[Diploma of continuing education from the Society of Physician of Thüringia]. / Fortbildungsdiplom der Landesärztekammer Thüringen.

The diploma of continuing medical education (DCME) gives the possibility to describe and document the effort of the physicians to accomplish continuing medical education and quality assurance which is a claim of the professional rules for physicians. Stimulation of the physicians to participate lectures is a further goal of the DCME. The DCME which can't be used as a title, is supposed to be for physicians, who finished their specialisation. Acquisition of DCME is voluntary. For the DCME, the candidates have to participate 100 hours of continuing medical education with given theme setting for 3 years. The DCME represents an useful proof for the fulfilling of the duty of continuing education as well as for evaluation of given lectures.

[Experiences in organization of medical graduate and continuing education in the new German country (Thüringen)]. / Erfahrungen beim Aufbau der ärztlichen Fort- und Weiterbildung in einem neuen Bundesland (Thüringen).

The switch from a state controlled to a self responsible continuing medical education could be completed in Thuringia within the first years after the reunification. Higher performances demonstrated by the just mentioned analyses can be observed quantitatively as well as qualitatively. This concept of our academy concerning a professional and regional decentralization in combination with centralized offers for further education has been proved. A good teamwork between the organizers and participants succeeds more and more in finding out the kind of teaching needed. Medical education can be planned globally and according to the needs. New ways of training can be searched and may go beyond country borders.

Collagen peptidase and type III procollagen peptide serum levels in chronic liver diseases.

The concentration of the N-terminal peptide of procollagen III and the activity of collagen peptidase (PZ-peptidase) were measured in sera from 92 patients with chronic liver disease. In patients with liver cirrhosis and chronic hepatitis with transformation of liver structure, high values were found for both variables compared with hepatoses and chronic hepatitis without transformation. The concentration of procollagen III peptide and the activity of collagen peptidase in serum increased with increasing degrees of fibrosis and, even more markedly, with increasing degrees of mesenchymal activity in the liver.

[Biotransformation in liver damage]. / Zur Biotransformation bei Leberschäden.

Xenobiotics may produce liver damages. Vice versa primary liver diseases influence metabolism and elimination of drugs. The activity of the isoenzymes of the monooxygenase system which catalyze biotransformation reactions in the liver can be tested by model substances (Cyt P-450Pb: Metamizol, Cyt P-450MC: Caffeine, Cyt P-450db1: Debrisoquine). It can be influenced by estrogens, gestagens, smoking, alcohol. Only severe stages of liver diseases reduce the biotransformation of drugs. Thus in liver cirrhosis the excretion of unchanged furosemide is increased. The bioavailability of propranolol is changed by a reduced first pass effect in liver cirrhosis. In patients with drug hepatitis after dihydralazine 15 out of 17 patients are genetically slow acetylators and they show also a lower activity of phase I cytochrom P-450 catalyzed biotransformation reactions. The same holds true for patients with haemochromatosis. Determination of the 7-ethoxycoumarin-O-deethylase (ECOD) in liver biopsy samples allows the correlation of the decrease in biotransformation with the increase of liver cell necrosis, intraacinous fibrosis and structural changes. Possibly the changes in biotransformation caused by liver diseases are connected with a disturbed regeneration of the liver corresponding to the concept of the "streaming liver".

[Simultaneous administration of various model substances for characterizing in vivo biotransformation in chronic liver diseases]. / Die simultane Gabe verschiedener Modellsubstanzen zur Charakterisierung der in-vivo Biotransformation bei chronischen Lebererkrankungen.

16 patients with different chronic liver diseases were given single doses of the model substances caffeine, metamizol, sufamethacine and debrisoquine. This was followed by the simultaneous administration of all these substances as a "cocktail". A comparison between the single and the "cocktail" dosage did not reveal any significant differences in the pharmacokinetic parameters. So the "cocktail" administration is even possible in chronic liver diseases. Requiring relatively little time, it makes statements possible concerning various cytochrome P450 enzymes including the types of hydroxylation and acetylation. Intraindividual variations can be ruled out.

[The internist--responsibilities, professional practice and self concept. An introduction]. / Der Internist--Aufgaben, Tätigkeit und Selbstverständnis. Eine Einführung.

An analysis of claim and reality causes doubt about the fact whether the internal medicine as a basic clinical subject may at present fully meet its commission. The working group "ethics" of the GDR Society of Internal Medicine has worked out a material concerning the questions of the tasks, the activity and the self-appreciation of the internal specialists and puts it under discussion.

[NMR research on blood plasma for tumor detection--a method for mass screening?]. / NMR-Untersuchungen an Blutplasma zur Tumordetektion--Eine Methode zum Massenscreening?

Recently, a simple NMR test was proposed to distinguish patients with and without malignant diseases by line-width analysis of methyl and methylene lipoprotein resonances in human plasma (4). We have reevaluated this proposed cancer detection technique at 250 MHz (magnet field strength 5.9T). The mean line width for 11 controls was 31.2 Hz (SD 4.1 Hz). For 8 patients with untreated malignant tumors, the line width was 27.5 Hz (SD 3.9 Hz). The data confirm the reported lower line widths of human plasma NMR resonances for patients with malignant tumors compared with controls (4). However, the statistical significance (P greater than 0.07) does not justify to use this technique for individual differential diagnostic purposes without further improvements of the method.

[Resorption and biotransformation of model substances in primary idiopathic hemochromatosis (siderophilia)]. / Resorption und Biotransformation von Modellsubstanzen bei der primären ideopathischen Hämochromatose (Siderophilie).

In 12 patients with primary idiopathic haemochromatosis absorption and biotransformation were measured by model substances. Aim of the investigation was the correlation of the biotransformation of the liver with the degree of liver injury and the clinical picture. We determined in patients and compared with control group: elimination of metamizol in urine, absorption and elimination of caffeine in serum, serum concentrations and elimination of sulfamethazin in urine, absorption of xylose, - In patients with haemochromatosis accompanied with slight liver damage only demethylation of metamizol was slackened. In patients with higher degree of liver damage the elimination of metamizol as well as of caffeine was decreased. Because of the high percentage of slow acetylators in the patient group metabolism of sulfamethazine is decreased. - There was no correlation between iron loading of the organism, absorption of xylose and biotransformation of the model substances.

[Biotransformation in patients following Depressan-induced hepatitis]. / Biotransformation bei Patienten nach Depressan-Hepatitis.

In 17 patients who more than 1 year ago had suffered from a dihydralazine induced hepatitis the biotransformation velocity was investigated and compared with a healthy control group. 15 out of the 17 patients and 5 out of the 10 volunteers are slow acetylators. All slow acetylators eliminate sulfamethazine more slowly than rapid acetylators.--The elimination of caffeine and metamizol--test substances for oxidative biotransformation reactions--was retarded in patients after dihydralazine induced hepatitis in comparison to control persons. Slow acetylators have to be controlled carefully because of their higher risk of dihydralazine induced drug hepatitis.

[The internist--generalist or specialist?]. / Der Internist--Generalist oder Spezialist?

Also after the elimination of certain subjects and after the development of subspecialisations internal medicine has remained the central clinical basic speciality. The synoptic medical thinking and acting with a coordination of all special examinations to a coherent view and treatment of the patients is incumbent on the internal specialist as "general internal specialist" or so-called "generalist". The central point of the intermedical care of the population lies in the work of the internal specialist. This has consequences also for the education and further training. In the auditory and at the patient we must be able to show the students and physicians trustworthy how internal medicine as general internal medicine is organised in its full extent and is practised by a medical superintendent who is qualified to do this.

[Platelet spreading in diabetes mellitus]. / Untersuchungen der Thrombozytenausbreitung bei Diabetes mellitus.

In 162 test persons divided into healthy control persons and diabetics of type I and type II the thrombocyte spreading was investigated according to the method of Breddin. Age, sex, degree of seriousness of retinopathy, duration of diseases, present level of blood sugar and HbA1 concentration were taken into account. Spread thrombocyte forms were increasingly found in old age, in diabetics of both types and a close relation to the extent of retinopathy was evident. As diabetic retinopathy became evident and with growing degree of seriousness, spread forms of thrombocytes were increasingly found, so that the increased spreading capacity may be interpreted as a disturbed metabolic and blood vessel situation in diabetes mellitus.

Results of treating stage III and IV malignant non-Hodgkin's lymphomas (NHL).

Malignant non-Hodgkin's lymphoma (NHL) patients were enrolled and analyzed retrospectively in 2 successive study groups. The first group consisted of 57 patients divided into low- and high-grade malignant NHL according to the Kiel classification, the second one included 104 patients divided into low-, intermediate-, and high-grade malignant NHL. The more individualized and more intensive polychemotherapy of the 2nd group yielded clearly better treatment results compared to the first group, especially in high-grade malignant NHL. The complete remissions rose from 32% to 59%, the recurrence rates fell from 62% to 20%, the 5-year survival time of patients under age 30 increased from 0 to 48%. In intermediate-grade malignant NHL, intensive therapy yield results that are as beneficial as those of mild therapy in low-grade malignant NHL (5-year survival rate 62% and 65%, respectively).

Enzyme activities of collagen peptidase (CP), monoaminoxidase (MAO) and N-acetyl-beta-D-glucosaminidase (beta-NAG) as fibrosis marker in chronic liver diseases.

The activities of enzymes collagen peptidase (CP), monoaminoxidase (MAO) and N-acetyl-beta-D-glucosaminidase (beta-NAG) in the serum are related to the development of hepatic fibrosis. These enzymes were determined in the sera of 121 liver-biopsied patients who were subdivided by morphological criteria into 4 different grades of fibrosis (0 to greater than or equal to 3). CP shows the best correlation with the extent of fibrosis. beta-NAG, indeed, bears of relationship to the morphologically proven extent of fibrosis, however, significant increases in activity are also encountered in patients with liver diseases, but without liver fibrosis. The validity of these fibrosis markers is calculated in order to differentiate between low- and high-grade fibrosis. With a sensitivity of 86% and a specificity of 92%, CP possesses the best predictive value of 85.7%. The results can still be improved by the combination of CP and beta-NAG.

[Early detection and follow-up of solid tumors]. / Früherfassung und Verlaufskontrolle solider Tumoren.

The early recognition of solid tumours as presymptomatic diagnostics is only reasonable, when it leads to a gain of survival time and survival rate. The evidence of effectiveness by randomized studies (apart from carcinoma of the cervix) was proved up to now only for the carcinoma of the breast (mammography) and the carcinoma of the colon (occult blood in the stools). The target-specific screening within well defined risk groups is to be recommended, when the subsequent chain of investigations and the therapy chain is ascertained. For the control of the course increasingly tumour markers are used including monoclonal antibodies against tumour-associated antigens.

[Value of alpha 1-fetoprotein (AFP) determination with an ultramicro-ELISA immunoassay in chronic liver diseases with special reference to hepatocellular cancer]. / Untersuchungen zur Wertigkeit der Alpha 1-Fetoprotein-(AFP)-Bestimmung mit einem Ultramikro-ELISA-Immunassay bei chronischen Lebererkrankungen unter besonderer Berücksichtigung des hepatozellulären Karzinoms (HCC).

920 determinations of alpha 1-fetoprotein were performed in 564 patients with mainly hepatological diseases. For AFP determination double antibody sandwich technique with 10 microliter final volume was used. The ultramicro-ELISA-method, which meets all criteria of a screening parameter, is simple and far more economic than RIA or a commercial enzyme immunoassay. The 3s limit was determined to be 23.2 for men and 29.8 ng/ml for women. 24/26 (= 92.0%) hepatocellular carcinomas (HCC) showed elevated serum AFP concentrations. The serum AFP concentrations in the hepatocellular carcinoma showed different constellations of the findings: 1. AFP below 215 ng/ml (= range suspicious of hepatome, according to Poltenauer); 2. AFP moderately exceeds 215 ng/ml; 3. AFP weeks before death excessively increasing from moderately elevated ranges; 4. AFP decreasing prior to death; 5. AFP course fluctuating; 6. AFP within normal range. 231 liver cirrhoses showed elevated values in 28.1%. Active liver cirrhoses had significantly more often AFP concentrations above 30 ng/ml than inactive had (31.9% as opposed to 10.8%). Active liver cirrhoses and cirrhoses with decompensation of the portal vein had significantly more often (34.9% of 83 probands) increased AFP values than inactive, compensated cirrhoses had (11.9% of 42 probands). Various pathomechanisms of the neosynthesis of AFP in HCC, in liver metastases and in benign liver diseases are discussed. Increases in AFP above 500 ng/ml are practically indicative of hepatocellular carcinoma. Low-grade elevations of AFP in benign liver diseases and liver metastases can be categorized by considering other criteria (persistent or transitory AFP?/trend - increase?/serum concentration) including clinical/paraclinical features. The determination of AFP by the above-mentioned method allows to make a better hepatologic diagnosis. It ist suitable for the still improvable early diagnosis of HCC. AFP screening should be employed in risk groups (liver cirrhoses, HBsAg carriers, chronic HV-B patients).

[Panmyelopathy and myeloproliferative syndrome]. / Panmyelopathie und myeloproliferatives Syndrom.

From the viewpoint of a territorial haematological centre with a certainly preselected number of patients the initial symptom of bi- or pancytopenia in 3/4 of the cases proves as first reference to a myeloproliferative or myelodysplastic syndrome. Of these cases 62.5% transferred into a crisis of blasts; that is, they must be regarded as real preleukemia. The morphology of the bone marrow as well as the stem cell cultures obtained from this give important references to the diagnostic classification of the early changes as well as to their prognosis.

[Epidemiology of hormone dependent malignant tumors--ovulation inhibitors and liver tumors]. / Zur Epidemiologie hormonabhängiger maligner Tumoren--Ovulationshemmer und Lebertumoren.

Since the first descriptions of liver tumours associated with the intake of steroid contraceptives, the literature has presented an increasing number of case reports as well as epidemiological studies on the relationship between benign liver tumours and the utilization of these drugs. We report 11 benign cases and one malignant case of liver tumours in connection with the intake of these steroid preparations.