Crohn's Disease and Diverticulitis. Difficult Differential Diagnosis and Differential Therapy in Case of Coincidence: In a 50-year-old patient both Crohn's disease localized in the sigma and diverticulosis had been diagnosed previously. Because of differential therapeutic consequences and for prognostic considerations the coincidence of these diseases requires accurate endoscopic, histologic and radiologic evaluation during exacerbations with acute symptoms in order to differentiate between active Crohn's disease and diverticulitis.
Efficacy of Gemfibrozil in Patients with Hyperlipoproteinemia (HLP) Type II a, II b and IV - Results of a Long-term Trial: Study objective: Influence of Gemfibrozil in a daily dose of 900 mg on atherogenic and antiatherogenic lipids in patients with HLP type II a, II b and IV. Design: Open unicenter trial over 72 weeks. Patients: 121 out-patients with HLP type II a (n = 27), II b (n = 53) and IV (n = 41). Interventions: 900 mg Gemfibrozil daily in the evening. End points: Reduction of atherogenic and increase of antiatherogenic lipids. Main results: In HLP type II a Gemfibrozil lowered total cholesterol, LDL-cholesterol and triglycerides by 11, 12 and 27%, respectively, whereas HDL-cholesterol increased by 7% (all changes significant). In HLP-type II b total cholesterol (- 13%), triglycerides (- 36%) and HDL-cholesterol (+ 11%) were changed significantly. In HLP-type IV triglycerides decreased by 35%, whereas LDL-cholesterol and HDL-cholesterol increased by 19% and 18%, respectively (all changes significant). Gemfibrozil had no influence on liver and kidney function, whereas thrombocytes increased. Subjective side effects, mostly gastro-intestinal symptoms, occurred in 13% of patients. Conclusion: Gemfibrozil in a daily dose of 900 mg, given in the evening, can be recommended for long-term therapy of HLP-types II a, II b and IV.
The Evans County, Georgia, cohort of the Hypertension Detection and Follow-up Program (HDFP) was reexamined seven years after termination of the trial in 1979. Of the 495 survivors, 91% of the hypertensives were evaluated by diastolic blood pressure levels, electrocardiograms, weight measurements, and questionnaire. In the HDFP 50% of the randomly selected patients had been treated in an intensive stepped care (SC) program and the other half had been referred to usual care (RC). After five years diastolic blood pressure levels were higher in RC than in SC; after twelve years blood pressure levels were still higher in RC than in SC in spite of greater use of blood pressure medication. During the five years of the trial there was no case of left ventricular hypertrophy (LVH) in SC. After twelve years the incidence of hypertrophy was lower in SC than in RC. The most frequently used blood pressure medications (chlortalidone, reserpine and methyldopa) did not influence quality of life. During the seven years of the posttrial period the hypertensives underwent weight changes. Weight loss of 15 lb was associated with normotension, even without medication; weight gain of 9 to 10 lb over seven years was associated with hypertensive blood pressure levels, even in formerly normotensives.
Morbidity and Mortality of Acute Myocardial Infarction. Data from the MONICA Augsburg Study Region (1985-1988): The risk of morbidity and mortality of acute myocardial infarction (AMI) in 25-to-74-year-old residents of the study region of Augsburg (study population: 160,000 men, 170,000 women) was evaluated from 1985 to 1988. The data for the male population show a reduction of AMI incidence of - 6.0%, a reduction in the attack rate of - 13.9% (p < 0.05), and a reduction in death rate of - 11.6%. These reductions are especially evident in the male age groups of 55 to 74 years. The female population shows a statistically non-significant increase in incidence of + 11%, an increase in the attack rate of + 14%, and an increase in death rate of + 9%. With the exception of female patients registered in 1985, the 28-day case fatality of AMI events remained nearly constant from 1985 to 1988 (men: 55%, 54%, 56%, 57%; women: 67%, 62%, 59%, and 62%). In men with reinfarction a note-worthy increase in received thrombolytic treatment was found during the period of observation (1985: 13%; 1988: 34%). At the same time, there was an increase of coronary interventions performed in the Augsburg central hospital (aortocoronary bypass and percutaneous transluminal coronary angioplasty) from 211 (1985) to 813 (1987) and 747 (1988). Only the further course of the study will determine whether the reduction of AMI risk for men can be explained by changes in medical care or by a decrease in coronary risk factors in the study region.
Adverse Effects of Osteoporosis Treatment with Fluoride: Apart from gastrointestinal complaints, pain in the lower extremities is the most common adverse effect of fluoride therapy. Complaints in the extremities are the result of stress fractures and of calcium-phosphate deposition in the joint capsule or in paraarticular tissue. The fractures may be clearly demonstrated by Magnetic Resonance Imaging. Where osteoblasts do not react to fluoride with new bone formation and where mainly fluorapatite production by circumvention of brushite and octacalcium-phosphate formation occurs, calcium homeostasis is deranged. This was demonstrated in one of our patients with a lethal outcome on fluoride therapy.
An increasing number of patients suffering from polysomatic complaints with subjective feeling of "allergy against environmental noxious agents" is seen by the practising allergologist. Although often clearly evident at the first consultation, the patients usually deny psychosomatic interactions. 30 patients (20 female, 10 male) with this syndrome underwent an intensive allergological examination including place-bo-controlled oral challenge tests with foods and food additives. In addition, a psychosomatic examination was carried out. Although there was considerable overlap between various diagnoses, the following list of most important pathophysiological conditions was established: psychosomatic disorder (47%), allergy or pseudo-allergy (33%), endogenous psychosis (10%), focal infection (7%) and pension neurosis (3%). It is concluded from these data that these very difficult patients need the full efforts of an experienced allergologist in interdisciplinary cooperation. With all means - including placebo-controlled provocation tests - possible allergies or pseudo-allergies have to be excluded before a successful cooperation with an experienced psychiatrist or psychologist can be started.
Colour-coded Duplex Sonography in Angiology. Expensive Colourful Toy or Diagnostic Advance? Colour duplex sonography (triplex sonography) provides technical diagnostic benefits wherever a number of vascular processes are to be found in long vessels or where a process occurs at an atypical site. This is not only true of arteries that supply the brain, but especially of peripheral arteries and veins. The advantages concern both the reliability of the results and the time taken for the investigation. An essential advance is seen when investigating low-echo occlusions and stenoses or mixed stenoses with large, low-echo sections, again in both arteries and veins. Recognition of thromboses of the deep conductive veins in the calf and in the thigh under difficult echo conditions has been made easier and more reliable. Demonstrating conductive vein insufficiency and demarcating insufficiency at the mouths of veins has become simple, safe and quick, even for small reflux volumes. This enables the insufficient section to be identified quickly and accurately. Colour duplex sonography thus represents a genuine diagnostic advance and should be applied also in specialist practices.
Glomerular Filtration Dynamics and Proteinuria: Vascular resistance of the glomerular arterioles in the kidney together with arterial blood pressure are major determinants of the glomerular filtration dynamics. Alterations in these resistance vessels in the course of hypertension of glomerular nephropathy may lead to a disturbed excretory function of the kidney, proteinuria and blood pressure alterations. Glomerular hypertension and hyperfiltration are pathogenetic concepts presently favoured in the development of these changes in excretory pattern, in particular of diabetic microalbuminuria. Central to current therapy to normalize the resistance of glomerular arterioles are agents such as Ca++-antagonists and ACE-inhibitors. The therapeutical concepts derived from the hypothesis of glomerular hypertension and hyperfiltration, however, are not supported by firm experimental data. Therefore, at present it appears to be premature to accept one or the other therapeutic concept as an established treatment of these functional disorders.
Sexual Transmission of Hepatitis Viruses: In order to determine the contribution of sexual transmission of the various hepatitis virus types, 191 heterosexual patients with sexually transmitted diseases (STD) and 390 well-matched blood donors were analysed for the prevalence of hepatitis A, B, C and D viruses in their serum. As compared to blood donors, STD patients had a significantly higher risk to acquire types A (47,0 vs. 20,8%), B (30,9 vs. 4,1%) and C (4,7 vs. 0,5%) hepatitis. An acute hepatitis A or B infection was not recognized on the basis of lgM-anti-HAV or lgM-anti-HBV tests. Probably due to its higher concentration in the serum, HBV is transmitted sexually more effectively than HCV. Whether the increased prevalence of HAV in STD patients is directly related to sexual transmission or other concurrent risk factors for this disease (e.g. travelling) is uncertain. The study clearly shows the need for active immunization against hepatitis A and B in STD patients and promiscuous heterosexual persons. Condoms may prevent spread of HCV similar to HIV.
The diagnosis in patients with migraine or headache of tension-type is based on anamnestic criteria because of the absence of specific instrumental diagnostic instruments up to now. EMG-analysis of exteroceptive suppression periods of temporal muscle activity and Doppler ultrasonographic measurement of enddiastolic flow velocity in the median cerebral artery during a Valsalva manoeuvre are new techniques, which offer the benefits of high diagnostic evidence and low expenditure in instrumentation and time.
