Zeitschrift fur die gesamte innere Medizin und ihre Grenzgebiete最新文献

Our investigations carried out in patients with diabetes mellitus revealed oxidative stress loads. The study presented here was to clarify whether a therapy with antioxidants can contribute to an improvement of prognosis. 80 patients affected with a long term diabetic late syndrome were randomised and arranged to 4 groups of n = 20 each. In contrast to a control group these patients received 600 mg of alpha lipoic acid or 100 micrograms of selenium (sodium selenite) daily or 1200 IE of D-alpha-tocopherol respectively for a time of 3 months. In comparison with the control group all groups treated in an antioxidative way showed significantly diminished serum concentrations of thiobarbituric acid reactive substances and of urinary albumin excretion rates. The symptoms of distal symmetric neuropathy measured according to the thermo- and vibration sensitivity also improved in a highly significant manner. The results prove that oxidative stress plays a promoting role in developing of long term diabetic late complications and that a therapy with adjuvant antioxidants may lead to a regression of diabetic late complications.

In 16 persons of the control group (group I) and in 27 patients with coronary heart disease (group II) value of two-dimensional echocardiography was determined combined with exercise, transoesophageal left atrial pacing, dipyridamole and cold pressor tests in detecting myocardial ischaemia. Changes of ST-segment in the ECG, left ventricular ejection fraction and wall motion in the 11 segments were studied during the tests. Sensitivity, specificity and predictive value confirming and excluding ischaemic heart disease of the analyzed parameters were determined. The sensitivity and the specificity of exercise, left atrial pacing, dipyridamole and cold pressor tests during the analysis of ST-segment were 70%, 81%, 37%, 4% and 62%, 67%, 94%, 100%, respectively. Two-dimensional echocardiography analysis did not increase the diagnostic value of the exercise and left atrial pacing tests, whereas the diagnostic value of dipyridamole and cold pressor tests were increased.

354 sera from venous blood of patients with various rheumatic diseases and AIDS were assayed for the presence of reactive nitrogen intermediates. Compared to healthy individuals, the serum levels of nitric oxides from patients with connective tissue diseases and inflammatory rheumatic diseases were elevated (P < 0.01) by 170-600% and those from HIV-infected patients by 220%.

In case of an emergency it is the moral and legal obligation of every physician render first aid. For immediate and effective prehospital treatment a certain minimum of medical equipment should be available. In this article, drugs and essential technical equipment of a doctor's first aid kit are recommended which has proved useful in the management of respiratory and cardiovascular emergencies. Monitoring of vital functions as well as the emergency treatment itself require technical equipment. The proposed essential equipment allows every first-aid doctor--beyond simple measures of basic life support--to reverse life--threatening derangements of vital organ systems and to save time before definite treatment in the hospital.

Distinction is made between peripheral and autonomic neuropathy. The former is usually painful, while the latter is especially associated with cardiovascular, gastrointestinal and urogenital disturbances. In the diagnosis of peripheral neuropathy, a basic neurological examination (reflex status, vibratory sense) takes precedence over measuring the velocity of nerve conduction and determining the temperature and pain thresholds. The diagnostic approach to the autonomic disturbances is organ-specific (testing of cardiovascular reflexes, sonographic and scintigraphic determination of gastric emptying, infusion urography and uroflowmetry). Early diagnosis and optimal diabetes control are the therapeutic consequences. Symptomatic treatment includes the administration of analgesics, antidepressants and carbamazepine. A newer drug being currently tried is mexiletine. High doses of alpha-liponic acid as well as the fat-soluble B vitamins are used for causal therapy. Clinical trials with aldose reductase inhibitors and gamma-linolenic acid are under way.

Treatment and outcome of 111 patients who fell ill with Wegener's granulomatosis (WG) between 1966 and 1990 were analysed retrospectively. The mean observation time after diagnosis had been 47 (1-288) months. At the time of diagnosis 37 patients suffered from locoregional symptoms only, whereas the disease was generalised in 74 patients. Two regimes of treatment were differentiated: "conventional" treatment, i.e. daily application of cyclophosphamide/prednisolone (FAUCI scheme) or azathioprine/prednisolone or prednisolone alone, and "stage-adapted" treatment, characterised by change of different treatments (e.g. cyclophosphamide pulse therapy, cotrimoxazole) according to the extent and activity of disease. In patients who received stage-adapted treatment, relapses occurred significantly more frequently than in conventionally treated patients. On the other hand, lethal outcome was much more frequent in conventionally treated patients.

Clinical teaching, partly based on the examination and treatment of outpatients, became more and more common at the universities of the end of the 18th century, thus prompting the setting up of so-called "teaching hospitals" forming part of the university concerned and specialising in the disciplines of internal medicine, surgery and obstetrics. This phase of practice-oriented teaching progressed only slowly because of locally different basic conditions and activities. Occasionally it took decades help of communal and private institutions when setting up such teaching facilities. This development is explained taking the University of Halle in the early 19th century as an example.

Vertigo is very often an unspecific symptom. The author differentiates between vestibular or systematic vertigo and non-vestibular or unsystematic vertigo. The diseases of the central vestibular system are described. Not only the special diagnostic methods (e.g. electronystagmography) but also the anamnesis and simple clinical investigation are presented. The overview includes drug therapy and physical therapy of vertigo from a neurological point of view.

Reports on sickness osteomalacia are relatively rare in Europe. Distinction from other painful illnesses of the locomotor system is difficult. A case of osteomalacia has been reported which was caused by a primarily biliary cirrhosis of the liver as well as by chronic cholecystitis and pancreatitis.

The authors report on the influence of autogenous training on blood pressure at rest and under stress conditions in patients with coronary heart disease following coronary bypass operation. We investigated the influence of autogenous training on the microcirculation and the left ventricular ejection fraction (LVEF) as well. The results showed a significant decrease in blood pressure at rest and also an increase of muscle circulation F and of LVEF.