Strategies for handling treatment failure successfully.

This article addresses the topic of treatment failure in psychotherapy. The authors argue that treatment failure is common, that it is rarely discussed, and that clinicians do not manage it effectively. They elaborate on a well-established hypothesis-testing model of clinical work to provide an algorithm that includes strategies clinicians can use to prevent, identify, overcome, and accept treatment failure. They illustrate the use of the algorithm to guide the initially failing treatment of a hypochondriacal attorney. They conclude with a discussion of obstacles to using the algorithm. The algorithm is largely orientation neutral, but cognitive-behavior therapists are likely to find it most compatible with their theoretical model. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Intra-epithelial carcinoma of the cervix uteri. Our experience with treatment, the role of conization

The authors re-emphasize that the sure diagnosis of carcinoma of the cervix depends on histology; having considered a series of 15,000 smears in an article on cytological screening for carcinoma of the cervix. They show that the main prop of this histological examination should definitely be conisation. They furthermore prepare an inventory of the different possible methods of treatment of intra-epithelial carcinoma, stating for each method the advantages and disadvantages of the method. Their attitude to treatment is conservative, and they believe that conisation in every case is sufficient when complete removal of the in situ lesion is carried out whatever the age of the patient is. They state the limits of this method and define clearly the contra-indications for such a scheme of treatment, which can only be carried out routinely with the absolutely necessary cooperation of a cytology laboratory and faultless histology.     

Effect of dental treatment on the lung function of children with asthma

In this preliminary study, the authors evaluated whether dental treatment can trigger a reaction in the hyperactive airways of children with asthma, thereby affecting lung function. They also examined the variables, if any, that predict a change in lung function in relation to dental treatment. They tested the lung function of 57 6- to 18-year-old subjects with histories of active asthma, using spirometry before, immediately after and 30 minutes after routine dental treatment. Results revealed a statistically significant decrease (P < .05) in lung function and a clinically significant decrease in lung function in approximately 15 percent of the subjects.     

Dermoid cysts of the oral cavity

The authors describe ethiology, clinical picture, diagnosis and treatment of the dermoid cyst of oral cavity floor. They show the advantages after using ultrasonography and computer tomography in treatment of these cysts.     

Lifesaving thrombolysis--in the light of contraindications

The authors review the different methodological suggestions concerning thrombolysis, especially from the aspects of the absolute and relative contraindications of the treatment. They present case reports to prove that in patients with life threatening thromboembolic diseases some points of contraindications may be disregarded. They suggest a new strategy of absolute and relative contraindications be made considering the currently available recently introduced thrombolytic therapy.     

A survey of ventilator circuitry changing practices in the UK

The aneurysms of the celiac trunk are the rarest aneurysms of the visceral arteries. From 1958 only 69 cases have been reported in the international literature. They are frequently asymptomatic and their discovery is more often occasional. They can rupture in 15-20% of the cases with a mortality approaching 80% of the cases. This explains the need of a surgical treatment even in the asymptomatic cases. Personal experience in the surgical treatment of a case of aneurysm of the celiac trunk is reported and a survey of the literature on this matter is made.     

Positional anomalies of the intestine in adults

Anomalous intestine positions arise during embryologic development. They are rare in adults and cause uncharacteristic but chronic discomforts. They can produce life-threatening complications at any time. They are thought of too rarely, and radiologically shown anomalies are easily misinterpreted. Frequently they are discovered only during operation. The 178 anomalous intestine positions are here analyzed partly newly named and discussed to facilitate detection, to prevent complications, and to make rational treatment possible. There are 24 different typical forms, which are explained by disturbances of the embryologic rotation, growth, or fixation of the intestine.     

Novel tools for localizing ion channels in living cells

The authors report two cases of colovesical fistula as a complication of diverticular disease. They underline the increasing frequency of this complication, although the less frequent one. They also stress the importance of clinical and instrumental examinations that are several and among which TC scan can be crucial for surgical treatment. The therapy, exclusively surgical, can be made in one or two steps, according to patient status.     

Milieu therapy: toward a definition for reimbursement

The authors identify certain essential elements and processes within the milieu therapy approach that could provide the basis for reimbursement of this treatment modality under insurance. They also examine a philosophical framework, various guidelines, and a mechanism for accountability in the use of this form of treatment.     

Urinary complications of the resectable cancers of the cervix uteri (author's transl)

The authors studied the urinary complications following 721 operations performed between 1960 and 1974 for cervix uterin carcinoma. The surgical method was the one used at the Fondation Curie according to the protocol of treatment. They have noted that: --first, the surgical act as primary treatment (672 cases) was innocuous, as this series showed only 0,6% of the severe complications; in contrast, when the surgery is performed for a recurrence after a total dose irradiation, the severe complications raised to 8%; --secondly, the uretero-hydronephroses following this type of surgery are relatively frequent on the systematic urograms, but most of them are quite asymptomatic and without later sequelae only 0,3% of them required a surgical treatment. The authors analyse the factors influencing the ureteral stenoses, especially the extent of lymphadenectomy and the associated external irradiation. They studied too the ureteral stenoses due to a local recurrence.     

Methods for increasing the service durability of cold rolling mill rolls

Various conditions of heat treatment of low-alloy pearlitic steels, medium-alloy martensitic and pearlitic-martensitic steels, and high-alloy ledeburitic roll steels are studied. Practical recommendations for increasing the quality of roll tools are developed. They consist of the application of cyclic heat treatment, including cyclic subzero treatment. The increase in the service durability of rolls after the implementation of these recommendations under industrial conditions is analyzed.     

How antibiotics work: protein synthesis

1. Antibiotics are important agents for the treatment of infections. 2. They are special chemicals produced by a few species of microorganisms which inhibit the growth of other micro-organisms. 3. They inhibit growth by attacking one of five sensitive sites. 4. A selection of antibiotics attacking the protein synthesis mechanism are identified and their modes of action described.     

Methods for evaluating treatment and rehabilitation progress in patients with stroke]

Based on the contemporary literature review, we have been introduced generally used neurological scales estimating the influence of new method of treatment on stroke progress. They are used to evaluate to treatment and rehabilitation progress. We also paid attention on the necessary elements, which every scale should contain and have been characterized generally used scales in neurological practice.     

Characterization of a de novo 48,XX,+r(X),+r(17) by in situ hybridization in a patient with neurofibromatosis (NF1)

The authors analyze the errors in the treatment of detachment of the retina in children. The errors were found not only in the surgical policy, but in the management of the pre- and postoperative period as well. They suggest rational methods for the pre- and postoperative management of patients with detachment of the retina and adequate schemes of surgical treatment.     

Radiological opacities of the knee after intra-articular injections of osmic acid

Unusual radiological opacities have been observed in 29 cases after intraarticular injection of osmic acid in 113 knees of 72 patients under treatment for a chronic exudative synovitis in different types of rheumatic diseases. They are statistically more frequent after the injection of 200 mg than after 100 mg (33.9 and 15.7% respectively). Most of the time, they are located in the suprapatellar pouch. The opacities appear soon after the injection and can last for several years. They do not seem to have an unfavorable influence on the clinical course. They appear to be caused by a deposition of osmium in synovial fat tissue. From here the osmium might stimulate fibrosis. The radiological image has to be differentiated from intra-articular calcifications, synovial ossifications and various periosteal osteogenic processes.     

Hypertension in pregnancy--chaos in terminology of literature world-wide

The authors submit an account of the terminology of toxemia of pregnancy and hypertension during pregnancy which are used in the world literature. They draw attention to the lack of uniformity which leads to a distortion of statistics. Differences in the nomenclature and incorrect enlistment of hypertension may lead also to an inadequate type of treatment and conduction of delivery. The authors recommend the use of nomenclature based on the pathogenesis and on their own experience. They emphasize the difference in the pathogenesis, therapy, prognosis and prevention of different types of hypertension.     

Experience in using acupuncture reflexotherapy combined with weight-reducing diet therapy in hypertension

AIM: To study the effectiveness of acupuncture in combination with unload diet against hypertension. MATERIALS AND METHODS: 137 patients with mild hypertension have undergone unload diet therapy or therapeutic fasting in combination with acupuncture. Acupuncture therapy was carried out according to the physiological model. The unload diet therapy was performed according to the method of Iu. S. Nikolaev and consisted of voluntary fasting. RESULTS: The treatment resulted in a decrease of cholesterol levels and blood pressure, positive trend in ECG. For 3 years 20 patients with mild hypertension had normal blood pressure. They kept on diet, had short-term courses of fasting, exercised in free-choice regimen. CONCLUSION: Acupuncture in combination with diet therapy are recommended for treatment of blood hypertension. They can be used alone or in combination with drug therapy.     

Laparoscopic intracorporeal anastomosis in the colon using the biofragmentable anastomotic ring--an animal study

The authors report about surgical treatment of herpes simplex encephalitis, although conservative management of this disease is the method of choice in the first place. They draw a lesson from this case that certain cases of large space occupying lesions of infectious origin leading to brain stem compression may require surgical management, even if they customary treatment is conservative.     

What is wrong with end-of-life care? Opinions of bereaved family members

OBJECTIVE: To describe family perceptions of care at the end of life. METHODS: In a representative sample of older people who died from chronic diseases, family members were interviewed about satisfaction with treatment intensity, decision-making, and symptom relief in the last month of life, and gave suggestions to improve care. RESULTS: Interviews were completed with 461 family members, 80% of those contacted. They reported that 9% of decedents received CPR, 11% ventilator support, and 24% intensive care during their last month of life. Family members could not recall a discussion of treatment decisions in 23% of cases. Presence or absence of a living will did not affect the likelihood of no discussion (22% vs 24%, P = .85). Family informants desired more treatment to sustain life in 8% of deaths. They or the decedent wanted treatments doctors did not recommend in 6% of deaths but refused recommended therapies in 18% of deaths. They believed more care to relieve pain or other symptoms was indicated in 18% of deaths. Asked to make positive or negative comments about any aspect of terminal care, 91% of comments on hospice were positive. Nursing home care received the smallest proportion of positive comments (51%). Family members recommendations to improve end of life care emphasized better communication (44%), greater access to physicians' time (17%), and better pain management (10%). CONCLUSION: Bereaved family members are generally satisfied with life-sustaining treatment decisions. Their primary concerns are failures in communication and pain control. Discussions that focus on specific treatment decisions may not satisfy the real needs of dying patients and their families.