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Pneumomediastinum, defined as abnormal presence of air in the mediastinum, is a rare cause of acute chest pain. The condition may occur spontaneously as well as a secondary consequence of trauma or medical interventions. The spontaneous pneumomediastinum (Hamman's syndrome) is associated with a good prognosis, even without intervention. However, undelying severe conditions such as gastrointestinal perforations should be excluded. Diagnosis might be made using conventionell chest x-ray; a CT scan may give additional useful information. A subcutanous emphysema is a common finding in patients with pneumomediastinum. The presence of air in the epidural space of the spinal canal (pneumorrhachis) is a rarely seen but likewise mostly benign complication. We report a case of a young man with Hamman's syndrome and pneumorrhachis, provoked by acute asthma exacerbation; despite pronounced symptoms, his condition could be treated conservatively., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Alongside imaging techniques, pulmonary function testing helps in the diagnosis of underlying disorders such as asthma and chronic obstructive pulmonary disease (COPD) or fibrosing lung disease. However, disease severity grading is also important, as well as disease follow-up under therapy. The value of spirometry as a first-line diagnostic test, whole-body plethysmography in advanced diagnostics, the measurement of transfer factor, as well as blood gas analysis are outlined. The importance of spiroergometry, echocardiography, and right-heart catheterization, particularly in the functional assessment of pulmonary vascular disorders, is described. Tests in respiratory sleep medicine, such as polysomnography, as well as tests for diagnosing chronic respiratory failure, are part of the respiratory physician's diagnostic armamentarium.

Objectives: Case management by health care assistants in small primary care practices has proven effective in improving depression symptoms in depressive patients. Resource consumption and costs of this intervention have not been evaluated yet., Methods: Health care assistants and general practitioners of 15 participating practices were interviewed for intervention-related time expenditures. Intervention costs were based on individual labour costs., Results: The annual time spent was 6.3 h per patient for health care assistants and 3.6 h for general practitioners (mean 8.9 patients per practice). The case management caused costs of € 277 per patient and year., Conclusions: A telephone-based case management as add-on therapy improves quality of primary care depression therapy while causing only moderate costs for health care providers., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: Medical rehabilitation aims at improving disorders of functions, capacity and participation. The present study investigates the degree to which inpatient psychosomatic rehabilitation improves disorders of capacity., Methods: 213 inpatients (149 females, 64 males) from a psychosomatic rehabilitation unit were investigated at the beginning and end of a six-week treatment using the Mini-ICF-Rating for Psychological Disorders (Mini-ICF-APP), an observer-rating instrument for the assessment of disorders of capacity, especially in regard to social functioning., Results: There were significant improvements in all dimensions of disorders of capacity. Patients who were discharged as able to work benefited most from the rehabilitation treatment, whereas patients who were on sick leave at discharge showed only moderate improvement. Those who were able to work at admission but discharged as sick leave had the highest values in disorders of capacity in both measurements. Patients suffering from complex mental illnesses did show only moderate improvement. The greatest changes were seen with respect to "planning and structuring of tasks", "competency" and "non-work activities" while assertiveness did show the smallest changes., Conclusions: The data show that psychosomatic inpatient rehabilitation produces positive effects on disorders of capacity.

Supplementary to the description of diseases at symptom level, the International Classification of Functioning, Disability and Health (ICF), edited by the WHO, for the first time enables a systematic description also at the level of disabilities and impairments. The Mini-ICF-Rating for Mental Disorders (Mini-ICF-P) is a short observer rating instrument for the assessment of disabilities, especially with regard to occupational functioning. The Mini-ICF-P was first evaluated empirically in 125 patients of a Department of Behavioural Medicine and Psychosomatics. Parallel-test reliability was r = 0.59. Correlates were found with cognitive and motivational variables and duration of sick leave from work. In summary, the Mini-ICF-P is a quick and practicable instrument.