[Screening for colorectal cancer: a cost benefit analysis on a health prevention programme at the Boehringer Ingelheim Company]. / Darmkrebsscreening im betrieblichen Umfeld: Kosten-Nutzen-Analyse einer Maßnahme zur Gesundheitsförderung bei Boehringer Ingelheim.

BACKGROUND AND OBJECTIVE: In Germany, approximately 70.000 people are diagnosed with colorectal cancer every year. With early diagnosis the recovery rates are over 90 % and early intervention can significantly reduce the costs of medical treatment as well as the economic losses from worker productivity. We here present the organisational procedure for bowel cancer screening and have weighed the costs against benefits to employees, the company and the healthcare system. The screening costs are compared with economic benefits. METHODS: The target group for the study consisted of all 11.536 employees at the company's site in Germany. Volunteers were given a standardized questionnaire about the risk factors for colorectal cancers and an immunological fecal occult blood test (IFOBT). If risk factors for development of colorectal cancer were present or if the test result was positive, a colonoscopy was recommended in accordance with DGVS guidelines (German Society of Digestive and Metabolic diseases). RESULTS: A total of 4.287 employees (37.2 %) indicated an interest in undergoing screening; at the end of the period 3.958 complete datasets (2.296 men and 1.662 women, mean age 51.2 years) were available for evaluation. A colonoscopy was performed on 114 persons. Six cases of overt cancer were detected with three in the 36 - 50 age group and three in the 51 - 65 age group. Five of the six cases were stage T1 or T2. Adenomatous polyps were found and removed in 29 persons. The calculated cost benefit ratio was 1:2 for the company and 1:35 for the public health system. CONCLUSION: Using the example of colorectal screening, this study represents a cost benefit analysis of this preventative health measure in a company environment. The results show that even while taking into account the financial and personal commitment required, the cost benefit ratio is positive both for the company and for the healthcare system.

Rotigotine transdermal system for perioperative administration.

We present a series of patients participating in clinical trials with the rotigotine transdermal system. All patients were scheduled for surgery with general anaesthesia unrelated to the trial procedure or to rotigotine. Perioperative administration of rotigotine appeared to be feasible and efficacious. No safety issues emerged from these observations.

Alcohol and drug abuse in burn injuries.

Two studies are described in this paper. In the first study 225 acutely, severely burned patients were retrospectively investigated as to admission blood alcohol level and history of chronic alcohol abuse. The influence of further risk factors, circumstances and therapeutic data was studied, in particular the influence of gender, full-thickness burns, smoke inhalation injury, smoking, length of total and ICU stay, and suicide attempt. The 70 patients with positive blood alcohol levels on admission had a significantly higher fatality rate (31.5 per cent) in comparison with the 18.1 per cent fatality rate of patients with a negative blood alcohol level. Both groups had nearly identical mean TBSA and mean age. Chronic alcohol abuse was noted in 59 patients. These patients were found to have a higher fatality rate (31.4 per cent, 22/70) compared with that of patients without a history of chronic alcohol abuse who had an overall fatality rate of 18.1 per cent (28/155). No significant difference was found between non-intoxicated and acutely intoxicated alcoholics (31.4 vs 29.3 per cent). Our conclusion is that intake of alcohol before burn injury represents an independent risk factor. The second study was a prospective study of 16 consecutively admitted burn patients, who were evaluated for both drug and alcohol intake. Five patients had positive drug levels and five had positive alcohol levels. Five patients had a history of chronic drug and/or alcohol abuse. This incidence of alcohol and drug abuse supports the findings of our retrospective study.

Yersinia enterocolitica serodiagnosis: a dual role of specific IgA. Evaluation of microagglutination and ELISA.

The microagglutination technique for the detection of antibodies against Y. enterocolitica, serovars 3 and 9 (corresponding to O-groups I and V), was compared with the conventional tube agglutination. An immunoglobulin class specific, indirect ELISA (polyvalent immunoglobulin, IgG, IgM, and IgA) was established employing as antigens formalinized whole bacteria ("OH"-antigens) and LPS preparations (hot phenol-water extraction). ELISA titers and net absorbancy (ELISA-"units") of single serum dilutions were in good agreement; the same was true for ELISA and agglutination results. Specificity (against healthy controls) and sensitivity of both serologic techniques were comparable. Cross-reacting antibodies against serovars 3 and 9 could be identified in the ELISA. Correct serovar-specific diagnosis was possible in 95% with a single assay (polyvalent Ig assay with LPS-antigen). The sensitivity of the LPS-ELISA was superior to the "OH" antigen assay after infections by serovar 3 strains, and antibodies were detected with LPS preparations for a longer period following reconvalescence. Specific IgA, due to its rapid decrease during reconvalescence, on one hand impresses as a valuable marker for the differentiation of recent disease from uncomplicated past infections, while persistence of IgA appears to be associated with Yersinia-induced arthritis. Persisting IgM but rarely IgA titers were characteristically found in patients with prolonged enteric yersiniosis.

[Pregnancy and birth of monozygous female twins following in vitro fertilization and embryo transfer]. / Schwangerschaft und Geburt monozygoter weiblicher Zwillinge nach In-vitro-Fertilisation und Embryotransfer (IVF-ET).

The rate of identical twins after in vitro fertilisation and embryo replacement is higher than after physiological conception. The present paper reports on the first delivery of twins (identical twins) after in vitro fertilisation and embryo replacement. The in vitro fertilisation and embryo replacement of one 4-cell stage resulted in a twin pregnancy. The difficult pregnancy, early delivery and intense perinatal care of the children deserves special consideration. In addition the paper gives a survey on the present number of deliveries after in vitro fertilisation and embryo replacement given at the 3rd World Congress on In Vitro Fertilisation and Embryo Transfer at Helsinki in May 1984.