Low back pain is a frequent reason for consultation in general practice. Many patients are treated in cooperation with an orthopaedic surgeon which requires an effective exchange of information. The aim of this study was to investigate the level of communication between general practitioners (GPs) and orthopaedic surgeons.In this retrospective observational study referrals from GPs and corresponding response letters from orthopaedic surgeons were analyzed. GPs were asked to provide reasons for referral and to rate the quality of the response letters.A total of 12 out of 82 GPs from the teaching network of the Medical School of Gottingen participated in the study. Of 911 referrals to ambulatory orthopaedic surgeons within 3 months, 34% (n=312) were referred for low back pain. GPs provided little information beyond a diagnosis on the referral contrary to their self-perception. Most referrals (61%) were initiated by patients and most of them were considered at risk for chronification (72%) by the referring GP. Despite a formal obligation to report back, GPs received a response letter for only one-third (114/312) of the patients. GPs rated most of them as satisfactory, however, 59% were unsatisfied with the treatment recommendations. Only 10% of the letters contained psychosocial details. The information provided in the orthopaedic response letters was heterogeneous and only partly fulfilled the criteria set by the Interdisciplinary Society for Orthopaedic Pain Management.Incomplete and scant information on referral forms from GPs and a high non-response rate from orthopaedic surgeons suggest that current health care system and referral forms do not promote effective communication about the patient. This might explain the satisfaction of GPs with the orthopaedic response letters despite the lack of information. The GPs dissatisfaction with the treatment recommendations reflects the limited treatment options for chronic low back pain in ambulatory care.

Rückenschmerzen sind ein häufiger Konsultationsanlass in der hausärztlichen Praxis. Die Behandlung der Patienten erfolgt oft in Kooperation mit Orthopäden und erfordert daher einen effektiven Informationsaustausch. Ziel dieser Arbeit war es, die Kommunikation zwischen Hausärzten und Orthopäden zu untersuchen.

For Abstract see ChemInform Abstract in Full Text.

An overview of a current research project is given which deals with the congener specific synthesis and analysis of PCT and the reactions of these compounds under thermal stress. A prerequisite for analytical method development and the investigation of specific reactions under thermolysis conditions is the availability of single PCT congeners. The selective synthesis of PCT was successfully performed by the application of the SUZUKI-coupling reaction for eight congeners, so far. Some of those were already thermally treated in mini-ampoules and in a laboratory-scale incinerator. The main reaction products resulted from dechlorination reactions and elimination of one phenyl ring. Formation of ether bridges to furan structures could also be observed to some extent.

Defined polychlorinated terphenyl (PCT) single congeners as reference standards are the prerequisite for the development of analytical methods for their determination and quantification in the environment. The selective synthesis of PCTs for environmental analytical purposes by application of the Suzuki-coupling reaction is described. Under easily modified standard reaction conditions of this coupling process the PCTs can be obtained by reaction of benzeneboronic acids with dibromobenzenes mostly in good yields, as described by the synthesis of following PCT congeners: p-PCT (3,3("),5,5(")-tetrachloro-, 2,2("),4,4(")-tetrachloro-, 2('),3,3("),5,5(")-pentachloro-); m-PCT (3,3("),5,5(")-tetrachloro-) and o-PCT (3,3("),5,5(")-tetrachloro-). The terphenyl congeners were characterized by NMR (1H, 13C)- and FT-IR-spectroscopy. Their purity was checked by GC/MS analysis. The experimental and quantum-chemically calculated FT-IR-spectra were compared and it was shown, that the determination of the chlorine substitution pattern in the terphenyl congeners by their typical absorption spectra is possible.

The vibrational spectra of 3,3′′,5,5″-tetrachloro-p-terphenyl, 2,2″,4,4″-tetrachloro-p-terphenyl, 2′,3,3″,5,5″-pentachloro-p-terphenyl and 3,3″,5,5″-tetrachloro-m-terphenyl have been calculated using hybrid density functional theory (B3LYP/6-31G*) and a single scaling factor. The calculated spectra have been compared to experimental gas phase spectra. The agreement between theoretical and experimental spectra is excellent and allows the identification of an unknown congener just by pattern recognition. Differences of individual C–Cl bond strengths were studied by compliance matrix calculations.

Emissions during thermal utilization of wood residues were studied at two small-scale firing systems. Effects of primary technical measures on reduction of NOx, CO, PCDD/F, and PAH were tested in the flue gases of an underfeed stoker (250 kW). The organic pollutants were also analyzed in the ashes. Chipboards, untreated wood, and wood with preservatives (CrCuB = CCB) were applied. It was shown that an optimization of the combustion parameters for low CO and NOx-emissions did not necessarily result in the reduction of PCDD/F and PAH. At the second furnace, a pre-oven system (65 kW), effects of full and part load operation were tested without technical modifications. Here, PCDD/F and PAH concentrations in ashes and flue gases mostly increased at part load operation. Due to the decreased temperatures, concentration of CO increased. Unexpectedly NOx increased at part load operation burning chipboards. Using wood, regardless of whether treated with CCB preservative or not, the load had no effect on the amount of the NOx emission.

Because of former depositions of dioxin-containing industrial sewage sludges in a municipal landfill (1983–1993), investigations on the possible hazards from polychlorinated dibenzo-p-dioxins and -furans (PCDD/F) during regular operations on site became necessary within the scope of an preliminary acute assessment of the environmental health situation. To achieve this, samples of different compartments (air, soil, sediment) were taken to determine wether an increased residual pollution with PCDD/F is discernible. The analytical results do not indicate any hazard for the staff or the environment on the air path, that is by wind erosion or volatilization, if no excavation work is carried out. For recultivation activities on the polluted old landfill site, however, working precautions are recommended to exlude possible risks for the workers. Informations about contamination of ground water are to be gathered. For this, drill cores through the body of the old landfill will be analyzed in the near future.

The serum levels of three major granulocyte proteins were measured in patients with onchocerciasis, bancroftian filariasis and intestinal schistosomiasis and compared to controls from patients with malaria, Africans living in areas not endemic for these infections and healthy Germans. The investigation comprised the determination of the eosinophil granule proteins eosinophil cationic protein (ECP) and eosinophil-derived neurotoxin (EDN/EPX), and the neutrophil/monocyte granule protein myeloperoxidase (MPO). ECP and EDN/EPX levels were found elevated only in the three helminth infections that are associated with eosinophilia, while MPO was found elevated in all tested disease groups. The levels of eosinophil granule proteins observed in the helminth diseases by far exceeded those described for bronchial asthma and atopic dermatitis. ECP, EDN/EPX and MPO serum levels reflect the ongoing disease and are related to functional activity of the respective leukopoetic system. ECP and EDN/EPX appear to be markers of the eosinophil effector system and MPO a marker of the neutrophil and/or monocyte/macrophage effector system. Significantly higher ECP levels in chronic hyperreactive onchodermatitis (sowda) versus generalized onchocerciasis seem to reflect an augmented degree of antigenic stimulation, eosinophil activation and eosinophil turnover rates, indicating a more active mechanism of parasite clearance in sowda patients.

SUMMARYThe antisecretory action of the antidepressant drugs trimipramine, doxepin and nortriptyline was studied in two different in‐vitro test systems; the isolated and enriched guinea‐pig parietal cell and the purified H+/K+‐ATPase preparation. The effect of the antidepressants was compared with that of the neuroleptic agents chlorpromazine, triflupromazine, trifluoperazine, haloperidol, fluspirilene and with that of the tricyclic anticholinergic agent pirenzepine. All neuroleptics and antidepressants inhibited acid formation in intact parietal cells with IC50 values in the nanomolar range. The inhibitory potency for each compound was identical regardless of whether histamine or db‐cAMP was used as stimulant. Isolated H+/K+‐ATPase, measured in the presence of 5 mmol litre−1 KCl, was inhibited by all psychotropic drugs with IC50 values in the micromolar range. EGTA did not affect the inhibitory potency at the H+/K+‐ATPase, indicating that the action of the drugs does not depend on their calmodulin blocking activity. Pirenzepine was ineffective in both test systems. Kinetic studies done with nortriptyline, chlorpromazine and haloperidol showed a competitive type of inhibition with respect to K+ at low inhibitor concentrations. This competitive type was changed to a mixed type of inhibition with increasing inhibitor concentrations, demonstrating cooperative effects between drug binding and K+ activation of the enzyme. From these data it is suggested that antidepressants and neuroleptics act by an allosteric mechanism of action, and that the lipid solubility is a significant factor to establish enzyme inhibition.

Trial 1: eight diets containing between 25 and 54% sucrose and correspondingly between 47 and 23% crude protein were fed to replicate groups of trout for 44 or 45 days. Feed conversion increased only when the sucrose content was above 36% and crude protein correspondingly below 40%. Decreasing the protein content by increasing the proportion of sucrose improved the protein efficiency ratio (PER) between 47 and 40% protein; PER values lower than for the diet containing 47% crude protein were obtained only when the protein concentration was less than 36%.

Auf der Basis von vergleichenden Ganzkörperanalysen wurden Energie-Bilanzen an wachsenden Regenbogenforellen ermittelt. Sieben Teile einer aus Fischmehl und Casein bestehenden Grundmischung wurden entweder mit 1,3 Teilen Sonnenblumenöl oder mit 3 Teilen einer der folgenden Komponenten gemischt: Glucose, Saccharose, Lactose, Maisquellstärke oder Gelatine. Jede der so entstandenen Mischungen wurde ebenso wie eine ausreichende Menge der Grundmischung pelletiert. Gleiche Mengen derjenigen Mischungen, die eines der Kohlenhydrate oder Gelatine enthielten, under der Grundmischung wurden in einem 46 bzw. 47 Tage dauerndem Versuch an je zwei Becken mit jeweils elf Forellen einer anfänglichen Lebendmasse von 15 g gefüttert. Von der Mischung mit Sonnenblumenöl wurden 83% und ausserdem von der Grundmischung an zwei weitere Becken 70% Gemenge an kohlenhy drathaltigen Mischungen gefüttert. Zwischen 31 und 46% der gefütterten Brutoenergie und zwischen 21 und 38% des gefütterten Rohproteins wurden von den Forellen angesetzt. Durch Differenzbildung zwischen den Ergebnissen der einzelnen Ver-suchsgruppen gegenüber derjenigen Gruppe, die nur 70% der Grundmischung erhielt, konnten folgende Teilwirkungsgrade für die Verwertung der Brutoenergie der Zulagen errechnet werden: Lactose 11,0%, Gelatine 19,4%, Fischmehl/Casein 43.1%, Glucose 57.4%, Maisquellstärke 61,2%, Sonnenblumenöl 63,2%., Saccharose 63,5%. Ausser dem Sonnenblumenöl bewirkten all Zulagen zum Teil erhebliche Steigerungen im Gehalt an Rohfett und N-freien Extraktstoffen in den Lebern der Forellen.

ZusammenfassungWachsende Regenbogenforellen erhielten als Versuchsdiäten eine Grundmischung aus Fischmehl und Casein entweder allein oder nach Verschnitt mit 30 bzw. 40 % Maisquellstärke oder Saccharose. Durch das Verschneiden sank der Proteingehalt des Futters von 68 auf 42 bzw. 34%. Die Versuchsdauer betrug im ersten Versuch 60, im zweiten 132 bis 145 Tage, wobei sich die Lebendmasse der Fische mindestens verdoppelce bzw. mindestens vervierfachte. Infolge starker Glykogen‐Einlagerungen war das relative Lebergewicht bei Fütterung der Saccharose‐Mischungen, und signifikant stärker bei Fütterung der Quellstärke‐Mischungen gegenüber der Fütterung der Grundmischung erhöht.Quellstärke führte in höherem Maße als Saccharose zu gesteigerten Aktivitäten der Glucokinase in der Leber. Die Phosphoenolpyruvat‐Carboxykinase wurde durch Quellstärke starker gehemmt als durch Saccharose. Dabei trat das Enzym in allen Gruppen zu über 75% in den Mitochondrien auf.Von den lipogenetisch wirksamen Enzymen wurden die Aktivitäten der 6‐P‐Gluconat‐und NADP‐Malat‐Dehydrogenase sowie der ATP‐Citrat‐Lyase nach Stärkefütterung signifikant erhöht. Aus den Ergebnissen ist zu schließen, daß Glucose aus Maisquellstärke und Saccharose in den Intermediärstoff wechsel der Forelle eingeschleust wurde. Im Vergleich zur Stärke‐Gruppe erhöhte Transaminase‐Aktivitäten dürften nach Verfütterung der Grundmischung auf einem überangebot an Aminosäuren in der Saccharose‐Gruppe auf einem relativen Energiemangel beruhen.