Clinical philosophy in the context of pediatric care

Medical care may be better in many countries than it currently is. Developing countries are in the need to catch up with affluent countries, and rich countries have a need for answering the question of how quality of health care can be improved for their total population despite increasing high-technology-induced cost through comprehensive cost-benefit analyzes. Health is about 85% dependent on general health care and 15% on medical care. The current quality differences of health care not only have their roots in economic crises, but in the lack of application of the thought model of ‘root-cause-effect long-term consequences.

The questions arise as to whether this lack of integration of philosophical perspectives and activities contributes to deficiencies in the health care system and how philosophy could lead to new pathways of thinking. Obviously, the health systems of many European countries are having major problems translating the necessary changes in care from the theory level to the policy executive at the practical level. Furthermore, in many health care systems, adequate socio-philosophical concepts for adapting to constantly changing social conditions are missing with regard to adequate, accessible and affordable health care.

This presentation discusses the pros and cons of greater involvement of spiritual welfare, clinical philosophy and philosophical practices in medical care for adolescents in order to improve 1. adherence to therapy, 2. resilience and 3. resonance in the treatment triangle of ‘patient-family-therapist’.

Behavioral and fMRI evidence of the differing cognitive load of domain-specific assessments

Standards-referenced educational reform has increased the prevalence of standardized testing; however, whether these tests accurately measure students' competencies has been questioned. This may be due to domain-specific assessments placing a differing domain-general cognitive load on test-takers. To investigate this possibility, functional magnetic resonance imaging (fMRI) was used to identify and quantify the neural correlates of performance on current, international standardized methods of spelling assessment. Out-of-scanner testing was used to further examine differences in assessment results. Results provide converging evidence that: (a) the spelling assessments differed in the cognitive load placed on test-takers; (b) performance decreased with increasing cognitive load of the assessment; and (c) brain regions associated with working memory were more highly activated during performance of assessments that were higher in cognitive load. These findings suggest that assessment design should optimize the cognitive load placed on test-takers, to ensure students' results are an accurate reflection of their true levels of competency.

First results of endocavity evaluation of the microvascularization of malignant prostate tumors using contrast enhanced ultrasound (CEUS) including perfusion analysis: first results

AIM

Detection of prostate cancer lesions using transrectal contrast enhanced ultrasound (CEUS) of the prostate utilizing quantitative perfusion analysis.

METHOD

20 patients (mean age 63 years, 47-71) with biopsy proven prostate cancer underwent transrectal ultrasound (TRUS) prior to radical prostatectomy by 2 experienced examiners using a multifrequency endocavitary probe (5-9 MHZ, LOGIQ E9, GE Healthcare, Chalfont St Giles, UK) to detect cancer-suspect lesions. CEUS was performed dynamically up to 3 Min after bolus injections of 2.4 ml SonoVue® (BRACCO, Italy). Digital cine loops were analyzed by an independent blinded examiner using perfusion quantification software with colour-coded parametric images in order to define suspect regions based on the perfusion-related parameters early wash in rate (WIR), mean transit time (MTT) and rise time (RT). The results of CEUS perfusion analysis were compared with the histopathology after surgery, obtained from whole mount sections.

RESULTS

After prostatectomy and histopathology, 34 prostate cancer foci were found in 20 patients. In 30/34 cases an early enhancement within the tumor was detected by CEUS perfusion analysis without early wash out. By evaluating the MTT and RT tumor detection was possible in 29/34 and 25/34 cases. The highest detection rate of prostate cancers was obtained by analysis of early contrast enhancement (priot to the normal prostate parenchyma), with a sensitivity of 88%, specificity 100%, NPP 60%, PPV 90%, in clinically suspicious cases with good correlation to the postoperative histopathological findings (r = 0.728).

CONCLUSION

This pilot study demonstrates, that quantitaive analysis of perfusion parameters obtained with transrectal CEUS could be helpful for characterization of neoplastic microcirculation of prostate cancer, for preoperative localization of cancer-suspect areas and for therapy guidance and management.

Development and initial experience with the new "exposure database of the federal states"

The Workgroup of the State Measuring Authorities for Chemical Occupational Safety (ALMA) was established in 1987 by the State Committee for Occupational Safety and Safety Technology (LASI) for the purpose of exchanging experiences between the measuring institutes and authorities of the federal states supporting the commercial regulation authorities in the field of dangerous materials. A workgroup was assigned by ALMA in 1995 to determine the theoretical and practical basis for the establishment of an exposure database commonly available to the federal states. In the first stage, the theoretical data structure of the planned database was defined. The purpose of this was to ensure the exchange of exposure data between the federal states in the future and to allow common evaluation of the data. In the second stage, the practical benefits of the database were determined in a trial run. This database makes possible and simplifies the documentation of both the exposure measurements of the state measuring authorities and also those of external (private) measuring bodies.

Non-random distribution of mutations in the PHEX gene, and under-detected missense mutations at non-conserved residues

Thirty newly detected mutations in the PHEX gene are reported, and pooled with all the previously published mutations. The spectrum of mutations displayed 16% deletions, 8% insertions, 34% missense, 27% nonsense, and 15% splice site mutations, with two peaks in exon 15, and 17. Since 32.8% of PHEX amino acids were conserved in the endopeptidases family, the number of missense mutations detected at non-conserved residues was smaller than expected, whereas the number of nonsense mutations observed at non-conserved residues was very close to the expected number. Compared with conserved amino acids, the changes in non-conserved amino acids may result in benign polymorphisms or possibly mild disease that may go undiagnosed.

Congenital muscular dystrophy with cerebral and ocular malformations (cerebro-oculo-muscular syndrome)

Two children with the features of the "Muscle, Eye and Brain (MEB) Disease" (SANTAVUORI 1977), i.e. congenital muscular dystrophy (CMD), cerebral malformations and ocular abnormalities are reported and correlations with other inherited autosomal recessive syndromes of CMD, Fukuyama type of CMD and the Walker-Warburg syndrome discussed. The association of CMD and cerebral lesions indicate an unfavourable clinical prognosis.