[Placebo interventions in medical practice]. / Placebointerventionen in der medizinischen Praxis.

Surveys of physicians showed that they use placebo interventions with different intentions in practice. The ongoing debate whether this is ethically acceptable requires to engage in this topic. More and more results from research have shown that placebo or contextual effects can be clinically relevant. It is worthwhile to think about the utilization of these effects for patients. For that purpose there are no ready-made solutions. Every physician has to decide for his or her own self whether and which therapy with doubtful specific efficacy he or she uses. This article may assist physicians to deal with this topic and to find an own well-grounded position.

Acupuncture as complementary therapy for back pain.

Back pain affects more than 9 million people in the United States and accounts for 25% of disability in all work-related injuries. It has a lifetime prevalence of 60%-90% and it costs more than $50 billion annually to manage back pain. The incidence of back pain in nurses is over 80% and accounts for more than 150 million working days per year being lost. Western treatment of back pain is controversial and often ineffective. Acupuncture as a therapeutic intervention is practiced widely in the United States. Research has demonstrated that acupuncture may benefit those who suffer from back pain when they have failed to respond to previous treatment by drugs, bed rest, epidural injection, physiotherapy, osteopathy, chiropractics, and surgery. Acupuncture is a powerful and complementary therapy for back pain.

Analysis of morphology and gait function after intraarticular calcaneal fracture.

Open reduction and internal fixation is suggested by an increasing number of investigators as preferable treatment of displaced intraarticular calcaneal fractures. Assuming that quasianatomical reduction coincides with adequate function, many surgeons rely on morphological parameters (standard radiography, computed tomography) to demonstrate the effectiveness of surgery by achieving an optimum restoration of calcaneal geometry and joint surfaces. In order to correlate morphologic parameters and functional assessment, a prospective study was performed on 45 patients after surgical treatment of intraarticular calcaneal fractures using standard radiographic and computed tomographic scores, clinical evaluation, and gait analysis (dynamic pedography). Mean follow-up time after reconstruction was 23 months (range 18-50). Although clinical evaluation and assessment of gait function corresponded well with each other, radiographic scores showed a poor to moderate correlation with functional evaluation (r = 0.29-0.62); this was probably due to the missing analysis of soft tissue parameters. The comparison of clinical results and gait parameters with the individual radiographical parameters allowed us to identify those factors, with the greatest influence seen on the functional prognosis (i.e., calcaneal width, arthrosis in the neighboring joints). Morphologic analysis after calcaneal reconstruction based on radiographic techniques cannot predict subsequent function or substitute for functional assessment. However, it does allow for practical conclusions for surgical strategy in primary osseous reconstruction or secondary corrections.

[Tolerability and pharmacokinetics of an intravenous immunoglobulin preparation in immunologically normal subjects and tolerability in patients with hypogammaglobulinemia resulting from chronic lymphatic leukemia]. / Verträglichkeit und Verweildauer eines intravenösen Immunglobulinpräparates bei immunologisch gesunden Personen und Verträglichkeit bei Patienten mit Hypogammaglobulinämie infolge chronischer lymphatischer Leukämie.

Tolerance, clinical effects and kinetics of an unmodified immunoglobulin preparation for intravenous use were investigated in 4 patients with advanced chronic lymphocytic leukemia. Previously, good tolerance of the preparation had been found in 49 immunologically normal patients. The four patients with secondary humoral immunodeficiency received doses of 140-360 mg IgG/kg per infusion as outpatients at monthly intervals. With one exception, no acute infections (pneumonitis), as commonly seen before, were observed during the observation time of 24 to 68 weeks, and the pre-existing chronic infections (bronchitis, sinusitis etc.) remained compensated without antibiotics. In all four patients tolerance of the preparation was good. In all cases of hypogammaglobulinemia a dose-dependent increase in the serum IgG concentration was observed immediately after the infusion. However, persistence of the serum IgG increase showed considerable interindividual differences. The half life of the tetanus and HBs antibodies (21.7 to 34.4 and 19.7 to 25.7 days respectively) found in 4 healthy volunteers is within the biological range. This indicates an unmodified structure of the antibodies of the IgG class contained in the preparation used.