[Integrated health care at Potsdam]. / ProCardio plus--Potsdam.

This paper reports in detail on a project of Integrated Health Care in cardiology at Potsdam, Germany. Information on the structure of the contract, the participants, the agreed claiming of benefits and provision of services are provided as well as relevant figures and contact data.

Use of microcalorimetry in monitoring stability studies. Example: vitamin A esters.

Vitamin A is very sensitive to chemical degradation caused by oxygen, light, heat, and other stress factors. If light and oxygen are excluded, the dominant degradation reaction for vitamin A derivatives is heat-induced formation of kitols, that is, dimers or higher oligomers. In this study vitamin A esters were used as model systems to evaluate microcalorimetry as a tool for monitoring the stability of heat sensitive substances. To obtain more knowledge about the model reaction, analytical investigations (supercritical fluid chromatography) were also performed. Because analytical and microcalorimetry data were consistent, a quantitative description of the kinetics and thermodynamics of the kitol formation reaction could be obtained. Aside from the academic motivation, this is important for practical purposes such as shelf life stability of vitamin A in feed, food, and pharmaceutical products. The vitamin A stability of a given sample can easily be predicted from the initial heat flow in a simple microcalorimetry experiment. Compared to conventional stability tests, this offers savings of money and time.

Regulation of polyamine synthesis and transport by retinoic acid and epidermal growth factor in cultured adult rat type II pneumocytes.

During injury of lung epithelial cells, the type II pneumocyte proliferates and differentiates into a type I pneumocyte to restore the epithelium. Polyamines, which constitute a family of small organic polycations, are required for this process of cell repair. Because retinoic acid (RA) and epidermal growth factor (EGF) also are involved, the purpose of this research was to determine their effect on polyamine transport and synthesis in cultured type II pneumocytes. Rat type II pneumocytes were isolated, cultured overnight, and treated with RA and/or EGF for 24 hours. Polyamine transport was determined by [(3)H]spermidine uptake, and polyamine synthesis was assessed by the activity of the initial rate-limiting enzyme ornithine decarboxylase. EGF (100 ng/mL) significantly increased spermidine transport, but RA did not. At low concentrations of spermidine (2 microM), the combined effect of RA and EGF on spermidine transport was additive. Both EGF (25 ng/mL) and RA (1 microM) increased polyamine synthesis, and cotreatment resulted in an additive effect (a fourfold increase over the control). We also found that ornithine decarboxylase activity is greatly diminished in the presence of tyrphostin B56, which is a specific inhibitor for the tyrosine kinase of the EGF receptor, suggesting that polyamine synthesis within the type II pneumocyte may depend on activation of tyrosine kinase of the EGF receptor. These results indicate that RA and EGF increase the availability of polyamines, which may be important in the lung cell repair process.

Hemispheric asymmetries in category-specific word retrieval.

We examined whether 53 adult non-aphasic patients with either left (22) or right temporal lobe lesions (31) demonstrate dissociable patterns of hemispheric asymmetries in category-specific word fluency tasks. The patients were asked to articulate as many appropriate words as possible within 60 or 90 s in response to six target categories. There was no effect of patient groups on the overall fluency. However, patients with a left-sided temporal lobe lesion were impaired retrieving words to 'initial letters' and to the category 'animals'. Right temporal lobe patients were impaired retrieving 'tools' and words referring to specific visual attributes. There were no fluency differences for 'food-supermarket goods' and 'flat interior'. We conclude that temporal lobe damage can result in category-specific impairments in word retrieval depending on the affected hemisphere.

Psychophysiological analysis of mental load during driving on rural roads--a quasi-experimental field study.

The objective of this study was the development and validation of an integrated measure-assessment approach (driving performance and psychophysiological indicators) for the assessment of driving demands of rural road segments as a starting point for design. With 31 student test drivers and a selection of six study roads, the reactivity of psychophysiological parameters was evaluated based on a general model of cognitive-energetic effort regulation according to Hockey (1993). The road curvature change rate was introduced as the independent variable, which served as a criterion of objective road difficulty. Based on a reliability analysis, the longitudinal and cross-sectional stability, especially for heart rate (HR) and blink rate (BR) measures, is sufficiently high. Both these psychophysiological variables and speed vary as a function of the curvature change rate of the rural road segments. The speed parameter differentiates very strongly the different curvature change rates. Among the psychophysiological indicators, changes in the blink rate almost exactly mirror the level of the curvature change rate owing to the fact that the BR decreases almost steadily with increasing curvature change rate. Cardiovascular parameters, such as heart rate (HR) and heart rate variability (HRV), and skin conductance response (SCR) also vary in relation to driving difficulty of road segments, but at levels of intermediate curvature other additional road characteristics may also influence these measures.

The cancer risk in the stomach subjected to nonresecting procedures. An experimental long-term study.

Whereas there is no longer any significant controversy regarding whether the resected stomach is subject to an increased risk of cancer, this question remains of great importance in terms of the cancer risk of nonresecting procedures performed on the stomach. Attention was given in particular to investigating with respect to carcinogenic potential the influence of gastrotomy. Heineke-Mikulicz pyloroplasty, gastrotomy plus pyloroplasty, vagotomy plus pyloroplasty, and gastroenterostomy without resection. As with resecting procedures, the carcinomas were also first observed in larger numbers following the nonresecting procedures without application of carcinogen. Of the 227 animals surviving the prescribed period 16 developed carcinomas of the stomach following application of carcinogen. 20 developed gastric carcinomas without carcinogen. Which individual factors in this multifactorial process might be the main contributors to carcinogenesis cannot be ascertained from our study.

When is a corrective procedure indicated for the operated stomach?

Disease occurring as a direct consequence of the surgical treatment of ulcers is not infrequently an indication for remedial surgical intervention. Most frequently it is necessary, on the one hand, to refer to objective information such as the histological findings as well as a gastric function analysis, and, on the other hand, to the clinical picture of the illness. Therefore, we have attempted to summarize the symptoms, the morphology, and the function into a synopsis, which would make it possible t match the severity of gastric disease with a particular mode of therapy. The sum of the three parameters provides a point value between three and twelve. It is our belief that surgical intervention is to be seriously considered above a point score of seven (SFM-Index).

Cell-kinetic investigations in the operated rat stomach to show the influence of duodenogastric reflux. An experimental long-term study.

In has been proven in our own studies that the frequency of carcinoma is closely correlated with the varying intensity of duodenogastric reflux occurring as a result of surgery. Now it was our objective to provide information regarding the changes in cell proliferation kinetics in support of the already established relation, toward which end we conducted an additional autoradiographic study on the gastric mucosa of the same operated animals. Five different operative procedures were performed on the stomachs of 265 female Wistar rats. 3H-Thymidine was used for labeling. Comparison of the labeling rates with the type of operative procedure used revealed an average labeling value typical for each particular procedure. It became evident that increased reflux quite obviously leads to an increase in cell proliferation.

The time structure of depressive mood in schizophrenic patients.

This research focused on the depressive mood of 134 inpatients with a diagnosis of schizophrenia. All of the patients filled in a self-rating mood scale (Befindlichkeits-Skala by von Zerssen) every other day. The frequency of depressive mood and the intensity and dynamics of each period of depression were analysed with the aid of defined algorithms. Marked depression was found in more than half of the patients. Depression was seen predominantly at the beginning of hospitalization, and subsequent occurrences were not concentrated in any specific time periods. The results suggested that depression in schizophrenia is predominantly an experience or consequence of the underlying illness and that pharmacological factors are not of as great importance as has been thus far assumed in the literature.

Operation-sequel carcinoma--an experimental study.

Gastric-stump carcinoma, a special form of gastric carcinoma, is seen as a late complication of gastric surgery performed on the carcinoma-free stomach. In the present experimental series a considerable number of carcinomas were observed, for the first time, in rats after gastric surgery without additional application of a carcinogen. The rate of malignancies arising in the gastric stump correlates closely with the intensity of the duodenogastric reflux provoked by different surgical procedures. The important role of duodenogastric reflux for the development and growth of gastric stump carcinoma is thus established beyond doubt. While bearing in mind the need for caution in translating experimental results to man, this study does suggest the value of reflux-preventing techniques in the surgical management of gastric diseases. Patients who have undergone an operation are at increased risk of developing carcinoma, and therefore require consequent and regular follow-up examination. The introduction of surgical prophylaxis and careful postoperative surveillance are the only effective methods for the prevention of gastric stump carcinoma.

The course of depression for different types of schizophrenia.

During 197 courses of treatment for schizophrenia, depressive mood was evaluated every other day with a self-rating mood scale. The different patterns of depression identified in an earlier study could be correlated with the diagnostic subgroups of schizophrenia in which the patients were classified. Hebephrenic affect disturbance appeared as temporal discontinuity of depressive mood during the courses of treatment. Patients with a paranoid type of schizophrenia were the least depressed and had the fewest fluctuations of mood. Although patients with a schizoaffective type of schizophrenia exhibited characteristic changes between manic and depressive mood, their mood within a manic or depressive period was more stable than that of any other subgroup. The differences in depressive course are discussed in terms of their symptomatological and diagnostic significance.

Gastric stump carcinoma--new aspects deduced from experimental results.

The actual influence of surgical technique on the pathogenesis of gastric stump carcinoma has not been fully explained, even under experimental conditions. We attempted to elucidate the problem by a series of experiments with Wistar rats assessing the postoperative consequences of Billroth I resection, B II resection with Roux-en-Y gastroenterostomy, B II resection with Braun's anastomosis, and plain gastroenterostomy without resection, and defining their influence on the development of carcinoma in the gastric remnant. Based on general clinical observations and randomized endoscopic and radiologic examinations, the date for killing and autopsy was fixed on the 56th after the surgical intervention. The number of malignant neoplasms was found to rise in proportion with the intensity of duodenogastric reflux resulting from the respective operative procedures: No tumors were found after B II resection with Roux-en-Y gastroenterostomy, but tumor incidence in the other groups rose from 10% in the animals subjected to B I resection, to 23.1% in those with B II resection plus Braun's anastomosis, and finally to 30% in animals with B II resection only, but no Braun's anastomosis. Gastroenterostomy without any resection even produced a tumors incidence of 70.8%. The present paper is presumably the first to report about gastric carcinomas that arose after surgery alone, without additional carcinogen exposure.

[Asymmetrical macrodactyly]. / Asymmetrische Makrodaktylie.

A case of asymmetrical macrodactyly is reported with special regard to the conservation of the remaining function. It is shown that partial resection of the metacarpal bones, performed for functional reasons, leads to a satisfying result, while the amputation of the fingers, proposed for cosmetic reasons, is not recommended.

[Multiple gastric carcinoid, its diagnosis in gastric polyposis (author's transl)]. / Das multiple Magenkarzinoid in der Differentialdiagnose polypöser Magenveränderungen

Carcinoid of the stomach, hormonally inactive, is diagnosed with MDP, gastroscopy and biopsy. Solitary carcinoids are treated with excision in toto with immediate histology of the edges. Multiple gastric carcinoids require gastrectomy.

[Diverticula of the stomach - diagnosis of their importance (author's transl)]. / Das magendivertikel - diagnostische Möglichkeiten zur Beurteilung der Dignität

Gastric diverticula may be due to dilatation or traction. 75% are found in the fundus, 15% in the prepyloric antrum. In 10% they were situated elsewhere. Symptoms are unspecific. Radiography has to be combined with endoscopic investigation of their nature. Smaller diverticula are mainly treated conservatively, the larger ones will require surgery because of chronic symptoms and complications.

[Lymphogenic osteomyelitis of the foot (author's transl)]. / Das Bagatelltrauma - Ursache lymphogener Vorfussosteomyelitis

The special way of infection of the lymphogenic osteomyelitis caused by trivial trauma is demonstrated in 4 cases. Germ ascension is done by lymphatics or fissures in the tissue, as it is well known in the panaritium ossale. The treatment consists in removing the focus of infection, irrigation-suction drainage and specific antibiotic therapy. Trivial trauma of the lower extremity should be treated according to the principles of asepsis.