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Psychiatric disorders are associated with autonomic dys-regulations. There is evidence that these dys-regulations are partly responsible for the increased mortality in patients with psychiatric disorders. The determination of the heart rate variability (HRV) is a method easily applicable and allows the assessment of the autonomic control of the heart rate regulation. A multitude of HRV parameters with different physiological meanings have been introduced, the most widely used parameters are presented and characterized in this paper. Many studies have shown a reduced HRV in patients with major depression. Most studies found a reduced parasympathetic activity. However some authors discuss an elevated sympathetic activity. The magnitude of HRV reduction correlates to the severity of the depression. In patients with coronary diseases, major depression is an independent risk factor of mortality. Antidepressive therapy with serotonin reuptake inhibitors has failed to improve the prognosis of this patients. Patients with panic disorders also have a reduced HRV due to an elevated sympathetic control and reduced vagal control. In schizophrenic patients a reduced HRV was found in long term electrocardiogram recordings, whereas short term recordings did not show a reduced HRV. Patients with Alzheimer's disease also have a reduced HRV, which is limited to the low frequency component. Therapy with cholinesterase inhibitors further influences HRV by reducing the high frequency component and might increase the risk for arrhythmias. HRV analysis and integration in the assessment and monitoring of psychiatric patients before and during therapy elucidate the role of autonomic disturbances in such diseases and may help to optimize treatment.

Background/aims: Alpha-interferon (IFN-alpha) is an effective treatment for chronic hepatitis B but only 25-40% of patients will profit from a long-term beneficial response to the currently recommended schedule of 3-6 MU given 3 times a week for 6 months. Clinical trials are therefore needed to investigate alternative modifications of interferon therapy, including combinations of different antivirals or immune modulators in order to improve the therapeutic approach to chronic hepatitis B infection. In a phase II trial we evaluated whether a combination of natural interferon-beta (nIFN-beta) with strong antiviral activity plus recombinant interferon-gamma (rIFN-gamma) with a predominantly immunomodulatory activity is able to increase the response rate compared to historical controls treated with IFN-alpha in a conventional regimen., Methodology: Forty patients with chronic hepatitis B were included in this trial of combined interferon therapy at a dosage of 6 MU nIFN-beta during week 1 followed by 3 MU for weeks 2-4 plus rIFN-gamma at a daily subcutaneous (s.c.) injection of 150 microg during the entire 4 weeks of the treatment period. Patients entered the trial on the basis of the following criteria: hepatitis B surface antigen (HBsAG), HBeAG and HBV-DNA positive for at least 6 months, HDV, EBV, CMV, anti-HIV negative, and chronic hepatitis proven on biopsy taken within 4 weeks of entry as well as 6 and/or 12 months after interferon therapy. The final diagnosis and classification of chronic hepatitis has been based on guidelines according to a revised classification of chronic hepatitis (Desmet 1994). The post-treatment follow-up was 12 months., Results: The combined interferon therapy achieved complete responses with seroconversion from HBeAG to anti-HBe and a negative HBV-DNA (dot blot) test, as well as normalization of ALT activity in 15 patients, and partial response with negativation of HBV-DNA concomitant to a decrease in aminotransferase activity to near normal levels in 6 patients. Nineteen patients showed no response to viral markers but showed relief of clinical symptoms as well as pronounced decrease of serumtransaminase activity. Grading of liver biopsies demonstrated an improvement of histologic parameters after the interferon regimen in half of the evaluable patients (n=22). Histological response has been quantified by a reduction in the score of histological activity (HAI-index) from 12.6 before to 7.6 after interferon therapy, and in the inflammation and cellular degeneration score (ICD) from 9.9 to 5.2. Histological response, however, failed to show a consistent correlation with serologic response. This medium-dose combination of interferon-beta and interferon-gamma was tolerated very well by the patients, this good tolerability being explained by tachyphylaxis in response to daily interferon doses. No serious side effects or decompensation of liver function were observed during the 4-week period of therapy or the follow-up, despite the special clinical situation where 60% of the patients included in the study presented with histologically proven cirrhosis (35% of them with clinical manifestation of mildly decompensated cirrhosis)., Conclusions: This short-term regimen of combined nIFN-beta + rIFN-gamma therapy in patients with chronic hepatitis B proved to be equieffective to long-term treatment with interferon-alpha and combines high clinical tolerability with good practicability, as it can be administered on an in-patient basis, ensuring close patient monitoring.

Over the last two-and-a-half years a committee of experts, consisting of members of the three leading German sexology associations, developed guidelines for treating and assessing transsexuals. Their purpose is to improve the care for patients with sex identity disorders and to ensure that such care is of uniform quality to avoid erroneous decisions to the disadvantage of those affected. The guidelines are set out in full.

170 patients who had suffered trauma to bones or soft tissues were examined by a digital and a conventional film/screen technique. In addition to "standard" and edge-enhanced images, post-processing was carried out and compared with conventional radiographs. Four radiologists and two surgeons evaluated the compacta, spongiosa, soft tissues, fractures and osteo-synthetic materials as shown on the two systems. The "standard" digital images are inferior to film images, but edge-enhanced images showed definite advantages for demonstrating soft tissues. Evaluation of osteo-synthetic material is limited by the creation of artifacts. Recognition of detail can be significantly improved by using post-processing with optimized parameters.

Biographical data and the evaluation of the scientific work of Corti taken from Austrian, German, Italian, Swiss and American medical historiographers are summarised and completed by details and documents of the time Corti spent in Vienna. It is pointed out that Corti received important impulse for his later research when he was Hyrtl's assistant.

In order to determine the initial bacterial contamination of corneal donor material the abraded epithelia from 125 donors, i.e., 250 globes, were examined immediately after enucleation. Of these, 49 (19.6%) were sterile, while 201 (80.4%) were contaminated. Monoinfection was identified in 174 globes and mixed infection in 27. The pathogen most frequently isolated was Pseudomonas aeruginosa. Neither the donor's age not the time elapsed between death and enucleation had any influence on the contamination rate. Prolonged hospitalization of donors leads to an increase in gram-negative bacteria. The necessity of antibacterial prophylaxis prior to keratoplasty is pointed out.

A prospective study was performed on seven male and eight female patients with normal hepatobiliary findings to investigate the effect of 20 mg nifedipine on cholecystokinin-induced gallbladder contraction. Each patient received 1 IDU (Ivy dog unit) cholecystokinin per kg body weight intravenously on two consecutive days, with additional administration of 20 mg nifedipine sublingually on the second day. Gallbladder volumes were assessed by ultrasonography over a period of 25 minutes. Cholecystokinin induced a maximal reduction in the mean initial volume of 56.8 +/- 3.6%. After nifedipine, this volume change was significantly reduced to 30.9 +/- 5.1% (p less than 0.001). Thus our data suggest for the first time that the calcium-channel-blocking agent nifedipine can have an effect on human gallbladder kinetics.

The measures taken by the emergency physician can in many cases decisively affect the subsequent course of a chest trauma. In cases where the injured person has to be extricated from collapsed structures the medical officer has to decide on the mode and sequence of the rescue operation, prevent further damage and initiate shock therapy, intubation and artificial ventilation while the rescue operation is in progress. Emergency treatment also includes infusion therapy, if necessary via a central venous catheter; intubation, suction drainage and artificial ventilation; evacuation of fluid from the pleural cavity, mediastinum and pericardium combined with electrodiagnosis (ECG) and electrotherapy (defibrillation) if necessary. By closely observing the reaction and condition of the patient during transport to hospital he can provide important information regarding further treatment, especially in polytraumatized persons. Close collaboration between the trained rescue teams of the Fire Service, the emergency medical officer and the hospital staff has succeeded in reducing the mortality rate of combined chest injuries to 13%. 87% of cases who had received emergency treatment were subsequently admitted to hospital.

The value of lymphography and CT in the diagnosis of abdominal lymph node metastases was compared in 82 patients with various types of malignant disease. In the presence of systemic disease or testicular tumours, CT increased the recognition of lymph node metastases and their extent, particularly of high para-aortic deposits which were frequently underestimated by lymphography. Lymph nodes in the pelvis are more easily identified. CT is the first choice for the investigation of systemic disease and testicular tumours. This will, in addition, also demonstrate abnormalities of the organs and assist in radiation planning. CT is a simple procedure which is also very valuable in following the effect of treatment. For metastases from other origins, lymphography is often more valuable since CT is unable to identify metastases in lymph nodes if these are not enlarged. The two methods complement each other and their combination provides improved diagnostic information.

A case of gastric perforation due to a gastric metastasis of a primary bronchogenic carcinoma is presented. While ten cases of small intestinal perforation secondary to bronchogenic tumor spread were identified in the literature, there appears to be only one further report on a gastric perforation caused by bronchogenic carcinoma.

The presence of Campylobacter pylori was investigated in duodenal, antral and fundic biopsies of 149 consecutive patients undergoing upper gastrointestinal tract endoscopy by biopsy urease tests (CLOtest; "CLO test") and histologic examination ("HIST") after modified Giemsa staining. Positive results were obtained rarely in the duodenum (4.7% and 12.8% by CLO test and HIST, respectively), but equally frequently in antral (48.3% and 62.4%) and fundic biopsies (55.0% and 54.4%). Using combined evaluations ("COMB") of both CLO test and HIST results, and disregarding isolated positive histologic grades "1" as C. pylori negative, the detection rates were 6.0, 53.0 and 56.4% in the above order and 63.1% overall at any of the biopsy sites. There was no close correlation between the rapidity of the color conversion of the biochemical test and the microscopic grading of C. pylori density. A positive CLO test in single antral biopsy specimens was an accurate predictor of the presence of C. pylori as compared with HIST (predictive value positive PVpos 0.97), while negative antral BUT results did not rule out C. pylori colonization of the upper GI tract (PVneg 0.52 compared with HIST). An additional negative CLO test from fundic biopsies increases the PVneg to 0.58.

We examined 21 patients with focal lesions of the liver. Routinely we used T1 weighted, proton weighted and T2 weighted measurement modes, mainly with repetition times of 1.6 sec and echo delay times of 35 or 120 msec. Using these parameters we can see characteristic changes of the signals of the liver tumours. Cystic lesions usually show a strong decrease of the signal in the T1 weighted images in comparison with the normal liver pattern, in the proton weighted images a weak decrease but also in some cases a weak increase of the signal; in the T2 weighted images they show signals of very great intensity. We can differentiate haemangioma of cystic lesions because of the very strong signal in the proton weighted images in comparison with the normal liver pattern, which we could not see in any other focal liver disease. Metastases and hepatoma produced low signal intensity in the T1 weighted image. The proton weighted and the T2 weighted images show signals with a slightly greater intensity compared with the normal pattern, i.e. a very good possibility to distinguish hepatoma and metastases from cystic lesions or haemangioma. The differentiation from hepatoma and metastases cannot be made with NMR up to now. We are also not able to differentiate the focal nodular hyperplasia (FNH) from metastases. We used a 0.35 T supraconductive magnetic system.

A report on experiences with the Heine-mini-ophthalmoscope with gliding regulation of intensity of illumination for fixation test in children employing a fixation object newly developed by K. Heilmann.

The authors report a further case of methimazole-associated liver damage and present a brief review of eleven previous cases found in the literature. The main clinical features of this 58-year-old female patient were laboratory evidence of leucopenia and cholestasis, and biopsy features of fatty liver parenchyma degeneration with granulocytic portal infiltration and bile stasis, demonstrated 20 days after the initiation of antithyroid therapy with 20 mg methimazole daily. An immediate cholestatic liver reaction was also provoked by drug rechallenge, with spontaneous amelioration of signs and symptoms after drug discontinuation.