MEDICINE

been studied in psychotherapy research for some time,

but the results so far have been heterogeneous (2, 3). In
addition to numerous physical disorders, yoga has also
been shown to be effective for chronic non-tumor pain and
addiction disorders, as Dr. Wolter commented. Studies on
alcohol and other substance dependences have also been
included in our meta-analysis. However, we excluded
some promising primary studies on the efficacy of yogic
breathing techniques in nicotine dependence because the
authors investigated only this isolated yoga component.
The authors of both letters call for the wider
acceptance and the increased therapeutic use of yoga in
practice. We can only agree with these statements. In
addition, it seems worth studying the efficacy of yoga
as a possible measure for relapse prevention.
DOI: 10.3238/arztebl.2016.0661c

REFERENCES
1. Klatte R, Pabst S, Beelmann A, Rosendahl J: The efficacy of bodyoriented yoga in mental disordersa systematic review and
meta-analysis. Dtsch Arztebl Int 2016; 113: 195202.
2. McRoberts C, Burlingame GM, Hoag MJ: Comparative efficacy of individual and group psychotherapy: a meta-analytic perspective.
Group Dyn 1998; 2: 10117.
3. Cuijpers P, van Straten A, Warmerdam L: Are individual and group
treatments equally effective in the treatment of depression in adults?
A meta-analysis. Eur J Psychiatry 2008; 22: 3851.
PD Dr. phil. Jenny Rosendahl
Rahel Klatte, M.Sc.
Universittsklinikum Jena
jenny.rosendahl@med.uni-jena.de
Conflict of interest statement
The authors of all contributions declare that no conflict of interest exists.

CLINICAL SNAPSHOT
A 28-Year-Old Man with Impaired Vision

Osler spots and Janeway lesions on the patients fingers and toes at the time of admission.

A 28-year-old man with acutely impaired vision, headache, and fever was referred to the emergency room because of
suspected meningitis. His vital signs on admission were: blood pressure, 110/75 mmHg; heart rate, 125/min; temperature,
38.5C. Physical examination revealed the skin changes shown in the images. Transesophageal echocardiography was
performed without delay and revealed a threadlike vegetation on the aortic valve. The laboratory findings were: WBC,
14 900/L; platelet count, 30 000/L; CRP, 147 mg/L (normal, <5 mg/L). Antibiotic therapy with ampicillin/sulbactam and
gentamicin was initiated as recommended in the pertinent guidelines; blood cultures taken beforehand were positive 24 hours
later for Staphylococcus aureus. The patients further course was complicated by recurrent endocarditis after aortic valve
replacement and by an intracranial hemorrhage extending into the ventricular system, causing hemiplegia. A bicuspid aortic
valve was a predisposing factor for this patients endocarditis. Impaired vision is a rare initial manifestation of endocarditis and
led to the initial misdiagnosis of meningitis in this case. Magnetic resonance imaging of the brain revealed numerous septic
emboli as the cause of the patients neurologic abnormalities.
Dr. med. Peter Korsten, Klinik fr Nephrologie und Rheumatologie, Universittsmedizin Gttingen, peter.korsten@med.uni-goettingen.de
Prof. Dr. med. Sabine Blaschke, Interdisziplinre Notaufnahme, Universittsmedizin Gttingen
Conflict of interest statement
The authors declare that no conflict of interest exists.
Cite this as: Korsten P, Blaschke S: A 28-year-old man with impaired vision. Dtsch Arztebl Int 2016; 113: 662. DOI: 10.3238/arztebl.2016.0662
Translated from the original German by Ethan Taub, M.D.

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