Outpatient alcohol detoxification: Implementation efficacy and outcome effectiveness of a model project

Background: The aim of the study was to examine the practicability and implementation efficacy of an alcohol outpatient detoxification model and the concomitant `motivational' psychotherapeutic approach. Method: This was an open prospective study to examine the implementation efficacy, practicability and medical safety of a novel psychotherapy-based, integrated outpatient detoxification model in alcohol-dependent patients. Patients were carefully screened for relevant neuropsychiatric disorders and other exclusion criteria and then seen on a daily outpatient basis for 5 - 7 days. Patients received psychotropic or other medication, if necessary (CIWA-A score >16). Beside management of withdrawal symptoms, psychotherapeutic interventions were conducted to motivate the patient for further alcohol therapy. Results: Of 557 patients screened 331 entered the program. For medical reasons 226 patients had to be admitted for inpatient detoxification, 122 patients in a special alcohol unit, 101 patients in a general hospital. 198 (60%) of the outpatients received psychotropic medication during treatment. 312 (94%) of these patients successfully completed treatment. 301 (91% of the initial sample) patients entered a consecutive 3-month motivational phase of a two-phase alcohol treatment program. 139 (46%) patients successfully completed the 1-year consecutive outpatient treatment. Conclusions: Outpatient detoxification, at least in a highly structured frame, can be considered as a safe and efficient therapeutic approach. The data of this study also indicate that psychotherapeutic interventions and motivation for further abstinence and treatment may work in alcohol-dependent patients on an outpatient basis. Further controlled trials are necessary to compare the effects of outpatient versus inpatient withdrawal. Copyright (C) 2004 S. Karger AG, Basel

Effects of scopolamine on matching to sample paradigm and related tests in human subjects

This was a double-blind placebo-controlled study with a cross-over design to examine the effects of scopolamine on cognitive functions in young healthy subjects. Scopolamine hydrobromide was administered subcutaneously to 12 subjects (mean +/- SD age 23.8 +/- 2.2 years) at doses of 0.3 and 0.6 mg in comparison with two placebo conditions. Scopolamine at both doses produced marked sedation as rated by subjects and an observer. In the continuous performance test, vigilance was impaired by both doses of scopolamine. The span of apprehension test showed differing results (only the high dose of scopolamine showed a performance decrement only in the three-character version of the span of apprehension test). Significant impairment by both doses of scopolamine was seen in immediate and delayed free recall, continuous visual recognition, running word recognition and running picture recognition. While scopolamine caused a significant slowing in average reaction times for simultaneous matching as well as for delayed matching, subjects made more errors under scopolamine compared to placebo only in delayed matching, not in simultaneous matching. Also, the main outcome of matching to sample showed significant effects only in delayed matching, not in simultaneous matching. Notable in this study is the incongruity between the simultaneous matching test and the span of apprehension test on the one hand and the other cognitive tests used on the other. These results demonstrated that scopolamine has a greater effect on memory than on attention. Thus, the scopolamine-induced effects in the present study seem to be more relevant to Alzheimer's disease in an advanced phase than to normal aging. Copyright (C) 2003 S. Karger AG, Basel

Split-rib reconstruction of the frontal sinus: two cases and literature review

Abstract Background: Large defects of the anterior wall of the frontal sinus require closure using either autologous or foreign material. In cases of osteomyelitis, the reconstruction must be resistant to bacterial infection. Split-rib osteoplasty can be used in different sites. Methods: Two patients with malignant sinonasal tumours underwent repeated treatment, and subsequently developed osteomyelitis of the frontal bone. After adequate therapy, a large defect of the anterior wall persisted. Reconstruction was performed using the split-rib method. The literature on this topic was reviewed. Results: Both patients' treatment were successful. No complications occurred. A PubMed search on the topic of rib reconstruction of the frontal sinus and skull was performed; 18 publications matched the inclusion criteria. From these sources, we noted that 182 reconstructions yielded good results with few complications. Conclusion: Large defects of the anterior wall of the frontal sinus can be closed successfully using autologous split-rib grafting. Aesthetic outcome is good and donor site morbidity is minima

Critical Casimir forces in colloidal suspensions on chemically patterned surfaces

We investigate the behavior of colloidal particles immersed in a binary liquid mixture of water and 2,6-lutidine in the presence of a chemically patterned substrate. Close to the critical point of the mixture, the particles are subjected to critical Casimir interactions with force components normal and parallel to the surface. Because the strength and sign of these interactions can be tuned by variations in the surface properties and the mixtures temperature, critical Casimir forces allow the formation of highly ordered monolayers but also extend the use of colloids as model systems.Comment: 4 papges, 4 figures, accepted at Phys. Rev. Let

Efficacy of an intensive outpatient rehabilitation program in alcoholism: Predictors of outcome 6 months after treatment

Treatment of alcohol-dependent patients was primarily focused on inpatient settings in the past decades. The efficacy of these treatment programs has been evaluated in several studies and proven to be sufficient. However, with regard to the increasing costs in public healthcare systems, questions about alternative treatment strategies have been raised. Meanwhile, there is growing evidence that outpatient treatment might be comparably effective as inpatient treatment, at least for subgroups of alcohol dependents. On that background, the present study aimed to evaluate the efficacy of a high-structured outpatient treatment program in 103 alcohol-dependent patients. 74 patients (72%) terminated the outpatient treatment regularly. At 6 months' follow-up, 95% patients were successfully located and personally re-interviewed. Analyses revealed that 65 patients (64%) were abstinent at the 6-month follow-up evaluation and 37 patients ( 36%) were judged to be non-abstinent. Pretreatment variables which were found to have a negative impact (non-abstinence) on the 6-month outcome after treatment were a higher severity of alcohol dependence measured by a longer duration of alcohol dependence, a higher number of prior treatments and a stronger alcohol craving (measured by the Obsessive Compulsive Drinking Scale). Further patients with a higher degree of psychopathology measured by the Beck Depression Inventory (depression) and State-Trait Anxiety Inventory (anxiety) relapsed more often. In summary, results of this study indicate a favorable outcome of socially stable alcohol-dependent patients and patients with a lower degree of depression, anxiety and craving in an intensive outpatient rehabilitation program

The C(-1019)G 5-HT1A promoter polymorphism and personality traits: no evidence for significant association in alcoholic patients

The 5HT1A receptor is one of at least 14 different receptors for serotonin which has a role in moderating several brain functions and may be involved in the aetiology of several psychiatric disorders. The C(-1019)G 5-HT1A promoter polymorphism was reported to be associated with major depression, depression-related personality traits and suicidal behavior in various samples. The G(-1019) allele carriers are prone to depressive personality traits and suicidal behavior, because serotonergic neurotransmission is reduced. The aim of this study is to replicate previous findings in a sample of 185 Alcohol-dependent individuals. Personality traits were evaluated using the NEO FFI and TCI. History of suicidal behavior was assessed by a standardized semistructured interview (SSAGA). No significant differences across C(-1019)G 5-HT1A genotype groups were found for TCI temperament and character traits and for NEO FFI personality scales. No association was detected between this genetic variant and history of suicide attempts. These results neither support a role of C(-1019)G 5-HT1A promoter polymorphism in the disposition of personality traits like harm avoidance or neuroticism, nor confirm previous research reporting an involvement of the G allele in suicidal behavior in alcoholics. Significant associations, however, were detected between Babor's Type B with number of suicide attempts in history, high neuroticism and harm avoidance scores in alcoholics

Melanoma of the middle ear: initial presentation, Fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography imaging and follow up

Abstract Background: We present a rare case of primary mucosal melanoma of the middle ear imaged with 18F-fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography (FDG-PET/CT). Method: Clinical, radiological, intra-operative and histological findings are discussed. Results: An 88-year-old woman presented with intermittent otorrhoea of the left ear for several months. Otoscopy revealed a livid protrusion of the tympanic membrane. Melanoma was not suspected initially, but was established on transmembranous biopsy. Pre-operative 18F-fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography revealed a mass lesion in the left tympanic cavity with high fluoro-deoxyglucose uptake, as well as an ipsilateral intraparotid lymph node metastasis. The patient underwent surgical treatment. The diagnosis of melanoma was confirmed histologically. Conclusion: In this rare case, clinical, radiological and surgical findings led to the diagnosis of a primary mucosal melanoma of the middle ea

The value of 18F-FDG-PET/CT imaging for sinonasal malignant melanoma

The aim this study was to evaluate imaging findings using position emission tomography (PET) in combination with computed tomography (CT) and 18F-fluorodeoxyglucose (18F-FDG) in sinonasal malignant melanoma (SNMM) of the head and neck in a retrospective analysis of a consecutive cohort of patients. 18F-FDG-PET/CT examinations were performed for initial staging and compared with CT or magnetic resonance tomography (MRI), and 18F-FDG-PET alone. Medical records were reviewed retrospectively with regard to the location and the size of the tumor. Furthermore, locoregional and distant metastases with a consecutive change in therapy detected by 18F-FDG-PET/CT were assessed. Ten patients suffering from sinonasal malignant melanoma were staged and followed by 18F-FDG-PET/CT imaging. A total of 34 examinations were obtained. 18F-FDG-PET/CT depicted all primary tumors adequately. Aside from one cerebral metastasis all regional and distant metastases were truly identified by using this method. In summary, if available, 18F-FDG-PET/CT is a valuable imaging modality for staging and re-staging sinonasal malignant melanoma to evaluate expansion of the primary tumor, locoregional disease, and distant metastase

Impact of extended sinus surgery on allograft infection, allograft function and overall survival in cystic fibrosis lung transplant recipients

BACKGROUND Studies investigating the impact of sinus surgery for cystic fibrosis (CF) patients performed early after lung transplantation (Ltx) are scarce. Recent studies evaluating frequency of respiratory infections and graft outcomes are not available. OBJECTIVES/HYPOTHESIS To determine whether there is a difference in allograft infection, allograft function and overall survival among CF lung transplant recipients with and without concomitant sinus surgery. STUDY DESIGN Retrospective single-center study. METHODS We examined 71 CF patients who underwent Ltx between 2009 and 2019 at our center. Fifty-nine patients had sinus surgery before or/and after transplantation and twelve did not undergo sinus surgery. We assessed the survival, the diagnosis of chronic allograft dysfunction (CLAD) and all elevated (> 5 mg/l) c-reactive protein episodes during the observed period. The infectious events of the upper and lower airways were categorized in mild infections (5-15 mg/l CRP) and severe infections (> 15 mg/l CRP). RESULTS There was no difference in the long-time overall survival (p = 0.87) and no benefit in the short-term survival at 4 year post-transplant (p = 0.29) in both groups. There was no difference in both groups concerning CLAD diagnosis (p = 0.92). The incidence of severe upper and lower airway infections (CRP > 15 mg/l) was significantly decreased in the sinus surgery group (p = 0.015), whereas in mild infections there was a trend to decreased infections in the sinus surgery group (p = 0.056). CONCLUSIONS CF patients undergoing Ltx benefit from extended endoscopic sinus surgery (eESS) in terms of frequency of severe infectious events of the upper and lower airways. There was no difference in overall survival and frequency of CLAD in the two groups

Rhinologic outcome of endoscopic transnasal-transsphenoidal pituitary surgery: an institutional series, systematic review, and meta-analysis

Purpose We aimed to summarize the available data on the objective rhinologic outcome after endoscopic transnasal-transsphenoidal (ETT) surgery. Methods Retrospective study on a consecutive cohort of treatment-naïve patients undergoing ETT pituitary gland surgery. Additionally, a systematic review and meta-analysis with focus on the rhinologic outcome, including postoperative smell function was performed. Results The institutional series incorporated 168 patients. A concomitant endoscopic septoplasty was performed in 29/168 patients (17.3%). A nasoseptal flap was used for reconstruction of large skull-base defects or high-flow CSF leaks in 4/168 (2.4%) patients. Early postoperative rhinologic complications (< 4 weeks) included epistaxis (3%), acute rhinosinusitis (1.2%) and late postoperative complications (≥ 8 weeks) comprised prolonged crusting (15.6%), symptomatic synechiae (11.9%) and septal perforation (0.6%). Postoperative smell function was not impaired (Fisher’s exact test, p = 1.0). The systematic review included 19 studies on 1533 patients with a median postoperative epistaxis rate of 1.4% (IQR 1.0–2.2), a postoperative acute rhinosinusitis rate of 2.3% (IQR 2.1–3.0), a postoperative synechiae rate of 7.5% (IQR 1.8–19.1) and a postoperative septal perforation rate of 2.2% (IQR 0.5–5.4). Seven studies including a total of 206 patients reported adequate outcome measures for smell function before and after ETT surgery. Only 2/7 studies reported an impairment of smell function postoperatively, especially in patients with nasoseptal flap harvesting. Conclusion Early and late postoperative rhinologic complication rates after ETT surgery for pituitary lesions seem to be low. A thorough evaluation of smell function, in particular in patients at risk for nasoseptal flap harvesting, may be an important factor in optimal postoperative care