Altona, Germany


Altona, Germany
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Fegert J.M.,Universitatsklinikums | Petermann F.,University of Bremen
Kindheit und Entwicklung | Year: 2011

Systematic examinations of whether negative events and experiences during youth and childhood have an effect on a person's life have increased. In 2011 various research, care, and support initiatives concerning children and adolescents traumatized or stressed by sexual abuse, child abuse, and neglect will be launched. In Germany thorough review is necessary. Low-threshold advisory services and forms of evidence-based psychotherapy are recommended. © Hogrefe Verlag, Gottingen 2011.

Naumann U.,Universitatsklinikums Bochum | Mavrogiorgou P.,Universitatsklinikums | Pajonk F.-G.B.,University of Gottingen | Juckel G.,Ruhr University Bochum
Anasthesiologie Intensivmedizin Notfallmedizin Schmerztherapie | Year: 2012

Psychosis can cause multiple psychiatric and somatic emergencies. Due to the complex character of the disease the communication and accessibility of the patient can be severely disturbed. In the pre-clinical emergency medical care the etiology of a psychosis remains often unclear, the most common causes are schizophrenia and drug-induced psychosis. Frequent emergencies are states of psychomotor agitation, self-endangerment and endangerment of others including suicidal tendencies/acts as well as catatonic and manic states. Antipsychotic drugs and benzodiazepines are the most efficient pharmacotherapeutic treatments. Extrapyramidal side effects of the prescribed medication can also cause the need for urgent medical care. In any case needs to be considered a severe somatic comorbidity. It is particularly necessary that all available information at the scene of emergency should be transferred to the clinicians since the further diagnostic and therapeutic assessment will rely hereon. © Georg Thieme Verlag KG Stuttgart • New York.

Pillhofer M.,Universitatsklinikums | Ziegenhain U.,Universitatsklinikums | Nandi C.,Universitatsklinikums | Fegert J.M.,Universitatsklinikums | Goldbeck L.,Universitatsklinikums
Kindheit und Entwicklung | Year: 2011

In recent years the prevention of child abuse and neglect (CAN) has become an issue of particular interest in Germany. Nevertheless, objective and representative prevalence rates ofCANaremissing. Therefore official statistical data as well as scientific studieswere reviewed and critically discussed in order to estimate the prevalence of CAN. Criminal records show incidences of less than 1%per year,whereas retrospective survey studies indicate a lifetime prevalence of >10 %. It is concluded that the existing statistical data are inadequate for objective conclusions about the prevalence of CAN and their longitudinal development. Thus it would be desirable to install a national strategy for data collection in Germany following the examples of Anglo-American and other European countries. © Hogrefe Verlag, Gottingen 2011.

Posttraumatic stress disorder (PTSD) is a common consequence of abuse and maltreatment during childhood and adolescence. There is strong evidence for the efficacy of trauma-focused cognitive behavioral therapy (Tf-CBT) after sexual abuse. This pilot study describes feasibility and preliminary treatment effects after mixed maltreatment types including domestic violence. 15 participants (six female; age M = 10.5, SD = 3.7) completed Tf-CBT. PTSD symptoms were analyzed after therapy. Reasons for dropping out are described for three patients. After treatment, there were significantly fewer symptoms compared to pre-treatment (CAPS-CA total symptom severity score: pre-treatment M = 40.6, SD = 10.5; post-treatment M = 15.2, SD = 14.3, p < .001, d = 1.8). Few drop outs occurred due to avoidance behavior and stressed caregivers. In addition to previous studies with sexually abused children, this study provides preliminary evidence for the effectiveness of Tf-CBT in a sample of patients with PTSD related to mixed maltreatment types. However, psychosocial stability of patients and caregivers is required. © Hogrefe Verlag, Gottingen 2011.

Schizoaffective disorders, acute and transient psychoses, and delusional disorders can be located on a continuum from schizophrenia to mood disorders. This theory of a psychotic continuum is supported by research data on genetic, biologic, phenomenological, course related and prognostic characteristics especially of schizoaffective disorders. In contrast, studies on neuropsychological impairments in the psychotic continuum are rare. This limited empirical base will be outlined; two own studies on cognitive performance in bipolar schizoaffective disorders and delusional disorder are presented. Neuropsychological studies extend the theory of a psychotic continuum on gradually increased cognitive impairments between the disorders. Implications for psychiatric diagnostics are discussed.

Hartmann M.,Universitatsklinikums
Tagliche Praxis | Year: 2013

Erysipelas is a severe soft tissue infection usually caused by streptococci. The infection is restricted to the dermis and subcutaneous tissues. Treatment with antibiotics is essential. Clinically is characterized by the rapidly spreading redness and swelling, lymphadenopathy and general symptoms, blistering and superficial haemorrhage are common. The leg is the commonest site, and there is mostly an epithel lesion as a possible portal of entry. The usual treatment is group G penicillin. The median treatment duration is 10 days. Adjuvant measures are anticoagulation, non-steroidal anti-inflammatory agents, dressings, immobilization and treatment of local predisposing factors such as inter- digital tinea.

A case of a chronic lymphatic leukemia (CLL) of a chemicals worker, who was exposed to ethylene oxide (EO) at the workplace for several years, is presented. From the occupational health point of view, it must be assessed whether CLL, according to the new classification of Non-Hodgin lymphoma, fulfils the preconditions of an occupational disease. The decisive factors for the causality assessment are the current findings on the human carcinogenicity of ethylene oxide, the estimation of the quantitative risk after occupational exposure to EO and the assessment of temporal processes between exposure and disease.

Och U.,Universitatsklinikums
Padiatrische Praxis | Year: 2011

This overview describes the possible application of enteral nutrition in paediatrics. If nasogastric or gastric tube feeding, application as periodic bolus or by an infusion food pump, standard or elemental food - the nutrition and the alimentotherapy which will be tolerated best can be selected from all these possibilities. Enteral nutrition is frequently used for preterm babies and babies with drinking weakness and dysphagia in paediatric neurology, as well as in oncology and for patients with anorexia. The nutrition therapy with the help of a tube also shows a greater success for some innate metabolic disorders. When planning the enteral nutrition, incompatibilities of the patient such as allergies or intolerances must be considered. The energy content of the food must be calculated in such a way that the children preferably grow according to the percentile average and increase in weight.

Diseases previously known as »chronic myeloproliferative diseases« are grouped as »myeloproliferative neoplasms« since the update of the WHO classification in 2008. All members of this group are neoplastic diseases of hematopoetic cells that are only slowly progressive and lead to massive proliferation of one or several cell lineages in the bone marrow, mostly accompanied by an increase of leukocytes, thrombocytes and/or erythrocytes circulating in the peripheral blood. Prominent members within this division of neoplasms are chronic myeloid leukemia (CML), polycythemia vera (PV), essential thrombocythemia (ET) and primary myelofibrosis (PMF) besides other, rare diseases. The Philadelphia-chromosome was described in patients with CML in 1960 and is a long-standing part of the diagnostic criteria for this disease. In 2005 the JAK2 mutation V617F was described in different frequency in all Philadelphia-negative MPN and was thus introduced into the WHO criteria for MPN in 2008. For a diagnosis of a specific MPN, clinical, pathological and molecular criteria thus have to be regarded together and are described.

Kohnert M.,Universitatsklinikums
Gynakologische Praxis | Year: 2014

The timing of weaning is a personal decision made by the mother in context of her social setting. The decision is influenced by subsequent pregnancies, maternal career planning or maternal health. Abrupt weaning is only necessary in case of unexpected maternal child separation or severe maternal illness. Routine weaning of the infant after six months is following the child's lead; after the child starts solid food, it will diminish breastfeeding and the weaning process begins gradually eliminating one breastfeeding session every two to five days or shortening sessions slowly or lengthening the time between nursing sessions. Weaning by means of "cold turkey" ("at a moment's notice") will often lead to an infection of the breast (mastitis) and is therefore not recommended. Drugs for weaning: Primary weaning (mother's choice or medical indications): first choice is cabergoline 1 mg in the first 24 hours after delivery (2 tablets); secondary choice is bromocriptine 2×2,5 mg/day (2x1/2 tablet) for ten days. Secondary weaning (if methods of routine weaning are not successful or in case of medical indications): cabergoline 2 tablet/day for 2 days or bromocriptine 2×1/2 tablet/day for 10 days. In any case one should explain especially cardiac and cerebral side effects of both drugs to the patient. Patients with preeclampsia or hypertension should be carefully examined before applying cabergoline or bromocriptine because of the side effect of birth drugs which can accumulate with the symptoms of these diseases.

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