Integrierte psychotherapeutische Behandlung von schwer psychisch Kranken: Zwischen Wünschbarkeit und Versorgungsrealität

Zusammenfassung: In den letzten 3Jahrzehnten hat sich die Behandlung von Menschen mit schweren psychischen Erkrankungen nachhaltig verändert. Das Bestreben, ein gemeindenahes, niederschwelliges Versorgungsangebot für diese Personengruppe bereitzustellen, hat zu einer Diversifizierung von gemeindepsychiatrischen Behandlungs-, Wohn- sowie Rehabilitationseinrichtungen für die Arbeitsintegration geführt. Auch die Behandlung akuter Krankheitsphasen erfolgt vermehrt gemeindenah und ambulant. Unabhängig davon wurde eine Reihe von Psychotherapieansätzen für die gleiche Patientengruppe entwickelt, die trotz ihrer Evidenzbasierung nur begrenzt Eingang in die psychiatrische Regelversorgung gefunden hat. Die Koordination verschiedener Versorgungsstrukturen und ihre Verknüpfung mit evidenzbasierten psychotherapeutischen Behandlungsinhalten sind deshalb Eckpfeiler der Weiterentwicklung. Diese Arbeit skizziert den gegenwärtigen Entwicklungsstand und vermittelt einen Überblick über die verschiedenen evidenzbasierten Psychotherapieansätze, die angesichts der Behandlungs- und Rehabilitationsziele wichtige Komponenten einer patientenzentrierten integrierten Versorgung von schwer und anhaltend psychisch Kranken bilde

The Use of the "Preclosure” Technique for Antegrade Aspiration Thrombectomy with Large Catheters in Acute Limb Ischemia

Purpose: This study was designed to assess retrospectively short- and mid-term outcomes of the use of a suture-mediated closure device to close the antegrade access in patients undergoing percutaneous aspiration thrombectomy with large catheters for acute leg ischemia. Methods: Between November 2005 and February 2010, a suture-mediated active closure system (ProGlide® 6F, Abbott) was placed before arterial sheath (mean 9F, range 6-12F) introduction in 101 patients (74 men, 73%, mean age 70.1±12.6years standard deviation). Data regarding mortality, complications, and factors contributing to vascular complications at the access site was collected for 6month after the intervention to detect device-related problems. As a coincidence, 77 patients had follow-up visits for a duplex ultrasound. Results: There were a total of 19 vascular complications (19%) at the puncture site, all of which were of hemorrhagic nature and none of which consisted of vessel occlusion. Two major outcome complications (2%) occurred. A retroperitoneal hematoma and a serious inguinal bleeding required additive treatment and did not result in permanent sequelae. Nine cases involved death of which eight were not attributable to the closure and one remained unclear. Successful closure was achieved in 95 patients (94%); additional manual compression was sufficient in the majority of the remaining patients. Numerous factors contributing to vascular complications were encountered. Conclusions: With acceptable short- and mid-term outcomes, the "preclose” technique can be a reliable option for the closure of a large antegrade femoral access even for patients at a high risk of vascular complications, such as those undergoing aspiration thrombectom

Mapping quantitative physiological traits in apple ( Malus × domestica Borkh.)

Efficient breeding and selection of high-quality apple cultivars requires knowledge and understanding of the underlying genetics. The availability of genetic linkage maps constructed with molecular markers enables the detection and analysis of major genes and quantitative trait loci contributing to the quality traits of a genotype. A segregating population of the cross between the apple varieties 'sFiesta' (syn. 'sRed Pippin') and 'sDiscovery' has been observed over three years at three different sites in Switzerland and data on growth habit, blooming behaviour, juvenile period and fruit quality has been recorded. QTL analyses were performed, based on a genetic linkage map consisting of 804 molecular markers and covering all 17 apple chromosomes. With the maximum likelihood based interval mapping method, the investigated complex traits could be dissected into a number of QTLs affecting the observed characters. Genomic regions participating in the genetic control of stem diameter, plant height increment, leaf size, blooming time, blooming intensity, juvenile phase length, time of fruit maturity, number of fruit, fruit size and weight, fruit flesh firmness, sugar content and fruit acidity were identified and compared with previously mapped QTLs in apple. Although 'sDiscovery' fruit displayed a higher acid content, both acidity QTLs were attributed to the sweeter parent 'sFiesta'. This indicated homozygosity at the acidity loci in 'sDiscovery' preventing their detection in the progeny due to the lack of segregatio

Bark Beetle (Coleoptera: Curculionidae: Scolytinae) Community Structure in Northeastern and Central Minnesota

Large-scale surveys of forest insects provide two distinct benefits: the detection of invasive and exotic species that cause millions of dollars of damage annually to forest and ornamental industries, and the addition of a wealth of species distribution and diversity information to the scientific community. We intensively surveyed the Northeast and East-central regions of Minnesota from 2006-2008 for invasive/exotic and native Scolytinae using Lindgren funnel traps baited with one of four lures (a/β-pinene, ultra-high-release ethanol [EtOH], EtOH+a-pinene, and Ips 3-part). We captured 16,841 scolytines (representing 25 genera) of which over 40% were Ips pini (Say) and Ips grandicollis (Eichhoff). We found two exotic Scolytinae, Scolytus multistriatus (Marsham) and Scolytus schevyrewi Semenov, both of which had previously been recorded in Minnesota. Two native species, Conophthorus coniperda (Schwarz) and Crypturgus pusillus (Gyllenhal), were reported for the first time in Minnesota. Non-metric multi- dimensional scaling and analysis of similarities indicate that lure types capture different Scolytinae communities, while year, weather pattern and region factors were not significant. We also report the seasonal phenology of the seven most abundantly captured species; Dendroctonus valens LeConte, Hylastes porculus Erichson, Hylurgops rugipennis pinifex (Fitch),I. grandicollis, I. pini, Orthotomicus caelatus (Eichhoff) and Pityophthorus spp. Eichhoff

Acute traumatic aortic rupture: early stent-graft repair

Objective: Prospective evaluation of early stent-graft repair of acute traumatic aortic rupture. Methods: Twelve patients with acute traumatic aortic rupture of the descending aorta, out of a series of 337 endovascular aortic procedures, were treated by implantation of self-expanding stent-grafts. The procedures were performed within a mean post-injury time-period of 5±7 days (median: 1 day). The feasibility of stent-grafting was assessed by CT scanning and echography. Implantation was performed under local (n=6), or general anesthesia (n=6) if patients were already intubated (n=5) or required a common iliac artery access (n=1). Results: The immediate technical success rate was 100%. There were no post-procedure complications in all but one patient, who died 12 h postoperatively (8% mortality). Complete sealing of the aortic rupture in the remaining 11 patients was confirmed by postoperative CT scans. There were no intervention-related morbidity or mortality during the mean follow-up of 17 months. One patient with peri-graft leakage was successfully repaired with an additional stent-graft 12 months postoperatively. Conclusion: Non-delayed or early stent-grafting in acute traumatic rupture of the descending aorta is feasible. This technique seems to be a valuable option, in particular when associated lesions may interfere with the surgical outcome. Immediate post-procedural CT scanning and/or echography should be performed, in order to rule out residual leakag

Aortic stent-grafting: successful introduction into the combined procedure for coronary artery bypass grafting and aortic aneurysm repair

Objectives: Coronary artery bypass grafting (CABG) and combined stent-grafting (SG) were evaluated to reduce morbidity and mortality of patients with descending or infrarenal aortic aneurysm. Methods: CABG and SG (thoracic n=6, infrarenal n=36) were performed during the same hospitalization in 42 patients (mean age of 73±14 years). In 29 patients (mean Euroscore: 9), SG was performed under local anesthesia 9±3 days after coronary surgery (simultaneous) and in 13 patients (mean Euroscore: 7) during the same anesthesia (synchronous). In the latter group, 11 out of 13 patients underwent off-pump CABG. All aneurysms were treated by implantation of commercially available self-expanding grafts. Results: CABG was successful in all, but one patient with left internal mammary artery hypoperfusion syndrome, requiring an additional distal saphenous graft to the left anterior descending coronary artery. SG was uneventful in 98% (41/42 patients). Postoperative computerized tomography showed incomplete sealing in seven patients (17%), but only the two attachment endoleaks had to be treated by one proximal and one distal SG extension. Overall hospital stay for the synchronous repair was 12.5±6 days and that of the simultaneous group 17.5±7 days. Thirty-day mortality was 5% (2/42) as one patient of the simultaneous group experienced a lethal cerebral embolism during SG and one patient of the synchronous group developed an untreatable infection. In the follow-up of 4 years, there were two vascular reinterventions but no additional procedure-related morbidity or mortality. Conclusions: This experience shows that combined CABG and SG of thoracic or infrarenal aortic aneurysm is a safe and less-invasive alternative to the open graft repair, especially in the older patients or patients with severe comorbiditie

Periskop-, Kamin- und Sandwichtechnik sowie VORTEC zur Vereinfachung der Behandlung von Aneurysmen der Aorta abdominalis und thoracoabdominalis

Zusammenfassung: VORTEC (Viabahn Open Revascularisation TEChnique) und die Kaminprothesentechnik sind Verfahren zur Erhaltung oder Wiederherstellung des Blutflusses von Aortenästen, die geplant oder als Notlösung bei offener Operation oder endovaskulärem Vorgehen eingesetzt werden können. VORTEC ist eine stentbasierte vaskuläre Verbindungstechnik zur Herstellung einer End-zu-End-Anastomose, die insbesondere geeignet ist, wenn die herkömmliche Nahttechnik schwierig ist (sein könnte). Es handelt sich um ein schnelles Verfahren, das praktisch ohne Blutflussunterbrechung und ohne Anastomosenblutung ist, die Durchgängigkeitsraten sind ähnlich gut wie bei Nahtanastomosen. Die Kamin-Periskop-Sandwich-Prothesentechnik ("chimney/periscope and sandwich graft technique”, CHIMPES) ist ein endovaskuläres Verfahren, bei dem parallele Endoprothesen zur Erhaltung oder Wiederherstellung des Blutflusses von Aortenästen verwendet werden, während ein herkömmlicher Aortenstent oberhalb ihres Ursprungs platziert wird. Es ist ein relativ schnelles Verfahren mit der Möglichkeit, selbst in Notfällen handelsübliche Produkte zu verwenden. Bei der Sandwichtechnik verlaufen parallele Prothesen zwischen 2Aortenstents. Publizierten Erfahrungen zufolge scheinen diese beiden Techniken besonders für die Behandlung von Aneurysmen der Aortenäste und der Aorta thoracoabdominalis geeignet zu sein, vor allem in Hochrisiko- oder Akutfällen. Die englische Volltextversion dieses Beitrags ist über SpringerLink (unter "Supplemental") verfügba

Ablation of an idiopathic left ventricular tachycardia originating from the posterior mitral annulus in a toddler

Ablation of a mitral annulus (MA)-ventricular tachycardia (VT), a rare form of idiopathic left VT, has not yet been described in patients <2 years of age. We describe a case of a toddler with an incessant, poorly tolerated idiopathic VT (190 bpm) refractory to medical therapy, which was successfully ablated in the left ventricle at the infero-posterior part of the MA. Different diagnostic and ablation steps are described. Mitral annulus-ventricular tachycardia, a rare form of idiopathic left VT, can safely and successfully be ablated in very young children