Zeitschrift fur arztliche Fortbildung最新文献

Urethral catheterization, intermittent self-catheterization and suprapubic catheters are reliable methods to drain the urine in the lower urinary tract. Only a strict indication for indwelling catheters can minimize the complications and negative side effects. All physicians, especially pediatricians, surgeons, neurologists and internists should be familiar with the problems of catheter drainage by using a strictly aseptic technique.

40% of the male patients suffering from gouty arthritis treated in our rheumatological unit during a three years period showed a chronic polyarticular course. In polyarticular gout, acute gouty attacks affect above all the joints of the upper limbs. Gouty arthritis in these patients shows an ascending pattern. Therefore, in case of unawareness of the clinical symptoms, differential diagnosis can be difficult especially when laboratory findings including uric acid levels are in normal ranges and classical radiological findings are missing. It is important to notice that the atypical joint attack in gouty arthritis is typical for polyarticular gout. In case of unclear arthritis the polarized light microscopy of the synovial fluid should always be demanded.

Improved surgical methods and changed management of invasive bladder cancer lead to an increased number of patients with urostomies. The number of patients with internal stents is increasing, too. Numerous surgical options are currently available for both male and female patients. Lifestyle implications are as important as the selection of the adequate diversion such as ileal conduit, continent cutaneous diversions or orthotopic bladder replacement.

In 20 patients, a hysteroscopic resection of myomas because of menometrorrhagia was carried out between February 1992 to July 1993. Solitary myoma was diagnosed before sonographically, hysteroscopically and histologically. 14 patients had been pretreated with GnRH-analogs for 2 or 3 months, whereas in 6 patients the transcervical resection of myomas was carried out immediately after menstruation. In a follow-up period of 3-18 months, an eumenorrhea could be reached in 19 patients. In one patient, a second session for a resection of a small myoma was necessary. There were no intra- or postoperative complications. The resection of myomas is a useful organ-retaining option of treatment in patients with submucous myoma and menometrorrhagia.

Drug-related renal damage is manifold in its origin, clinical picture and prognosis. The disorder can manifest itself as a purely functional phenomenon with tubular elimination of amino acids, enzymes, protein, glucose and electrolytes, or it is due to reversible hemodynamic changes; on the other hand, it may be accompanied by cell necrosis and inflammation. Hemodynamic, toxic, immunologic, or mechanically obstructive mechanisms or a combination of these play a pathogenetic role. It is important to know the renal parameters before and monitor them during treatment with nephrotoxic drugs; to avoid concomitant administration of two or more nephrotoxic drugs; and to make the diagnosis as well as terminate exposure rapidly.

Acute renal failure accompanied by an increase in retention parameters and oligo-anuria is a common medical problem. The most important medical task in nephrology is a fast diagnostic differentiation between prerenal-, renal- and postrenal failure. Using simple techniques such as case history, medical examination, ultrasound and specific analysis of serum and urine, it is possible to obtain a relatively certain diagnosis. Radiographic techniques with radiocontrast agents are contraindicated because of nephrotoxic side effects. The treatment of acute renal failure is based on the underlying disease. Apart from symptomatic treatment, there are only very few medications available to improve the excretory kidney function and diuresis. Complications like hyperkalemia, hyperhydration, metabolic acidosis and uremia require early renal replacement therapy. Especially in cases of extreme hyperkalemia, an immediate beginning of therapy is important. In the medical practice, emphasis should be placed upon the prevention of renal failure.

The demand for a quality controlled and quality proved continuing medical education (CME) has grown in the past. Especially the German "Bundesärztekammer" (society of physicians of Germany) has developed new models for CME and it's evaluation. This paper presents the background, methodology and results of two evaluations of CME for occupational physicians in health care institutions. The two symposia in 1994 and 1995 were evaluated using the same questionnaire. The comparative analysis of the results indicates the feasibility of the instrument and the validity of the results when used together with the results on an open discussion at the end of the symposium. It also demonstrates the value of the evaluation for future planning of comparable programs.

Intuition guided R. Steiner to refer to mistletoe as the future remedy for cancer. He proposed that its spiritual qualities support re-establishment of the harmonious integration of the alleged four different entities of human existence in a patient. The assumption of potency without chemical basis is derived from the dogmatic system of anthroposophic reasoning. It explains the evidently similar claim of clinical efficiency for the proprietary mistletoe extracts despite the lack of information on the actual contents of the complex mixtures and despite the conspicuous diversity of methods of manufacture for these products. Thorough scientific analysis of the published clinical experience does not justify this claim. Due to the increasing reference to defined substances in advertisements for commercial extracts, they should no longer avoid rigorous testing according to common quality standards. Interdisciplinary research efforts on the immunomodulatory galactoside-binding lectin illustrate how to yield a clinically testable substance from an ill-defined extract, thereby providing a notable example for rational investigation of unconventional treatment modalities.

Echinacea-containing drugs have to be classified according to the used plant species (Echinacea purpurea, E. pallida or E. angustifolia), the processed part of the plant (root, upper parts or whole plant), and the mode of processing. Significant pharmacological effects have been found in vitro and in vivo for the expressed juice of the upper parts of E. purpurea and for alcoholic extracts of the roots of E. pallida, E. angustifolia and E. purpurea. The activity is mainly directed towards the nonspecific cellular immune system. Several active constituents are discussed: polysaccharides, glycoproteins, caffeic acid derivatives (cichoric acid) and alkamides.

There is only one common medical law which is valid for all physicians. No therapy method can claim a special status or special rights. However, due to the considerable differences in training and qualification, the jurisdiction grants special rights to a healer without medical exam (non-medical practitioner) in comparison to a physician. Additionally, a physician has to take into account the limitations by the social legislation when he uses "special treatment methods" to avoid claims for compensation.