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Introduction: It is estimated that after premature rupture of membranes (PROM) at term, 60% of all women go into labour within 48 h, 95% within 72 h. Often labour is induced after 24 h because the risk of maternal and neonatal infection rises. The majority of clinicians advise hospital care to allow monitoring and detection of problems. But for low-risk patients who meet strict inclusion criteria, sometimes home management is possible. This study examines the safety and costs of home management. Material and Methods: We included 239 patients with PROM at term, 202 of them with hospital and 37 with home management. Patients who met the inclusion criteria were checked 12 h after PROM and were induced by the end of 24 h if labour had not begun spontaneously. Results: There were no differences in maternal or neonatal outcome. Women with home management were likely to spend less time in hospital and this was associated with reduced costs. Conclusion: Women with outpatient management of PROM had a shorter hospitalization stay without negative impact on maternal or fetal outcome. In times of increasing financial pressure on the medical system, outpatient management for PROM seems to be a viable option., (© Georg Thieme Verlag KG Stuttgart · New York.)

The section 125 of the German Social Statute Book No. III (unemployment insurance) determines the conditions for an unemployed insured person who is unable to work due to a disease. Ascertainment of the existence of the medical conditions governed by section 125 is not only a task for the physicians of the unemployment insurance, it is also a task for the doctors of the pension insurance and of the health insurance. Hence it is very important that all medical experts of social insurances are in consensus in view of these medical requirements. In this paper the medical conditions for section 125 are described: The disease must be so serious that the unemployed insured person will be unable to return to work within the next six months. The inability to work will be continuous. In this case the unemployment insurance continues to pay unemployment benefit in spite of the inability to work until the pension insurance body agrees to pay a pension.

In numerous tumors, metastasis can be limited to the liver. In non-resectable patients, regional treatment modalities, especially arterial cytostatic infusion, are favored in contrast to systemic chemotherapy, whereas intraportal or intraperitoneal application is not successful. Improved results with high response rates have been reported after development of intra-arterial (i.a.) long-term regimens with FUdR in patients with colorectal liver metastases using implantable pumps and ports. However, a survival benefit could only be demonstrated in comparison with a control group only treated symptomatically. Because of several reports on major local toxicity of i.a. FUdR treatment (i.e. chemical hepatitis and biliary sclerosis) several other effective i.a. 5-FU regimens have been developed. A randomized study has demonstrated superiority of i.a. 5-FU versus i.a. FUdR. In comparison with systemic treatment, superiority has only been demonstrated in patients with an intrahepatic tumor burden of < 25%. Publications about regional treatment of patients with breast, gastric cancer or carcinoid liver metastases are rare. Despite the high response rates reported, the benefit of arterial chemotherapy remains questionable. Overall, local long-term chemotherapy cannot be recommended outside of studies as a primary treatment. However, extensive experience and new drugs support the idea of conducting further regional studies.

Administration of 6,7-dimethyl-9-(D-1-ribityl)-isoalloxazine (riboflavin) solution (30 mg/200 ml) dissolved in a fruit juice to 5 volunteers resulted in increased relative bioavailability between 156 and 246% compared to the intake with water. The reason should be the delayed gastric emptying rate due to the osmotic pressure and the acidity of the juice.

The so-called psychosomatic pain syndrome of the locomotor system, particularly of the back (brachialgia, lumbalgia, sciatica), is often associated with deeper psychic disturbances, sometimes even with masked depressions or advanced neurotic conditions. Certain cases require special treatment such as psychotherapy or antidepressive pharmacotherapy. In many cases, however, a psychoanalgesic drug, Dolo Visano, has proven effective in these non-specific pain syndromes of the locomotor system. Dolo Visano is a combination of acetylosalicylic acid, codeine phosphate, diphenhydramine hydrochloride, nicotinic acid and meprobamate. The results of a clinical trial in 50 patients are described in detail. The drug was generally well tolerated.

Acute pain is "the barking police-dog of our health". It represents an efficient system of information introducing or evoking a series of defensive mechanisms concerning acute illness, whereas the chronic ache is senseless, because it doesn't take over any protective functions; on the contrary, it burdens the total organism, especially the vegetativum and the psyche as well. Chronic pain very often renders independent, then it is no longer any symptom of a disease, but the disease itself: the idiopathic or unspecific syndrome of pain. Analyzing, for example, rheumatological aspects of a case, you can recognise that there exist continuous transitions from concrete local pain to diffuse indefinite psychalgia, whilst that gliding scale is more and more defined by psychic causes. Many aspects of cases imply a lot of such components. Obviously those syndromes of diseases are increasing where only pure psychosomatic facts exist, that is to say when soma is not the primary source but the scenery.

The use of nonsteroidal anti-inflammatory drugs (NSAID) such as diclofenac for treatment of degenerative rheumatic disorders of the lumbar spine is of great significance in orthopedic practice. Clinical studies have shown that concomitant treatment with vitamins B1, B6, B12 and diclofenac provides more efficient pain relief than treatment using diclofenac alone. This study was undertaken in order to determine whether the duration of treatment with diclofenac for lower back pain can be shortened by adding B-vitamins to the therapeutic regimen. From September through December of 1986, 256 patients participated in a multicenter, controlled, randomized double-blind trial which compared the clinical efficacy of diclofenac (50 mg) with a combined therapy of diclofenac (50 mg) and vitamins B1, B6, and B12 (thiamine nitrate, pyridoxine hydrochloride, and cyanocobalamine, resp.; in dosages of 50 mg, 50 mg, and 0.25 mg, resp.). Patients were treated with 3 X 1 capsule daily for a maximum of two weeks, having the option to terminate participation in the trial after 1 week in the event of total pain relief. The data of 238 patients were able to be included in the evaluation. 29 patients opted to discontinue therapy due to remission on symptoms. Nineteen (65.6%) of these patients belonged to the combined therapy group, the other 10 (34.4%) having taken diclofenac alone; this difference is statistically significant (p less than 0.05). An important aspect in the evaluation of therapy was the patient response regarding the improvement of painful symptoms which, in addition to their subjective feedback, was reflected in the test results of the "Hoppe Pain Questionnaire (HPQ)." All parameters used as a measure of pain relief indicated superior results with the B-vitamin supplemented therapy when compared with results obtained with diclofenac alone. Moreover, after 3 days of therapy the "sensory" pain factor "sharpness" improved significantly. Undesirable side-effects were documented with 39 patients, 14 of them having discontinued therapy for this reason. No statistically significant difference could be determined within this group with regard to therapy. The study results document the positive influence of B-vitamins on painful symptoms and indicate that less NSAID is needed for pain relief when combined with B-vitamins.

Studies which support the assumption that an "arthritis personality" is a causative factor in the development of rheumatoid arthritis are methodologically inadequate. Some are mere descriptions; others use inappropriate control groups. The investigations also suffer from failure to provide information on patients' characteristics, such as socioeconomic status and disease parameters. Although the quality of investigations concerning the etiological role of stress in the onset of rheumatoid arthritis has also been reduced by theoretical and measuring difficulties, the evidence supports an influence of stressful events. Results of controlled studies mostly refer to a comparison of group means. An own investigation shows that correlation studies are able to describe differences between groups, even if the groups do not differ significantly in their means.

We attempted to ascertain to what degree pain experience in two groups of rheumatic patients is influenced by personality traits and psychosocial characteristics. 20 patients with fibrositis syndrome and 20 patients with rheumatoid arthritis completed the Freiburger Personality Inventory, the Giessen Test and the Revised Multidimensional Pain Scale. There was no difference in mean scores of the three questionnaires between the groups but patients with fibrositis syndrome tend to characterize themselves as being psycho-somatically disturbed. The number of significant correlations between pain scales and the personality scales is distinctly smaller in the fibrositis group than in the arthritis group. This result is interpreted as an indication for alexithymia in the fibrositis group.