Treating the distorted body experience of anorexia nervosa patients.
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Biomedical subjects
Publications and source records attributed to M Probst.
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Abdominal trauma has the priority in diagnosis and therapy after assuring cardiorespiratory function. Abdominal injuries are seen in 2%-5% of all accidents, often as polytrauma. In the FRG there are mainly blunt traumas (90%). Abdominal trauma is the leading injury in 51.6% of fatal traffic accidents. The frequency of the organ traumas is: spleen 30.2%, liver 19.2%, stomach/gut 13.1%, pancreas 5%, mesentery 2.2%. The consistently reported mortality rate of 20% obliges rapid and directed use of all diagnostic procedures, i.e. ultrasound, lavage, CT.
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In the patient unit of the University Clinic for Psychiatry at Kortenberg (K.U. Leuven) Belgium and in the Psychosomatic Hospital Bad Pyrmont, which specialises in the treatment of anorexia nervosa, a great deal of attention is given to the evaluation of body image via the video-distortion technique, the video-confrontation technique and the body attitude test (a questionnaire). These different methods as well as the first findings and experiences are described.
Though the disturbed body image is an essential phenomenon of anorexia nervosa, hardly any specific attempts are described to alter the way these patients experience their bodies. The authors present a body-oriented treatment method aimed at curbing hyperactivity, rebuilding a realistic self-concept, learning to enjoy one's own body, and developing social skills. The therapy is a mixture of different techniques among which video-confrontation appears to be an important element.
Super-radical surgery upon shoulder-girdle and chest wall often means mutilation and is therefore a heavy burden for the patient. Nevertheless it can have very rewarding results, if the indications are correct. They include treatment of soft tissue tumours, under certain conditions of metastases within the thoracic wall and very rarely of trauma. Experiences with 9 patients, treated between 1983 and 1985, are reported. Indications for these operations and their prognosis are discussed.
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In a prospective, controlled randomised study of 100 patients the healing of the sacral wound after abdomino-perineal exstirpation of the rectum with and without metronidazole parenterally was compared. A significant reduction in hospital stay and in postoperative time of drainage of the sacral wound was found. The primary wound healing, defined as healing without complications within 14 days, was registered in 84% in the treated group and in 56% in the controls. No influence was seen in the number of urinary tract infection by this treatment.
Crohn's disease, an inflammatory illness of the large and the small intestine, has rising incidence in highly civilized populations. Its etiology is unknown; multifactorial causes are assumed. The outcome and the effect on the individual are cancer-like. Surgical therapy is only helpful as far as the complications of the disease are concerned. Resection of the affected parts of the intestine will not lead to restoration, as the recurrence rate shows.
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Based on own experiences in handling a basal cell carcinoma of the junctional zone of the anal canal and in addition to the literature the following therapy is recommended: 1. Operation according to the criteria of anal carcinoma surgery (abdomino-perineal resection); 2. additional radiation therapy in cases of speech indication; 3. follow-up by periodical ambulant controls as it is practised after colorectal carcinoma operations.
Of a total of 3850 operations on the colon and rectum (1964--1980) 52 hand-made anastomoses after anterior rectum resection were performed from September 1979 to August 1980 (resection quota 47%) without intestinal fistula. These were compared with 52 anastomoses by machine (EEA). There was no extension of surgical indication by use of the machine. Complications like anastomotic insufficiency occurred in a similar range (hand: 4, machine: 3), but were easier to manage after machine suture. The number of other complications was comparable. Use of the machine gives advantages to the experienced surgeon, but it should only be used by those who are able to master the complex technique.
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