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While the mouth and teeth play a lifelong central role in a person's development and wellbeing, psychosocial aspects of disease and health are still only reluctantly included in dental explanatory models. Only dental anxiety with its disease quality of a specific phobia is generally recognized as a mental disorder requiring intervention. It is interpreted as an emotional reaction to aspects of dental treatment, which results in distress for the affected person and appears to be unreasonably intense given the actual dangers involved. Apart from that, the tendency to provide a somatic explanation for symptoms in the dental context persists. This bears implications for the expectations of those affected as well as for interdisciplinary cooperation. In order to improve interdisciplinary support and mutual understanding, the following article introduces the clinical pictures of craniomandibular dysfunction, bruxism, occlusal dysaesthesia, and somatoform prosthesis intolerance alongside dental anxiety. Psychosocial factors can profoundly influence the development, course, and management of these conditions., (© 2021. The Author(s).)

Dizziness/vertigo, falls and syncope are among the most common reasons for seeking medical care. As clinical entities they share common pathogenetic and clinical features and differences. The diagnostic work-up can often be initiated in a general practitioner's or internist's practice and, if necessary, completed in an interdisciplinary emergency unit. Simple diagnostic tools can be used in an outpatient setting to obtain valuable diagnostic information. First and foremost, it is important to differentiate between prognostically favorable clinical events and potentially serious disease. In younger patients diagnostic procedures should primarily focus on potential structural cardiac disease and/or primary arrhythmia. The same applies to elderly patients in whom, however, multicausal clinical symptoms and severe complications in the case of falls are characteristic. Elderly patients frequently require the involvement of various clinical specialties to investigate a broad spectrum of potential differential diagnoses in an interdisciplinary diagnostic approach, which is not always available in practice. In the emergency unit, decisions regarding inpatient care need to be made individually. In elderly patients, inpatient care is sometimes necessary not only due to acute disease, but also in order to ensure social care. Geriatric day hospitals may be a suitable option for some of these patients.

Background and Purpose: The primary care sector is of key importance for the management of patients with diabetes mellitus. The authors investigated (a) the prevalence of diabetes mellitus type 1 and type 2, (b) the type and frequency of non-drug and drug treatment and its association with the presence of diabetic complications, and (c) the quality of metabolic control by HbA1c., Methods: Using a nationwide probability sample of 3,188 general practices (response rate [RR] 50.6%), a total of 55,518 (RR 93.5%) patients were assessed in a prospective cross-sectional study by their physicians in September 2003 in a standardized manner using questionnaires, physician interview, and laboratory assessments. In addition to diabetes mellitus, 28 diseases were explicitly screened for, among them typical macrovascular (coronary heart disease, cerebrovascular disease, peripheral arterial disease) and microvascular disease (neuropathy, nephropathy, retinopathy, diabetic foot) complications., Results: The prevalence of diabetes mellitus was 0.5% (type 1) and 14.7% (type 2), respectively. 49.5% (type 1) and 50.2% (type 2) of patients had micro- or macrovascular complications. 6.8% did not receive any treatment, 13.5% received non-drug treatment, and 75.3% received oral antidiabetic drugs and/or insulin (26.6% a combination of two or more). Compared to diabetics without any complications, treatment intensity was significantly higher in patients with microvascular complications (odds ratio [OR] 3.02), but not in those with macrovascular complications only (OR 0.98). An HbA1c value>or=7.0% was recorded in 39.6% of patients., Conclusion: Compared to previous studies in this setting, the proportion of diabetics with drug treatment has increased. More patients receive antidiabetic drug combinations. Quality of blood sugar control appears to have improved as well.

Underlying causes of hypogonadotropic hypogonadism are acquired or congenital disorders of the hypothalamus or pituitary (e.g. pituitary adenoma, craniopharyngioma, prior radiotherapy, trauma, severe general diseases, extreme stress, genetic mutations). In addition to a comprehensive history and physical examination, the diagnostic work-up includes measurement of testosterone, LH and FSH, with the aim of differentiating between primary and secondary hypogonadism. Where indicated, investigation of pituitary function, the use of imaging procedures, possibly an olfactory test, a GnRH stimulation test or genetic analyses may be added. Depending upon the indication, treatment is effected with testosterone, GnRH or gonadotropines.

In Germany,traumatic brain injury (TBI) has an annual incidence of approximately 200000. In contrast to earlier assumptions, pituitary insufficiency is a common complication of TBI, with a prevalence of 30-50%. Since the symptoms are often nonspecific and may be masked by the sequelae of head injury, it may go unrecognized and may possibly aggravate the symptomatology of such injury. It is therefore to be recommended that patients who suffer a head injury should be examined to exclude pituitary gland insufficiency, by measuring the basal hormone level--where necessary in combination with stimulation tests.

In this study we developed another method for the detection of nasopharyngeal closing patterns. This investigation of dynamic closure patterns was based on flexible video-nasopharyngoscopy and was undertaken in both healthy subjects and patients with dysarthria. Quantitative assessments of pharyngeal wall excursions allowed evaluation of closure patterns which were then matched with a predefined, mathematically-based algorithm. The results showed that a greater velopharyngeal constriction was maintained in the following order: resonants, open vowels, forced expiration, closed vowels, consonants, and swallowing. Variations in phonetic expressions of phonemes mainly interfered with velum excursion, whereas the lateral pharyngeal mucosal wall was minimally involved and the posterior wall portions were unaffected. Velopharyngeal closure patterns varied with different tasks: the velum was mainly moved for phonetic parameters, while lateral and posterior pharyngeal wall motion was observed on a large scale for swallowing. Comparison of subject groups revealed that patients with dysarthrias had reduced velar motility, leading to a more frequent hypernasal sound. Here, lateral pharyngeal walls showed a variable motility that in some cases was even more than in healthy subjects. Both groups exhibited qualitatively comparable velopharyngeal closure patterns, but significant differences were proved in their distributions.

Since benign prostatic hyperplasia (BPH) is a very common and slowly progressive disease which requires surgical treatment in only one-third of those affected, surveillance of the condition on the basis of subjective symptoms is of considerable importance. For this reason, the WHO developed a prostate symptom score (WHO-PSS or I-PSS), which includes both irritative and obstructive symptoms, and which has become accepted all over the world. This score can be used both in investigative studies as a means of monitoring the efficacy of therapy, and as a very good instrument for patient management in the doctor's office.

In an open, prospective, multicentric observational study involving 419 specialist urological practices, the efficacy and tolerability of a combination preparation comprising Sabal extract WS 1473 and Urtica extract WS 1031 were investigated in 2080 patients with Alken's stage I or II benign prostatic hyperplasia. A before-and-after comparison revealed an improvement in the pathological findings and in the obstructive and irritative symptoms. For the most part, the efficacy and tolerability of the preparation were assessed by the physician to be "very good" or "good". At the end of treatment, most patients indicated an improvement in their prostatic symptomatology and in general quality of life. Fifteen patients (0.72%) were suspected of having developed mild side effects.

We report on 120 psychiatric in-patients who underwent electroconvulsive therapy (ECT) during 1980-1987. The patients were hospitalized in a regional psychiatric hospital, main indications for ECT being "neuroleptic treatment resistance" (44%) and "catatonia/stupor". Between 1980 and 1987 on average 0.7% (2.75%-0.1%) of admissions were treated by means of a course of less than 10 ECT sessions (62%) or less than 15 sessions (25%), 4% patients requiring 20 ECT sessions or even more. In over half of the patients bilateral electrode placement was chosen out of therapeutic considerations. Naturally, ECT was carried out under specialist anaesthesia and muscular relaxation. For drug-resistant patients average doses as needed before ECT are presented. 83% of patients showed remissions. Under strict indications ECT is still rated as a valuable treatment technique for a sub-group of psychotic in-patients.

The values of 7 urinary parameters in divided urine collections were measured in 20 patients with calcium oxalate stones and ten normal persons. On this basis the thermodynamic stone formation risk was calculated for the different urine collections. Stone formation risk in the 0-6 a.m. urine fractions appeared to be the most important. The risk of stone formation is significantly increased in the time from midnight to 6 a.m. To detect the risk situation the determination of oxalic acid, calcium, potassium and inorganic sulfate in night urine is adequate.

Since 1971, percutaneous transluminal angioplasty of peripheral arteries has been performed in 225 patients. There was an overall patency rate of 70-80% after 2 years. Our technique was then adapted and modified to perform coronary dilatation. This was performed successfully in 8 dogs in which selective coronary artery stenosis war induced by silk ligature and secondary inflammatory changes. The technique was then applied to the coronary lesions in postmortal humans and tested in the operating room during A-C bypass to evaluate vessel patency, peripheral debris etc.

The present paper deals with experimental and crystaloptical studies on synthetic and native Ca-oxalate. The findings are in favour of a uniform way of formation of Ca-oxalate stones from Ca-oxalate dihydrate crystals as primary crystallization product in urine, developing into the monochydrate phase by dehydratation. Rapid growth and a sufficiently high concentration of foreign ions (Mg) in the urine support the formation and stabilisation of dihydrate stones.

Progesterone as the main representative of gestagen-effective sexual steroide does not cause allone a statistically significant dilation of the lumina of the ureters compared with the adequate values of the control urogrammes. The fact that in pregnant rabbits no dilation of the ureters and of the renal pelvis was to be found allows the suspicion that during the pregnancy of the animal species used there are other mechanical conditions than during the human gravidity.

The fluorine content of 150 precisely differentiated urinary calculi from areas with and without fluoridated drinking water (FDW) was quantitatively determined using different analytic methods. The fluorine content differed according to the type of calculus. With an average of 2 mg/g of calculus substance, the whewellite or weddellite concretions in FDW areas have the greatest portion of fluoride. The degree of crystallization of carbonate calculi increases with increased percentage of fluorine, and the parameter of the reticulum is characteristically contracted.

A valve in distal direction was formed by means of invaginationion without opening the urinary tract in 15 undilated ureters in dog. After 3 months their function as an antireflux valve was checked. The result was good in 9 cases, a stenosis of the invaginat appeared in 4 cases and no antireflux effect was existing owing to the dislocation of the invagination in 2 cases. Details of the operative technique, causes of the failure, and the employment of the method in the human medicine were discussed.

By chronic intoxication with ethylene glycol or acute intoxication by Na-glyoxalate in the animal experiment a Ca-oxalatenephrolithiasis could be produced. At this model the influence of magnesium, pyridoxine and phosphate was studied. The combination therapy of magnesium and vitamin B6 can completely prevent the formation of Ca-oxalate-microliths in the kidney. The production of a preparation with 200 mg MgO and 10 mg pyridoxine per tablet for the metaphylaxis of oxalate calculi is recommended.

36 operations of the renal pelvis or ureter were carried out in 35 patients. In all these cases a split stenosis or a tissue defect were covered by free peritoneal patches. Urographic controls of 30 patients showed 29 good or very good results. The following statements can be made: 1. In cases of a secondary scarred stenosis, of renal pelvic or ureteral wall defects, plastic operations of intrarenal pelvis of transsinus operations of staghorn calculi the splitting with splinting and covering by autologous tissue seems to represent a suitable operation. -- 2. As material the renal capsule, the venous wall and the peritoneum are suitable. -- 3. In cases of severe ureteral stenoses, which have to be resected, especially in cases of considerable differences of the ureteral lumen, the semicircular suture with covering should be preferred to the circular suture. -- 4. The covering of the defects by patches of autologous material reduces the time of the postoperative urinary diversion with all its dangers and the period of hospitalization. -- 5. In cases of a short covered stenoses (up to 4 cm) postoperative disturbance of the transport or urine was observed only once. The results of stenoses, longer than 4 cm, cannot yet be evaluated.

The influence of a long-term application of 4 different hormonal contraceptives on the excretion of various constituents of the urine was examined. A reverse effect after stoppage of the medication is to be established in none of the other parameters with the exception of calcium.

Even though more than 50 cases of seminal vesicle cysts combined with ipsilateral renal agenesis or dysplasia have been described during the 20th century, such associated malformations of the upper urinary and genital tracts still deserve our attention on the one hand, as illustrations of embryological deviation and, on the other hand, because of the very difficult diagnosis. The typical symptoms and differential diagnosis of these conditions are described and illustrated by two of our own cases. The various therapeutic possibilities are presented.

After evaluation of the essential parameters concerning urinary calculi and patient with the help of adequate computer programmes in more than 30,000 persons some conspicious trends could be established. The necessity of operative removal of calculi is still relatively high in the most frequent species of calculi whewellite, weddellite, uric acid, struvite and carbonate apatite. Thus nearly 65% of all struvite and carbonate apatite calculi must be operatively removed in women. For individual species of stones with statistical certainty (alpha=0.01) the preference of the right kidney in women and of the left kidney in men is established. The summer months bring an increased risk of stone formation. The spontaneous passages show a highly significant increase from July to October (alpha=0.01), compared with the winter and spring months.

Medicamenty and compounds used in the metaphylaxis of urinary calculi were tested on an animal model for objectifying the effect. Kation changers, anthrachinones, diphosphates, and methylene blue were used.

The relationship between high dose progesterone treatment and pregnancy and dilatation of the upper urinary tract was investigated by doing intravenous urograms on eight female rabbits. Ten features of the urogram were studied. It was concluded that the administration of sex hormones to rabbits without any mechanical change in the ureters, did not lead to urographically demonstrable dilatation of the ureters. Negative findings in pregnant animals indicate that the mechanical situation in rabbits differs from that found in human pregnancy. The results are discussed with relation to the available literature.

In the present work the influence of stress situations on the concentrations and excretions of lithogenous urinary substances (calcium, oxalic acid, uric acid) has been studied in defined urine portions of 10 calcium oxalate stone patients and 10 normal subjects and the results compared to those of 20 stone patients and 10 normal subjects without stress. Stress may be objectified in the given task. The increase of concentrations and excretions of lithogenous urinary substances indicates an enhanced risk of stone formation. Uric acid is discussed as an agent promoting the calcium oxalate crystallization. New insights on the calcium oxalate stone genesis are gained from the results.

Krapp-Hydroxyanthrachinone given orally will, in a dosage of 150-200 mg, inhibit the intra-renal crystallization of calcium oxalate in the rabbit kidney following Glyoxalate intoxication. This inhibition is increased considerably by Na-Cu-Chlorophylline. The mechanism of action of the inhibitor substances is a specific surface adsorption prohibiting formation of microliths. This can also be shown in precipitation experiments in vitro. The authors suggest a certain clinical use of a combination of the tested dye with vitamin B6, citrate and magnesium preparations.