[Off-label use in cardiac surgery]. / "Off-label use" in der Herzchirurgie.

In the view of off-label use, special concern should be granted to obtaining informed consent from the patient. It is important to point out the test character of the treatment. The patient has to be informed about the risks that exist with the treatment. The patient has to know that a drug not yet approved for this treatment is being used and the risks linked with its use have to be addressed. In addition, informed consent has to be documented and the differences compared with the standard treatment have to be pointed out.

[Informed consent in aesthetic plastic surgery]. / Patientenaufklärung in der ästhetischen Chirurgie.

The informed consent plays a very decisive part in aesthetic plastic surgery. As there is often no medical indication in plastic surgery, the patient has to be informed about all the facts of an operation, especially about the possible risks. The legal requests for therapeutic and economic clarification gain in importance. The jurisdiction in Germany demands a merciless clarification for the patient. The patient needs to be clarified about all facts early enough so that he has a sufficient amount of time to weigh-up the pros und cons of the operation and if necessary to take advice from someone else. The sufficient documentation is very important at the sight of the extensive burden of proof at the expense of the physician.

[Caution in foregoing patient education]. / Vorsicht beim Aufklärungsverzicht.

A key part of the individual patient rights is the renunciation of explicit information on a planned surgical procedure. However, jurisdiction has assigned strict requirements for the validity of such a denial. To ensure legal validity of the denial, the surgeon has to obtain informed consent signed by the patient stating that the patient rejected detailed medical information, but did understand the nature of the planned procedure. The initiative to receive just limited medical information must be taken by the patient himself, not the surgeon. Thus, the patient may choose to receive either detailed or limited information on the surgical procedure. Important to know: A limited time schedule of the surgeon is not a valid justification for a limited informed consent.

[Critique of continuing medical education from the viewpoint of participants. Results of an evaluation of didactic seminars of the Academy of Continuing and Graduate Medical Education of the Hessen Federal Association]. / Kritik der ärztlichen Fortbildung aus Teilnehmersicht. Ergebnisse der Evaluation didaktischer Formen von Seminaren der Akademie für arztliche Fortbildung und Weiterbildung der Landesärztekammer Hessen.

In cooperation with the chair of academy of vocational training and educational planning of the University of Technology Darmstadt the academy planned and realized a systematic evaluation concerning participants's opinion and criticism. A half-standardized questionnaire was developed, tested and applied according to the rules and recommendations of the German medical association. Between 9/94 and 11/98, feedback from 121 of the academy's seminars was received. Most seminars were judged positively in view of clarity and stimulation of thoughts while there was considerably less praise for the contribution of self-information and the possibilities of communicating and interacting. With regard to the lecture's practical relevance most seminars were judged positively. Media design and management was considered insufficient by most of the participants, as were time management and pre-information. The idea of examining the effect of learning was rejected by most of the students: Better media were desired, as were more case studies and literature references.

Peptic ulcer in Greenland Inuit: evidence for a low prevalence of duodenal ulcer.

UNLABELLED: In an eight years period new peptic ulcer was diagnosed in 127 Inuit patients at the Central Hospital, Dronning Ingrids Hospital, Nuuk/Godthåb. The ratios: duodenal ulcers (DU): prepyloric ulcers (PPU): gastric ulcers (GU) were 17:22:88. The male:female ratio was 2:1. 46 of the patients were living permanently in Nuuk, 81 in The Districts. There were no significant differences in the type of ulcers among the two groups. The incidence of GU among the Nuuk population was comparable to the incidence in the Danish population (0.63/1000 inhabitants per year), whereas the mean age at the time of diagnosis was only 45 years, thus the patients were approximately 15 years younger than the Danish counterparts. The incidence of DU among the Inuits was 0.15/1000 inhabitants per year, significantly less than in the Danish population. The frequency of Helicobacter (H.) pylori infection among 56 Inuits with dyspeptic symptoms was: 0.61. Only 6/12 patients suffering from DU had a positive test for H. pylori infection. CONCLUSIONS: The incidence of duodenal ulcers in the Inuit population was only 10% of the incidence in a Danish population, whereas the incidence of gastric ulcers among the Inuits was comparable to the incidence among Danes. Only 50% of Inuit patients with proven DU had a positive test for H. pylori infection, whereas the frequency of H.pylori infection in a population with dyspeptic symptoms corresponded very well to the frequency reported from other populations.

Trehalase deficiency in Greenland.

Small-intestinal surgical biopsy specimens from 97 adult Greenlanders showed an incidence of trehalase deficiency in at least 8%. Trehalose tolerance tests performed in three individuals with low trehalase activity (6 IU/g protein) showed no increase in the blood glucose concentration. Three trehalase-deficient patients had lactase deficiency too. Trehalase deficiency is not considered to have any significance from a nutritional point of view.

Sucrase deficiency in Greenland. Incidence and genetic aspects.

The disaccharidase activities in small-intestinal surgical biopsy specimens from 97 Greenlanders were investigated. Five of the patients, or 5%, had sucrase deficiency. The diagnosis, sucrose malabsorption, was established by sucrose tolerance tests. In all parts of the world other than the arctic regions sucrase deficiency is a rare condition. The patients were divided into three separate groups in accordance with their sucrase activity. The middle group was considered to be heterozygote carriers of the sucrase-deficient gene. The number of people in the group corresponded to the theoretical number of heterozygotes in accordance with the Hardy-Weinberg equation, suggesting that sucrase deficiency is recessively inherited in a simple Mendelian fashion. Four of the five patients with sucrase deficiency had deficiency of lactase as well. The nutritional implications are discussed.

Epstein-Barr virus infection and serological profile in Greenland Eskimo children.

The Epstein-Barr virus (EBV)-specific antibody profile of 101 Greenland Eskimo children was determined. The proportion of children with serological evidence of recent or past primary EBV infections rose from 22% at 6 months of age to 79% at 24 months of age. All but 2 of 49 children more than 4 years of age proved seropositive. The geometric mean titre (GMT) of antibodies to the viral capsid antigen (VCA) was highest during the first 3 years of life and declined sharply to a lower, nearly constant level in older children. The GMT of antibodies to the nuclear antigen (EBNA), rose slowly during the first 4 years of life to its persistent level. None of the children had a history of illnesses comparable to infectious mononucleosis. The results have shown that in this population with an enhanced risk of nasopharyngeal carcinoma, primary EBV infection occurs at a very early age.

The concentration of vitamin B12, transcobalamins and folate in blood in a Greenland Eskimo population sample. Increased cobalamin and transcobalamin II in plasma compared with a Danish reference group.

The concentrations of cobalamin and transcobalamin I and II in plasma and of folate in erythrocytes were determined in a Greenlander population sample. Compared with the Danish reference group, cobalamin and transcobalamin II were increased in the Eskimos, whereas there were no differences in transcobalamin I and erythrocyte folate.

Immunoelectrophoretic studies on human small intestinal brush border proteins--amount of lactase protein in adult-type hypolactasia.

Jejunal biopsies from 15 Greenlandic and three Danish patients with adult type hypolactasia and nine Greenlandic and 15 Danish patients with normal lactase activity were analysed quantitatively for lactase protein by crossed immunoelectrophoresis. A constant correlation between the amount of lactase activity and immunologically reactive lactase protein was demonstrated irrespective of the lactase activity level. As immunoelectrophoresis expresses the amount of enzyme protein independent of the enzymatic activity, it is concluded that the low enzymatic activity in adults with hypolactasia is caused by a low amount of lactase and not by a modified inactive enzyme.