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Purpose/background: What are the options for early diagnosis, treatment and prevention of the occlusion of microvascular anastomosis after replantations? METHOD AND (CLINICAL) MATERIAL: This is a retrospective analysis of 336 cases involving primary microvascular repair after an injury between 1984 and 2000. In 272 cases this was a revascularisation and in 187 a replantation. In 23 cases the vascular anastomosis was located proximal to the wrist (macroreplantations) and 313 times distal to it (microreplantations/-revascularisations)., Results: Vascular complications developed in seven and 54 cases respectively. 40 % of these 61 patients showed a severe soft tissue compromise or/and had sustained an injury known to cause widespread intima lesions (15 avulsions, six crush injuries, one blast, one gun shoot, one RTA). 37 of the 61 patients had been injured by circulating saws. There were 34 arterial and 22 venous occlusions, four no-reflow-syndromes and one HIT-syndrome. Almost 90 % of these vascular complications occurred within the first four post-operative days, 50 % even within the first 36 hours. Treatment was surgical in 39/61 cases and conservative 22 times. In 55 % (33/61) of all cases this treatment was successful., Conclusion: With an overall incidence of 1 : 6 vascular crisis is not only the most consequential but also the most common post-operative complication after replantations. Timely operative and/or non-operative therapeutic measures can save more than half of the replants affected.

Out of the 127 amputated thumbs replanted at our unit during the last 15 years, there were 27 avulsion injuries. The average age of the 24 male patients was 33 years, that of the three female patients was 34 years. 70 % of the injuries were occupational accidents. Among the 27 patients, 21 had a complete and six an incomplete avulsion of the thumb. The level of avulsion-amputation was at the MP-joint ten times, between MP and IP joint ten times and at the IP-joint seven times. The healing rate of the subtotally avulsed thumbs was 100 %, that of the completely amputated thumbs 36 %. The most important post-operative complications observed were venous and secondary arterial thrombosis, whereby most of them occurred within the first 24 hours after replantation. The duration of ischaemia had a significant influence on the healing rate. In 80 % of the cases reconstruction of nerves have been carried out secondarily. A two-point discrimination was achieved in two cases only. The osteosynthesis was done almost exclusively with K-wires. Ten of 19 patients had to change their profession, while nine of them were able to return to their previous jobs, which in these cases were pre-dominantly white collar jobs. Another patient went for early retirement (he was a painter). All 19 patients followed-up had a range of movement of their saddle joints which was sufficient for the needs of most of the activities of daily life. Stiffness of the MP and IP joints was a common finding but had little functional impact, as it has been reported by other authors previously. We conclude from the results presented that in cases of avulsion injury of the thumb replantation is a procedure with significant chances of success.

The DTC promotes access to surgical care facilities of acceptable medical quality for all people in third world countries. To achieve this goal following concepts and activities are persued: Establishment of a 2-year training programme district surgery Postgraduate surgical training in Germany Workshops and annual scientific meetings Development of adapted surgical technologies Cooperation with national and international organisations Promotion of north-south partnerships between colleagues and hospitals.

The necessity for a standardized documentation system for the complementary sector of psychiatric care is pointed out, and the goals and requirements to be met are debated. The test-version of such a documentation system (abbrev. BADO-K) is shown. It consists of modules for the assessment of client-centered data, and for the documentation of the treatment process in various facilities. Furthermore, a module of questionnaires and instruments for assessing outcome variables (e.g. quality of life) is integrated. The principles for using the paper-pencil-version and the EDP-version are outlined and discussed with regard to the legal regulations concerning the protection of personal data. Finally, possibilities and limitations of the presented documentation system are discussed. It is argued that the BADO-K is an useful instrument for evaluating the process and outcome of community psychiatric care.

An instrument documenting the care process in in-patient psychiatric services within the German mental health care system has been developed (BADO). This paper reports on the development of a documentation system for all non-hospital based mental health services (day centres, community mental health centres, supported accommodation, work rehabilitation services for general adult psychiatric patients and people with substance misuse). The development process and the instrument (PC and paper and pencil version) are described. The documentation system (BADO-K) could be an important prerequisite for quality assurance in non-hospital based mental health care, and its structure ensures compatibility with the corresponding hospital-based documentation system.

In the wake of the disintegration of the policlinical system which had prevailed in the former German Democratic Republic, far-reaching restructuring has become necessary in the "new" German laender in the field of complementary psychiatric care. Establishment throughout the state of Saxony of a uniform outreach-based ambulatory service ranks as a first component towards building regionalized community psychiatric networks. In light of some twenty years of experience in the old laender, this function is considered a task of the Social Psychiatric Services ("Sozialpsychiatrische Dienste", SPDIs). The present study had been directed at a state-wide investigation of the expectations community-practice psychiatrists (n = 165), physicians in psychiatric clinics (n = 95) and staff working in SPDIs (n = 138) in Saxony hold regarding service programmes and operating methods of these newly established service delivery structures. Given the high return rates in this anonymous postal questionnaire study, the findings presented are considered near-representative. A concurrent finding for all of the groups interviewed, expectations concerning the client population to be serviced by the SPDIs focus on the group of persons with chronic mental illness. Also, the expectations expressed concerning major care/therapeutic services to be rendered by the SPDIs concur in their emphasis on a core area of immediately client-oriented SPDI activities. Between the two medical groups, a major difference found is that community-practice psychiatrists more frequently expect high SPDI commitment regarding sociotherapeutic programmes at an institutional level, whereas clinical physicians expect them to focus on taking over medical therapies in the narrower sense. The expectations SPDI staff hold relative to the therapeutic services to be rendered by themselves go beyond the scope of what has so far been implemented in their current activity, and qualitative content analyses are presented in the article for each of the areas concerned. Along with better staffing levels, removal of in-service organizational and further education deficits are identified by SPDI staff as the two main requirements for stabilizing their operations. In order to counter undue burdening of the SPDI with service expectations and to enable a more clear-cut positioning of its programme structures within a complex psychosocial service delivery system, it is necessary--at least in the state of Saxony--that further needs-oriented establishment and/or extension of community-based psychiatric services and agencies take place.

One of the highest rates of suicide occur in German-speaking countries and particularly in Saxonia. There are grounds for the assumption that the fact has been caused by a careful recording of suicides in this country since 1829. The paper describes the development of rates of suicide and the changes of the suicidal methods in Saxonia during the last one-hundred- and -fifty years with regard to age and sex.

When discussing and dealing with the way things went with German psychiatry during fascism the question arises constantly as to the scientific and theoretic self-interpretation of a specialist discipline that allowed itself to be misused without offering much resistance, if at all. The article makes an attempt to trace a few paths of specialist ideology at the turn of the 19th to the 20th century. The misuse of psychiatry and by psychiatry that has been practised both in the past and in the present cannot be understood if the guiding concepts of science generally ruling at the time are ignored.

As to the prevention of somatic and psychosomatic diseases it should be tested, whether life-events are of interest to pathogenesis of disturbances like multiple sclerosis and ulcerative colitis. The social readjustment rating scale (Holmes, Rahe) was used and the life-change-unite-score of the groups of patients (n = 30) and a normal population was compared. Patients with m.s. and u.c. have a significant higher LCU-score than the normal group. Between the two diseases one can find no difference.

An account is given of three patients who exhibited a malignant neuroleptic syndrome after the administration of neuroplegics. Like other authors, we identified typical elicitation factors and clinical characteristics. In one case a catatonic dilemma with lethal issue was observed. In the final case dealt with in this paper, the renewed application of neuroplegics following the termination of the malignant neuroleptic syndrome was tolerated without complications, whereas in the case of an epileptic patient with damage to the brain, the malignant neuroleptic syndrome returned upon dosage increase.

During spermatogenesis in mammals the evolutionary early histones are replaced step by step by more species specific nucleoproteins (protamines). The protamines protect the genetic information of the male against mutagenic or other damaging influences and possibly play a role in male fertility. A method was presented to study the nucleoproteins (NP) of single human ejaculates. This procedure was checked concerning its usability and validity by bull spermatozoa. The NP of cryopreserved human spermatozoa of fertile men and of infertility patients were investigated and compared with the electrophoretic patterns of NP of somatic hepatocytes of rat and mouse. A total of 48 semen samples were studied. Ten of these samples were obtained from semen donors of proven fertility and 38 samples were collected from male partners of infertile couples. Photodensitometrically it could be distinguished between percentages of non-protamines (PNP) and percentages of protamines (PP). The PP varied intra-individually with a mean standard deviation of 34%, analogously to the alterations of classical semen parameters. The PP of fertile men did not significantly differ from the infertility patients with normal spermiogram parameters but showed a significantly higher value compared with the semen samples with pathological spermiograms. On average the PP of all infertile patients were significantly lower than the PP of fertile semen donors.

The authors report experience obtained with the use of Lyogen Depot in outpatient aftertreatment of schizophrenic psychoses. There has been observed a highly significant reduction in the number of relapses as compared with the time when this drug had not yet been available. A positive balance will be obtained especially in those cases in which it is possible for all patients to be systematically included in the dispensary treatment scheme.

In recent years the initial attempts at algotherapy employing the predominating forms, such as medicinal treatment, electrotherapy, and operative treatment, have greatly improved the care of patients suffering pain. Psychological pain control techniques are a further feasible means of treatment. They include cognitive and behavioral intervention techniques in part already well known that can accompany and enhance traditional forms of anodyne therapy. By way of example, the concept of "pain inoculation" (Bullinger & Turk, 1982) is described in its sequence of phases. Methods of application in clinical practice are referred to.

Preliminary results obtained in epidemiological studies are reported. The data obtained shows extensive need for psychotherapy, with marked differences between urban and rural communities. Considerations on the present situation in psychotherapy are given and suggestions made for changes in the present system of treatment.

On three separate occasions, the authors taught at Gondar School of Medicine, attached to the University of Addis Ababa. They found that the neurological group of patients was determined by geographical rather than specifically tropical conditions, and that the psychiatric syndromes resembled those here, considerably influenced, however, by traditional rural medicine. The paper makes observations on comparative psychopathology.

The rehabilitative difficulties in part of the patients with schizophrenia are connected with premorbid disablements which lead to faulty social developments. An attempt is made to show by the example of some courses of diseases that the problems of these patients are largely similar; they are related to the patients entering the phase of vocational life, the establishment of appropriate partner relations and disturbed relations with the generation of their parents.

It is reported on the most important disease as a sequel of the intake of central-effective pharmaca (sedatives, hypnotics antiepileptics, analgesics and psychopharmaca). Psychopathological and neurological syndromes are described in detail.

The contribution deals with problems encountered during the psychiatric treatment of foreign patients, particularly with those from developing countries. It has been found that scope for socio- and psychotherapeutic treatment is very restricted and that the frequent necessity of returning these patients to their native countries leads to not unconsiderable conflicts. Questions of transcultural psychiatry are regaining importance in connection with increasing migration.

The present paper reports a model designed to optimize treatment of mental disorders. This model has as its basic principle the division into sections of the region to be cared for in addition to the restructuring of existing mental hospitals. The advantages of this model of sectionalisation are discussed in detail.