[Addressing the problem of terminal care in medical education--results of a survey of 565 students and physicians]. / Die Behandlung der Problematik der Betreuung Sterbender in Medizinstudium--Ergebnisse einer Befragung von 565 Studenten und Arzten.

Care for the dying is an important task for physicians. The ways in which this problem is dealt with during the medical training and the expectations of the people concerned were examined in 1989 and in 1994 by means of a questionnaire developed for this purpose. Altogether 565 junior doctors and medical students in Germany were asked. The number of people who declared that this topic was dealt with during their studies increased from 32.7% to 51%. The number of junior doctors and medical students who stated that they felt sufficiently prepared for care for the dying was low both in 1889 with 4.3% and in 1994 with 12.7%. Dealing with this problem seemed necessary to more than 97% of the people asked on both occasions. Results regarding the expectations and ideas of how and when this topic should be dealt with are also shown. Our results show that while there is a deficit in dealing with the topic "care for the dying" during medical training, there is a considerable interest in this subject among junior doctors and medical students.

[Changes in electrolyte and water balance in old age]. / Veränderungen des Elektrolyt- und Wasserhaushaltes im Alter.

The involutive restriction of renal function, of thirst, and loss of body fluid reduce the adaptability of the electrolyte- and fluid metabolism in the geriatric patient. The causes of hydromineral emergencies involving the elderly are discussed. It is explained how, in the geriatric patient, the rapid disturbance of fluid metabolism can frequently pose a more serious threat to life than the underlying pathology, and how awareness of this problem and its rapid resolution can often save the geriatric patient's life.

[Trends in the specialty of internal medicine: specialization and/or integration]. / Zum Trend im Fachgebiet der Inneren Medizin: Spezialisierung und/oder Integration.

The successes of modern medicine are results of the specialisation in medicine due to the technical development. With increasing specialisation several problems for education and training, for research and medical care develop, so, for instance, a total investigation of patients is not always given on a sufficient scale. Therefore it should increasedly be orientated to an education and training to a generalist both in the training of students of the subject human medicine and during the time of specialisation in the field of internal medicine. At the same time it appears necessary to discuss more intensely the integration and/or the specialisation with the internal specialists working in practice and in research, in order to develop at first a corresponding sense for the problems and to integrate the professional status of the generalist increasedly into the self-appreciation of all specialists of internal medicine.

[Relations between disordered exocrine pancreas function, alcohol consumption and age in alcoholics]. / Beziehungen zwischen gestörter exokriner Pankreasfunktion, Trinkmenge und Lebensalter bei Alkoholkranken.

During clinical withdrawal treatment, a disturbed exocrine pancreas function was found in 28 per cent of 72 alcohol addicts, which occurred in connection with an alcohol-induced pancreatitis. The clinical course was mainly quiescent. Altered bicarbonate concentrations and enzyme dissociations were found as a result of the secretin pancreozymin test. In alcohol addicts, the maximum activity of the amylase output was reached as early as 20 minutes and that of bicarbonate, trypsin and chemotrypsin not until 40 minutes post stimulationem. The sums of the logarithmically transformed 40-minute output of bicarbonate, amylase and trypsin displayed significant differences between the alcohol-addict and control groups. The degree of severity of the disturbed exocrine pancreas function was essentially a function of the daily amount of alcohol taken by the addict and of the age of the patient. The dysfunction was most evident in the 30-to-50-year-old patients. Chronic consumption of alcohol is assumed to give rise to a selective effect on the hydro-kinetic and ecbolic pancreas function.

[Enteral resorption kinetics in the aging process]. / Enterale Resorptionskinetik im Alternsgang.

With growing age functional and morphological changes in the alimentary tract appear. The age dependence of the intestinal absorption was investigated with the help of the modified D-xylose absorption test. By means of a graphic-mathematical evaluation of the blood level kinetics of D-xylose after oral and intravenous application the absorption rapidity (constant k12), the temporary position of the relative maximum of the D-xylose concentrations in the blood serum after oral application (time tm) and the size of the relative absorption of the small intestine were established depending on the time RR (t). Within the age range of 3 to 96 years it has been proven that a slowing down of the enteral absorption occurred with growing age. By prolonging the period during which the food components are absorbed in the small intestine (shift of tm towards later times) the old organism is just as capable of complete absorption as is the young one, even though the absorption processes take place at a slower rate. Absorption disorders in old age are due to morbidity and not, sui generis, to involution.

[Alcohol induced damage to the pancreas in patients with increased blood alcohol levels detected in road traffic]. / Untersuchungen über ethylische Pankreasschäden bei Patienten mit Blutalkoholnachweis im Strassenverkehr.

50 patients, driving motor-cars, having increased blood alcohol levels, were registrated and prosecuted. They voluntary underwent catamnestic researches for early diagnosis of alcohol induced lesions of the pancreas. In relation to the habitual drinking systems the study concluded 28 (56 per cent) healthy persons, 13 (26 per cent) alcohol endangered cases, 9 (18 per cent) alcoholics. Various biochemical parameters were changed, liver histomorphology resulted in about 50 per cent of cases a fatty degeneration of the liver and hepatitis. Special diagnostic methods (CCK-test, ERCP, ultrasound echography, computer-tomography) submitted in 24 per cent of cases suspect of alcohol induced pancreatitis. Results, which promote alcoholic pancreatic damage, are being discussed.

[Involutional peculiarities of digestion and resorption--deduction of preventive and therapeutic needs]. / Involutive Besonderheiten der Digestion und Resorption--Ableitung präventiver und therapeutischer Notwendigkeiten.

First indication of an age-related alteration of digestive tract can be proseed an age of fourty. In healthy elderly man functional capacity of nutritions is lowered. Normally the digestive capacity will be sufficient provided a reasonable nourishment. Usually the intestinal absorptive capacity tends to decrease in the elderly. But following delayed intestinal transit of nutritients absorption to a certain degree can occur sufficiently. Considering the nutrition of elderly people recommendations are given.

[Exsiccosis as an emergency condition in the aged]. / Die Exsikkose als Notfallsituation im Alter.

The involutive restriction of the renal function and of the thirst and the reduction of body water also diminished the range of efficacy and possibility for adaptation of the water metabolism of old people. Under geriatric aspects the causes for the senile exsiccosis are discussed. It is found that in old patients the quicker metabolism imbalance means a stronger threat of life that the disease itself. Often the consideration of this problem in much cases of diseases can save the life of the old patient.

A modified D-xylose absorption test.

A modified D-xylose-test is described which enables intestinal absorption to be assessed independently of renal and hepatic function. The speed of appearance of the peak of D-xylose-concentration in plasma after an oral administrated dose and the extent of absorption in the small intestine as a time-function, were analysed by graphic-mathematical evaluation of the kinetics of plasma D-xylose concentration after oral and intravenous administration. Small intestinal functional integrity was assessed in 172 normal individuals (aged from 3 to 96 years), also in 9 patients with coeliac disease. The speed and the extent of D-xylose absorption were significantly reduced in all cases of untreated coeliac disease and during relapse. There were no differences between normal individuals and treated patients. Experience over many years indicates that the modified D-xylose-test is a simple, reliable and inexpensive standard method for detecting changes in intestinal absorption.

Age-dependent alterations of intestinal absorption. II. A clinical study using a modified D-xylose absorption test.

With advancing age functional and morphological changes take place within the intestinal tract. The age-dependency of intestinal absorption has been studied using a D-xylose absorption test. The absorption rate (constant k12), the time of appearance of the relative maximum of the D-xylose concentrations in the blood serum after oral administration (time tm), and the extent of the relative absorption in the small intestine as a function of time RA(t) were determined by graphic-mathematical evaluation of the blood level kinetics of D-xylose after oral and intravenous administration. Within the age range of 3 to 96 yr, it has been proven that a slowing down of intestinal absorption occurs with advancing age. By prolonging the period during which the food components are absorbed in the small intestine (shift of tm towards the absorption processes take place at a slower rate. Absorption disorders in old age are due to morbidity and not, sui generis, to involution.

Age-dependent alterations of intestinal absorption. I. Theoretical aspects.

To test the absorption of orally administered D-xylose in the upper small intestine its concentration in the blood plasma must be measured. Absorption is determined as a function of time by subtraction of the blood values found after intravenous administration, which would indicate the rates of metabolism and extraction of xylose by the body. It is suggested that comparison with the behavior of a proposed four compartment model may give a biological interpretation of the results. The possible dependence of amount and rate of absorption can be determined if the same time after feeding of the same diet is used in each absorption measurement. It is suggested that the time point to be used for administration be that time at which the highest concentration of xylose in the peripheral blood is found.

[Therapy of pancreatitis and excretory pancreatic insufficiency in elderly patients]. / Therapie der Pankreatitis und exkretorischen Pankreasinsuffizienz bei alten Patienten.

Early active conservative therapy is of decisive importance for the prognosis of acute pancreatitis. Irrespective of the age of the patient a standardized basic therapy has to be adopted, but even in the old patient elective surgical treatment should not be regarded as "ultima ratio". As a matter of principle, conservative measures should first be taken to treat chronic pancreatitis. Surgery will be indicated in the presence of resistance of therapy or complications irrespective of the patient's age. Insufficiency of the excretory pancreatic function in old age may be asymptomatic, whereas gastrointestinal complaints can be improved or eliminated by enzyme substitution. But if the gastrointestinal symptoms complex in the elderly cannot be influenced by the administration of pancreatic enzyme, it would not be serious to dismiss such symptoms as consequences of the process of ageing.

[Function diagnosis of small intestine absorption using the modified D-xylose absorption test]. / Funktionsdiagnostik der Dünndarmresorption mit Hilfe des modifizierten D-Xylose-Resorptionstests.

Based on a biophysical model of the absorptive system a modified D-xylose test has been inaugurated, which is well suited to comprehensively assess the process of intestinal absorption. According to the author's experience of many years the test is a well-suited method for detecting changes in intestinal absorption. It excels by its high validity and reliability. Its practical accomplishment is easy and needs no expensive equipment. The method and the processing and evaluation of the measured values are described in detail.

[Iatrogenic disorders of the pancreas in old age]. / Iatrogene Störungen des Pankreas im Alter.

Besides the effects of iatrogenic and environmental factors on the pancreas, the article describes the effects of senile changes on the morphology and function of the excretory pancreas. The article pays particular attention to pancreatic trauma and post-inflammatory conditions, postoperative syndromes, the endoscopic retrograde cholangiography of the pancreas, the effects of alcohol on the pancreas, and rare pancreas conditions, which, in old age, may lead to morbid functional restrictions.