Showing papers in "Wiener Medizinische Wochenschrift in 1995"

Autologous stem-cell transplantation in multiple myeloma.

Abstract: Autologous stem cell transplantation is an important option in the treatment of patients with multiple myeloma. 130 transplants using autologous marrow or peripheral stem cells were reported to the EBMT registry. The overall complete remission rate in evaluable patients was 48 percent. The median overall survival was 27 months. Factors of importance for survival were the response to treatment before transplantation, the stage at diagnosis, and the number of chemotherapy treatment lines before transplantation. Further studies should compare autologous bone marrow transplantation to chemotherapy and allogeneic transplantation.

Rhythmic brain activity in sleeping bees

Abstract: In honeybees, which are in a sleep-like state of rest the neuronal activity can be recorded in brain regions where memory traces are stored including the mushroom bodies. During nocturnal resting periods short episodes occurred during which the overall spike activity was markedly increased. In addition, ongoing rhythmic variations of spike rate could be recorded. The variations covered 2 frequency bands within the range of 0.4 Hz to 1.2 Hz. Periodical variations of spike rate were present when no visible antennal movements occurred and also when accompanied by spontaneous antennal twitches or during swaying movement of the antennae. Swaying movements took place at the end of short antennal movement episodes with a frequency that corresponded to the periodical variations in spike rate. Thus, there may be a relation between episodes of antennal movements and rhythmic spike activity recorded in the mushroom bodies during episodes of antennal immobility.

Behandlung des idiopathischen und urämischen Restless-legs-Syndrom mit L-Dopa. Eine doppelblinde cross-over Studie

Abstract: In a randomized, controlled and double-blind cross-over trial with L-Dopa and placebo we evaluated the effects of a single bedtime dose of L-Dopa 100 to 200 mg on sleep quality and frequency of periodic leg movements (PLM) in 17 patients with idiopathic and in 11 patients with uremic restless legs syndrome (RLS) by polysomnography, actigraphy, and subjective ratings. Treatment with L-Dopa showed significant reduction of the number of periodic leg movements and the PLM-index most pronounced during the first 4 hours of bedtime. Subjective evaluation confirmed improvement of sleep quality. L-Dopa proved to be effective in idiopathic and uremic RLS without any severe side effects.

Erectile dysfunction in patients with type I diabetes mellitus

Abstract: To improve diabetes care according to the St. Vincent Declaration an interdisciplinary working group on erectile dysfunction in patients with diabetes was installed in the Departments of Internal Medicine, Urology and Psychiatry at the University of Graz. The screening and basic diagnostic procedures are performed in the diabetes clinic in the Department for Internal Medicine. To inform the patients about the options of treatment of diabetic erectile dysfunction and to determine prevalence data an anonymous questionnaire with a pre-stamped envelope was sent to 133 male patients with diabetes mellitus type I (IDDM). 59 (44%) of the questionnaires were returned and could be analyzed. Mean age and diabetes duration were representative for the male diabetes population. The prevalence of erectile dysfunction in this group was 49%. 7% of the patients were completely impotent. None of the patients reported the use of erection aids as a vacuum device or intracavernosal injection of smooth muscle-relaxant drugs. The prevalence of erectile dysfunction is high among patients with diabetes mellitus type I. Modern management offers satisfactory success in most cases, therefore screening for erectile dysfunction and adequate therapy should be offered to all patients.

[Falling asleep at the wheel: the chief cause of severe traffic accidents].

Abstract: All fatal traffic accidents on highways in Bavaria in 1991 have been analyzed. The most frequent single cause for the 204 accidents was falling asleep (24%). A time of day analysis revealed that the highest accidents frequencies could be observed at 6:00 a.m. and 2:00 p.m. In addition an age effect could be observed. The majority of the day accidents were caused by older drivers, while most of the night accidents were caused by younger ones. Language: de

Normative data for muscle strength in relation to age, knee angle and velocity.

Abstract: Standardized normal values are necessary to assess the performance with respect to the momentary functional state as well as a documentation of a training or rehabilitation program. The isokinetic extension strength of the right and left knee was investigated in 147 healthy male subjects between 17 and 70 years who were divided into 6 age groups. Normative data are given in dependence on age, knee angle and various velocities and regression equation in relation to the knee angle and for the peak torque in relation to the angular velocity. We found a significant decrease in maximum torque with increasing angle acceleration (p < 0.001) and a correlation between strength and body mass (p < 0.05). The highest values were found in the group of 20- to 29-year olds, while the strength was lower up to age 20. The decrease in force between 25 to 70 years ranges up to 37% at a velocity of 10 degrees/s, up to 41% at a velocity of 60 degrees/s and up to 50% at a velocity of 180 degrees/s.

Clinical manifestations of Parkinson disease

Abstract: The deficiency of dopamine leads to the lack of every-day movements and mobility. Loss of coordination and facial expression shows the complexity of non-verbal expression. This means a severe problem in communication. Especially the akinetic patient needs a lot of help from his/her surrounding. The clinically different forms of the disease will be shown due to the communicational and interactive aspects.

[ALS-like sequelae in chronic neuroborreliosis].

Abstract: CSF investigation in a 61-year old female patient with clinical picture of motoneuron disease gave evidence for chronic infection with Borrelia burgdorferi. Improvement of clinical and CSF findings could be observed after antibiotic therapy. The diagnosis of amyotrophic lateral sclerosis which was initially suspected had to be revised and the disorder was interpreted as chronic neuroborreliosis.

Hemodynamic regulation during postural tilt assessed by heart rate- and blood-pressure variability combined with impedance cardiography.

Abstract: Assessment of heart rate and heart rate variability (HRV) are used in sports medicine and space medicine to give conclusions about the functional state of the autonomic nervous system. Furthermore, reduced HRV and changed blood pressure variability (BPV) are accepted as risk factors in patients with cardiovascular diseases, metabolic syndrome and neurologic disorders. The aim of the first studies was to combine the evaluation of central hemodynamic (impedance cardiography) with HRV and BPV evaluation in the time and frequency domain (fft tracking) based on a standardized clinical test with automated protocol output. Data acquisition and -analysis was realized beat to beat (Kohto Ltd., Moscow) during forced breathing (150 s, 6 breath/min) and postural tilt (7 min, supine, transition to 55 degrees in 4 s, 7 min upright) allowing one to evaluate: orthostatic response type including impedance cardiography; activation of vagal afferences and efferences by forced breathing; vagal and sympathetic components during initial heart rate and blood pressure responses; characteristic changes of spectral balance of HRV and BPV (measured at the finger) during early regulation. First investigations on 34 normal volunteers subdivided into two age groups and on 13 patients with different diseases indicate that besides the age dependent changes (reduced HRV, reduced cardiac performance, reduced regulatory amplitudes and baroreflex sensitivity) individual response types can be described and dysfunction of different reflex loops can be detected. Consequently, the assessment of specific influences onto circulatory control by therapy, sport and rehabilitative training is possible and further studies are necessary.

Metabolic and cardiorespiratory reactions in tennis-players in laboratory testing and under sport-specific conditions.

Abstract: Metabolic and cardiorespiratory reactions were investigated during a sport-specific incremental field test (FT) for tennis and compared with a treadmill step test (TT) in a group of 13 trained male tennis players In both the FT and the TT lactate acid (La), heart rate and oxygen uptake (VO2) were measured VO2 was determined using a portable telemetric system (K2, Cosmed, Italy) Aerobic- (AT) and anaerobic threshold (ANT) at a blood lactate concentration of 2 mmol/l and at 4 mmol/l respectively was indicated to characterize the endurance capacity of the athletes In both FT and TT, minimum value of lactate equivalent (LE(min)), measured in every exercise test, was also registered At AT and ANT values for HR (AT: p < 0001; ANT: p < 0001) and VO2 (AT: p < 0001; ANT: p < 0001) were significantly higher in FT than in TT at submaximal loads At LE(min) only higher values for HR (p < 005) were registered in FT In contrast to maximum range significantly higher values for VO2 (p < 0001) could be seen in TT (there were no significant differences for HR) Comparing maximum lactate (La(max)) subjects reached a higher lactate (p < 005) in TT A particular aim of our investigation was to characterize the individual cardiopulmonal and metabolic adaptation of tennis players, considering sport-specific criteria As a result, differences in cardiorespiratory and metabolic adaptations could be determined between laboratory TT and FT This finding seems to point to the fact that, using field testing in addition to laboratory exercise testing, makes a better judgement of aerobic and anaerobic endurance under sport-specific conditions possible Furthermore, it was important for us to put data, determined in the field test into practice, using the given pattern of the field test as an element of training This kind of training has the advantage of combining an individually intensity-controlled specific endurance training for tennis with a training of technical skills

[Microinvasive, CT-controlled periradicular therapy in treatment of chronic intervertebral disk-induced functional disorders].

Abstract: The disease of the spinal column is number 2 of common diseases world-wide and leads to high business- and commerce-related losses as well as to high expenses for the health care systems. An effective treatment of this disease is given by the microinvasive. CT controlled periradicular therapy (micro PRT). Under visibility, the tip of a canula is led directly and high precisely in close neighbourhood to the prolaps, then locally NaCl and cristaline cortisone (40 mg Volon A) is instillated. The periradicular distribution and the distribution into the epidural space is documented via contrast medium. A retrospective study with 220 patients and a prospective randomized double blind study with 40 patients (10 mg vs. 40 mg Volon A) were carried out. The average age of the retrospective collective was 53.1 +/- 12.4 years, average treatment period 18.4 weeks, and the mean follow-up 17 months. The mean value of successful treatment of lumbal spine was at 60% (spine 88.5%) with protrusion, with prolaps at 75% (spine 94%), with sequester at 94%, and with stenoses at 69% (spine 60%). With 78.8% of the patients, the percentual result was constantly good at the time of questionnaire as to the end of the treatment. 7.7% still took analgesics, 5.9% were post-operated. 1.8% of the patients made a pension application. The average age of patients within the prospective randomized double-blind-study was 47.2 +/- 11.9 years. At 27.5% of the patients, the start of pain was about more than 5 years ago and goes back to about 23 years (72.5% had pain more than 1 year). The mean value of visits was 4 physicians per patient, and 5 months of follow-up. There is a high significant improvement in results within the group with 40 mg Volon A (p = 0.0351479). The entire improvement, subjectively estimated (visual analogical scale) within this group was at 90%. After end of therapy, 83.3% (n = 30) had stopped the taking of analgesics and the neurologic deficit decreased significantly. Furthermore, significant reduction of prolapses could be observed at 60% of the patients in both study groups (n = 156). The CT scopic micro PRT with 40 mg Volon A leads to a significant improvement of pain and neurologic symptoms caused by chronical disk herniation.

Kidney function and electrolyte metabolism in healthy pregnant women

Abstract: In pregnant women alterations in kidney function, hormone, electrolyte and water metabolism are common findings. In 15 healthy pregnant women the kidney function and electrolyte metabolism were investigated during pregnancy and after delivery. The glomerular filtration rate measured by creatinine clearance was 20% higher in the I. trimester than in the II. and the III. trimesters and after the delivery. The sodium clearance was in the III. trimester significantly lower than in both the I. and the II. trimesters (p < 0.001, p < 0.01); the fractional sodium excretion was lowest in the third trimester. Furthermore the serum calcium concentration decreased significantly in the II. and III. trimester in comparison to the I. trimester (p < 0.01, p < 0.001), which was associated with a moderate increased urinary calcium excretion. The phosphate clearance increased during pregnancy and decreased approximately 50% after delivery (p < 0.01). The magnesium clearance was 40% higher in the third trimester in comparison to the I. trimester (p < 0.05) and 61% higher than the value post delivery (p < 0.01). The uric acid clearance during pregnancy was markedly increased and decreased 70% after delivery (p < 0.05). The results showed that in the III. trimester an intensive sodium retention occurred, which is associated with an increase of the plasma volume, interstitial fluid and body weight. The decreased serum calcium concentration in the II. and III. trimesters, the increased urinary calcium excretion as well as increased phosphate clearance suggest an increased parathyroid-hormone secretion.(ABSTRACT TRUNCATED AT 250 WORDS)

[The European experience with megadose therapy and autologous bone marrow transplantation in solid tumors with poor prognosis Ewing sarcoma, germ cell tumors and brain tumors)].

Abstract: Since 1984 a total of 2085 patients with solid tumors have been registered in the European Bone Marrow Transplantation Registry for Solid Tumors (EBMT-STR). The major aim of this registry is to supply data by retrospective analysis for the innovation of prospective, randomized studies. 104 Ewing's sarcoma patients received megatherapy followed by autologous bone marrow transplantation (MGT/ABMT). The 2-year overall survival was 31% in 14 patients with multifocal disease in first complete remission (CR1) and was 37% for 15 patients in second CR (CR2). (6 patients with local disease in CR1 have been excluded.) These results are better than observed under conventional dose chemotherapy. 67 patients were grafted with measurable disease showing a response rate of 72%. The 2-year overall survival was 25% during primary treatments and 33% and 10% for sensitive and resistant relapses, respectively. 201 patients with germ cell tumors received MGT (combinations of platinum derivates, VP16, cyclophosphamide, ifosfamide) followed by ABMT. The overall survival at 5 years was 10% in refractory patients and 58% for 113 responding patients not in CR1 (i.e. first partial remission, CR2 and sensitive relapses). Based on these results and a French randomized trial a prospective, randomized study is underway comparing MGT versus conventional chemotherapy in chemosensitive patients. 219 adults with malignant brain gliomas underwent a program consisting of surgery, MGT (BCNU in the majority)/ABMT and radiotherapy. The overall survival at 3 years was 12%, the median survival was 11 months after ABMT. Life quality after ABMT was good, but no major improvement in terms of prolonged survival was achieved.(ABSTRACT TRUNCATED AT 250 WORDS)

Women and smoking

Abstract: Of the 300,000 deaths attributable to smoking among women in developed countries in 1985, 21% were coded to lung cancer, for example, 41% to cardiovascular diseases, primarily coronary heart disease and stroke, and 18% to chronic obstructive pulmonary disease. Overall, female deaths rates from lung cancer in developed countries increased by almost 200% between 1957 and 1987. Smoking and tobacco consumption is a health risk for women at all ages. All women, regardless whether they are pregnant, performing oral contraception or estrogen replacement should not smoke; if they are not able to stop on their own, appropriate counselling and therapy should be provided according to the state of the art. Women who smoke typically go through the menopause 2 or 3 years earlier than non-smokers. Cigarette smoking to increase the risk of estrogen-deficiency diseases, as cardiovascular risk and postmenopausal osteoporosis. Many women want to give up smoking for a number of reasons, such as health, freedom from smoking dependence, financial worries and of course pregnancy. Women find it more difficult to quit than men because of lack of social support, more reliance on cigarette to cope with stress and anxiety and fear of weight gain. Although many women manage to refrain from smoking for a long, they may relapse in situations involving negative emotions, such as conflicts, stress, loss. Men however, tend to relapse in positive situations, such as social events. Smoking cessation programmes have to cover specifically women's need including basic health education, discussion of withdrawal symptoms, strategies to maintain non-smoking and prevent relapse, continuing group support, stress management, advice on weight management, nutrition, fitness and exercise.(ABSTRACT TRUNCATED AT 250 WORDS)

Right ventricular function in patients with obstructive sleep apnea

Abstract: Obstructive sleep apnea often affects the cardiovascular system. So far, only few data are available on its influence on the function of the right ventricle that can be evaluated by gated radionuclide ventriculography. This technique was performed on 68 patients with polysomnographically verified obstructive sleep apnea. 27.9% of the patients showed an impairment of right ventricular function. There was no correlation between right ventricular function and degree of obstructive sleep apnea or pulmonary artery pressures--as evaluated by right heart catheterization. Gated radionuclide ventriculography thus seems to be suitable for early detection of pathological effects of obstructive sleep apnea on the function of the right ventricle.

Clinical study of the effectiveness of filters in vacuum cleaners for reducing the concentration of dust mites in the household

Abstract: The faeces of the dust mite are the most significant source of allergy for those allergic to the dust mite. During vacuum cleaning, faecal particles are emitted from the cleaner and into the air to form pathological concentrations. The aim of the study was to discover if these extreme concentrations could be prevented by the use of appropriate filters. As the allergen source, dust mite faeces were used. A Miele vacuum cleaner type S424i was used without filter, with S-Class filter, and with Super Air Clean Filter. In the first test 1 g, and in the second test 2 g of dust mite faecal particles were evenly spread and then vacumed up. While using each filter in turn, the expelled air was measured for faecal concentrations. The analysis was performed by counting the number of faecal particles, and determining the content of major allergen Der p I in the expelled air. Without a filter there was a massive concentration of faecal particles in the expelled air. The simple filter Type (S-class-filter) achieved a significant reduction on the emission of allergens. The more complex special filter (Super air clean filter), was able to remove all traces of allergens from the expelled air.

Isokinetic cycle ergometer--application in sports medicine.

Abstract: Paper deals with application of fully computerized isokinetic cycle ergometer with on-line registration of effective crank force in sports medicine, namely in functional diagnostic and rehabilitation. The system allows to carry out the time and position course analyses of effective pedal force and power produced at various revolution rates. Maximal or mean values of force and power produced by action of right and left leg may be used for the estimation of strength as well as for detection and quantitative assessment of lateral functional deficit for example due to injury. Short term bouts on isokinetic cycle ergometer may be applied as an effective means for the improvement of strength of lower extremities in patients as well as in competitive cyclists. The estimation of individual fluctuation of effective force (i.e. differences between maxima at horizontal and minima at vertical crank position) may be used for the evaluation of pedalling technique. Short term all-out efforts at various cadences allow to register not only peak and mean force and power at particular revolution rates, but also to estimate an optimal individual revolution rate, i.e. those allowing to produce highest power output. Such information can be employed for diagnostic assessment of anaerobic capabilities, namely in cyclists. Isokinetic cycling with self-controlled effort may be also used as a comfortable aerobic exercise. It may be concluded that isokinetic cycle ergometer represents a valuable diagnostic as well as therapeutic tool, which may be utilized in several areas of sports medicine.

Changing gears in the human circadian mechanism

Abstract: Subjects who live in isolation and without information on time of day, develop, in all their functions, free-running circadian rhythms whose common periods usually scatter around 25 h. That means that the circadian system, though desynchronized from the 24-h day, remains internally synchronized. However, if the sleep-wake cycle gets longer than 28 h, or shorter than 22 h, the rhythms of autonomic functions uncouple from the sleep-wake cycle, resulting in a state of internal desynchronization. In internally synchronized as well as in desynchronized systems, the intervals between meals change in strong proportionality to the duration of wake time, nevertheless, neither the caloric intake per meal nor body weight are altered. Hence, there must be a saving of energy with increasing wake time. This is accomplished by a reduction of muscular work, as becomes evident from the negative correlation between locomotor activity per hour and wake time. On the occurrence of internal desynchronization, the regression lines describing the correlations mentioned above are shifted against each other in such a way that the consumption of energy adapts to the needs economically. This mechanism is comparable to the effects of a variable geer.

Graft-versus-host disease after autologous bone marrow transplantation: a realistic expectation?

Abstract: The immunobiological mechanisms involved in the manifestation of an autoaggressive disease after autologous bone marrow transplantation (BMT) and cyclosporine A (CyA) treatment are still unclear. This disease, which in animals shows clinical and histopathological features in the skin, liver and gut similar to those of graft-versus-host disease (GVHD), is called autologous GVHD and associated with the appearance of CD8+ cells with a lytic specificity for a public epitope on MHC class II. 2 steps are supposed to be essential for the induction of autologous GVHD: firstly, the elimination of a host resistance or an autoregulatory mechanism of self tolerance by high dose chemotherapy including total body irradiation, and secondly, the prevention of clonal deletion of MHC class II-restricted auto-reactive T-cells by CyA. Several experiments describe a possible antitumor effect of this disease in vitro as well as in vivo. The CD8+ cells kill tumor cells in vitro and survival of animals with autologous GVHD challenged with low doses of tumor cells is better than that of animals without autologous GVHD. In an attempt to reduce the relapse rate after autologous BMT, induction of GVHD with CyA treatment was investigated in clinical trials. A syndrome similar to the one described in rats was observed also in humans. However, symptoms were confined to the skin, appeared earlier than in experimental transplantation and were always self-limiting. Further investigations aiming at understanding in more detail the immunobiological mechanisms in human autologous GVHD and phase III clinical trials will have to be completed in order to define the role of this disease in clinical transplantation.

[Patient compliance of hypertensive patients in the physician's practice].

Abstract: Compliance of hypertensive patients is primarily estimated in participating patients in clinical trials. Although compliance is overestimated by pill-counting, this technique is most frequently used. 389 Austrian general practitioners studied compliance in 945 hypertensives, using the Medication Event Monitoring System. The patients were asked to take the ACE-inhibitor Cilacapril once a day between 7.00 a.m. and 9.00 a.m. Each package opening was registered by a microprocessor located in the cover of the drug vial. In this study it turned out that only 1.3% of the patients did open their vials between 7.00 a.m. and 9.00 a.m. 2 thirds of the patients actually took less than 80% and 36% less than half of the prescribed medication. There was no correlation between compliance and sex, age, smoking habits, tolerance or duration of hypertension. Even fall in blood pressure was the same in compliant and non compliant patients. The conclusion is that compliance is bad in a general practitioner setting and further more that casual readings as performed in this study are an insufficient tool to judge efficacy.

[Incidence of ovarian hyperstimulation syndrome in in-vitro-fertilization treatment over a period of 11 years]

Abstract: A total of 2915 cycles of controlled ovarian hyperstimulation (COH) were performed from 1981 to 1992 in an in-vitro fertilization--embryo transfer (IVFET) programme at our institute. In 325 (11.2%) cycles an ovarian hyperstimulation syndrome (OHSS) developed. It was defined if more than 10 follicles with a size of > 15 mm were found on the day of follicle puncture. OHSS was found to be more frequent in the 3rd quarter of the years. Soltriol or melatonin may play a role in this context. Additionally, we were able to confirm some risk factors that were previously reported to be associated with the OHSS: use of gonadotropin-releasing hormone agonist (GnRHa) protocols, and young age (< 35 years). The pregnancy rate was found to be higher among OHSS cases.

Inflammatory demyelinating neuropathy in neuroborreliosis

Abstract: A patient with acute onset of radicular pain developed an asymmetric neuropathy within a few weeks Neurophysiology and nerve biopsy findings revealed a demyelinating neuropathy Cerebrospinal fluid showed mild pleocytosis, increased protein levels and elevated antibody titers against Borrelia burgdorferi suggesting Lyme neuroborreliosis Although peripheral nervous system complications of Lyme borreliosis are common, the association with chronic demyelinating neuropathy has not been described before

[Clinical trials--methodological gold standard or naive reductionism?].

Abstract: The methodological concept of the randomized controlled clinical trial is a relatively recent invention. It is widely accepted to be the only means of conclusively establishing a cause effect relationship between a given therapeutic intervention and an observed outcome. There are, however, numerous pitfalls. Ethical concerns and/or practical problems can seriously affect both proper randomisation as well as the use of a placebo treatment as the control intervention. Sometimes blinding of the patients or the therapist may be difficult or even impossible, depending on the availability of a similar treatment without the specific therapeutic effect, whereas a satisfactory investigator blinding can be achieved in most instances. Practical problems can be minimised by adapting the trial design to the given clinical situation. The fact that a number of drawbacks exist, must, however, not be used as an argument to abstain from performing such studies--simply because there is no better alternative.

Psychophysiologic insomnia and periodic leg movements in sleep syndrome

Abstract: In 31 patients with psychophysiological insomnia, the relationship between periodic leg movements and sleep was studied. Patients with frequent periodic leg movements estimated their sleep latency to be longer than did patients with few or without leg movements. There were no other significant differences regarding sleep structure and subjective sleep quality between both groups. It appears likely that frequent periodic leg movements in patients with psychophysiological insomnia (not suffering from a restless legs syndrome) can be considered an accidental finding rather than an important factor involved in the pathogenesis of the disorder.

Methodology for analysis of binary sequences in heart rate

Abstract: A qualitative and quantitative method for the description of heart rate variability is demonstrated. It is based on a symbolic coding of time series taken from heartbeat intervals and calculation of the value "entropy" as a measure for information. Entropy seems to be a propriate measure to gain insight into the temporal structure underlying the phenomenon of heart variability.

Lyme borreliosis and cardiomyopathy

Abstract: According to current opinion there is acute, self-limiting Lyme carditis, and chronic Lyme carditis. Acute Lyme carditis manifests mostly as transient conduction disorders of the heart (e.g. AV-blocking I to III), and as supraventricular and ventricular rhythm disturbances, pericarditis, myocarditis, and pancarditis in single cases. Chronic Lyme carditis is defined as a case of chronic heart failure confirmed by positive serology and endomyocardial biopsy. Anamnestic aid is rare. Neither tick-bites nor preceding or accompanying erythema chronicum migrans are constantly reported. Seropositivity and control of its specificity by western blot are indicative but no etiological proof. Even histological detection of spirochetes in endomyocardial tissue or cultivation of borrelia from endomyocardial biopsy are no final etiological proof of the respective cardial disorder. Those findings, however, are an indication for antibiotic treatment. According to the severity of the disorder, antibiotics are administered orally (penicillin or derivatives) or parenterally with penicillin or cephalosporins of the 3rd generation over 4 and 2 weeks, respectively.

Psychological and physiological dependence in smokers and there effect on motivation for smoking cessation

Abstract: The typical onset of cigarette smoking is determined on various psychological and social factors. The period of experimental smoking may be followed by habituation. Habituation involves development of skill in inhalation and regulation of nicotine dose, becoming accustomed to the mood-altering and other pharmacologic effects of nicotine, and development of a pattern of conditioned reinforcement from smoking. Many smokers continue to smoke because nicotine helps them to regulate mood. The nicotine intake leads promptly and noticeable to pleasant, desired psychotropic effects. In the event of physical dependence, the occurrence of withdrawal symptoms results in renewed nicotine intake. Psychological and physiological dependence could be very different among smokers and this has important implications on the motivation for smoking cessation. Using the Fagerstrom Test for Nicotine Dependence (FTND) to assess nicotine dependence in a population 6.000 randomly selected Austrians were interviewed. 42% of men and 27% of women were found to be smokers. 3 groups of smokers differing in dependence can be described: 36.5% are nicotine addicted; 30.2% must be psychosocial dependent because they show nearly no sign of nicotine dependence; and there is a group between, difficult to classify them as more psychological or more nicotine addicted.

Modification of liver parameters by adjuvant administration of proteolytic enzymes following chemotherapy in patients with ovarian carcinoma

Abstract: In a single-blind placebo controlled trial with 3 parallel groups the effects of concomitant administration of proteolytic enzymes (either tablets or dragees) on the influence of the liver parameters to a carboplatinum chemotherapy were investigated. 59 female patients were enrolled into this study after ovarial cancer surgery. Out of these 59 patients 23 were allocated to the placebo group, 24 to the tablet form and 12 to the dragees preparation. The study medication was administered from day 2 to 7 after each of the 6 chemotherapy cycles in monthly intervals in a dosage of 2 tablets t.i.d. placebo, 2 tablets t.i.d. Wobe-Mugos and 10 dragees t.i.d. The main efficacy criteria for the adjuvant study treatments were SGOT, SGPT, Gamma-GT, alkaline phosphatase and lactate dehydrogenase. The data of these parameters indicate an overall beneficial effect in patients in both of the verum groups compared to placebo and provide--in combination with other safety data documented in this study--evidence, that the concomitant administration of Wobe-Mugos does not negatively affect the overall tolerability.