Treatment of anxiety, tension and restlessness states with Kava special extract WS 1490 in general practice: a randomized placebo-controlled double-blind multicenter trial.

The efficacy and tolerability of 150 mg/d Kava special extract WS 1490 were investigated in a randomized, placebo-controlled, double-blind multicenter study in patients suffering from neurotic anxiety (DSM-III-R diagnoses 300.02, 300.22, 300.23, 300.29, or 309.24). 141 adult, male and female out-patients received 3 x 1 capsule of 50 mg/d WS 1490 or placebo for four weeks, followed by two weeks of observation without study-specific treatment. During randomized treatment the total score of the Anxiety Status Inventory (ASI) observer rating scale showed more pronounced decreases in the WS 1490 group than in the placebo group. Although a treatment group comparison of the post-treatment ASI scores was not significant (p > 0.05), an exploratory analysis of variance across the differences between treatment end and baseline, with center as a second factor, showed superiority of the herbal extract over placebo (p < 0.01, two-sided). 73% of the patients treated with WS 1490 exhibited ASI score decreases > 5 points versus baseline, compared to 56% for placebo. Significant advantages for WS 1490 were also evident in a structured well-being self-rating scale (Bf-S) and the Clinical Global Impressions (CGI), while the Erlangen Anxiety, Tension and Aggression Scale (EAAS) and the Brief Test of Personality Structure (KEPS) showed only minor treatment group differences. Although the results show consistent advantages for WS 1490 over placebo in several psychiatric scales and indicate significant improvements in the patients' general well-being, the differences versus placebo were not as large as in previous trials which employed 300 mg/d of the same extract. WS 1490 was well tolerated, with no influence on liver function tests and only one trivial adverse event (tiredness) attributable to the study drug.

[Therapy of recurrent exudative erythema multiforme. Effectiveness of thalidomide--report of a case]. / Therapie des rezidivierenden Erythema exsudativum multiforme. Wirksamkeit von Thalidomid--ein Fallbericht.

The authors report on the efficacy of thalidomide used to treat recurrent erythema exsudativum multiforme associated with herpes simplex with massive involvement of the entire skin and also the nasal mucosa in a 73-year-old woman. Efficacy in terms of healing and the prevention of recurrence proved to be very good.

[Is the general practitioner still the family physician today?]. / Ist der Hausarzt auch heute noch Familienarzt?

As the data collected in a survey we conducted show, a major part of the modern general practitioner's work continues to be in the field of family medicine. This fact is also confirmed by the results of other surveys of general practice today. Patients still appreciate their GPs as a source of good medical care and counseling for the whole family. Our own study has shown that most patients would even like to see an expansion of the GP's counseling activities. The duration of the doctor-family relationship extends over many years, and is frequently longer than a decade.

[The Ostringer (Prevention) Model. Results of family medicine supervised "community behavioral medicine"]. / Das Ostringer (Präventions-) Modell. Ergebnisse hausärztlich verantworteter "gemeindebezogener Verhaltensmedizin".

To evaluate the German intervention model of "Community-related Behavioural Medicine" in reducing cardiovascular risk during a major prevention study (phase I) and to investigate the efficiency of a long-term evaluation by establishing a Local Health Information System for which cooperating primary care physicians carry responsibility (phase II). In the intervention city of Bruchsal (GCP evaluation, phase I), the cardiovascular risk factors were reduced: smoking (-9.4%), obesity (-17.1%), hypertension (-51.4%) and hypercholesteremia (-12.8%). In the general practices of Oestringen (LOHIS-evaluation, phase II), the prevalence of smoking, from 1992 to 1994 (-23.8%, p < 0.01) as well as hypertension (-22.2%), p < 0.01) continued to decrease; there was no further reduction of hypercholesteremia and over-weight.

[Incidence of insulin resistance in peripheral arterial occlusive disease patients. Pilot study in a general medicine practice]. / Häufigkeit der Insulinresistenz bei pAVK-Patienten. Pilotstudie in einer allgemeinmedizinischen Praxis.

UNLABELLED: Few data are available on the correlation between peripheral occlusive arterial disease and metabolic syndrome. The present pilot study therefore investigated patients with and without PAOD and compared their vascular risk pattern with that of healthy controls. METHOD: With the aid of Doppler US measurements of blood pressure differences (tibiobrachial Doppler Index [DI], 59 patients were divided up into three groups: "healthy" (DI > 0.8 to < 1.0), "suffering from PAOD" (DI < 0.8) and "endangered" (DI > 0.8 to < 1.0). In each patient an oral glucose test (100 g) was done and insulin levels measured; in addition, the lipid fractions and fibrinogen were determined in the fasting patient. RESULTS: The groups, matched for age and weight, showed typical differences between patients with PAOD and healthy controls: lowered HDL cholesterol, elevated systolic blood pressure, triglycerides, total and LDL cholesterol and insulin. In addition, disorders of the glucose tolerance test were also more common. This shows that the patients with vascular disease have the typical risk factor pattern for metabolic syndrome as compared with controls in which point they are similar to patients with CAD. CONCLUSION: In patients with PAD, intensive non-medical therapy, such as weight reduction and physical exercise are likely to reduce the vascular risk-as has been shown for CAD patients.

[Prevalence of hypertension in childhood. A study of 21 family physician practices]. / Prävalenz der Hypertonie im Kindesalter. Eine Untersuchung in 21 hausärztlichen Praxen.

BACKGROUND INFORMATION: Very few studies have been published on the incidence of hypertension in childhood and adolescence, in particular in the doctor's office. METHOD: In view of this, the Lehrauftrag Allgemeinmedizin at the University of Heidelberg carried out a study in the Northern part of the German State of Baden-Württemberg involving 21 general practices and 410 children aged between 4 and 18 years. In addition to a questionnaire covering personal, social and family data, the systolic and diastolic blood pressures were determined by automatic oscillometric measurement, and also using a mercury sphygmomanometer. RESULTS: Hypertension was found in 2.93% of the children examined. At the time of diagnosis, half of all the children were suffering from some acute disease; however, more than 40% were discovered "by accident". Interesting relationships were found between hypertension, body weight, nicotine and alcohol abuse, sporting activities and family data, which, however, owing to the small number of subjects, were not amenable to more detailed analysis.

[The evaluation of dry chemical laboratory methods. Their value within the framework of step-by-step diagnosis in general medicine]. / Bewertung trockenchemischer Labormethoden. Stellenwert im Rahmen der Stufendiagnostik in der Allgemeinmedizin.

In a prospective study involving eleven general practices, dry-chemical laboratory methods were compared with wet-chemical methods in the establishment of the diagnosis. The study included 658 patients in whom defined liver disease, lipid metabolic disturbances, diabetes mellitus or hyperuricemia were clinically suspected. In the "dry chemistry" group, between 12 and 29% fewer basic examinations (ESR, Hb, erythrocytes, leukocytes) were performed than in the "wet chemistry" group. In addition the number of analyses per patient in the so-called search program and among the subsequently requested laboratory analyses were also lower by about 21% in the "dry chemistry" group. This indicates that through the use of "dry chemistry", laboratory examinations can be used with greater selectivity. A further advantage of "dry chemistry" is the appreciably shorter time required to establish and report the diagnosis.

Zopiclone versus nitrazepam: a double-blind comparative study of efficacy and tolerance in elderly patients with chronic insomnia.

A randomized, double-blind, comparative trial of zopiclone versus nitrazepam was conducted in 74 geriatric chronic insomniac patients. Following a 7-day wash-out period, two parallel groups, successively received a placebo for 7 days, then either 7.5 mg zopiclone or 5 mg nitrazepam for another 7-day period. Efficacy on sleep was assessed by a sleep analogue scale and the Spiegel Sleep Questionnaire, residual effects by psychometric tests and tolerance by a standardized question, as well as by clinical and laboratory tests. Zopiclone and nitrazepam were more active than placebo on all tests of efficacy. In contrast with nitrazepam, zopiclone was devoid of effect on neurological function. In addition, the condition on awakening was better with zopiclone.

Guar and its effects on metabolic control in type II diabetic subjects.

The effect of guar mini-tablets (5 g t.i.d.) on carbohydrate and lipid metabolism of outpatients with overt diabetes mellitus with glycosuria (is greater than 5 g/24 h) was determined in an open-controlled, randomized, multicenter, crossover study. A 4-wk pretreatment period was followed by a 6-wk treatment period. The treatment period consisted of a 2-wk guar period (treatment period II), which was followed by the wash-out period. The other half of the patients received treatment in the reverse order. Out of 93 patient records, 79 (41 sulfonylurea [SU] and 38 insulin-treated) were suitable for statistical analysis. No relevant weight-reducing effect of guar could be found in both 2-wk treatment periods. At the end of treatment period II, the lowering of the 1-h postprandial values of blood glucose (SU 12%, insulin 10%), cholesterol (SU and insulin 25%) was significant after 2-wk of guar treatment compared with the wash-out period. No clinically relevant changes in the safety laboratory parameters were observed during guar treatment. Side effects were observed in 40 of the 93 patients included in the trial. Treatment had to be discontinued in 11% of the patients due to gastrointestinal side effects. On the basis of our results,guar treatment in combination with sulfonylurea and insulin can be recommended for the improvement of carbohydrate and lipid metabolism.