[Utilization of Outpatient Psychotherapy and Outpatient Psychiatric Treatment by Men and Women after Inpatient Treatment due to Suicide Attempt or Acute Suicidal Crisis]

OBJECTIVE

The strongest predictor of suicide attempts is a previous suicide attempt. Individuals hospitalized for suicidal ideation and behavior face an increased risk of suicide following discharge. This study investigates the extent to which outpatient treatment services are utilized the first 6 months after discharge and whether men and women differ in this regard.

METHOD

The study examines data of 124 individuals (with suicide attempts (lifetime), 59.7% female) on the use of outpatient treatment services in the 6 months after inpatient treatment.

RESULTS

37.9% (N=47) of individuals reported not having used any treatment services at all. Men were significantly less likely to make use of the services.

CONCLUSION

Members of a group with an increased risk of suicide, to a large extent, fail to make use of outpatient treatment services. Discharge management should increasingly focus on (gender-specific) barriers and pave the way for treatment in outpatient.

Understanding suicidal ideation-a network analysis of the Interpersonal Needs Questionnaire

INTRODUCTION

Identifying various interacting risk factors for suicidality is important to develop preventive measures. The Interpersonal-Psychological Theory of Suicidal Behavior (IPTS) postulates suicidal ideation resulting from the occurrence of Perceived Burdensomeness (PB) and Thwarted Belongingness (TB). Suicidal behavior ultimately occurs if people have a Capability for Suicide. In past studies, the validity of TB was often not empirically confirmed, questioning which of the aspects of TB are central and related to suicidal ideation and whether applied measurement methods adequately capture the construct.

METHOD

Using a sample of 3,404 individuals from different clinical and nonclinical settings, 30% (1,023) of whom reported suicidal ideation, two network analyses were conducted on the Interpersonal Needs Questionnaire (INQ) and a variable mapping suicidal ideation.

RESULTS

Analyses revealed that some items of the INQ were not related to suicidal ideation and the most central items did not have the strongest associations to suicidal ideation.

CONCLUSION

Based on these results, a shortened version of the INQ with the four items that showed the strongest associations with suicidal ideation in the network analyses was suggested.

Phenotyping suicidal ideation and behavior: Comparing clinical characteristics and future suicide attempts between suicidal subtypes in two clinical samples

OBJECTIVES

To further validate the concept of suicidal subtypes distinguished by indicators of suicidal thinking and behavior with regard to clinical characteristics and past and future suicide attempts.

METHODS

Psychiatric inpatients were assessed (study 1: ecological momentary assessments in 74 depressed inpatients with suicidal ideation; study 2: clinical assessments in 224 inpatients after a suicide attempt and over a 12-month follow-up period). Subtypes were identified using latent profile analysis (based on indicators of real-time suicide ideation) and latent class analysis (based on features of past suicide ideation and suicide attempt characteristics). Comparisons between subtypes included clinical characteristics (depression, suicidal ideation, trait impulsivity, childhood trauma) as well as past (study 1) and future (study 2) suicide attempts.

RESULTS

Suicidal subtypes emerged that are characterized by suicidal ideation means and stability and features of past suicidal behavior (four in study 1, three in study 2). The subtypes differed in terms of depression/suicidal ideation, but not in terms of trait impulsivity/childhood trauma. Although not significant, the subtypes "high-stable" and "low-moderate stable" reported multiple re-attempts more frequently during follow-up than the "low-stable" subtype in study 2.

CONCLUSION

Differences in clinical variables (and by trend in future suicide attempts) clearly point to the clinical relevance of suicidal subtypes (with variability of suicidal thoughts playing a particularly important role).

Fear of Recurrence in Young Adult Cancer Patients—A Network Analysis

Simple Summary

Fear of cancer recurrence is a main concern for the majority of cancer patients during their disease. Young adults with cancer may experience fear of recurrence throughout their lives, given their relatively long potential survival time. More research is needed to identify evidence-based interventions that can adequately address this fear. Investigating the underlying mechanisms that trigger and sustain fear of cancer recurrence is an important step toward this goal. Network analysis is a useful tool to study symptoms and their structural relationships. The aim of this study is to apply the network analysis approach in a sample of young cancer patients to comprehend their specific symptomatology and define the optimal structure of a questionnaire to assess fear of recurrence in this patient group. Future studies may seek to replicate our findings among different age group samples to identify network structures and potential targets for clinical intervention.

Abstract

Due to the high survival rates of many young cancer patients and a high risk of second tumors, fear of cancer recurrence (FCR) can cause serious impairment for adolescent and young adult (AYA) cancer patients. The aim of this study is to analyze the structure of the Fear of Disease Progression Questionnaire (FoP-Q-12) to better understand the construct of FCR. We performed a cross-sectional survey on a sample of AYA patients aged 15–39 years with different tumor entities. FCR was measured using the FoP-Q-12, and a network analysis was conducted to examine the relationship of FCR symptoms. The importance of individual items in the network was determined using centrality analyses. A total of 247 AYA patients (81.8% female, median age 31.0 years) participated in the study. The mean FCR score in the sample was 35.9 (SD = 9.9). The majority of patients reported having high FCR (59.5%), according to the established cut-off. The two questionnaire items with the strongest association related to fears about work, and the most central symptom was the fear of serious medical interventions. The centrality of emotional issues in the sample indicates that these symptoms should be prioritized in the development of interventions targeting FCR. Further research should address this topic with larger samples of patients in other age groups and in longitudinal studies.

Suicidal ideation among recently arrived refugees in Germany

BACKGROUND

Refugees are considered a high-risk population for developing mental health disorders. Yet little research has been conducted on suicidal ideation among refugees resettled in Western high-income countries. In the present hstudy, suicidal ideation and its association with different socio-demographic, flight-related, and mental health-related factors were analyzed in recently arrived refugees in Germany.

METHODS

The study was conducted in a reception facility for asylum-seekers in Leipzig, where 564 newly arrived adult residents participated. The questionnaire included socio-demographic and flight-related questions as well as standardized instruments for assessing suicidal ideation (item 9 from PHQ-9), a variety of traumatic experiences (LEC-5), posttraumatic stress disorder (PCL-5), depression (PHQ-8), and somatic symptoms (SSS-8). Multiple logistic regression models were run to predict suicidal ideation in relation to different socio-demographic, flight, and mental health-related factors.

RESULTS

In total, 171 (30.3%) participants who had just or very recently arrived in Germany reported having experienced suicidal ideation within the two weeks prior to being assessed. Those who reported suicidal ideation also reported higher prevalence of somatic symptoms, posttraumatic stress disorder, depression, and experiences of sexual violence, as well as worse self-rated mental and physical health. In addition, there were significant independent associations between suicidal ideation and (1) younger age, (2) longer flight duration, (3) experiences of sexual violence, (4) symptoms of posttraumatic stress disorder, and (5) symptoms of depression.

CONCLUSIONS

The results emphasize the association between suicidal ideation and different clinically relevant mental health symptoms among newly arrived refugees in Germany. Special attention should not only be given to refugees suffering from symptoms of poor mental health, but also to those of younger age as well as refugees who have experienced sexual violence, as they might be affected by suicidal ideation whether or not they suffer from other mental health problems.

Defeat, entrapment, and suicidal ideation: Twelve-month trajectories

BACKGROUND

Defeat and entrapment have been highlighted in the development of suicidal ideation within the Integrated Motivational-Volitional model of suicidal behavior. Research suggests that entrapment has to be differentiated into internal and external entrapment. The aim of this study was to investigate the associations between defeat, internal, external entrapment, and suicidal ideation within and prospectively over measurements.

METHODS

A sample of 308 psychiatric inpatients (53% female) aged 18 to 81 years (M = 36.92, SD = 14.30) was assessed for the four constructs after admission to a psychiatric ward and six, nine, and twelve months later. Multilevel analyses were conducted to examine associations.

RESULTS

Defeat was associated with (a change in) internal and external entrapment. Defeat predicted a change in internal entrapment over time. Defeat and internal, but not external, entrapment were associated with (a change in) suicidal ideation. Internal entrapment was able to predict suicidal ideation. Internal entrapment and defeat predicted a change in suicidal ideation over time.

CONCLUSION

Results highlight the importance to distinguish between internal and external entrapment, and their specific association with suicidal ideation. Perceptions of internal entrapment are of central relevance when experiencing suicidal ideation and should be considered in clinical practice.

Suicidal behavior in the social environment: Does exposure moderate the relationship between an individual's own suicidal ideation and behavior?

INTRODUCTION

Suicidal behavior still cannot be sufficiently predicted. Exposure to suicidal behavior in the personal social environment is assumed to moderate the individual's transition from suicidal ideation to suicidal behavior within the Integrated Motivational-Volitional Model of Suicidal Behavior (IMV-model). This study aimed to investigate this moderating effect in a German high-risk sample.

METHODS

We interviewed 308 psychiatric inpatients (53% female) aged 18 to 81 years (M = 36.9, SD = 14.30) admitted after attempted suicide (53%) or due to an acute suicidal crisis (47%) regarding exposure events in their social environment. Four types of exposure events were analyzed using moderation analyses: familial suicides/suicide attempts, non-familial suicides/suicide attempts. Additionally, the numbers of reported exposure events were compared between patients with and without a recent suicide attempt as well as between patients with lifetime suicide attempts and lifetime suicidal ideation.

RESULTS

Neither moderating effects of exposure events on the relationship between lifetime suicidal ideation and recent suicidal behavior nor group differences between suicidal ideators and suicide attempters regarding the exposure events were found.

CONCLUSIONS

Exposure events might have differential and possibly protective effects on suicidal behavior - depending on type and quality (intensity, personal relevance, and recency) of event - and on the outcome (suicide vs. suicide attempt).

Predicting suicidal ideation in a longitudinal high-risk sample: Multilevel analyses and 12-month trajectories

BACKGROUND

The Interpersonal Theory of Suicide states that suicidal ideation (SI) results from perceived burdensomeness (PB) and thwarted belongingness (TB). Cross-sectional studies found associations with SI. This study examined the prospective prediction of SI.

METHODS

Three hundred and eight inpatients reporting severe SI or a recent suicide attempt were assessed four times within 12 months. The prediction of SI was examined using multilevel analyses, group comparisons, and logistic regression analyses.

RESULTS

Cross-sectionally, PB and TB were associated with SI. Prospectively, neither PB nor TB predicted SI. We found no autocorrelation of SI over time. Patients with persistent and fluctuating SI reported higher PB at T0. PB predicted the persistence of SI over 12 months.

CONCLUSION

Results emphasize cross-sectional associations between PB, TB, and SI. PB and TB could not predict the intensity of SI over time. SI did not predict itself over time. PB was associated with a persistent trajectory of SI over 12 months.

Child abuse and suicidality in the context of the Interpersonal Psychological Theory of Suicide: A network analysis

OBJECTIVES

While there is evidence for an association of child abuse with suicidality in the course of life, the underlying mechanisms remain unclear. The Interpersonal Psychological Theory of Suicide (IPTS) provides a theoretical framework to investigate this relationship. The present study examines how different subtypes of child abuse are related to suicidal ideation and to attempts in the context of the IPTS.

METHODS

146 psychiatric inpatients (M = 37.9 years, 62% female) with an acute suicidal crisis (n = 71) or a recent suicide attempt (n = 74) were examined at baseline (T0) and six (T1) months later. We measured emotional, physical, and sexual abuse, the constructs of the IPTS (thwarted belongingness, perceived burdensomeness, and capability for suicide) and suicidal ideation as well as suicide attempts. Using the statistics program R, a network analysis of all named constructs was conducted. Centrality measures were computed.

RESULTS

Emotional abuse was the most central kind of abuse in the network and had a direct relationship with suicide attempts and an indirect relationship with suicidal ideation via perceived burdensomeness. Physical and sexual abuse showed no significant relations with the different constructs of the IPTS.

CONCLUSION

The major limitation of this study was the modest sample size which reduced the number of variables able to be included in the network. Regarding child abuse, the results underline that emotional abuse plays a central role in this network and may be important for suicide risk assessment. Future research should address this topic in a larger sample.

PRACTITIONER POINTS

Emotional abuse was the most central kind of abuse in this network analysis. Sexual abuse was the only kind of abuse with a direct relation to suicidal ideation. Capability for suicide had just a marginal position in the network analysis. Early interventions addressing the effects of child abuse are recommended. Replications in larger samples and with more relevant variables are needed.

Testing the Four Main Predictions of the Interpersonal-Psychological Theory of Suicidal Behavior in an Inpatient Sample Admitted Due to Severe Suicidality

This study aimed to evaluate four main predictions of the Interpersonal Psychological Theory of Suicide (IPTS): the importance of perceived burdensomeness (PB), thwarted belongingness (TB), hopelessness (H), and capability for suicide (CS) for (passive/active) suicide ideation, suicide intent and suicide attempts. N = 308 psychiatric inpatients admitted due to severe suicidality (53.6% female: n = 165; age: M = 36.82, SD = 14.30, range: 18-81) completed self-report measures of TB, PB, H, CS and suicide ideation as well as interviews on suicide intent and suicide attempts. TB and PB were associated with (passive/active) suicidal ideation, whereas the three-way interaction PB, TB, and H was not associated with active suicide ideation. Fearlessness about death in conjunction with active suicidal ideation was not associated with suicide intent and the interaction of PB, TB, and CS was neither predictive of recent suicide attempt status nor lifetime number of suicide attempts. Given the cross-sectional nature of the data, conclusions on causality should be handled carefully. The results challenge the theoretical validity of the IPTS and its clinical utility-at least within the methodological limitations of the current study. Yet, findings underscore the importance of PB in understanding suicidality.

From decision to action: Suicidal history and time between decision to die and actual suicide attempt

A substantial proportion of suicide attempts seem to be realized in a sudden manner. However, it is unclear how suicide attempters showing a rapid transition from the decision to die to acting differ from suicide attempters showing a slower transition regarding their suicidal history. The main aim of this study was to determine the proportion of suicide attempters, who reported a rapid transition (≤5, ≤10, ≤180 min) between their decision to die and their actual attempt. Furthermore, attempter groups (≤ vs. >5, ≤ vs. >10 and ≤ vs. >180 min) were compared regarding suicidal history (ideation, plans, and number of lifetime as well as 12 month suicide attempts) as well as depression, hopelessness and trait impulsivity. In total, 118 inpatients (62.7% female; age: M = 38.71, SD = 14.71) hospitalized due to a recent suicide attempt were assessed using structured clinical interview measures assessing suicidal history and self-report instruments. Thirty-six percent reported a time period of ≤5 min, 44% a time period of ≤10 min and 73% a time period of ≤180 min between their decision to die and their attempt. Participants with a rapid transition (≤5, ≤10, ≤180 min) did not differ from participants with a slower transition (>5, >10, >180 min) regarding suicidal history, depression, hopelessness and trait impulsivity. Taken together, a rapid transition seems common, but nevertheless, rapidly realized suicide attempts cannot necessarily be characterized as impulsive.

The role of the 5-HTTLPR polymorphism in acquired capability for suicide

OBJECTIVE

According to the Interpersonal Psychological Theory of Suicide, capability for suicide comprises two dimensions: fearlessness about death and elevated pain tolerance. The short (S) allelic variant of the serotonin transporter gene-linked polymorphic region (5-HTTLPR) has repeatedly been associated with more violent and lethal suicide methods and lethality of suicide attempts. The current study aimed to investigate whether 5-HTTLPR allelic variants are associated with fearlessness about death and pain tolerance/persistence and whether it moderates the relationship between childhood maltreatment and acquired capability for suicide.

METHOD

A cohort of 208 inpatients hospitalized due to a recent suicide attempt or severe suicidal ideation was genotyped for the 5-HTTLPR and assessed for childhood maltreatment. Subjective pain tolerance and fearlessness about death as well as objective pain persistence was assessed using a pressure algometer.

RESULTS

Fearlessness about death, pain tolerance, and pain persistence did not differ between 5-HTTLPR genotypes. However, there was a significant correlation between self-reported childhood maltreatment and fearlessness about death that emerged exclusively in homozygous S-allele carriers.

CONCLUSION

Results suggest that there are no "high-risk"-alleles that generally increase capability for suicide. However, in terms of future suicide-related behaviors exposure to childhood maltreatment events could exert a particularly negative influence on homozygous S-allele carriers by increasing their fearlessness about death.

Interpersonal theory of suicide: prospective examination

BACKGROUND

The interpersonal theory of suicide (IPTS) is one of the most intensively researched contemporary theories on the development of suicidal ideation and behaviour. However, there is a lack of carefully conducted prospective studies.

AIMS

To evaluate the main predictions of the IPTS regarding the importance of perceived burdensomeness, thwarted belongingness and capability for suicide in predicting future suicide attempts in a prospective design.

METHOD

Psychiatric in-patients (n = 308; 53.6% (n = 165) female; mean age 36.82 years, s.d. = 14.30, range 18-81) admitted for severe suicidal ideation (n = 145, 47.1%) or a suicide attempt completed self-report measures of thwarted belongingness, perceived burdensomeness, capability for suicide, hopelessness, depression and suicidal ideation as well as interviews on suicide intent and suicide attempts and were followed up for 12 months. Logistic regression and receiver operating characteristics (ROC) analysis were conducted.

RESULTS

The interaction of perceived burdensomeness, thwarted belongingness and capability for suicide was not predictive of future suicide attempts, but perceived burdensomeness showed a significant main effect (z = 3.49, P < 0.01; OR = 2.34, 95% CI 1.59-3.58) and moderate performance in screening for future suicide attempts (area under the curve AUC = 0.729, P < 0.01).

CONCLUSIONS

The results challenge the theoretical validity of the IPTS and its clinical utility - at least within the methodological limitations of the current study. Yet, findings underscore the importance of perceived burdensomeness in understanding suicidal ideation and behaviour.

Validation of the motivational phase of the integrated motivational-volitional model of suicidal behavior in a German high-risk sample

BACKGROUND

The Integrated Motivational-Volitional (IMV) model of suicidal behavior proposes in its motivational phase that perceptions of defeat and entrapment (total, internal and external entrapment) lead to the development of suicidal ideation and that thwarted belongingness and perceived burdensomeness moderate this process. The aim of this study was to test the motivational phase of the IMV model cross-sectionally in a German sample of psychiatric inpatients.

METHODS

A total of 308 psychiatric inpatients (53% female) aged 18 to 81 years (M = 36.92, SD = 14.30) were included in the study and investigated within 14 days after psychiatric admission due to suicide attempt (53%) or acute suicidal crisis (47%). Statistical analyses included a mediation analysis and moderation analyses.

RESULTS

Results demonstrate a simple mediation of defeat via entrapment (total, internal and external entrapment) on suicidal ideation. The interaction between thwarted belongingness and perceived burdensomeness was confirmed as a motivational moderator.

LIMITATIONS

Limiting factors of the present study are the cross-sectional design and the retrospective assessment of suicidal ideation.

CONCLUSION

The main assumptions of the motivational phase of the IMV model could empirically be confirmed. Perceptions of defeat, internal and external entrapment, thwarted belongingness, and perceived burdensomeness should be taken into account with regard to prevention, risk assessment and interventions of suicidal ideation and attempts. However, future investigations based on prospective data are warranted.

Validation of the German capability for suicide questionnaire (GCSQ) in a high-risk sample of suicidal inpatients

BACKGROUND

The German Capability for Suicide Questionnaire (GCSQ) was developed to measure fearlessness of death and pain tolerance - two constructs central to the Interpersonal Theory of Suicide. Initial scale development, definition of the factor structure and confirmation of the two-dimensional factor structure was performed in samples suffering from relatively low levels of suicide ideation/behavior. The present study aimed to validate the German Capability for Suicide Questionnaire (GCSQ) in a high-risk sample of suicidal inpatients.

METHODS

Factor structure, reliability and validity were investigated in a sample of inpatients (N = 296; 53.0% female; age in years: M = 36.81, SD = 14.27) admitted to a hospital due to a recent suicide attempt or an acute suicidal crisis (in immediate need of inpatient treatment). To establish convergent validity, interview-based assessments of lifetime suicide attempts and non-suicidal self-injury as well as questionnaire-based assessments of painful and provocative events were used. Finally, stability of GCSQ-scores over a follow-up period of 12 months was assessed.

RESULTS

Results indicated good psychometric properties, and provided additional evidence for construct validity and stability of the subscales over a one-year period, and demonstrated adequate fit of the data with respect to the original factor structure.

CONCLUSIONS

Results suggest that the GCSQ is a brief, reliable, and valid measure of capability for suicide that can be used in clinic assessment and research.

Psychometrische Eigenschaften und Faktorstruktur der deutschen Version der Beck-Suizidgedanken-Skala (BSS): Validierung an einer Stichprobe psychiatrischer Patienten

Ziel der Studie Dimensionalität, Reliabilität und konvergente Validität der deutschsprachigen Beck Scale for Suicidal Ideation (BSS) sollen erstmalig in einer klinischen Stichprobe untersucht warden.

Methodik 308 stationäre Patienten nach Suizidversuch/mit akuter Suizidalität wurden rekrutiert (53,6% weiblich); 224 füllten die vollständige BSS sowie weitere Fragebögen für Depression (DESC), Hoffnungslosigkeit (BHS), interpersonale Variablen (INQ) und Defeat (DS-d)/Entrapment (ES-d) aus. Neben konfirmatorischen Faktoranalysen (CFA, Prüfung von Modellen mit 1, 2, 3 und 5 Faktoren) zur Dimensionalitätsprüfung wurden Pearson-Korrelationen zur Bestimmung der konvergenten Validität berechnet.

Ergebnisse Insgesamt erzielt das 5-Faktoren-Modell den besten Fit; ohne Berücksichtigung des RMSEA-Wertes ist der Modell-Fit zwischen den verschiedenen Modellen allerdings vergleichbar. Im Rahmen der mehrfaktoriellen Modelle entstehen inhaltlich vergleichbare Subskalen. Akzeptable interne Konsistenzen zeigen sich nur für die Subskalen, die passive Todeswünsche (α>0,80), aktive Suizidgedanken (α>0,73) und suizidhandlungsbezogene Items (α>0,70) erfassen. Der BSS-Summenscore sowie die Subskalen, die passive bzw. aktive Suizidgedanken abbilden, korrelieren moderat mit DESC, BHS, INQ und DS-d/ ES-d (r zwischen 0,25 und 0,66), während die handlungsbezogene Subskala keine (INQ, Thwarted Belongingness) bzw. geringe Assoziationen zeigt (r zwischen 0,14 und 0,27).

Schlussfolgerung Die CFAs liefern keinen eindeutigen Hinweis für eine ein- oder mehrdimensionale Struktur der BSS. So ist die Auswertung über den BSS-Summenwert trotz Hinweisen auf dessen Reliabilität und konvergente Validität aus empirischer Sicht kritisch zu bewerten.

Short defeat and entrapment scale: A psychometric investigation in three German samples

BACKGROUND

The present study aimed to validate the German version of the Short Defeat and Entrapment Scale (SDES).

METHODS

Validity and reliability were established in an online (N = 480), an outpatient (N = 277) and an inpatient sample (N = 296). Statistical analyses included confirmatory factor analyses (CFA) and group differences in defeat and entrapment.

RESULTS

For the online and the inpatient sample, the CFA indicated a two-factor solution, whereas for the outpatient sample both one- and two-factor solutions fitted the data equally well. Scale properties for the two-factor solution (defeat and entrapment subscale) were excellent. Thus, further analyses were based on this solution. For the online and the outpatient sample, suicidal ideators and suicide attempters scored significantly higher in defeat and entrapment than non-ideators and non-attempters.

LIMITATIONS

Limiting factors of the study were the different measures across the samples and the cross-sectional design of the study.

CONCLUSION

Though results were partly mixed, we found support for a two-factor solution of the instrument showing excellent psychometric properties in all three samples. The two-factor solution is further expected to have higher clinical utility than a one-factor solution. Suicidal ideators and suicide attempters in the online and outpatient sample showed higher scores in defeat and entrapment than non-ideators and non-attempters, emphasizing these two concepts as predictors for suicidal ideation. All in all, the present study supports the general validity and reliability of the SDES. However, future investigations based on prospective data are warranted.

Do suicide attempters and suicide ideators differ in capability for suicide?

Suicide ideation is a prerequisite for suicide attempts. However, the majority of ideators will never act on their thoughts. It is therefore crucial to understand what differentiates those who consider suicide from those who attempt suicide. The aim of this study was to investigate the role of different aspects of capability for suicide (fearlessness about death, subjective pain tolerance, objective pain persistence) in differentiating suicide ideators from suicide attempters, single attempters from multiple attempters and recent attempters from distant attempters. A total of 308 psychiatric inpatients (53.6% female; age: M=36.92, SD=14.30) suffering from suicide ideation with or without lifetime suicide attempts were compared regarding fearlessness about death, subjective pain tolerance and objective pain persistence (assessed with a pressure algometer). No differences in fearlessness about death, subjective pain tolerance and objective pain persistence were found in suicide ideators vs. attempters, single vs. multiple attempters and recent vs. distant attempters. It might be presumed that fearlessness about death, subjective pain tolerance and objective pain persistence do not offer useful information for the differentiation between suicide ideators and attempters, however, there are several limitations to take into account. Further effort is needed to understand more clearly what differentiates suicide ideators from suicide attempters.

Psychometric properties of the German version of the suicide cognitions scale in two clinical samples

The present study aimed at evaluating the psychometric properties of German Suicide Cognitions Scale (SCS-18/SCS-9) in two clinical samples. Validity and reliability were established in an outpatient- (n = 277) and in an inpatient sample (n = 75). Statistical analyses included confirmatory factor analyses, correlation analyses, between-group comparison by history of lifetime suicide attempts, and regression analyses. The three-factor model showed good model fit for the long version of the SCS (SCS-18). For the short version of the SCS (SCS-9), a bifactor model yielded the best fit. Overall, the total scale of the SCS-18 and the SCS-9 and the subscales of the SCS-18 showed satisfactory internal consistency, as well as good convergent validity. The SCS-18 subscales and the SCS-9 demonstrated clinical utility by differentiating between participants with prior and without prior suicide attempts. The SCS (subscale unsolvability and SCS-9 score) predicted current suicide ideation as well as suicide ideation 7-10 days later - even after controlling for established risk-factors (e.g., depression, hopelessness, interpersonal variables). Results suggest that the SCS-18 and the SCS-9 are reliable and valid measures to assess suicidal cognitions that can be used in clinical as well as in research settings.

Sonographische Untersuchung des ovinen Euters

Gegenstand und Ziel: Entwicklung und Etablierung eines ultrasonographischen Untersuchungsganges am Schafeuter unter Abgleichung makroskopischer und histologischer Befunde. Material und Methoden: In einem ersten Versuch wurden 18 isolierte, nach Laktationsstadium eingeteilte Euter klinisch, sonographisch und histologisch untersucht. Im zweiten Versuch erfolgte bei 134 lebenden Schafen, eingeteilt in vier Gruppen, eine klinische und sonographische Untersuchung der Milchdrüsen. Die Tiere der Gruppe 1 mit unterschiedlichem Laktationsstadium (n = 8) wurden insgesamt zehnmal im Abstand von 2 Tagen untersucht, die Probanden der Gruppe 2 (n = 5; hochtragend bis 28 Tage post partum) zweimal wöchentlich und die Schafe der Gruppe 3 (n = 7; ante bzw. post partum mit und ohne Lämmer) alle 4 Tage untersucht. Bei den Schafen der Gruppe 4 mit unterschiedlichem Laktationsstadium (n = 114) fand eine einmalige Untersuchung in der Herde statt. Um eine größere Praxistauglichkeit zu erreichen, kamen drei verschiedene Ultraschallgeräte zum Einsatz. Ergebnisse: Sonographisch lassen sich am Schafeuter Drüsenparenchym, die Pars glandularis und papillaris der Zisterne mit Milchfüllung, die dazwischen gelegene Ringfalte, das Zentralband und die Blutgefäße darstellen und beurteilen. Bei der Herdenuntersuchung konnten sonographisch mehr Tiere mit pathologischen Euterbefunden detektiert werden als durch die klinische Untersuchung. Alle drei eingesetzten Ultraschallgeräte eigneten sich gut zur Untersuchung des ovinen Euters. Schlussfolgerung und klinische Relevanz: Die sonographische Untersuchung des Schafeuters ergänzt die klinische Untersuchung und ist unter Praxisverhältnissen gut durchführbar. Tief im Euter liegende Prozesse (Abszesse), die mit Palpation und Milchkontrolle nicht erfasst werden, lassen sich durch die Ultraschalluntersuchung nachweisen.

Rentabilitätsberechnung des Kaiserschnitts beim Schaf

Gegenstand: In der vorliegenden Studie wird eine Rentabilitätsberechnung zum Kaiserschnitt beim Schaf nach konservativ nicht korrigierbarer Schwergeburt erstellt. Material und Methode: Die Berechnungen stützen sich auf 119 durchgeführte Kaiserschnitte und das anschließende Schicksal der Mutterschafe und entwickelten Lämmer. Ergebnisse: Eine konservativ nicht korrigierbare Schwergeburt stellt für Schafhalter immer ein Verlustgeschäft dar. Werden die Tiere nicht behandelt, sondern euthanasiert, liegt der finanzielle Schaden bei 117,90 荤. Dieses Verlustgeschäft kann bei Tierhaltern mit mehr als 10 Mutterschafen durch eine Sectio caesarea um ca. 20% auf 95,08 荤 minimiert werden, weil diese Tierhalter mit der Mutterschaf-/ Grünlandprämie über eine zusätzliche Einnahmequelle pro Mutterschaf verfügen. Diese Berechung gilt nicht für Hobbyschafhalter mit weniger als 10 Mutterschafen, da hier die Einnahmen durch diese Prämien wegfallen. In diesen Fällen spielt jedoch meist nicht nur der ökonomische Aspekt für oder gegen die Operationsentscheidung eine Rolle. Schlussfolgerung: Die in dieser Studie dargestellten Berechnungen zeigen, dass der finanzielle Rahmen der Schafhaltung eng ist. Trotzdem stellt die Operation die ökonomisch überlegene Strategie gegenüber der Euthanasie dar, wenn Mutterschaf und Lämmer die Operation überleben. Mit 97,8%iger Wahrscheinlichkeit lohnt sich somit die operative Therapie.

Dynamik der Elektrolytkonzentrationen im Blutplasma von Rindern mit operativ beendeter Torsio uteri intra partum

Gegenstand und Ziel: Es sollte überprüft werden, inwieweit beim Rind die Elektrolyte im Blutplasma durch eine Torsio uteri intra partum einschließlich operativer Behandlung (Gruppe 1) im Vergleich zu mit Sectio caesarea beendeten Dystokien ohne Torsio uteri (Gruppe 2) bzw. Normalgeburten (Gruppe 3) während der ersten 10 Tage post operationem/partum beeinflusst werden. Material und Methoden: In die Studie gingen 45 schwarzbunte Rinder mit chirurgisch therapierter Torsio uteri intra partum ein. Im Abstand von 24 Stunden, beginnend unmittelbar präoperativ, bis 10 Tage post operationem (p. o.) wurden Blutproben aus der Vena jugularis externa entnommen und Gesamtkalzium, anorganisches Phosphat, Mg2+, Na+, und K+ bestimmt. Die Vergleichsgruppen umfassten jeweils 11 Tiere. Ergebnisse: Die Veränderungen der Plasmaspiegel von Gesamtkalzium, anorganischem Phosphat, Na+ und K+ waren bei den 33 überlebenden Rindern mit Torsio uteri und den Tieren der Gruppen 2 und 3 gering. Der Magnesiumplasmaspiegel fiel postoperativ besonders bei Gruppe 1, aber auch bei Gruppe 2 im Vergleich zu Gruppe 3 signifikant ab und verblieb bis zum Ende der Beobachtungszeit unterhalb des Referenzbereichs. Bei den 12 verendeten Patienten mit Torsio uteri traten im Vergleich zu den überlebenden Rindern mit Gebärmutterdrehung eine deutlichere, am vierten postoperativen Tag signifikante Hypomagnesiämie und ein signifikant erniedrigter Plasmakaliumspiegel auf. Schlussfolgerung: Nach geburtshilflich-chirurgischen Eingriffen sollten bei Rindern die Elektrolytplasmaspiegel insbesondere von Magnesium und Kalium überprüft und die Elektrolyte gegebenenfalls substituiert werden. Klinische Relevanz: Ein postoperativ niedriger Plasmakaliumspiegel in Verbindung mit einer Hypomagnesiämie ist bei Rindern, die wegen einer Torsio uteri operiert wurden, ein Hinweis auf eine schlechte Prognose quoad vitam.

Operative Behandlung der Necrobacillosis laryngis beim Kalb

Im Gegensatz zu Belgien, den Niederlanden oder Teilen Frankreichs ist die Necrobacillosis laryngis beim Kalb im deutschen Sprachraum ein eher seltenes Krankheitsbild. Das Hauptsymptom der Erkrankung stellt die Atemnot dar. Schlechte Haltungsbedingungen, Mangel an Vitamin A sowie Läsionen im Kehlkopfbereich begünstigen eine Infektion mit dem Haupterreger, Fusobacterium necrophorum. Einem schleichenden, oftmals unbemerkten Erkrankungsbeginn folgt häufig eine perakute Atemnot, die meistens durch weithin hörbares Röcheln, erhöhte Körperinnentemperatur und allgemeine Schwäche mit eingeschränktem Stehvermögen charakterisiert ist. Eine konservative Behandlung (Bepinseln des Rachen- und Kehlraumes mit Antiseptika in Verbindung mit lokaler und/oder parenteraler Antibiotikaapplikation) ist zu diesem Zeitpunkt aufgrund akuter Erstickungsgefahr nicht mehr Erfolg versprechend. Nach eingehender laryngoskopischer, röntgenologischer bzw. sonographischer Untersuchung und Abgrenzung gegenüber Differenzialdiagnosen (z. B. Stimmbandparalyse ohne Entzündungssymptomatik) muss ein operativer Eingriff zur Rettung des Tieres erfolgen. Chirurgisches Verfahren, Anästhesie, Nachbehandlung und Prognose werden im folgenden Beitrag beschrieben.

Evaluation of an Electronic Periodontal Probe Versus a Manual Probe

INTRODUCTION

Diagnosis of periodontal diseases requires reco-rding of clinical and periodontal variables. Possible measurement errors in recording the periodontal findings are dependent on the measurement method.

AIM

The purpose of the trial was to investigate an electronic, pressure-calibrated probe compared with a standard, manual measurement probe used to take periodontal variables.

MATERIALS AND METHODS

The study included 25 subjects suffering from periodontal disease. Their findings were taken by two users on a randomized basis using a standard probe and an electronic, pressure calibrated probe, at an interval of 24 hours. The recorded clinical variables contained Pocket Depth (PD), Attachment Level (AL), Bleeding on Probing (BOP), the complete time needed to take the findings and the sensation of pain experienced by a Visual Analogue Scale (VAS). The data were statistically analyzed using the paired t-test.

RESULTS

The measurement values (24 patients) for PD (p=0.03) and BOP (p=0.01) indicated a significant difference (paired t test, p>0.05), while there was no statistical difference for AL (p=0.064). A classification of PD into groups of 1-3mm, 4-6mm and ≥7mm showed that the manual method measured higher values than the electronic method (p=0.001). The measurement values did not reveal any significant differences (p>0.05) with respect to the total time needed to take findings and the measurement time for PD/AL. There was a significant difference (Wilcoxon-test, p<0.05) in VAS values (p=0.048) and in terms of the time needed to record the findings for BOP (p=0.004).

CONCLUSION

It can be assumed that the electronic probe should mainly be used in the supportive periodontal therapy. Present study showed that the use of a standard manual probe is essential to review conspicuous or unclear measurement values, or when treating deep pockets higher than 7mm.

Clinical Efficacy of Azithromycin as an Adjunctive Therapy to Non-Surgical Periodontal Treatment of Periodontitis: A Systematic Review and Meta-Analysis

INTRODUCTION

Over the years, numerous trials have sufficiently documented benefits of adjuvant administration of antibiotics in combination to Scaling and Root Planing (SRP) in treatment of periodontitis. Nevertheless there are justified doubts in respect to antibiotics administration with regard to increasing development of resistances.

AIM

The aim of this review study and meta-analysis was to verify a possible benefit of Azithromycin (AZM) as an alternative adjuvant antibiotic in combination with SRP.

MATERIALS AND METHODS

Electronic databases (Pubmed) were searched from the earliest point of record until May 2015. A hand search was also conducted. The variables considered in this respect were Probing Depth (PD), Clinical Attachment Level (CAL), Bleeding on Probing (BOP) and SRP. A meta-analysis containing trials comparing SRP as a sole therapy with SRP and administration of AZM was produced once all of the data obtained had been reviewed.

RESULTS

Six randomised clinical trials were accepted into the review and the meta-analysis following the process of trial selection. Meta-analysis revealed larger overall effects by the systemic administration of AZM compared with SRP on their own in terms of PD, CAL, BOP, Plaque-Index and total bacterial load reduction after three and six months.

CONCLUSION

The data used in this study revealed that the systemic administration of AZM is beneficial compared with SRP on its own for the treatment of chronic periodontitis.

Einfluss von Torsio uteri und Sectio caesarea auf den Gehalt des C-reaktiven Proteins im Blutplasma von Rindern

Gegenstand: Untersuchung des Einflusses konservativ nicht therapierbarer Torsio uteri intra partum mit Sectio caesarea auf den Blutplasmagehalt des C-reaktiven Proteins (CRP) im Vergleich mit Dystokien anderer Genese und Sectio caesarea sowie Normalgeburten beim Rind. Material und Methode: In die Studie gingen 55 Rinder ein, eingeteilt in drei Gruppen. Gruppe 1 bestand aus 31 Rindern mit operativ beendeter Torsio uteri intra partum. In Gruppe 2 befanden sich 13 Tiere mit durch Kaiserschnitt beendeter Dystokie anderer Genese und in Gruppe 3 11 Kühe mit Normalgeburten und ungestörtem Puerperium. Im Abstand von 24 Stunden, beginnend unmittelbar präoperativ, bis 10 Tage post operationem wurden Blutproben aus der V. jugularis externa entnommen und das CRP im Plasma mittels ELISA quantitativ bestimmt. Ergebnisse: Schwere intrazelluläre Ödeme und Nekrosen am Uterus als Folge einer Torsio uteri intra partum führten zu einem Anstieg der CRPKonzentration, eine Ovariohysterektomie bedingte einen Abfall des CRP-Spiegels. Der alleinige chirurgische Eingriff einer Sectio caesarea verursachte keine wesentliche akute Veränderung der CRP-Konzentration. Aufgrund der großen individuellen Variation der CRP-Konzentrationen war eine Definition eindeutiger Grenzwerte bei den einzelnen Tiergruppen nicht möglich. Eine prognostische Aussage zur Fertilität nach Torsio uteri und Kaiserschnitt lässt sich anhand des CRP-Werts nicht ableiten. Der positive Einfluss der Milchleistung auf die CRP-Konzentration im Blutplasma konnte bestätigt werden. Schlussfolgerung: Nekrosen und schwere intrazelluläre Ödeme am Uterus beeinflussen die CRP-Blutplasmakonzentration deutlich. Klinische Relevanz: Hohe CRP-Werte (> 90 μg/ml) sprechen bei Rindern mit Torsio uteri intra partum für eine schwere Uterusschädigung, die mit einer drastischen Verschlechterung der Prognose quo ad vitam einhergeht. Eine Ovariohysterektomie kann in diesen Fällen eine gute Therapieoption sein.

Enzymaktivitäten und Substratkonzentrationen im Blutplasma von Rindern mit operativ beendeter Torsio uteri intra partum

Gegenstand und Ziel: Es sollte überprüft werden, inwieweit durch Torsio uteri intra partum und notwendiger operativer Behandlung der Stoffwechsel von Leber, Niere und Muskulatur während der ersten 10 Tage post operationem im Vergleich zu operativ beendeten Dystokien anderer Genese bzw. Normalgeburten beeinflusst wird. Material und Methoden: In die Untersuchung gingen 45 Rinder mit operativ beendeter Torsio uteri intra partum ein. Im Abstand von 24 Stunden, beginnend unmittelbar präoperativ, bis 10 Tage post operationem wurden in Blutproben aus der V. jugularis externa die Aktivitäten der Enzyme GLDH, AST, LDH, CK sowie die Konzentrationen der Substrate β-Hydroxybutyrat, Bilirubin, Cholesterin, Harnstoff, Kreatinin und Laktat bestimmt. Die Vergleichsgruppen beinhalteten wegen anderer Dystokien operierte Rinder und solche mit Normalgeburten. Ergebnisse: Die Aktivitäten von GLDH, AST und LDH zeigen sich bei Rindern mit Torsio uteri in den ersten vier postoperativen Tagen besonders deutlich ausgeprägt und signifikant erhöht gegenüber Vergleichstieren mit Dystokie anderer Ursache bzw. Normalgeburt. Sie sind Ausdruck eines stark beeinträchtigten Leberstoffwechsels in dieser Zeit. Die Nierenfunktion wird von einer Torsio uteri intra partum wenig, der Harnabfluss dagegen offensichtlich stark beeinträchtigt. Schlussfolgerung: Eine operativ behandelte Torsio uteri intra partum ist nicht mit einer operativ beendeten Dystokie anderer Genese oder mit einer Normalgeburt gleichzusetzen. Klinische Relevanz: Eine präoperativ zum Erstuntersuchungszeitpunkt stark erhöhte Kreatininkonzentration stellt einen Hinweis auf eine schlechte Prognose quoad vitam dar. Bei Rindern mit operativ beendeter Torsio uteri intra partum wird in den ersten vier Tagen nach dem Eingriff eine Leberschutztherapie empfohlen.

Pathologisch-anatomische Veränderungen am torquierten Uterus des Rindes zum Zeitpunkt der operativen Geburtshilfe

Gegenstand und Ziel: Die makroskopischen und mikroskopischen Veränderungen des torquierten Uterus beim Rind zum Zeitpunkt der operativen Geburtshilfe werden erfasst und den Torsionsstadien gegenübergestellt. Material und Methoden: Die makroskopische Befundung erfolgte bei 54 Rindern mit operativer Geburtshilfe infolge Torsio uteri intra partum, die lichtmikroskopischen Untersuchungen wurden an 40 während der Sectio caesarea entnommenen Uteruswandproben durchgeführt. Eine Uteruswandprobe konnte bei der Schlachtung 1,5 Jahre nach erfolgter Sectio caesarea wegen schwerer Torsio uteri entnommen werden. Ergebnisse: Bei den makroskopischen Befunden handelte es sich um Verfärbungen der Uteruswand von rosa-rot über blau-lila bis grau. Die Uteruswand war verdickt und unelastisch. Auf der Oberfläche des Organs waren gestaute Gefäße und Hämatome sichtbar. Selten lag eine Thrombosierung größerer arterieller und venöser Uterusgefäße vor. Das Fruchtwasser erschien unterschiedlich stark blutig verfärbt, die Eihäute wiesen starke Ödeme auf. Die Plazentome waren in einigen Fällen von zirkulären Hämatomen umgeben. Die Ligamenta lata uteri wiesen Hämatome, Ödeme und Rupturen auf. Auch an Mesovarium und Ovarien bestanden Stauungen und Hämatome. Die mikroskopischen Befunde der Uteruswand waren durch Blutungen, Ödeme, Thrombosen, Nekrosen und Entzündung gekennzeichnet. Schlussfolgerung: Alle Strukturen der Gebärmutter und ihrer Adnexe werden durch eine Torsio uteri geschädigt. Klinische Relevanz: Mit zunehmendem Torsionsstadium treten massivere pathologische Veränderungen am Uterus auf. Dabei wird die Prognose hinsichtlich der späteren Fertilität maßgeblich durch Hypoxie und regenerative Entzündungen beeinflusst.

Hämatologische Verlaufsuntersuchungen bei Rindern mit chirurgisch beendeter Torsio uteri intra partum

Gegenstand und Ziel: Es sollte Überprüft werden, inwieweit durch Torsio uteri intra partum und notwendiger operativer Behandlung das Blutbild während der ersten 10 Tage post operationem im Vergleich zu Normalgeburten beeinflusst wird. Material und Methoden: In die Untersuchung gingen 49 Rinder mit operativ beendeter Torsio uteri intra partum ein. Die Patienten wurden entsprechend derSchwere der Erkrankung in drei Stadien eingeteilt. Im Abstand von 24 Stunden, beginnend unmittelbar präoperativ bis 10 Tage post operationem,wurden Blutproben aus derV. jugularis externa entnommen und Hämatokritwert(Hk), Hämoglobinkonzentration (Hb), mittlere Hämoglobinkonzentration der Erythrozyten (MCHC) sowie die Zahl an Gesamtleukozyten, Granulozyten, Lymphozyten/Monozyten und Thrombozyten bestimmt. Ergebnisse: Postoperativ kam es über den Beobachtungszeitraum zu einem signifikanten Abfall von Hk und Hb. Einem dreitägigen postoperativen Absinken der Thrombozytenzahlfolgte ein kontinuierlicher Anstieg. Das weiße Blutbild war durch einen biphasischen Verlauf charakterisiert: Nach einem Leukozytenabfallfand sich ein leichter Anstieg als Ausdruck einer Entzündungsreaktion. Statistisch nachweisbare Unterschiede zwischen den drei Torsionsstadien bestanden praktisch nur bei Hk und Hb. Tiere mit besserer Fertilitätspro- gnose (Torsionsstadium 1) zeigten geringere Blutwertveränderungen als Rinder mit schlechterer bzw. schlechter Fertilitätsprognose (Stadium 2und 3). Schlussfolgerung: Durch eine Torsio uteri intra partum mit operativer Behandlung werden primärder Hk und das Hb beeinflusst. Klinische Relevanz: Wegen niedriger Wertevon Hkund Hb müssen Patienten des Torsionsstadiums 3 postoperativständig Überwacht und eine Bluttransfusion in Betracht gezogen werden.

[Etiology of torsio uteri in cattle: a review]

An overview about various observed phenomena, assumptions, and relations concerning the development of uterine torsion in cattle is presented. Furthermore, contradictory observations and old ideas are relativated and more accurate interpretations are given. It is known that the fetus himself is moving what is considered a reason for a torsion of the uterus. Intrauterine movements of the fetus are physiologic, and therefore other factors for uterine torsions are likely to be involved. A very plausible explanation for the selective occurrence of uterine torsion in cattle seems to be decreased amniotic fluid in relation to the size of fetus and uterus, because other influences can also be observed in all or at least in a high number of other animals. Destabilizing factors concerning the uterus (tonus decreased, uterus outside bursa supraomentalis) increase the possibility of developing a torsio uteri but are not compelling for the torsio uteri.

The effect of rank order on feed intake and growth of fattening pigs

On the basis of 120 fattening pigs, classified in 6 groups of 20 animals each, the rank order was determined and its influence on the feed intake behaviour as well as on the fattening progress was studied. The results show that with respect to the total length of stay at the trough and to the time per visit to the feeding station the dominant barrows stayed significantly longer at the feeding place than their subordinate pen mates. Additionally, they showed a higher weight at the end of the fattening period and a higher weight gain per day of fattening. As to the frequency of the visits to the feeding station there was no significant difference between high-ranking and low-ranking animals during the period of observation.

Rating of isolated disseminated tumor cells in bone marrow in comparison with other factors of prognosis in breast carcinoma

BACKGROUND

Despite the use of radical loco-regional therapeutic methods and although conventional methods of diagnosis give no indication of metastases at the time of operation, distant metastases develop in approximately 50 percent of the carcinoma patients within 5 years. While with the R0 resection of solid tumors local relapses are mainly a matter of concern for the operating surgeon, distant metastases can be traced back to systemic dissemination of tumor cells at the time of operation.

AIMS

The goal of our prospective six year continuous study is to compare the rating of the IDT BM with established prognosis factors and to reach conclusions for the practice.

METHODS

A prospective study is represented in which 197 patients suffering from breast carcinoma were analyzed for prognostic relevance of detected isolated disseminated tumor cells in the bone marrow (IDT BM). The patients were operated between 1993-1997 and subsequently observed until 1999. The monoclonal antibodies CK II and A45-B/B3 were used with the immuno-cytochemical standard method for detecting IDT BM. For the purpose of cell cultivation, the cells were marked with the HEA 125 antibody and separated by means of magnetic cell sorting (MACS). In this investigation, only the presence of isolated disseminated tumor cells detected by the

RESULTS

A45-B/B3 antibody proved to be an independent prognostic factor for survival time. The risk of an earlier death increased with the detection of IDT BM at least by a factor of two. The detection of IDT BM also represented an independent prognostic factor for the time until advancement of the tumor. The risk of an earlier relapse of the tumor increased with the detection of disseminated tumor cells in the bone marrow containing the A45-B/B3 antibody by at least a factor of four.

CONCLUSION

A generally acknowledged standardization of the method is desirable. Due to the importance of the independent prognostic IDT BM factor, this method of ascertaining the pathological stage should be established at institutions of higher learning.

Die Polymelie beim Kalb – Übersicht mit Fallbeschreibungen zur operativen Behebung

Die Polymelie stellt eine beim Kalb relativ häufig auftretende kongenitale Missbildung dar. Dem Erscheinungsbild nach lässt sie sich in zwei Gruppen einteilen: Die eine Gruppe ist charakterisiert durch symmetrische oder asymmetrische Doppel- oder Zwillingsmissbildungen, folglich über teilweise oder vollständige Verdoppelung des Achsenskeletts, während bei der anderen Gruppe Gliedmaßenverdoppelungen oder -vervielfältigungen vorliegen. Eine exakte Trennung zwischen beiden Phänotypen gelingt nicht immer. Die Ursachen für diese nicht erbliche Anomalie sind nicht bis ins Detail geklärt. So werden für Doppelmissbildungen infektiöse Ursachen wie Virusinfektionen, aber auch nichtinfektiöse Ursachen wie pflanzliche Toxine oder eine Überalterung der zur Befruchtung gekommenen Oozyte diskutiert. Bei der einfachen Extremitätenverdoppelung handelt es sich offenbar um Keimversprengungen oder Defekte während der frühen Embryonalentwicklung.

Anhand der Kasuistik von dreizehn Kälbern mit Polymelie, zehn davon in der zugänglichen Literatur recherchiert sowie drei Patienten, an denen eigene Untersuchungen mit operativer Entfernung der überzähligen Gliedmaßen erfolgreich durchgeführt wurden, wird das vielfältige Erscheinungsbild dieser Missbildung dargestellt, gleichzeitig die Entscheidungsfindung für oder gegen ein operatives Vorgehen unter tierschutzrelevanten Aspekten diskutiert.

Detection of cytokeratin-positive cells in bone marrow in breast cancer and colorectal carcinoma in comparison with other factors of prognosis

A prospective study is presented in which 293 patients suffering from breast cancer and colorectal carcinoma were analyzed for prognostic relevance of detected isolated disseminated tumor cells in bone marrow (IDTBM). The patients underwent surgery in the period from 1995 to 1997 and remained under observation until 1999. The monoclonal antibody A 45-B/B3 was used in the standard immuno-cytochemical method for detecting IDTBM, which represented an independent prognostic factor for survival time in patients with breast cancer or colorectal cancer. In breast cancer, when IDTBM were detected, the survival period was reduced by at least half. When disseminated tumor cells containing the A45-B/B3 antibody were detected in bone marrow, the risk of an earlier relapse of the tumor increased at least fourfold. In colorectal cancer, detection of IDTBM reduced survival time by a factor of 1.2-4.3. The risk of earlier relapse increased when disseminated tumor cells containing the A45-B/B3 antibody were detected in bone marrow by 2.8-8.1. Therefore, the use of IDTBM as an independent prognostic factor would provide an important method for determining the pathological stage of various cancers. Standardization of this technique into a generally accepted method would be especially desirable in treatment of patients with breast or colorectal cancer.

[Immunocytochemical detection of cytokeratin positive cells in human bone marrow of gastric and colorectal cancer patients]

We looked for disseminated tumour cells postoperatively in the bone marrow of 22 patients with gastric cancer and of 26 patients with colorectal cancer. On an average the follow-up was 6.5 months in the gastric cancer group and 9 months in the colorectal cancer group. In 27% of the gastric cancer group and in 30% of the colorectal cancer group follow-up aspirates were obtained. Micrometastases were detected in 96% of colorectal cancer patients and in 77% of gastric cancer patients. Both, postoperative and follow-up aspirations showed clear differences in the number of ck+ cells between the iliac crest sides. The majority of cells formed clusters from 2 to about 200 cells. In both groups no significant correlation was found between the number of tumour cells detected and the established risk factors (stage, tumour extension, lymph node involvement, distant metastasis) or the disease-free survival. In the gastric cancer group higher numbers of ck+ cells were seen in the low tumor stages I and II, as compared to stage III and IV. Besides, in this group significantly more ck+ cells were detected in younger patients (age under 63,5) than in the older group over 63,5 years. Colorectal cancer patients did not show this correlation. In follow-up aspirations the number of ck+ cells of the colorectal and also the gastric cancer group showed a tendency of rise in relapse and of fall in disease-free survival. There was a tendency of higher rates of ck+ cells in the colorectal cancer group when compared to gastric cancer patients.