Based on existing models for pain chronicity and effective treatment strategies for patients with chronic low back pain, a multidisciplinary rehabilitation programme for an outpatient group setting was developed. The main treatment components address the patient's physical functional capacity (functional restoring), cognitive and affective processes (pain management strategies), and behavioural and ergonomical aspects (back school elements). Short-term (immediately after intervention) and long-term effects (at 6-months follow-up) of the intervention were assessed in a randomized controlled study. Dependent variables were pain measures, functional capacity, disability, muscular strength and endurance, pain and posture-related self-efficacy, attitudes, depression, well-being, behavioural habits and posture assessed by a standardized behavioural observation method. Immediately after the intervention, patients in the treatment group (n=36) showed significant improvement over patients in the control group (n=29) in all variables except depression and muscular strength and endurance. At 6-months follow-up, compared to pretreatment scores, patients continued to show beneficial effects in pain intensity and frequency, posture, posture-related self-efficacy and well-being. In contrast to post-treatment results, there were also significant improvements in strength and endurance. Overall results testify to the effectiveness of the intervention programme. Future studies (with larger sample sizes) should aim at a further improvement of functional capacity and disability perception, an analysis of differential treatment effects, and strategies for an improved long-term maintenance of the changes induced by the programme.

Drug Prescribing for Patients with Chronic Kidney Disease in General Practice: a Cross-Sectional Study

Die stimulierende Wirkung humoraler und nervaler Einflüsse auf die exokrine Pankreassekretion ist gut belegt, die Rolle der einzelnen Faktoren für die Regulation der Elektrolyt-und Enzymsekretion jedoch noch unklar. Kürzlich berichteten Tiscornia et al. über den trophischen Effekt einer trunkulären Vagotomie auf das exokrine Pankreas. Das Pankreas nahm an Größe zu, gleichzeitig kam es aber zu einer verminderten Lipasesekretion. Die Freisetzung der übrigen Enzyme wurde durch die Vagotomie dagegen nicht beeinflußt [15]. Der Wirkmechanismus dieser Beobachtung ist unklar. Ziel der vorliegenden Arbeit war es, die trophische Wirkung der trunkulären Vagotomie auf das exokrine Pankreas im Hinblick auf die Rolle der gastrointestinalen Hormone Gastrin und pankreatisches Polypeptid (PP) zu untersuchen, weiterhin sollte der Effekt der trunkulären Vagotomie auf das endokrine Pankreas studiert werden.

Two newly developed photometric assays for the estimation of faecal chymotrypsin were studied in comparison with the established titrimetric method in 46 patients and 8 healthy volunteers, who had undergone a secretin-pancreozymin test for diagnostic purposes. The correlation between the two photometric methods and the titrimetric method was good (r = 0.90 and r = 0.91), revealing similar diagnostic sensitivity and specificity. As both photometric methods are less time-consuming and may be performed using a standard laboratory equipment, they offer a good alternative to the established titrimetric method for faecal chymotrypsin estimation.

The NBT-PABA test, an oral pancreatic function test, was performed in 67 patients with proven chronic pancreatitis (secretin pancreozymin test or intraoperatively) and was pathological in 60 (89.6%). Prolongation of urinary collection period from 6 to 9 hours did not improve the diagnostic value. In comparison with the NBT-PABA test the sensitivity of trypsin and chymotrypsin determination in stool was 40.6% and 62.2%, respectively. In severe exocrine pancreatic insufficiency when pathological fecal fat excretion was demonstrable (steathorrhea) the accuracy of fecal enzyme determination was clearly higher (59.1% and 91.8%, respectively). Thus the NBT-PABA test is an alternative diagnostic tool for exocrine pancreatic insufficiency when the secretin-pancreozymin test, and fecal enzyme and fecal fat determination are too complicated. However, as intact absorption of NBT-PABA is possible, the test only provides a qualitative and limited quantitative evaluation of pancreatic function.