[Quality of care and health economics in occupationally acquired hepatitis C in German health care workers between 1993 and 2004]. / Versorgungsqualität und Gesundheitskosten bei berufsgenossenschaftlich anerkannter Hepatitis C. Untersuchung in der Modellregion West zwischen 1993 und 2004.

BACKGROUND AND OBJECTIVE: Data for quality of care and health economics in patients with occupationally acquired hepatitis C are lacking in Germany. The aim of this study was to analyse quality and economics of health care in occupationally acquired hepatitis C recognized by the Employees Compensation Boards between 1993 and 2000 in the area of Cologne and Bochum, Germany. METHODS: Results for 192 patients (146 women and 46 men, mean age 42 +/- 10 years) were analysed, using a standardized evaluation form. In addition to direct medical costs and diagnostic and therapeutic performance, disability days and benefit payments were also analysed. The observational period was from 01.01.1993 to 31.07.2004. Disability benefits were considered from 1983 onwards. RESULTS: HCV genotype 1 accounted for 79 % of infections. 112 patients (58 %) received antiviral treatment at least once. There were no differences in treatment rates between patients with prognostically favorable genotypes (2/3) and those with unfavorable HCV types (1/4) (59 % v. 60 %) or patients with low and those with advanced fibrosis (61 % v. 64 %). A sustained virological response was achieved in 53 % of treated patients. Disability days were more frequent in patients receiving antiviral treatment (214 v. 67 days). The cost of medication made up a major part of health care expenditure (mean of i 13,279 per patient). In addition, total disability benefits of i 6,933,789 were paid out between 1983 and 2004. CONCLUSION: Occupationally acquired hepatitis C is a major health-economic burden in Germany. Quality of health care corresponded to guidelines at any one time and sustained virological response was in the range of large controlled trials. However, 69 % of the patients remain chronically infected and are at risk for disease progression and transmission.

[Metachronous second carcinoma after curative treatment of cholangiocarcinoma by duodenopancreatectomy]. / Metachrones Zweitcarcinom nach kurativer Behandlung eines Cholangiocarcinoms durch Duodenopankreatektomie.

In comparison to pancreatic cancer, extrahepatic cholangiocarcinoma has a better prognosis and a higher resection rate, but it is tainted with the occurrence of metachronic tumors. Metachronic tumors of the female genitalia are described in the literature, but metachronic gastric cancer after curative treatment of cholangiocacinoma is also possible.

Broad Frequency Range Study of the Dielectric Properties of Suspensions of Colloidal Polystyrene Particles in Aqueous Electrolyte Solutions.

The dielectric properties of suspensions of spherical polystyrene particles with radii of 34 and 50 nm, in aqueous electrolyte solutions were measured in the frequency range of 10 kHz to 30 GHz using HP 4192A impedance and 8753A network analyzers, and double path interferometers. The samples were prepared from the stock suspensions with a high particle concentration (volume fraction of 0.4), which were used either unchanged or diluted with increasing amounts of water down to a concentration of 0.05. The permittivity and total loss spectra showed three well-defined relaxation regions, which could successfully be interpreted using an existing model [Grosse, C., J. Phys. Chem. 92, 3905 (1988)] (corrected by including a term of counterion diffusion on the particle surface). A model spectral function was fitted to the data using seven free parameters: the static conductivity of the electrolyte solution, three parameters associated with the relaxation of the electrolyte solution, and just three parameters for the description of both the counterion and the Maxwell-Wagner relaxations. For different particle concentrations, the values of the surface conductivity (obtained from the Maxwell-Wagner parameters) remained essentially constant, while the low-frequency relaxation parameters exhibited very good agreement with theoretical predictions in Delgado, A. V., Arroyo, F. J., Gonzales-Caballero, F., Shilov, V. N., and Borkovskaya, Yu. B., Colloids Surf. A, in press. Copyright 1998 Academic Press.

NES test performance in a large US Army veteran sample: relationships with both demographic factors and traditional neuropsychological measures.

A large sample of Vietnam-era US Army veterans completed a set of 16 neuropsychological tests, including six computer-based tests from the Neurobehavioral Evaluation System (NES), during medical examinations supervised by the US Centers for Disease Control (CDC). Data for 881 participants of the Agent Orange Validation Study (AOV) and Vietnam Experience Study (VES) were available for analysis from public access data tapes provided by CDC. Information was available for several potential covariates from demographic questionnaires, a medical examination, and a medical history. Explorator, principal components factor analysis of 16 test variables yielded four factors, including one on which most of the NES tests loaded. The single best predictor of most neuropsychological performance variables was an index of general intellectual level as measured at entry into the Army almost 20 years before the neuropsychological examinations. Alcohol drinking variables were not related to neuropsychological performance. Several measures of general intelligence were compared for use as covariates of neuropsychological test performance. All were superior to years of education in statistically controlling for general intellectual level.

Validation of the Clance Imposter Phenomenon Scale.

The Clance Impostor Phenomenon Scale (CIPS; Clance, 1985) was compared to the newly developed Perceived Fraudulence Scale (Kolligian & Sternberg, 1991). The two scales were found to have high internal consistency and to correlate in a similar manner with other measures. Further, discriminant validity evidence for the Impostor Phenomenon (IP) was provided by comparing the CIPS to measures of depression, self-esteem, social anxiety, and self-monitoring. The IP was related to, but substantially discriminable from, these constructs. Finally, construct validity evidence for the CIPS was provided through principal components analysis that yielded three stable factors: Fake, Discount, and Luck.

Speed and accuracy effects of fingers and dexterity in 5-choice reaction tasks.

In two experiments we studied the influence of dexterity (controls, typists, pianists) and of differences between the five fingers of the dominant hand on speed and accuracy in a 5-choice reaction task. We used five coloured squares (Blue, Green, Yellow, Red, White) as stimuli, randomly varying foreperiods (3-10s) and an intermediate stimulus-response-compatibility. The results reported here were independent of sex, foreperiods, and colour of stimuli. In Experiment 1 (N = 168) with three groups (controls, typists, pianists) thumb and little finger showed significantly shorter reaction times than did index, middle, and ring finger. This difference did not interact with dexterity. Averaged across all the fingers typists and controls did not differ. Pianists showed significantly shorter reaction times than these two groups. Experiment 2 (N = 40) replicated all these findings. In both experiments groups did not differ in speed-accuracy-trade-off. The accuracy of the fingers was independent of dexterity. In all three groups the little finger showed the lowest rate of false alarms and the highest degree of reliability. The frequency distribution of finger confusions in all groups was in accordance with the spatial proximity of fingers: the closer their proximity the higher were the rates of confusion. In addition, these distributions showed an asymmetry across all three groups. The finger next to the 'correct' finger in direction towards the thumb showed the highest false alarm rate in each case.

Pavlovian conditional stimuli cannot always be defined solely in physical terms.

Twenty-four university students received differential Pavlovian conditioning with two colored stimuli separately accompanied by shock, and two other colored stimuli separately presented without shock. The reinforced and nonreinforced pairs of stimuli both contained complementary elements. After differentiation between the reinforced and nonreinforced elements was established, the complementary pairs were each additively mixed, (i.e., presented at the same time and in the same locus), producing two identical white compounds (established by pilot study). The subjects' skin-conductance responses to the two compounds showed that their different conditioning histories did not result in different responses. Rather, a simple declining function was obtained, resembling habituation or extinction. It was concluded that the definition of the conditional stimulus as a physical event is inappropriate in studies in which physically different stimuli may result in identical internal processes (or phenomenologic experiences)--for example, in additive color mixture.

Pressure-induced growth (PIG) of atretic esophagus: a contigent management for high-risk esophageal atresia.

A method is described by which a balloon catheter is inserted into the lower pouch, avoiding aspiration pneumonia due to overflow of gastric contents via a lower tracheoesophageal fistula in high-risk cases of esophageal atresia. As a side-effect there is an enlargement of the lower pouch, termed by the authors "pressure-induced growth". The prevention of aspiration pneumonia, induction of growth of the atretic segment, and the application of this method as the first part of a staged management of esophageal atresia in high-risk cases are the advantages.

Pulmonary arteriovenous fistula in childhood.

We report two cases of children with pulmonary arteriovenous fistula treated at the University Clinic of Mainz. This angiodysplasia is relatively more diffuse and the clinical signs are more marked in childhood. The non-invasive techniques should be preferred for diagnosis. Complications occur frequently even in asymptomatic children so it is recommended to operate them. The local excision without extirpation of lung tissue should be preferred to segmentectomy or lobectomy for peripheral lesions. Therapeutic embolisation should be tried in inoperable cases.

Double atresia of the oesophagus.

An extremely rare type of congenital malformation of the oesophagus with double atresia and a midportion oesophageal cyst without fistula is presented. The long course of its diagnosis and definitive management are discussed. The interposition of the "cystic" part between the upper and lower segments to produce continuity of the oesophagus by means of a double anastomosis is warranted only if the cyst is sizeable enough to allow a good anastomosis without tension. Furthermore immediate histological frozen sections should demonstrate the cyst to be a part of the oesophagus.

[Ocular findings in multiple endocrine neoplasia type II b (author's transl)]. / Augenbefunde bei multipler endokriner Neoplasie Typ II b.

The MEN II b syndrome is a form of multiple endocrine neoplasie (MEN). The main features are medullary carcinoma of the thyroid, pheochromocytoma, adenoma of the parathyroid glands and a marfanoid appearance. The authors report a case of MEN II b with a characteristic combination of ocular findings: thickened upper eyelids, ectopia puncti lacrimalis, decreased secretion of the lacrimal gland, medullary corneal nerves and a ring of neuromatous tissue at the limbus corneae. The differential diagnosis and the possibility of early diagnosis and management of this endocrine neoplasia are discussed in detail.

Abrasion method for the immediate management of surface thermal injuries of childhood.

Retrospectively 173 cases of surface thermal injuries of childhood have been reviewed according to their respective modes of immediate surgical management of abrasion, open and closed-air treatment and discussed with reference to some publications. Despite the application of antibiotic or antiphlogistic dressings in the other two groups, the abrasion method using high speed rotating grinding heads to convert the burn into an easily manageable surgical wound shows a lesser frequency of infection and inflammation and promotes quick natural healing. The method which is not widely used proves conducive in the management of burns in childhood.

[Graphic demonstration of finger mobility in the grasping region]. / Die graphische Darstellung der Fingerbeweglichkeit im Greifraum.

To test the functional capacity of a finger, the documentation of its range of motion is of great importance. The capacity to grasp is determined by the flexion and extension ability of the finger joints. Dexterity is based on the mobility field of the finger end, within the grasping area. Both can be shown graphically. A table is described with which the mobility within the grasping area of each finger can be tested and documented without joint measuring. The advantage of this method is the easy handling and the graphic demonstration, allowing a very precise judgment of the functional capacity of a finger. The graphic demonstration is especially qualified for testing disabled fingers as well as showing progress during physiotherapy.

Alcohol withdrawal reactions in rhesus monkeys.

The magnitude of the ethanol withdrawal reaction was assessed in rhesus monkeys (Macaca mulatta) following 96 hours of either constant or systematically fluctuating blood ethanol concentrations (BEC) using both physiological tremor and scores on a behavioral checklist as dependent measures. Although specific BEC (50, 100, 200 or 300 mg/dl) were not reliably related to changes in mean frequency of tremor, this measure was a statistically significant curvilinear function of time as measured before and after zero BEC during the withdrawal period. Further, scores from the behavioral checklist demonstrated a dose-response relationship with respect to BEC. The data also suggest that systematically fluctuating BEC are associated with less severe withdrawal reactions when compared with appropriate data from the constant BEC condition.

Great apes and rhesus monkeys as subjects for psychopharmacological studies of stimulants and depressants.

A group of experiments is described in which chimpanzees and orangutans are utilized as subjects in research projects designed to evaluate the effects of stimulant and depressant drugs on learning and performance. Efficiency of performance on a task which measures spaced responding was impaired when subjects smoked cigarettes containing delta9-tetrahydrocannabinol prior to testing. In a sequential learning task, these subjects also demonstrated reduced performance when stimulatn drugs were orally administered before testing. Depressant drugs did not produce comparable decrements in sequential learning performance. Physical and behavioral tolerance and dependence on ethanol were investigated in rhesus monkey subjects using a variety of experimental procedures, including forced oral acceptance, intragastric intubation, intravenous infusion, and conditioned voluntary oral acceptance.

Retention of functional tolerance to ethanol in rhesus monkeys (Macaca mulatta).

Tolerance to ethanol (3 g/kg 90 min prior to testing) was assessed in a group of 4 rhesus monkeys in which tolerance development had been observed using the same behavioral task one year prior to the present study. Although some decrements in performance on a two-choice discrimination reversal learning task were observed, these changes were transient and statistically insignificant. Results indicate that functional tolerance persisted throughout a one year abstinence period.

Induction of physical dependence upon alcohol in nonhuman primates.

Following the description of the alcohol withdrawal syndrome in man, efforts have been made to use the nonhuman primate as an animal model for studying the development of physical dependence upon alcohol. There is now general agreement regarding the qualitative description of the withdrawal reaction in the rhesus monkey, and various approaches, including intravenous infusion, intragastric intubation, and nonvolitional oral intake of ethanol have been successful in producing withdrawal in these animals. There still remain the major problems of developing objective procedures for quantitatively assessing the severity of the withdrawal syndrome and establishing the dose dependent and time dependent relationships between ethanol intake and the development of physical dependence. Until these basic issues are empirically resolved, little progress can be expected in our understanding of the critical determinants of the addictive process.