[Cost effectiveness of clopidogrel in secondary cardiovascular prevention: a cost-effectiveness analysis based on the Caprie Study]. / Die Wirtschaftlichkeit von Clopidogrel in der kardiovaskulären Sekundärprävention: eine Kosten-Effektivitäts-Analyse auf der Grundlage der Caprie-Studie.

As a result of medical progress each year numerous new therapies are introduced to the medical community, and each of them must prove its usefulness in two arenas. Firstly, does the new therapy improve outcomes relative to conventional therapy? If this test is passed, the second question is: are the improved outcomes worth the extra costs? Controlled clinical trials answer the first question and economic analysis, the second. The CARPIE-Study has proven, that Clopidogrel, a new antiplatelet drug, was superior in secondary prevention of cardiovascular events to aspirin. On the basis of this study we conducted a cost-effectiveness analysis from the perspective of Swiss third party payers. The following costs were included in the analysis: treatment costs of aspirin and clopidogrel, myocardial infarction, ischaemic stroke and primary non-fatal intracranial haemorrhage. For the calculation of the years of life gained the DEALE-method was applied. The net costs of treating 1000 patients, i.e. incremental drug costs less savings of treatment costs, are Fr. 1.5 Mio. The intervention with Clopidogrel lead to an additional gain of 63 life years in compared to aspirin. At additional yearly cost of Fr. 722.--per patient the analysis yield a cost-effectiveness of CHF 24,164 (nominal) Fr. 22,837 (discounted) per additional year of live saved. The results suggest that the cost-effectiveness of Clopidogrel in secondary prevention lie well within the range of other preventive cardiovascular interventions. Therefore, from an economic perspective the use of Clopidogrel in secondary prevention of major cardiovascular events in patients with atherosclerotic vascular disease is justifiable.

[Value of ultrasound study and dual energy x-ray absorptiometry (DEXA) for assessment of risk of osteoporosis]. / Stellenwert von Ultraschalluntersuchung und Dual Energy X-Ray-Absorptiometry (DEXA) zur Abklärung des Osteoporoserisikos.

UNLABELLED: Screening postmenopausal women for preventing osteoporosis at an early stage is the main topic of several studies. The present paper evaluates the place of ultrasound measurements in comparison with Dual Energy X-ray-absorptiometry (DEXA). METHODS: 247 women (41 women < or = 50 yrs, 103 women 50-60 yrs, 103 women > 60 yrs) underwent DEXA of the vertebrae and hip and concommittantly ultrasound measurements of the calcaneus. RESULTS: The DEXA values in the vertebral column vary considerably and are lowest in L1 and highest in L4. The femur on the other hand shows lowest values in the Ward triangle (T = -1.6 SD), and highest in the trochanter (T = -0.3 SD). Speed of sound (SOS) gives lower T-values (-1.2 SD) than broadband ultrasound attenuation (BUA) (-0.3 SD). Statistical analysis (Spearman, Pearson) shows no correlation between ultrasound and DEXA measurements and therefore do not permit analogies between hip and vertebral column and vice versa. CONCLUSIONS: Our data show that the fracture risk of an individual woman can be adequately ascertained only by DEXA-measurement of vertebrae and femur. Ultrasound measurement today cannot be recommended as routine screening or diagnostic method.

[Epidemiological study of sleep disorders in patients in Swiss general practice]. / Epidemiologische Studie über Schlafstörungen bei Patienten in Schweizer Allgemeinpraxen.

The aim of the study was to assess the prevalence, severity, associated factors and diagnosis of sleep disorders in general practice. Over 700 patients were investigated with a multiple choice questionnaire in 24 general practices in Switzerland. To assess sleep disorders, criterion A for insomnia according DSM-III-R was applied. The prevalence of sleep disorders was 44%, 64% of these were classified as mild, 31% as moderate and 5% as severe. 50% of the female patients complained about insomnia compared to 36% in males. Retrospectively, 74% of the patients stated having suffered from sleep disorders for more than one year (mild 76%, moderate 69%, severe 75%). 70% of patients with mild, 42% with moderate and 30% of patients with severe insomnia didn't inform their physicians about their sleep difficulties on the occasion of an earlier consultations. Patients with moderate or severe insomnia felt moderately or markedly disabled in their quality of life (71%) and work (58%). To estimate general anxiety and depressive state, self-rating scales were used (STAI, D-S). In comparison to reference values for healthy volunteers, insomniac patients had significantly higher scores on both scales, which were associated with the severity of sleep disorders, corroborating the association of sleep disorders with anxiety disorders and depressions. The physicians diagnosed in 18% of insomniacs a psychiatric disease, in 52% a psychoreactive disorder and in 26% a somatic etiology. The study shows that sleep disorders are a frequent syndrome in general practice and often not reported to the physician; therefore, the patients should routinely be questioned about sleep problems, and associated psychiatric diseases should be considered.

[Comparative study of the lower uterine segment after Cesarean section using ultrasound and magnetic resonance tomography]. / Vergleichende Untersuchung am unteren Uterinsegment nach Sectio caesarea mittels Ultraschall und Magnetresonanztomographie.

To determine whether ultrasound (US) or magnetic resonance imaging (MRI) gave more accurate and objective information about the thickness and continuity of scarred isthmical myometrium following previous Caesarean section (CS), US and MRI assessments of the scarred myometrium in 10 pregnant women (37-41 weeks gestation) after 1-8 CS were compared with each other and with findings at subsequent elective CS. Vaginal ultrasound gave more accurate information about the condition of the scarred isthmical myometrium than MRI, since US always allowed precise differentiation of isthmical myometrium from the urinary bladder wall and thus measurements of the scar thickness; there was a good correlation to intraoperative observations. MRI achieved better contrast resolution with T2- than T1-weighted and proton density-weighted spin-echo sequences. However, differentiation of the various tissues was either impossible (T1- and protondensity-weighted sequences) or less informative than with US. Image quality of body and posterior wall of the uterus was better with MRI (T2-weighted sequence) than with US.

[Reduction of MRT time in the female pelvis using T2-weighted Fast-Spinecho(FSE)-technique. A quantitative and qualitative comparison of conventional spinecho(SE) and Fast-Spinecho(FSE)-sequence]. / Verkürzung der MRT-Messzeiten im weiblichen Becken mit Hilfe der T2-gewichteten Fast-Spinecho(FSE)-Technik. Quantitativer und qualitativer Vergleich der konventionellen Spinecho(SE)- und Fast-Spinecho(FSE)-Sequenz.

The fast spin echo (FSE) technique leads to time saving by individual phase coding of several spin echoes within one repetition interval. The new sequencing was compared quantitatively and qualitatively with conventional spin echo sequences in 30 patients with gynaecological pelvic disease. The signal-to-noise ratio was higher on FSE images in all tissues but to a variable degree. This led to an increased contrast-to-noise ratio, particularly between fat and solid structures, and to a reduction in the contrast between fat and fluid. Artifacts were reduced in FSE sequences leading to improved image quality in 83% and increased diagnostic information in 10%. This is of particular advantage when using time consuming T2-weighted sequences, which are necessary for the examination of the female pelvis.

Effect of hypothyroidism on phosphorus metabolism in muscle and liver: in vivo P-31 MR spectroscopy study.

Hypothyroidism is known to affect nearly every organ and organ system of the human body. The goal of the present study was to gain insight into the phosphorus metabolism and bioenergetic function of striated (calf) muscle and liver in patients with hypothyroidism before and after thyroid hormone treatment. With an ISIS (image-selected in vivo spectroscopy) magnetic resonance (MR) technique for volume selection, phosphorus-31 metabolism of the calf muscle in 10 patients and of the liver in seven patients with severe hypothyroidism was studied before and after treatment. In addition, spectra from the calf muscle and liver were obtained in 10 healthy volunteers. Relative to those from the healthy subjects, the P-31 MR spectra from patients with hypothyroidism showed a significantly diminished phosphocreatine/inorganic phosphate ratio (P less than .01). After thyroid hormone substitution therapy, this ratio returned to normal values within several weeks. No statistically significant changes in the spectra of liver tissue could be detected. The results support the theory that hypothyroidism induces a hormone-dependent, fully reversible impairment of the energy metabolism of striated muscle. Changes in liver metabolism observed with biochemical methods are apparently not detectable with state-of-the-art P-31 MR spectroscopy.

123I-iomazenil: a quantitative study of the central benzodiazepine receptor distribution.

Fourteen patients with temporal lobe epilepsy, 9 patients after amygdalohippocampectomy and 3 healthy volunteers were examined with the new benzodiazepine receptor marker 123I-Iomazenil and SPECT. For comparison perfusion SPECT studies with 99mTc-HMPAO were done and a quantitative ROI analysis of the data performed. This quantitative analysis consisted of calculation of right-to-left ratios for 123I-Iomazenil SPECTs, whereby values of 1 were obtained with narrow standard deviations. ROI measurements of the medial occipital, frontal and parietal cortex, the cerebellum and white matter showed a pattern of benzodiazepine receptor concentration in concordance with that previously found in PET and autoradiographic studies, if 123I-Iomazenil ROIs were normalized to the corresponding 99mTc-HMPAO ROIs. The abnormal distribution in the temporal lobes will not be discussed in this paper.

[Magnetic resonance tomography in malignant genital tumors]. / Magnetresonanztomographie maligner Genitaltumoren.

Magnetic resonance imaging (MRI) is a valuable noninvasive method for evaluating the female and male pelvis. The advantages of MRI include direct multiplanar imaging and excellent contrast resolution. The superb soft-tissue contrast provides unique depiction of the characteristic zonal architecture of the uterus, vagina and the prostate. The role of MRI in the pre- and posttherapeutic evaluation of carcinoma of the endometrium, cervix, ovaries, vagina and prostate is described. Our own experience with patients with a suspected tumor recurrence shows that MRI is able to distinguish tumor recurrence from posttherapy fibrosis if the interval between therapy and MRI is more than one year. MRI seems not to be useful in differentiating these entities at an early stage after treatment.

[Positron-emission tomography (PET) in the evaluation of metabolic processes in the myocardium]. / Die Positronenemissionstomographie (PET) zur Beurteilung des metabolischen Zustandes des Herzmuskels.

Nuclear cardiology, and in particular myocardial scintigraphy, is used with increasing frequency to detect the presence of ischemia before revascularization by angioplasty or coronary artery bypass grafting. On the basis of recent publications it is evident that there are certain conditions in which conventional diagnostic methods suggest the presence of myocardial necrosis, but there is persistent metabolically active myocardial tissue. One of these conditions is the "hibernating myocardium". Patients with this disease entity will show an improvement in cardiac function after revascularization in over 85% cases. Therefore, the diagnosis of "hibernating myocardium" has a high predictive value. Differentiation between irreversible myocardial necrosis and "hibernating myocardium" is possible by positron emission tomography (PET) combining imaging of myocardial metabolism with imaging of myocardial perfusion. With 30 months, 36 patients with established myocardial infarction and a suspicion of "hibernating myocardium" have been examined in the PET scanner at the Paul Scherrer Institute, Villigen. Images of glucose metabolism were obtained by 18-fluoro-deoxyglucose and perfusion images were obtained using thallium in a first phase (thallium-SPECT at rest) and rubidium-82) as a positron emitter in second phase. We were able to identify patterns that suggest the presence of "hibernating myocardium", in 19 of 36 patients (53%). The basic principles and limitations of myocardial positron emission tomography are discussed.

[Secretion of proteohormones and steroids in postmenopause and in women with corporal uterine cancer (author's transl)]. / K otázce vylucování protehormonu a steroidu v postmenopauze a pri korporálním karcinomu delozním

PIP: The hypophyseal, adrenal, and ovarian hormonal production of 5 women, aged an average of 62.8 years, with corporal uterine cancer was determined. 5 healthy women in menopause, aged an average of 58.8 years, were used as a control. Serum samples were used to show the levels of follicle stimulating hormone (FSH) luteinizing hormone (LH), ACTH, estradiol-17beta, and cortisol. At the same time, urine analysis revealed levels of steroids: aggregate estrogens, 17-ketosteroids, and 17-OH steroids. Some differences were found between the levels of cortisol and estradiol-17beta. No differences were found between the levels of FSH, LH, and ACTH. The statistical results lead to the conclusion that a link between corporal uterine cancer is quite possible, but not definitely indicated.^ieng

[Statistic evaluation of anamnestic and clinical findings in a premature labor collective of 245 cases]. / Statistische Auswertung von anamnestischen un klinischen Befunden bei einem Frühgeburtenkollektiv von 245 Fällen

245 cases of premature birth were compared from the point of view of frequency of aetiologically significant factors with 200 cases of normal birth. The perinatal progress of these premature and normal births was also followed up. It was possible to obtain statistical confirmation of the connection between prematurity and frequent occurrence of some of these parameters. Prominent amongst these are previous abortions and premature births, cervical insufficiency and malformation of the uterus, multiple pregnancies and anomalous foetal position, also placental insufficiency. Increased mortality and morbidity--including perinatal complications--were recorded at the same time. Knowledge of predisposing factors will in many cases make it possible to recognize in good time when pregnancies may be at risk and give adequate supervision and treatment where appropriate.