Toxic Syndrome have been reported in pig farmers. Nasal and bronchial provocation challenges with swine confinement dust include influx of neutrophils and other inflammatory cells as well as mediators. In cross-sectional and longitudinal studies, endotoxin turns out as the probably most relevant parameter associated with lung function impairment. Further studies are clearly needed focusing on the prognosis of non-obstructive bronchitis in swine farmers and on health effects of reducing airborne contaminants in swine confinement houses.