[The rheumatic hand - diagnostics in practice]. / Die rheumatische Hand - Diagnostik in der Praxis.

Many rheumatic diseases show changes and are visible in the hands. The pattern of distribution in the relevant joints, soft-tissue changes, skin manifestations, neurological and vascular symptoms and clinical findings provide fundamental information. Imaging and lab results provide diagnostic support. In this review, common diseases are presented in terms of their clinical expressions in the hands: osteoarthritis, rheumatoid arthritis, gout, calcium pyrophosphate dihydrate deposition disease, psoriatic arthritis, reactive arthritis, systemic sclerosis, dermatomyositis/polymyositis and systemic lupus erythematosus. Furthermore, we discuss pathological findings of the hands as a result of diabetic cheiroarthropathia, endocarditis, secondary hypertrophic osteo-arthropathy and chronic regional pain syndrom.

On the neurotrophic control of acetylcholine receptors at frog end-plates reinnervated by the vagus nerve.

To test whether the properties of subsynaptic acetylcholine (ACh) receptors in skeletal muscle fibre are influenced by the type of the innervating neurone some pharmacological properties of ACh receptor in normal end-plates and in denervated end-plates reinnervated by the vagus nerve in the frog were compared. Blockade of nerve-evoked synaptic currents by 200 microM-hexamethonium was stronger at vagus-reinnervated than at normal end-plates. Blockade at both types of junctions was voltage dependent. The effect of hexamethonium on equilibrium currents induced by bath-applied ACh and carbamylcholine was similar at the two types of junctions. At both normal and vagus-reinnervated junctions, decamethonium had similar partial agonist properties. Following a step in membrane potential, the relaxations of ACh-induced conductance changes at the two types of junctions were affected in a similar fashion by hexamethonium: hyperpolarization first produced a fast decrease and then a slow exponential increase in conductance. Upon depolarization, a fast increase was followed by an exponential decline to its original level. The time constant of the slow relaxation was slightly prolonged compared to control. These findings are consistent with a fast blocking action of open channels by hexamethonium. The effectiveness of hexamethonium in blocking end-plate currents was reduced in the presence of (+)-tubocurarine, indicating that hexamethonium has a competitive blocking action on the receptors. These results do not indicate that the pharmacological properties of the ACh receptors are changed after an end-plate is reinnervated by a preganglionic neurone. The differential effect of hexamethonium on transmission at normal and vagus-reinnervated end-plates is discussed as a consequence of different transmitter release characteristics at the two types of junctions.

[Ambulatory treatment of sex offenders with cyproterone acetate (Androcur). A catamnestic study]. / Ambulante Behandlung von Sexualdelinquenten mit Cyproteronacetat (Androcur). Eine katamnestische Untersuchung.

The authors report about the catamnestic inquiry concerning 13 patients with sexual problems treated with cyproterone acetate (CA) of whom 12 relapsed repeatedly in sexual delinquency. Since 1972 the Basle University Psychiatry Outpatient-Department treated 12 of these patients with CA-tablets and psychotherapy. One patient was treated in the same way by a head physician of the Basle University Psychiatry Hospital. Reason for CA-intake: 6 patients took CA because they were obliged by legal order. 4 patients were "voluntarily" ready to take CA for fear of imprisonment. 2 patients who were not accountable for their crimes were treated with CA and one patient desired CA-medication because he suffered from his masochism severely. The mean age of the patients was 34.5 years, the mean daily dosage 115 mg. Result of CA-therapy and psychotherapy: 11 patients (85%) did not relapse under CA treatment which lasted on the average three years. 3 patients succeeded under CA treatment with full social integration. 3 patients showed an improvement of social integration and 3 patients one of whom received Disulfirame (Antabus) reduced alcohol intake. After having ended or interrupted CA-medication two of 7 patients relapsed. 3 patients who did not relapse after stopping the CA-intake were observed for as long as 3 years. As forensic psychiatric consequence it follows that CA in combination with psychotherapy can be considered--in spite of the side-effects linked with it--as a method of choice in the ambulatory treatment of sexual delinquents who have frequently relapsed and whom psychotherapy alone did not help.