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

On the whole, diabetic microangiopathy can be understood as the clinical renal-retinal syndrome. About 10% of all diabetics die of end-stage renal failure, more frequent in IDDM. With an incidence of 14% diabetic retinopathy is one of the major causes of blindness in adulthood. In the non-proliferative state, the pathological changes are limited to the retina, whereas the alterations affect both retina and vitreous in the proliferative state. Photocoagulation is the treatment of choice. If photocoagulatory treatment is not possible because of cataract, vitreous surgery (pars-plana vitrectomy) could improve visual prognosis. The clinical features hypertension, proteinuria and finally renal failure define the term "diabetic nephropathy". The increased intraglomerular pressure is the main pathological alteration of incipient nephropathy. Microalbuminuria essentially determines the prognosis: in IDDM it concerns the incidence of a manifest nephropathy, in NIDDM the excessively increased incidence of cardiovascular mortality. Sonographically, the kidneys are large with bright and wide parenchyma. Along with the development of end-stage renal disease the kidney size diminishes. According to Mogensen, nephropathy is divided into five stages: Stage 1, the early stage, is defined by hypertrophy and hyperfiltration. Stage 2 shows incipient structural changes without any clinical findings. Stage 3 is characterised by persistent microalbuminuria. Stage 4 leads to increasing renal failure and stage 5 to end-stage renal disease and the necessity of dialysis treatment. Incipient nephropathy demands a strict treatment of both hypertension and diabetes. In the meantime, ACE inhibitors are the treatment of choice. In case of dialysis treatment continuous ambulant peritoneal dialysis (CAPD) is usually preferred.

A large body of evidence supports the hypothesis that type I diabetes is an autoimmune disease. The development of type I diabetes can conceptually be divided in three stages: 1. genetic susceptibility, 2. pretype I diabetes with beginning beta-cell destruction and insulitis, and 3. clinical overt type I diabetes. During stage 2, an unknown "triggering event" leads to inflammation and active autoimmunity towards beta cells. In this chapter, recent developments concerning genetics and environmental factors, pathogenic mechanisms, prediction, and immunotherapy of type I diabetes will be reviewed.

The metabolic syndrome (syndrome X) is characterized by elevated insulin levels, obesity of the android type, disturbed lipid metabolism with increased triglycerides (VLDL elevated, HDL decreased) and an association with hypertension. The cause of this syndrome appears to be an insulin resistance of the skeletal muscle. The molecular mechanism leading to skeletal muscle insulin resistance is not understood, however an abnormality of signal transduction from the insulin receptor to glycogen synthase is suggested. It is believed that this syndrome represents a potentially prediabetic situation. Furthermore it is believed that this syndrome gives rise to cardiovascular complications in certain predisposed populations.

A critical immunological survey is given on etiology and pathogenesis of ulcerative colitis and Crohn's disease. Since antigen specific suppressor cells are presumably not very likely, the appropriate hypotheses must be replaced by new ones. Assuming disturbances of the regulation of the immune system as the key to etiopathogenesis, a genetic hypothesis can be presented. This hypothesis is based on the assumption of physiological and pathogenic autogenes as well as regulator genes.

It is possible to register video-densitometrically the gastrointestinal motility visible in fluoroscopic image using a video-signal analyser. The influence of metoclopramide at the propulsive movement of the stomach wall of rats was checked in vivo. The propulsive gastric movement increased in case of small doses of metoclopramide, higher doses stopped the motility. The propulsive gastric movement is parallel to the evaluation of the stomach. Metoclopramide has only a mild influence on the contraction frequency. We found that videodensitometry is also a practical method for evaluation of local wall motility of an intestinal segment of a rabbit. The non-visible motion is recorded and evaluated by means of several physical parameters (frequency, moving velocity of waves). Videodensitometry does not supply information on the causes of motion; hence, a combination with other methods, i.e. the registration of the electromyogram (EMG), is useful. In this way the mechanical answer to EMG-changes is simple to quantify. The experiment with rabbits affords a proof regarding the practicability of the method for pharmaco-physiological investigations.

Widely differing conditions applied to practice-oriented medical teaching at universities in the various German principalities or territorial states in the 18th century. Initially, the institutions used by professors as "collegium clinicum" belonged either to foundations or were being run on a private basis. It was only in the second half of the 18th century that these institutions became state-supervised, with the inclusion of the discipline of surgery. The results of such reorganization are demonstrated, taking Halle and the work done by Johann Friedrich Gottlieb Goldhagen as examples.

From 20 patients with acute pancreatitis the activities of the antioxidative enzymes glutathione peroxidase (GSH-Px) and superoxide dismutase (SOD) were estimated in the blood serum immediately before and during therapy with sodium selenite. The results demonstrate significant (p < 0.01 respectively < 0.05) enhanced activities of GSH-Px under the selenite therapy. Serum SOD activities were not significant influenced by the selenium treatment. The results obtained were not dependent on the reference basis (units/mg protein or U/l serum) used.

64 patients with histologically proven gastric carcinoma were investigated by endosonography (EUS), computed tomography (CT) and conventional transcutaneous sonography (US). In 50 patients a resection of the stomach was performed and the histological findings were compared with the results of preoperative staging. In all cases EUS was successful in demonstrating the tumour. With CT tumour visualisation was possible in 17 (35.4%), with US in 7 (14.6%) cases. The pT-stage was correctly determined preoperatively by EUS in 40 (81.6%) with CT and US in only 12 (25%) and 4 (8.3%) patients, respectively. The staging accuracy of EUS amounted to 80% in T1-, 81% in T2-, 100% in T3-, and 67% in T4-stage. The sensitivity in demonstrating lymph node metastases was 81.3% for EUS, 25.8% for CT and 9.7% for US. The specificity in this regard was 72.2% for EUS, 83.3% for CT and 100% for EUS. The overall accuracy for determination of pN-stage was 78% for EUS, 47.9% for CT and 41.7% for US. EUS is clearly superior to CT and US in the locoregional TN-staging of gastric carcinoma.