[Inpatient withdrawal treatment of patients suffering from alcohol addiction in Berlin (1993-1999)]. / Stationäre Entzugsbehandlungen von Patienten mit der Diagnose Alkoholismus in Berlin (1993-1999).

On account of the Hospital Statistics Regulation from 1990 all hospitals have to run a diagnosis-related and regionally structured hospital documentation, beginning with the year 1993. In the State of Berlin, this routine documentation from 74 hospitals of Berlin is centralised in the Statistics State Office. We obtained the data records with the main diagnosis alcoholism (303 ICD 9) for the years 1993 to 1999 for evaluation. The treatment frequency is male dominated with average yearly 400 vs. 100 female cases per 100 000 inhabitants. In East Berlin men reached due to continuous increase of cases for the first time in 1998 higher values in comparison with West Berlin. The treatment frequency of female West Berlin patients is in the period under review continually about twice as high than that of female East Berlin patients. The age peak for both sexes lies between 40 and < 50 years. The patients were especially treated in the wards of "psychiatry" (ca. 40 %), of "addiction diseases" (ca. 30 %) and "internal medicine" (ca. 23 %). The average hospital retention period was reduced from 22 (1993) to 12 days (1999).

The influence of geopolitical change on the well-being of a population: the Berlin Wall.

OBJECTIVES: Social cohesion is recognized as a fundamental condition for healthy populations, but social cohesion itself arises from political unity. The history of the Berlin Wall provides a unique opportunity to examine the effects of partition on social cohesion and, by inference, on health. METHODS: This ethnographic study consisted of examination of the territory formerly occupied by the Wall, formal and informal interviews with Berlin residents, and collection of cultural documents related to the Wall. Transcripts, field notes, and documents were examined by means of a keyword-in-context analysis. RESULTS: The separation of Berlin into 2 parts was a traumatic experience for the city's residents. After partition, East and West Germany had divergent social, cultural, and political experiences and gradually grew apart. CONCLUSIONS: The demolition of the Wall--the symbol and the instrument of partition--makes possible but does not ensure the reintegration of 2 populations that were separated for 40 years. The evolution of a new common culture might be accelerated by active attempts at cultural and social exchange.

[Effect of different factors on the bone forming properties of recombinant BMPs]. / Einfluss unterschiedlicher Faktoren auf die knochenbildenden Eigenschaften von rekombinanten BMPs.

The extent of BMP-induced new bone formation is mainly determined by the number of mesenchymal target cells in the recipient bed as well as by the biological half-life of the BMP molecules within the tissue. While the number of inducible cells is determined by the age and vascularization of the tissue, the retention time of the BMP molecules can be influenced. One possibility is the coupling of BMPs to suitable carriers, which significantly increases the osteoinductive effect. The reason for this is the physical binding of BMPs to the carrier material, which delays the resorption of the proteins. Other factors are the composition of the carrier materials, their structural stability, and possible dislocations of carrier particles. The local tissue concentration of BMPs can also be increased by an enhanced binding of the proteins to the extracellular matrix. A BMP-2 mutant (BMP-2xa) was produced by the specific modification of the amino acid sequence using recombinant technologies. BMP-2xa induces heterotopic bone formation at significantly lower concentrations than natural BMP-2. Furthermore, BMP-2xa-induced bone tissue possesses a higher bone density.

[EHBMP-2. Initial BMP analog with osteoinductive properties]. / EHBMP-2. Erstes BMP-Analog mit osteoinduktiven Eigenschaften.

For the first time a non natural BMP-variant (EHBMP-2) with osteoinductive properties was produced by expression in E. coli through specific mutation of the amino acid sequence. The substitution of 12 N-terminal amino acids by a nonsense sequence results in a neglectible affinity of EHBMP-2 to the extracellular matrix. In vitro EHBMP-2 induces dose-dependent cartilage formation in neonatal muscle tissue. Single intramuscular implantation in mice results in the formation of an ossicle with functional active bone marrow. The size of the ossicle depends on the amount of implanted EHBMP-2 and can significantly be increased by the combination with a collagen carrier. The largest bone formation is observed after injection of EHBMP-2 containing collagen suspensions. In rats a stronger osteoinductive activity can be achieved by coupling of EHBMP-2 to collagen discs than by coupling natural BMP-2 to the same collagen carrier. Critical size defects in rats' mandibular angels can be restored by the combination of granular collagenous bone matrix (ICBM) with EHBMP-2. Further investigations have to show whether the altered pharmacokinetics of EHBMP-2 has advantages regarding its therapeutical use and tissue-engineering.

Biocompatibility testing of a new silver-impregnated catheter in vivo.

The purpose of this investigation was to compare the local effects of polyurethane (Tecothane) and silicone tubes with or without silver impregnation in rats. Bacterial colonization or infection of the exit site and/or tunnel were documented and interpreted. All tubes were placed subcutaneously or percutaneously in the neck of 41 Sprague-Dawley rats and guided beneath the dorsal muscles into the peritoneal cavity. The incidence of bacterial abscesses along the implanted tubes was evaluated daily. After 90 days, or earlier if sepsis developed, the animals were killed painlessly and various organs and tissues from the entry site and the catheter tunnel examined histologically. In the group where polyurethane tubes were placed percutaneously, there was no difference in the frequency of abscesses between silver-impregnated and non-impregnated tubes (5/6 with and 5/7 without silver). The only difference noted was in the group with percutaneously placed silicone tubes between those with and without silver. Abscesses only occurred in 2/4 animals in the silver group and in 5/5 animals in the control group. Histological examination showed no difference in either group between infectious and foreign body reactions. Silver particles in subcutaneous, muscle and peritoneal tissue could not be demonstrated.

[Alcohol abuse and dependence in former East Germany and new united Germany]. / Alkoholmissbrauch und -abhängigkeit in der ehemaligen DDR und in den neuen Bundesländern.

The objective of this paper is the description of the transformation process after the reunification of East- and West-Germany taking the health care structures for alcoholics as an example. First the epidemiology of alcohol abuse and alcohol dependence are presented such as the individual alcohol consumption. These data are completed by hospital data. The social and organizational problems created by the transformation process after the reunification of Germany are described. Necessary structural changes and the expected development are discussed.

Overexpression or ectopic expression of MUC2 is the common property of mucinous carcinomas of the colon, pancreas, breast, and ovary.

Mucinous carcinomas of the colorectum have been reported to overexpress the intestinal mucin MUC2. The purpose of this study was to determine whether this alteration is shared by mucinous tumours of the ovary, breast, and pancreas. A total of 40 breast carcinomas (22 of mucinous and 18 of ductal invasive type), 39 ovarian adenocarcinomas (16 mucinous, 23 serous), 47 colorectal carcinomas (25 mucinous and 22 non-mucinous), and 41 pancreatic adenocarcinomas (14 mucinous, 27 non-mucinous) were investigated by immunohistochemistry with the anti-MUC2 monoclonal antibody 4F1 and the expression pattern was ranked. MUC2 mucin is expressed in the normal colonic epithelium; in the normal epithelium of the breast, ovary, and pancreas, it was not detectable by immunohistochemistry or by reverse transcriptase-polymerase chain reaction (RT-PCR). In agreement with previous reports, the colonic mucinous carcinomas differed significantly from the non-mucinous carcinomas by strong MUC2 expression. In all mucinous carcinomas of the ovary, breast, and pancreas, de novo expression of the MUC2 gene was observed, which differentiated mucinous and non-mucinous carcinomas of these tissues (P < 0.001). The overexpression or ectopic expression of the MUC2 gene exhibited by mucinous carcinomas of four organs indicates a common genetic lesion associated with the mucinous tumour phenotype.

Brachydactyly in a child with duplication-deficiency subsequent to t(15;20)(q25.2;p12.2)mat. Candidate regions on one or both chromosomes?

We report a child with a duplication-deficiency subsequent to t(15;20)(q25.2;p12.2), transmitted in at least 5 generations, who showed features of 15q- syndrome. We speculate that brachydactyly--most likely because of brachymesophalangism--is a feature of the phenotype of this chromosomal aberration and points to candidate gene(s) in this region. A similar brachydactyly was, however, reported with dup(20p1-pter).

Prenatal findings in patients with prolonged QT interval in the neonatal period.

OBJECTIVE: To describe prenatal abnormalities of cardiac rhythm in patients with prolonged QT interval in the neonatal period. DESIGN: A retrospective analysis of the results of fetal echocardiography and the outcome in patients with prolonged QT interval in the neonatal period who had been referred for prenatal evaluation. SETTING: Two university hospitals. PATIENTS: Nine patients with prolonged QT interval in the neonatal period who had been referred for prenatal evaluation. Fetal echocardiograms were obtained from 24 to 40 weeks of gestation. Indications were fetal bradycardia (five patients), a family history of long QT syndrome (two patients), and complex arrhythmias (two patients). RESULTS: Seven fetuses had persistent sinus bradycardia without ventricular arrhythmias (heart rates 70-120 beats/ min). Five patients were treated with propranolol, after the diagnosis had been established by postnatal electrocardiogram (ECG). One of these patients died suddenly at the age of 3 weeks, after the treatment had been stopped because of profound bradycardia. One of the remaining two patients who did not receive propranolol had a syncope at the age of 6 weeks. Two fetuses presented with frequent runs of ventricular tachycardia and intermittent bradycardia caused by intermittent, functional second degree atrioventricular block. Both patients died on the first day of life despite treatment with propranolol and transvenous temporary pacing. CONCLUSIONS: Sinus bradycardia in an otherwise normal fetus may be a symptom of long QT syndrome. Postnatal ECGs and a family examination are strongly recommended in these children. In fetuses with frequent runs of ventricular tachycardia and intermittent second degree atrioventricular block long QT syndrome should be suspected prenatally. These high risk patients should be delivered in centres with a paediatric cardiology unit.

Aplasia of the optic nerve in two cases of partial trisomy 10q24-ter.

We report two cases with partial trisomy of 10q24.1-ter with concomitant deficiency of 7pter and 4qter, which share aplasia of the optic nerve and malformation of the anterior chamber. A review of published observations of partial trisomies of 10q showed that abnormalities of the eye, and particularly of the orbital region, are frequent, but ophthalmological studies are lacking. We conclude that our findings demonstrate a major effect of this chromosomal imbalance.

Ascending central nervous spreading of a spinal astrocytoma.

A 43-year-old man died from the complications of astrocytoma metastasis. He first noticed symptoms of a lumbar disc prolapse in 1979. In 1987 a pilocytic astrocytoma (grade I) of the spinal cauda was removed. In 1989 a tumor recidivation at the same site was partially removed. Histology showed a grade II astrocytoma. Two months later the patient developed symptoms of increased intracerebral pressure. CSF cytology showed polymorphic giant tumor cells with hyperchromatic nuclei and a glioblastoma of the cerebral ventricles was diagnosed. The patient died from cardiovascular complications. The post-mortem investigation revealed an astrocytoma of the conus medullaris with an anaplastic ventral area (grade IV). This area was inaccessible to the biopsy. It is believed that tumor metastases from anaplastic parts spread along the spinal cord and brainstem and finally invaded the brain and cerebral ventricles.

[The diagnosis "alcoholism" in the hospital--analysis of the frequency of admission and length of stay for 1970-1988]. / Die Diagnose "Alkoholismus" im Krankenhaus--Analyse der Häufigkeit und Verweildauer für die Jahre 1970-1988.

During 18 years occurred an enormous (fivefold) increase of the country-wide registered frequency of in-patient cases with the diagnosis alcoholism. This development is connected with a decrease of the length of stay. Fife hypotheses to these findings are discussed. The dynamic is different by age, sex and hospital wards. The various length of stay indicates different contents of treatment, from the detoxication with the shortest length of stay (0-3 days) to the narcotherapy (several months) to the long-stay patients (several years).

Observing client-therapist interaction in behaviour therapy: development and first application of an observational system.

A category system for coding the interaction in psychotherapy (CIP) is presented. Six therapists carried out 64 standardized intake sessions with clients presenting with chronic insomnia. The sessions were fully coded by three raters using the CIP. The 19 client categories as well as the 18 therapist categories showed sufficient reliability with kappa coefficients of 0.80 and 0.79 respectively. The frequencies of the client and the therapist categories of the first versus the second half of the interview were compared. Shifts in the behavioural patterns of therapists and clients during the course of the interviews are in accordance with the given rationale of the session. Correlations between the observational data and subjective ratings of the participants are further evidence for the utility of the CIP.

[Correlation of the incidence of ambulatory and inpatient treatment in neurology/psychiatry in the course of a year]. / Zum Verhältnis von ambulanter und stationärer Behandlungshäufigkeit in der Neurologie/Psychiatrie während eines Jahres.

There should be more out-patient treatment of neurological and psychiatric disorders. This first-ever coverage of the morbidity of out-patient treatment over a period of one year in Berlin enables appraisal in comparison to the amount of inpatient treatment, broken down according to diagnosis, age, and sex. This offers pointers for future training and capacity.

[Correlates of disordered sleep: a replication study]. / Korrelate des gestörten Schlafes: eine Replikationsstudie.

90 good and 106 bad sleepers were compared in respect to sleep quality and quantity as well as to several other aspects of life. Several questionnaires were used to measure sleep and day time behavior. In addition, a newly developed sleep questionnaire, containing 60 items, was used and factor analysed. The three resulting factors were "helplessness", "distress" and "attitude about sleep". The comparisons between good and poor sleepers showed that stress and insufficient coping skills contribute to the maintenance of sleeping disorders. These results represent a successful replication of a previous study. The comparisons between the different subclasses of sleep disorders showed a few differences, but essentially the conclusions are true for all of the three kinds of sleep disorders. Consequences for the target areas addressed in the treatment of sleep disorders are discussed.