[Iatrogenic lesion of the radial nerve--disability in domestic work concerning liability]. / Iatrogene Radialisschädigung--die konkrete Behinderung der Hausfrau in der Haftpflichtversicherung.

In liability cases caused by accidents, the actual compensation for consecutive sustained damage to the patients' health and pain is not sufficient. Moreover, besides payments for a loss of earning capacity, the compensation for loss of efficiency in daily life such as for domestic work might be necessary. Therefore, distinct indications for the expert's appraisal exist.

Determination of azithromycin in gastric biopsy samples.

OBJECTIVES: To measure the concentration of azithromycin in gastric biopsy samples of gastritis patients undergoing Heliobacter pylori eradication treatment with azithromycin as one antibiotic constituent of the medication. PATIENTS: Seven male outpatients, non-smokers, non-alcoholics, aged 25-40 years (mean 32 years), suffering from gastritis with involvement of H. pylori. METHODS: The patients received a 5-day treatment with azithromycin (1 x 500 mg on day 1 and 1 x 250 mg on days 2-5), 40 mg pantoprazole once daily and 2 x 400 mg metronidazole once daily. Samples of gastric tissue were obtained from 5 patients and of gastric juice from 2 patients, at the occasion of gastroscopic interventions. The gastric samples were subject to analysis of azithromycin, using a highly sensitive and specific HPLC method with electrochemical detection. RESULTS: The median concentrations of azithromycin in gastric tissue amounted to 7.5 microg/g on day 2 and to 9.7 microg/g on day 5 of the treatment. Four days after the end of treatment, median concentrations were still at 3.9 microg/g. In all tissue samples, azithromycin concentrations were well above the MIC for H. pylori (0.25 microg/ml). The well-known tissue affinity of azithromycin was underlined by the lack of detectable levels in gastricjuice. CONCLUSION: The high concentrations of azithromycin observed in gastric tissue of patients with gastritis on a 5-day dosage regimen point to a favorable pharmacokinetic basis for a role of azithromycin as a component of the eradication therapy of Heliobacter pylori.

Study of referral process between general practitioners and specialists in health insurance clinics in Alexandria.

The present study was designed to investigate the reasons for which patients are referred by G.Ps to G.M. specialists, and to assess the extent to which referred cases need specialist care. The study sample included specialists of general medicine working at 4 of the H.I.O. polyclinics and all G.Ps who referred cases that were considered as inappropriate referrals by the study specialists, as well as 20% of Patients referred to G.M. specialists by G.Ps. were systematically randomly selected during a period of 10 consecutive days. The results indicated that the rate of inappropriate referral to G.M. specialists was high, the rate of discrepancy between G.P. and specialist diagnoses was generally high, there was a high discrepancy between G.Ps and specialists regarding the reason for inappropriate referral, and there was poor communication from the lower (G.P.) to the higher (specialists) levels in the referral process. Reasons for referral to specialists were not recorded by G.Ps in 100% of cases. To overcome these problems H.I.O. should place special emphasis on the professional training and continuing education of G.Ps, with special attention to the few common conditions that were responsible for the greater proportion of referral problems. At the same time, H.I.O. should strengthen the technical and administrative control over G.P. referral behavior.

Study of workload of general medicine specialists working in the health insurance clinics.

This study was conducted at 4 of the H.I.O. polyclinics in Alex. with the objective of examining the change in visit rate per 1000 beneficiaries for general medicine specialty at H.I.O. clinics during a 4-year period (1985-1988) and to detect any trends that may have a bearing on the H.I.O. standards for supply of specialists. Data were collected from H.I.O. statistics department, H.I.O. regulations, and also through researcher's observation and specialists' interview. The collected data was used to describe the workload in terms of annual visit rate, actual number of working hours, the specialists' average production hours per day, the specialists' average idle time per day, the estimated number of required specialist working hours per day, and the specialists' recommended working hours per day. The results revealed a rising trend in the rate of use of general medicine specialist services and a definite shortage of supply of general medicine specialists was found in all clinics compared to H.I.O. standards. On the other hand, recommended supply based on specialist opinion was less than the H.I.O. standards but more than the current supply. Accordingly H.I.O. should re-estimate the specialist population standard and should seek the commitment of specialists to the revised standards.

Biological assessment of exposure to antimony and lead in the glass-producing industry.

The oxide of trivalent antimony is used in the glass-producing industry as a refining agent and as a glass colouring. The batch contains up to 2% Sb2O3, a substance which has shown carcinogenic properties in animal experiments. The internal levels of antimony and lead in blood (SbB and PbB) as well as the excretion with the urine (SbU and PbU) were determined by hydrid and electrothermal atomic absorption (HY-AAS and ET-AAS), respectively. In addition, measurements of airborne Sb2O3-concentrations were performed. The 109 volunteers were employed in four different fields: melting area, batch bunker, glass-washing area, and transport/maintenance. Differences between the concentrations of antimony and lead in blood and urine with respect to the fields of activity were evaluated statistically. The highest values of airborne Sb2O3, with up to 840 micrograms/m3 (TWA), were detected in the batch bunker. Correspondingly, significantly enhanced SbU-values from 1.5 to 15.7 micrograms/l (median: 5.0 micrograms/l) were found in specimens collected from the batch mixers. In the same group, the lead excretion (PbU) with values from 9 to 110 micrograms/l (median: 43 micrograms/l) was also found to be the highest. Due to the fast renal excretion of antimony, the determination of SbU is useful for biological monitoring.

[Studies on the strain on drivers during high-speed driving]. / Untersuchungen zur Beanspruchung des Fahrpersonals bei Schnellfahrten

In modern industrial countries the technological progress has shifted the occupational stress to the psychomental sphere. In the course of this alteration the number of work places with driving, controlling, and monitoring increased considerably. On 10 engine-drivers during high-speed driving from 210 to 250 km/h heart rate and electrocardiogram were monitored continuously. The blood pressure was measured intermittently. The elimination rate of catecholamines in urine, and the levels of cyclic AMP and catechol-O-methyltransferase in plasma were determined in reference to the trial to quantify the psychomental strain by biochemical parameters. In consequence of the individual affective conditions of the engine-drivers it has been attempted to scale the subjective strain.