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Introduction: So far there has been little evidence of the extent to which project steps can affect the timing and successful implementation of research projects in general practitioner (GP) practices. Using the example of an intervention study on palliative care, the aim of this article is to report a) how the overall course of the project turned out compared to the original planning, and b) what recommendations can be derived to promote efficient implementation of intervention studies in GP practices., Methods: In two workshops each, GP practice teams selected specific measures to improve their palliative care and tested them during a four-month implementation phase. In order to track the progress of the project, the times at which the practice teams reported their participation in the study, the individual project steps and the contacts were documented and descriptively analysed using Microsoft Excel., Results: Due to a high willingness of practice teams to participate in the intervention study, recruitment was completed on time. The overall duration of the project was extended due to an increased workload for the preparation of an unexpectedly high number of selected measures to improve palliative care., Discussion: Conducting intervention studies in GP practices is promising if practice teams take an active and co-determining role during the entire research process. Research projects can best be implemented if they involve minimal time commitment for the practice teams, and if continuous personal support from the study team is ensured., Conclusion: When planning future intervention studies with a high participatory share of GP practice teams, it is advisable to take into account potential additional work for the preparation and further development of intervention measures., (Copyright © 2021. Published by Elsevier GmbH.)

Two cases of symptomatic proctitis with rectal tumors suspicious for malignancy are presented. A florid regenerative proctitis was shown in the histological examination. In both cases a sexually transmitted infection (STI) was causing the symptoms. In rare cases STIs present as pseudo tumors mimicking malignancy in clinical examination and endoscopic/radiological analysis. A close collaboration between gastroenterologist and pathologist is necessary for a correct diagnosis and to prevent unnecessary surgical treatment., (© Georg Thieme Verlag KG Stuttgart · New York.)

Bleeding and perforation in esophageal cancer patients are rare but associated with a high morbidity and mortality. Because of disappointing results after primary surgical exploration and resection endoscopic intervention was introduced as the primary treatment option with an improved outcome. Aortoesophageal and esophagobronchial fistulas may occur spontaneously or secondary to stenting of the esophagus. They are uncommon but fatal if untreated. The first option is prompt placement of a stent graft as a bridging solution followed by surgical treatment.

Introduction: The aim of the study was to evaluate the efficiency of the endovenous use of laser for treatment of varicose veins. In particular the influence of laser energy on the perivenous temperature, the postoperative clinical and duplex ultrasound course was taken into account., Method: The patients were divided into two groups. In 33 cases the laser therapy was used without perivenous liquid protection. In 30 cases a 0.9 % NaCl solution has been injected around the vein. The laser used was a 980 nm diode laser (Ceralas D 980, Biolitec AG, Bonn). The pulse-mode procedure has been applied for triggering the laser impulse (1.5 s pulse length, 1.5 s pause with a 3 mm withdrawal of the laser fibre. The laser energy was 15 watt. 20 cm distal to the saphenofemoral or saphenopopliteal junction a thermo unit measured continuously the perivenous temperature. Clinical and duplex ultrasound checks were carried out before and on the day of the operation. Further checks followed on the first and tenth day after the operation and 8 weeks and 6 months afterwards., Results: The perivenous temperature prior to ELT was 31.3 degrees C, then dropping after the injection of the NaCl solution by 3.4 degrees C. During the ELT the temperature rose by 10.0 degrees C without and by 5.5 degrees C with infiltration. The rise in temperature happened only 3 cm before the tip of the laser fibre arrived at the thermo unit and fell quite rapidly. 98 % of the veins showed within the time period of 2 to 14 months an effective occlusion controlled by duplex ultrasound without refluxing segments. All operations were out-patient treatments. The patients were able to take up work after 1 to 7 days., Conclusion: The endovenous laser treatment is an innovative method for the treatment of varicose veins. Considering the mid-term subjective and objective outcomes this method can not only compete with the conventional surgery but has proved to be superior as regards the recurrence rate and patient's comfort. The study presented here, did not find a risk of damage to surrounding non-target tissue.

An open problem of the lipid lowering agent ciprofibrate (rac-2-[4-(2,2-dichlorocyclopropyl)-phenoxy]-2-methylpropanoic acid, CAS 52214-84-3) is its metabolism concerning the conjugation with amino acids and glucuronic acid. It could be solved by syntheses of the needed reference compounds--unknown up to now--and administration of ciprofibrate to volunteers and rats. Unexpectedly the conjugation compounds with amino acids are stable in vitro and in metabolism. There was no evidence for any conjugation reaction with amino acids by investigating samples of urine and faeces. On the contrary the urine of humans contains 90-97% of beta-O-acylglucuronide, whereas rat urine shows only 10% of the calculated amount.

In 1992 and 1999, dental health in 20- to 79-year-old adults from the canton of Zurich was assessed with a standardized method (WHO). The aim was to establish the current state and changes of dental health. Roughly half of the 852 approached adults selected by chance did take part. In 1992 and 1999, the mean number of unfilled, decayed teeth (DT) was on a low level in all age classes (0.2 to 1.8 depending on age class and examination year). The number of missing teeth (MT) in older adults (60-79) was on a high level (8.8 to 13.4). The number of filled teeth (FT) was highest (14.8 to 16.2) in middle-aged adults (40-59). Total loss of teeth was found only in older adults (60-79). Lack of a "functional" own dentition (5 teeth present in each quadrant) was found in roughly half of the 60- to 69-year-olds and two thirds of the 70- to 79-year-olds. In 1999, the state of the roots and loss of attachment was assessed. Wedge-shaped defects were found in more than half of the middle-aged adults (40-59). Carious roots were found in more than half of the 70- to 79-year-olds. Nearly half of the 70- to 79-year-old participants showed "severe" loss of attachment (> or = 6 mm). In the short period from 1992 to 1999, a significant decrease of 3.7 DMFT was found in 20- to 49-year-old adults. The decrease of 0.9 MT and 2.1 FT means also a decrease in treatment need in this age segment. In contrast, in the 50- to 79-year-olds no change in dental health could be established.

We report on the case of a 40-year old patient with extreme neurofibromatosis with severe kyphoskoliosis and deformation of the thorax. The patient died from malignant transformation which occurred multifocally with extensive pulmonary metastases. The well-known thoracic manifestations of neurofibromatosis are reviewed.

Tachyarrhytmias often occur during increased emotional arousal or mental excitation. The implantable cardioverter defibrillator (ICD) allows the exact documentation of arrhythmic episodes and their time of onset. Therefore, the type of arrhythmia can be differentiated as well as the circumstances surrounding the event. These features allow the assessment of possible psychic arrhythmogenic factors in the natural environment. We analyzed the ICD-protocols of three male patients (in ages between 60 and 68), whose devices had successfully terminated a ventricular tachycardia and compared the onset of the episodes with the patients' detailed descriptions of the corresponding life situations. The analysis of the circumstances at the time of arrhythmia-onset revealed a relationship between the occurrence of life-threatening arrhythmias in natural environment and emotional stress. The stressors could be defined as situations of increased vulnerability leading to sympathetic excitation. The induction of tachyarrhythmia was promoted in case 1 by acute psychic distress (public speaking), by the increasing panic-attack-like vicious circle of the cognitive anticipation of an unfavorable outcome (case 2), and an adverse anger reaction superimposed on persistent feelings of help- and hopelessness (case 3). These findings are in line with several experimental and epidemiological studies providing evidence for a relationship between psychic arousal and the induction of tachyarrhythmias. The knowledge of emotional and mental factors that function as a trigger for arrhythmias may lead to new therapeutic approaches in the prevention of sudden cardiac death.

Chlormezanone, a chiral centrally acting muscle relaxant, will be cleaved at its S-C-1 bond by an autoprotolytic process. The optimum of chemical stability exists between pH 2 up to pH 9 with a maximum at pH 7.4. The plasma half life at 37 degrees C is 76 h. Enzymes do attack the products of cleavage namely 4-chlorobenzaldehyde and 2-carboxyethane-sulfinic-acid-N-methyl-amide. The main metabolite in urine is 4-chlorohippuric acid in the range of up to 70% of the oral administered dose to humans. No cytochrome P-450 is engaged in the cleavage of the S-C-bond.

In a double blind study altogether 41 patients with obliterating arteriosclerosis at stage II after Fontaine have been treated for 26 weeks either with 3 X 100 mg Trapidil (Rocornal) daily or placebo. In the second half of the study under Trapidil in contrast to placebo a clinically relevant additional increase of the distance of the intermitent claudication was the result. On the other hand, the plethysmographically measured reserve of the arterial blood supply did not show any changes in the two groups. A specific influence of Trapidil on the lipoprotein metabolism is apparently not present, since there appeared favourable influence on the hyperlipoproteinaemia diagnosed in 37 out of 41 patients both under placebo and under Trapidil.

The activation of the blood platelets is the prerequisite for their participation in physiological and pathological intravasal processes. An aimed influence on the distinct functions of the blood platelets presumes an exact knowledge about course and regulation of the activation of the platelets. Investigations on glucose-6-phosphate-dehydrogenase-deficient platelets and on the effect of glutathione-oxidizing substances on normal platelets showed references to a regulatory significance of the cellular thiol/disulphide state in the process of activation. In this case particularly the arachidonic acid balance and the SH/SS-state of platelet proteins seem to be in close connection with reductive ways of metabolism.

On the conditions of an optimal therapy and with reference to certain contraindications the prognosis of patients with congenital heart diseases and their children scarcely differs from that of the normal population during gestation. The rate of decompensation in pregnancy was 4.1%, with 3.9% the rate of gestosis was significantly below that of the other patients. The perinatal mortality of the children of patients with congenital vitium cordis os 2.23%, the rate of newborn of 11.2% and the proportion of hypotrophic children of 8.38% were also not increased compared with the totality. By changed diagnostic and therapeutic conditions the relation of the congenital to the acquired vitia cordis has much altered in favour of the congenital ones. With a high proportion of women who underwent an operation of the heart among our patients the results shows that, apart from the already generally accepted absolute contraindications for a pregnancy, the prognosis for patients with stenoses of the outlet is clearly worse than that of the patients with other congenital heart diseases.

In 122 male patients with arteriosclerosis of pelvis and legs up to 5 resting electrocardiograms were registered in the course of 4 years. 5.2% of these electrocardiograms showed disturbances of rhythm. In these cases no significant differences in the serum magnesium level could be ascertained between patients with and without disturbances of rhythm.

A method for the preparation of human blood platelets is presented which substitutes the use of anticoagulants by a gelfiltration for the removal of plasma calcium from native blood. In a second step the platelets are separated from the gel filtered blood by a centrifugation on a Ficoll density gradient. The anticoagulant-free platelets reveal an intact morphological feature and a normal aggregation behaviour in response to different aggregation inducers. It was found that in ADP-induced aggregation monophasic aggregation is shifted to a biphasic one by increasing concentrations of extracellular calcium.

The results of isotopic renograms (ING) (n = 73) and renal concentration capacity tests (n = 65) performed at the same time before and during therapy of recurrences have been compared. In 43 children with chronic urinary tract infections. ING done prior to chemotherapy showed pathologic findings in 65% of children with bacteriuria. A significant correlation between normal and pathologic findings of ING and renal concentration capacity tests has been found. Impaired (normal) renal concentration capacity lead to pathologic (normal) ING in 74% of cases. 94% of children with a pathologic ING either had bacteriuria children with pyelonephritis (n = 19) the ING was pathologic, whereas in all children with cystitis (n = 8) it was normal. During therapy the ING became normal before the impaired renal concentration capacity returned to normal.