Functional gastrointestinal disorders among soldiers in peacetime versus out-of-area missions.

Functional gastrointestinal syndromes are chronic disorders of the abdomen with an absence of organic findings. The aim of this study was to compare the frequency and symptomatology of functional abdominal syndromes in soldiers during an out-of-area mission versus during peacetime at home. We examined 124 soldiers who sought medical care for abdominal symptoms at the German Field Hospital Trogir, Croatia. The control group consisted of 113 soldiers who were referred with abdominal symptoms to the Central Hospital of German Armed Forces Koblenz, Germany. After excluding an organic disease, the diagnosis of a functional disorder was made. Fourteen percent of the Implementation Force soldiers had symptoms of a functional syndrome. At home, the frequency of functional gastrointestinal disorders was 50%, significantly greater than the rate during the out-of-area mission (p < 0.0001). We conclude that functional gastrointestinal disorders are more rare during out-of-area missions than during peacetime. They are probably as frequent away from home as at home, but "health care seeking" is less frequent under the stressful conditions of out-of-area missions.

[Bilateral coronary fistula: a case report and review]. / Beidseitige Koronarfistel: Eine Fallpräsentation und Ubersicht.

A case is presented of an atypical arteriovenous coronary artery fistula which occurred in a young man who was admitted to hospital with constant stress-dependent dyspnea and a feeling of thoracic constriction. A continuous systolic-diastolic murmur above the 5th intercostal space to the left of the sternum was present. By means of transoesophageal echocardiography and heart catheterization a rather atypical bilateral coronary fistula was found. A bilateral coronary fistula had been formed from RCA and RCX which drained via a common intramural cavity into the right ventricle. The fistula was operatively closed. Bilateral coronary artery fistula are rare, being found with a frequency of 0.002-0.013% in heart catheterization. In 36 reported instances of bilateral fistulae it has been noted that drainage into the pulmonary artery is more common than is the case with single coronary artery fistulae. The therapeutic considerations correspond with those for single fistulae.

[Pulmonary aspergillosis in an immunocompetent female patient]. / Pulmonale Aspergillose bei einer immunkompetenten Patientin.

Symptoms of bronchopneumonia developed over 4 months in a 63-year-old woman in previously good health. The symptoms worsened despite treatment with tetracycline (500 mg twice daily for 10 days). Middle-lobe pneumonia was diagnosed both clinically and radiologically, but monotherapy with ofloxacin (200 mg twice daily) was ineffective, as well as combined treatment with gentamycin (80 mg), oxacillin (1 g) and azlocillin (5 g), each three times daily intravenously. Bronchoscopy revealed obstruction of the lumen of the right middle lobe bronchus by viscous purulent secretion which contained a high count of Aspergillus fumigatus, previously found in several sputum samples. The inflammatory process regressed completely within 12 days on itraconazole (200 mg twice daily), combined with nystatin inhalation (100,000 IU five times daily). The only possible aetiologically significant risk factor in this immunocompetent woman could have been her frequent use of a bio-waste container.

[Anomalies of the origin of the left coronary artery in differential therapeutic aspects]. / Abgangsanomalien der linken Koronararterie unter differentialtherapeutischen Aspekten.

In 2 patients different coronary anomalies concerning the left coronary artery are reported, both patients having atypical angina-like chest pain; the indications for coronary bypass surgery are discussed, based on our understanding of the pathophysiology leading to myocardial ischemia.

[Influence of digoxin upon the exercise ECG of healthy men (author's transl)]. / Der Einfluss von Digoxin auf das Belastungselektrokardiogramm Herzgesunder

Cardiac glycosides may cause in the exercise ECG of healthy persons S-T segment depressions, which imitate a coronary insufficiency. If this method of examination is to be carried out in diagnosing coronary heart disease, it is - therefore - recommended in many cases to discontinue, at all events, an eventual digitals therapy before the examination in order to avoid falsely positive results. 23 healthy men (average age 30.2 years) were applied digoxin of medially quick saturation over seven days. Exertion electrocardiograms at the bicycle ergometer were registered before and after digoxin application. In five further cases, plasma glycoside concentrations were evaluated by 86Rb erythrocyte assay; upon the degree of saturation used, these concentrations - on the sixth and seventh day - amounted to x = 1.03 ng/ml. The following items manifested after digoxin administration, under stress and after resting: Retardation of heart rate, declination of T amplitude, and individually to a very different extent - depression of the S-T segment. After application of digoxin, only 8 of the 23 test persons demonstrated S-T depressions that would have corresponded entirely to the conditions of a "coronary insufficiency". Thus, it appears to be justified to carry out - first of all and in order to exclude the possibility of a coronary insufficiency - an exertion electrocardiogram, without interruption of the glycoside therapy, also in patients who are undergoing a digitalis therapy. The reason for this measure is the fact that in healthy persons only one third of the cases must be expected to show a falsely positive result. If, however, significant S-T depressions occur, the examination has to be repeated after a sufficiently long-lasting glycoside-free interval.