[Multilocular thyroid gland ectopy]. / Multilokuläre Schilddrüsenektopie.

HISTORY AND CLINICAL FINDINGS: A 86-year-old woman was hospitalized two days before death. Her past history included essential hypertension and joint pain. Electrocardiography and laboratory findings revealed an acute myocardial infarction. Chemical laboratory examination demonstrated hyperthyroidism. The x-ray of the chest showed a tumor-like mass in the right lung and a nodular goiter with focal changes. Sonographically a tumor in the left colon was diagnosed. Inspite of intensive care the patient died two days later of cardiogenic shock. AUTOPTIC DIAGNOSIS: The autopsy revealed a transmural myocardial infarction with rupture of the heart wall. An adenocarcinoma of the rectum infiltrating the perirectal fatty tissue was diagnosed. Metastases were absent. Additional to an eutopic nodular goiter there was ectopic thyroid tissue in the lung, as a tumour mass under the visceral pleura, in the pelvic cavity and in the skeleton. The histologic findings revealed a close resemblance to the thyroid gland in normal anatomical position. In small foci in the eutopic and ectopic thyroid tissues there were signs of hyperthyroidism. There was no evidence of malignancy. CONCLUSION: One should always keep in mind that manifest hyperthyroidism, not explicable on the grounds of the thyroid findings in normal anatomical position can point to ectopic (multilocular) thyroid tissue, especially when there are "tumours" of uncertain origin.

[A model project on certification of continuous education by the Bavarian Chamber of Physicians]. / Modellprojekt Fortbildungszertifikat der Bayerischen Landesärztekammer.

Beginning with April 1st 1998 Bavarian physicians are invited to join a project on certification of continuing medical education on a voluntary basis. After a one year period, 1238 of practicing medical doctors (2.8%) received an official certificate on continuing medical education by the Bavarian Chamber of Physicians. In order to get the idea to certify postgraduate continuing medical education spread over the state of Bavaria, the Bavarian Chamber of Physicians takes every effort to support congress organizers to issue credit points. Customer oriented processes are applied as well as modern technologies such as bar-codes. The systematic approach to take part in continuing medical education as an important aspect of quality assurance in physician's profession reveals the chance to keep autonomy within the medical chambers.

Use of acarbose for eliminating the interval between meal consumption and insulin injection in patients with Type 1 diabetes.

This double-blind, placebo-controlled, cross-over study investigated whether acarbose therapy enables patients with Type 1 diabetes to administer insulin injections at the same time as meals without adverse glycaemic consequences, thus negating the need for an injection-meal interval (IMI). The valid-case population was 15. All patients were well controlled on insulin therapy and diet. Each patient underwent four 14-d treatment sequences: IMI of 0 min+acarbose; IMI of 30 min + acarbose; IMI of 0 min + placebo; IMI of 30 min + placebo. There was a 1-wk, placebo-controlled washout period between each treatment. A 50 mg acarbose or placebo tablet was taken with each of three meals for the first 3 d of each treatment; this was increased to 100 mg three times daily on the remaining 11 d. Blood samples were taken between 08.00 and 09.00 h at the end of each treatment sequence, during the fasting state and at the following times after breakfast: 30, 60, 120 and 180 min. The primary target variable was 1-hr postprandial blood glucose level after 14 d. The mean increase in 1-hr postprandial blood glucose level using an IMI of 0 min + acarbose was 51.1+/-53.2 mg/dl, compared with 46.6+/-50.4 mg/dl using a 30-min IMI + placebo. Data provided strong evidence that acarbose prevents the marked increase in postprandial glucose level normally observed when insulin is administered with a meal. Acarbose may thus be useful for patients with Type 1 diabetes who find IMIs inconvenient.

A comparison of the antihypertensive efficacy and safety of felodipine IV and nifedipine IV in patients with hypertensive crisis or emergency not responding to oral nifedipine.

OBJECTIVE: A clinical definition of a hypertensive emergency is excessively high blood pressure in the presence of symptoms indicating end organ damage. Equally high blood pressure without symptoms is called a hypertensive crisis. Patients with hypertensive crisis or emergency need prompt, effective, and specific therapy and a controlled reduction of blood pressure. METHODS: We performed a randomized, double-blind multi-centre study, to compare the safety, efficacy and tolerability of an intravenous (i.v.) infusion of two dihydropyridine calcium channel blockers (either nifedipine or felodipine) in 122 patients, of whom 63 were diagnosed as hypertensive emergencies and 59 as hypertensive crisis, who had not reacted adequately (diastolic blood pressure <115 mmHg) to 5 mg of nifedipine PO. RESULTS: Both drugs lowered blood pressure adequately in more than 90% of the patients and were well tolerated. Only one patient had to be withdrawn, because of an excessive decrease in blood pressure. CONCLUSION: Patients with excessively high blood pressure who do not react to oral nifedipine can be treated equally effectively with felodipine and nifedipine IV. Felodipine is easier to handle because of its lack of light sensitivity.