[Experiences with an ambulance for environmental medicine at the Hygiene Institute of the Heidelberg Universy Hospital]. / Erfahrungen mit der Umweltmedizinischen Ambulanz am Hygiene-Institut des Universitätsklinikums Heidelberg.

Outpatient department and advice centres for environmental medicine were established in the late eighties in Germany. Most of these institutions focus on patient-care, whereas scientific questions have only been dealt with randomely. Thus the evaluation of applied methods and procedures is not satisfactory at present. Patients suffering from "environmental-medical" disorders usually complain about chronic or recurring illnesses. Up to now the complex etiology has not been understood. Generally environment agents in a literal sense do not seem to be of great importance. It is merely impossible to verify the extent to which such exposures influences a multifactorial etiology. Acute health disorders or a disorder that can definitely be related to a specific cause occur very rarely in our field. Thus a serious methodological dilemma results for the clinical aspect of environmental medicine. Nevertheless an increasing number of patients associate their complaints to environmental influences such as harmful substances and physical environmental influences, e.g. electromagnetic fields. Mass media and some physicians support is idea. Scientifically unsound methods of treatment are often applied to "Environmental practices", "Environmental clinics", "Mobile Environmental Outstations", The results of diagnostic examinations are interpreted in a dubious fashion and questionable therapeutic advice is given. An extension of the environmental medical field is not only taking place in the private (commercial) sector; but public institutions, especially public health centres, are participating in the unreflected extension of the outpatient section for environmental medicine. As a consequence we decided to establish a research-oriented "Environmental Outpatient Department" as part of the Hygiene Institute of the Heidelberg University in 1993. The aim was an evaluation of the concept of outpatient stations and if required its further development. The main aspects of the Heidelberg outpatient station-concept will be shown as well as the first case related research results which have reinforced our critical attitude towards clinical environmental medicine. In less than a tenth of the presented cases environmental agents could be proved partly responsible for the mentioned complaints. In a third of all cases a connection between the suspected environmentally harmful substances or others and the apparent health disorders could neither be proved nor totally denied. There was, however, little evidence for a causal connection. In two-thirds of the cases physical-chemical environmental pollution could not be proved responsible for the complaints. More than half of the patients suffered from more or less obvious psychosomatic problems.

[Lumbosacral part of the dural sac and the topography of its contents]. / Uber den lumbosakralen Teil des Durasackes und die Topographie seines Inhalts.

The course of the fila radicularia in the caudal part of the dural sack is described (Diagram 1, Fig. 1), also the length of the dorsal fila is estimated (f.e. L5 = 138,6 mm), the height of the segments (f.e. S3 = 5,41, S4 = 3,88 mm), the length of the vaginae radiculares (f.e. L5 = 24,6 mm), its angle with the side border of the dural sack (f.e. L5 = 142 degrees) and the distances between the vaginae radiculares (f.e. L4-L5 = 26,67 (21-33) mm). The filum terminale of the spinal cord has a length of 153 (123-178) mm, the filum of the dural sack is 67,8 (48-92) mm long.