Internet and computer game addiction represent a growing mental health concern, acknowledged by the World Health Organization.OBJECTIVE To determine whether manualized cognitive behavioral therapy (CBT), using short-term treatment for internet and computer game addiction (STICA), is efficient in individuals experiencing internet and computer game addiction. DESIGN, SETTING, AND PARTICIPANTSA multicenter randomized clinical trial was conducted in 4 outpatient clinics in Germany and Austria from January 24, 2012, to June 14, 2017, including follow-ups. Blinded measurements were conducted. A consecutive sample of 143 men was randomized to the treatment group (STICA; n = 72) or wait-list control (WLC) group (n = 71). Main inclusion criteria were male sex and internet addiction as the primary diagnosis. The STICA group had an additional 6-month follow-up (n = 36). Data were analyzed from November 2018 to March 2019. INTERVENTIONSThe manualized CBT program aimed to recover functional internet use. The program consisted of 15 weekly group and up to 8 two-week individual sessions. MAIN OUTCOMES AND MEASURESThe predefined primary outcome was the Assessment of Internet and Computer Game Addiction Self-report (AICA-S). Secondary outcomes were self-reported internet addiction symptoms, time spent online on weekdays, psychosocial functioning, and depression.RESULTS A total of 143 men (mean [SD] age, 26.2 [7.8] years) were analyzed based on intent-to-treat analyses. Of these participants, 50 of 72 men (69.4%) in the STICA group showed remission vs 17 of 71 men (23.9%) in the WLC group. In logistic regression analysis, remission in the STICA vs WLC group was higher (odds ratio, 10.10; 95% CI, 3.69-27.65), taking into account internet addiction baseline severity, comorbidity, treatment center, and age. Compared with the WLC groups, effect sizes at treatment termination of STICA were d = 1.19 for AICA-S, d = 0.88 for time spent online on weekdays, d = 0.64 for psychosocial functioning, and d = 0.67 for depression. Fourteen adverse events and 8 serious adverse events occurred. A causal relationship with treatment was considered likely in 2 AEs, one in each group.CONCLUSIONS AND RELEVANCE Short-term treatment for internet and computer game addiction is a promising, manualized, short-term CBT for a broad range of internet addictions in multiple treatment centers. Further trials investigating the long-term efficacy of STICA and addressing specific groups and subgroups compared with active control conditions are required.

Two cases with spontaneous regression of a histologically confirmed hepatocellular carcinoma (HCC) are presented. This rarely seen phenomenon of a spontaneous tumor involution is discussed and compared with the current literature. The clinical symptoms were very similar to that of a liver abscess. A 56-year-old male suffered from a multicentric, highly differentiated, trabecular HCC. First symptoms were epigastric pain, septic fever and arthritis. The tumor marker AFP was constantly normal and no hepatitis could be verified. A resection of the tumor was performed. In patient 2, a 74-year-old male, a multicentric, clear cell HCC was found. The patient had completely recovered from hepatitis type B and within the liver tissue no viruses could be identified. Clinical symptoms were mainly characterized by upper abdominal pain and septic fever. AFP was excessively elevated (3850 ng/ml) but returned to normal preoperatively. In both cases, the specimen showed a subtotal necrotic HCC with insignificant amounts of vital tumor cells. Neither patient had a liver cirrhosis macroscopically, however patient 2 had local periportal fibrosis histologically. After 24 and 41 months of follow-up, respectively, both patients are in good health

Zusammenfassung Einleitung Alkoholkonsum in der Schwangerschaft birgt viele Risiken für das ungeborene Kind. Trotz präventiver Maßnahmen konsumieren manche Schwangere Alkohol. Diese Untersuchung zielt darauf ab, mögliche Gründe für den Konsum in der Schwangerschaft zu identifizieren und die Zuschreibung der Expert:innenrolle an medizinisches Fachpersonal durch die Betroffenen zu beleuchten. Material und Methoden In dieser Untersuchung wurden 9 Diskussionsthreads aus Onlineforen zum Thema Alkoholkonsum in der Schwangerschaft mit insgesamt 115 Diskussionsteilnehmern mittels Grounded Theory analysiert. Die diskursive Validierung der Ergebnisse erfolgte im Forschungsteam. Ergebnisse Es zeigte sich, dass die persönliche Definition der Mutterrolle Einfluss auf das Konsumverhalten hat. Frauen, die sehr um das Kindeswohl besorgt waren, konsumierten gelegentlich in Stresssituationen oder bei sozialen Anlässen, berichteten aber häufig über ein nach dem Konsum auftretendes schlechtes Gewissen. Frauen, die eigene Bedürfnisse stärker gewichteten, konsumierten eher aus Genuss oder weil sie sich durch Verbote bevormundet fühlten. Als förderliche Faktoren für die Zuschreibung der Expert:innenrolle an Gynäkolog:innen wurden eine Arzt-Patientenbeziehung auf Augenhöhe sowie eine ausführliche, non-direktive Aufklärung identifiziert. Als hinderlich zeigte sich dagegen eine paternalistische Haltung und das Aussprechen von Verboten. Diskussion Bei allen Frauen zeigte sich ein hoher Informationsbedarf zum Thema Alkoholkonsum in der Schwangerschaft. Die Arzt-Patienten-Beziehung scheint in der Informationsvermittlung eine wichtige Rolle zu spielen. Zudem wurde deutlich, dass der Unterstützungswunsch bei Frauen, die eine Abstinenz anstreben, nicht ausreichend erfüllt wird. Schlussfolgerung Der Alkoholkonsum in der Schwangerschaft sollte in der Betreuung aller Schwangeren regelmäßig angesprochen werden. Neben einer Aufklärung über die Risiken des Konsums sind Informationen zu Unterstützungsangeboten relevant.

A granular cell tumor is one of the rare tumors of the esophagus. We present the case of a 65-year-old male patient, who was admitted to our hospital for an elective cholecystectomy. In the routine diagnostic gastroscopy an intramural tumor in the distal esophagus was incidentally found. Repeated endoscopic biopsies did not reveal the histologic diagnosis, although endoscopic ultrasound invasion to the tunica muscularis could not be excluded. After indicating the operative therapy, the tumor was removed through a thoracoscopic approach. The histologic specimen showed a granular cell tumor of the esophagus (tumor of Abrikossoff). Since the tumor grade was unknown, our therapy seemed to be justified because of the low risk involved in minimally invasive operative procedures. There has been much discussion and controversy in the literature on this subject, including the potential for malignancy and the correct therapy regime, with a general shift to conservative or minimally invasive treatment. The case is discussed with a review of the literature.

Qualitative research methods, primarily interviews, have become more common in the field of addiction research. Other data sources were often neglected, although sources such as social media can offer insights into the realities of people, since social media also plays a relevant role in today's living environments. This article examines the use of online forums as an underutilized data source in contrast to telephone interviews, to identify methodological opportunities and challenges. We analyzed nine discussion threads and seven interviews about ‘alcohol consumption during pregnancy’. Discursive comparison of the results was performed with a focus on sampling issues, comparability and risks for participants and researchers. Key issues were present in both data sources. People with different opinions were openly hostile in forums, while tolerance was more often expressed in interviews. The interviews showed a rather mild communication style, which could be attributed to social desirability. In the forum discussions, the participants often expressed themselves very directly. To comprehensively grasp the subject matter of the research, it is important to recognize the types of communication promoted by different data sources. These results have implications for research about female substance use. Knowledge of the issues will bestow a valuable contribution to researchers working in the field of substance use to help develop appropriate research approaches, as they engage in research into this highly stigmatized and controversial area.