3D ultrasound in fetal spina bifida

3D ultrasound can be used to study the fetal spine, but skeletal mode can be inconclusive for the diagnosis of fetal spina bifida. We illustrate a diagnostic approach using 2D and 3D ultrasound and indicate possible pitfalls.

Cord entanglement in monoamniotic twins: 2D and 3D colour Doppler studies

Cord entanglement affects the majority of monoamniotic (MA) twins, accounting for the high proportion of intrauterine deaths of MA twins, and it is often present from early gestation. 3D ultrasound can be used to acquire volume data comprising information on umbilical colour Doppler flow, providing a very graphic depiction of cord entanglement. We have used 2D, "conventional" and a novel 3D display of colour Doppler ultrasound showing cord entanglement.

Psychotherapie bei depressiven Patienten mit koronarer Herzkrankheit: Weiterhin sinnvoll?

Depressive Symptome und depressive Störungen sind für die Erstmanifestation einer koronaren Herzkrankheit (KHK) bedeutsam und beeinflussen die Prognose nach einem ersten kardialen Ereignis negativ. Nach einer Studie zur Wirkung von kognitiver Verhaltenstherapie im Jahr 2003 (ENRICHD) wurde im Jahr 2007 die zweite große randomisierte kontrollierte psychotherapeutische Interventionsstudie für depressive Patienten mit KHK veröffentlicht (CREATE). ENRICHD konnte zwar antidepressive Effekte einer kognitiven Verhaltenstherapie sechs Monate nach dem Herzinfarkt nachweisen, jedoch gab es keinen Effekt auf die kardiale Prognose. Die Wirksamkeit von Psychotherapie (IPT) auf die depressive Symptomatik konnte in der zweiten Studie (CREATE) nicht belegt werden. Der Aufbau beider Studien und die daraus resultierenden Kritikpunkte wurden in diesem Beitrag dargestellt. Die externe Validität der Ergebnisse für die psychotherapeutische Versorgung depressiver KHK-Patienten im deutschen Sprachraum wurde kritisch kommentiert.

[Coverage of pressure sores with free flaps]

INTRODUCTION: The coverage of recurrent pressure sores with unstable scar in the surrounding tissue is still an unsolved problem in the literature. Local and regional transfer of tissue often does not meet the requirements of the tissue deficit. Especially in recurrent pressure sores, the adjacent skin has already been consumed due to multiple surgeries. As a good alternative, the microsurgical transfer of flaps offers viable tissue to cover even large pressure sores. METHODS: We performed a total of six free flaps in five patients who suffered from intractable pressure sores in the hip region. The age of the patients was between 41 and 63 years. The defect size varied between 6 x 6 cm and 25 x 30 cm. Two combined myocutaneous scapula-latissimus dorsi, two myocutaneous latissimus dorsi, one anteromedial thigh, and one rectus femoris flap were used to cover the defects. RESULTS: The average follow-up time was 29 months. Flaps provided stable coverage in four of five patients at 12-month follow-up. There was one subtotal flap necrosis that was subsequently treated with split-thickness skin grafting. CONCLUSION: In this series of five patients with six free flaps, we were able to show that the microsurgical transfer of tissue is a valuable option in the treatment of difficult pressure sores. Even in older and debilitated patients, this method is a good alternative to conventional local flaps.