[Complex umbilical cord vein pulsations in cases with twin-twin transfusion syndrome: prognostic implications]

Umbilical vein pulsations (UV-P) are due to various etiologies. The aim of the present study was to investigate the incidence and type of UV-P in monochorionic twins with twin-twin transfusion syndrome (TTTS).

Sonographic Assessment of Fetal Cardiac Function: Introduction and Direct Measurement of Cardiac Function

Noninvasive blood flow measurements based on Doppler ultrasound studies are the main clinical tool for studying the cardiovascular status in fetuses at risk for circulatory compromise. Usually, qualitative analysis of peripheral arteries and, in particular clinical situations such as severe growth restriction or volume overload, also of venous vessels close to the heart or of flow patterns in the heart are being used to gauge the level of compensation in a fetus. Quantitative assessment of the driving force of the fetal circulation, the cardiac output, however, remains an elusive goal in fetal medicine. This article reviews the methods for direct and indirect assessment of cardiac function and explains new clinical applications. Part 1 of this review describes the concept of cardiac function and cardiac output and the techniques that have been used to quantify output. Part 2 summarizes the use of arterial and venous Doppler studies in the fetus and gives a detailed description of indirect measures of cardiac function (like indices derived from the duration of segments of the cardiac cycle) with current examples of their application.

[Burden and need for psychosocial intervention of glioblastoma patients]

Glioblastoma patients should be provided with a professional health care system that helps reduce their psychosocial burden. The aim of this study was to identify patients in need of psychosocial intervention. In addition, it was examined whether physicians' assessments adequately address the burden patients are under and their need for intervention. During their visit to one of two neurosurgery outpatient departments, n = 49 glioblastoma patients filled out the short version of the Hornheider questionnaire (HFK). Consulting physicians also rated their patients' burdens in a specially adapted version of the questionnaire (HFK-F). The results of the psychometric evaluation with both instruments were satisfactory. The majority of the patients (76 %) were identified as in need of psychosocial intervention. All of them were correctly categorized with the physicians' ratings. Physicians overestimated some aspects of the patients' burden, particularly in regard to their problems with relaxing and fear of living with the illness. The patients' ratings concerning the quality of the information physicians provided and their overall state of health only corresponded with the physicians' ratings in roughly half of the cases.

[Adapted and Standardised Patient Management in the Treatment of Neovascular AMD in the Outpatient Setting of a University Eye Hospital.]

Visual results in treating neovascular age-related macular degeneration (AMD) using intravitreal injected anti-VEGF (IVT) clearly depend on injection frequency. Regarding to the European approval Ranibizumab has to be used only in cases of recurrent visual loss after the loading phase. In contrast monthly treatment--as also provided in the ANCHOR and MARINA studies--is generally allowed in Switzerland. However, it is commonly tried to reduce the injection frequency because of the particular cost situation in all health systems and of cause also due to the necessary strict monitoring and reinjection regimes, which raise management problems with increasing patient numbers. In this article the special treatment regimes of our University Eye Hospital is presented, in which a reduced injection frequency basically leads to the same increased and stable visual results as in ANCHOR and MARINA; however, needing significantly more injections as generally provided in other countries of Europe. The main focus for achieving this in a large number of patients is placed on re-structuring our outpatient flow for IVT patients with particular emphasis on patient separation and standardisation of treatment steps leading to significantly reduced time consumption per patient. Measurements of timing and patient satisfaction before and after restructuring underline its importance in order to be able to treat more patients at a high quality even in the future. The exceptional importance of spectral domain OCT measurements as the most important criterium for indicating re-treatment is illustrated.

Psychological Interventions for Infertile Couples: Does Gender Matter?

Purpose: Gender-specific differences exist between male and female infertility patients' mental health, the meaning of infertility in their lives, and the coping strategies used. This systematic review examines whether gender-specific aspects are addressed in psychological intervention studies for infertility and whether infertile women and men benefit equally from such interventions. Methods: Databases were searched to identify relevant articles published between 1978 and 2007 (384 articles). The review included both controlled and uncontrolled psychological intervention studies examining results for infertile women and men separately. Outcome measures (depressive symptoms, anxiety, and mental distress) and gender-specific baseline characteristics (mental distress at pre-assessment, cause of infertility, and medical treatment) were collected. A total of twelve studies were finally included. Results: In 10 of 12 studies, women exhibited higher levels of mental distress than men. Gender-specific aspects were not addressed in the psychological interventions. Examining the efficacy of psychological interventions revealed that women exhibited stronger positive mental health effects in 2 of the 12 studies. Conclusion: Psychological distress before psychological treatment seems more pronounced in women than in men. Therefore psychological interventions for infertile couples should take gender-specific aspects into account. More research is needed to address the gender-specific aspects regarding psychological interventions for infertility.

Emergency and elective implantation of covered stent systems in iatrogenic arterial injuries

To evaluate the effectiveness and safety of covered stents for the management of iatrogenic arterial injury.

[Extraarticular proximal phalangeal fractures of the hand: Functional conservative management using the Lucerne Cast (LuCa) - a preliminary prospective study]

The purpose of our prospective study was to document the clinical and radiological results of conservative-functional treatment of extraarticular proximal phalangeal fractures without immobilisation of the wrist.

Botanical drugs, synergy, and network pharmacology: forth and back to intelligent mixtures

For centuries the science of pharmacognosy has dominated rational drug development until it was gradually substituted by target-based drug discovery in the last fifty years. Pharmacognosy stems from the different systems of traditional herbal medicine and its "reverse pharmacology" approach has led to the discovery of numerous pharmacologically active molecules and drug leads for humankind. But do botanical drugs also provide effective mixtures? Nature has evolved distinct strategies to modulate biological processes, either by selectively targeting biological macromolecules or by creating molecular promiscuity or polypharmacology (one molecule binds to different targets). Widely claimed to be superior over monosubstances, mixtures of bioactive compounds in botanical drugs allegedly exert synergistic therapeutic effects. Despite evolutionary clues to molecular synergism in nature, sound experimental data are still widely lacking to support this assumption. In this short review, the emerging concept of network pharmacology is highlighted, and the importance of studying ligand-target networks for botanical drugs is emphasized. Furthermore, problems associated with studying mixtures of molecules with distinctly different pharmacodynamic properties are addressed. It is concluded that a better understanding of the polypharmacology and potential network pharmacology of botanical drugs is fundamental in the ongoing rationalization of phytotherapy.

[Iatrogenic preterm births and late preterm births of 340/7 to 366/7 - risks and chances]

Late preterm births with a gestational age of 340/7-366/7 are physiologically, anatomically and metabolically immature and develop medical complications significantly more frequently, have a high morbidity and an elevated mortality. Consideration of this knowledge will in future require new strategies for obstretric, peripartal and neonatal management options that take into account not only maternal risks and demands but also those of the infant.

Elevated bilirubin in acute and transient psychotic disorder

Mild unconjugated hyperbilirubinemia seems to be more common in patients with disorders from the schizophrenic spectrum than in other psychiatric patients or in the general population and has been linked to brain alterations. This spectrum however contains a number of diagnostic entities that might not share the same etiological and environmental factors.

[Anaesthesia and breast-feeding: should breast-feeding be discouraged?]

Until a few years ago an interruption of breast-feeding for 12 or even 24 hours was recommended for breast-feeding mothers after anaesthesia, this is no longer valid. If it is the mother's wish, if she is sufficiently awake and physically able, there is no reason not to start breast-feeding a mature and healthy baby immediately after recovery from a general or regional anaesthesia. Even breast-feeding after a Caesarean delivery with administration of the common anaesthetics in the usual (single) doses is no longer considered to be a problem since the amount of the substance taken up from colostrum is vanishingly small in comparison to the amount that is transferred by transplacental routes. Neither the pharmacological properties of the drugs used in association with anaesthesia nor clinical experience justify an interruption of breast-feeding.