[Reality of inpatient vasoactive treatment with prostacyclin derivatives in patients with acral circulation disorders due to systemic sclerosis in Germany]. / Versorgungsrealität der stationären vasoaktiven Therapie mit Prostazyklinderivaten bei Patienten mit akralen Durchblutungsstörungen bei systemischer Sklerose in Deutschland.

BACKGROUND: Raynaud's phenomenon and the frequently ensuing digital ulcerations represent an early and very distressing symptom in patients with systemic sclerosis (scleroderma, SSc) causing significant limitations in the ability to work and quality of life. The use of vasoactive drugs (especially intravenous prostacyclin derivatives) is recommended to reduce the risk of hypoxic tissue damage up to the loss of fingers. METHODS: In order to obtain information about the current state of treatment of patients with prostacyclin derivatives in routine clinical life in Germany, a survey was conducted among the centers affiliated to the German Network for Systemic Scleroderma (DNSS). In addition, a separate patient survey was conducted by the schleroderma self-help group (Sklerodermie Selbsthilfe e. V.), which only covered the symptoms Raynaud's syndrome, digital ulcers and the use of intravenous prostacyclin derivatives. RESULTS: Of the 433 patients surveyed 56% stated that they had already been treated with prostacyclin derivatives (iloprost/alprostadil) because of their illness and symptoms. A total of 61% received the treatment for severe Raynaud's phenomenon and 39% for digital ulcerations. Most respondents not only experienced an improvement in Raynaud's phenomenon and digital ulcers but also a significant improvement of limitations in everyday life. They also needed significantly less outside help and absenteeism from work was much lower. CONCLUSION: Patients consistently reported a positive effect of treatment with prostacyclin derivatives on Raynaud's phenomenon, acral ulcerations, pain and daily restrictions and felt well and safely cared for during inpatient treatment. These positive effects in the patients' perceptions provide crucial information supporting and confirming the current European and international treatment recommendations.

Large Variability of Frequency and Type of Physical Therapy in Patients in the German Network for Systemic Sclerosis.

OBJECTIVE: To determine the type and frequency of physical therapy (PT) prescribed by physicians for patients in the registry of the German Network for Systemic Sclerosis. METHODS: The data for 4,252 patients were analyzed using descriptive statistics, chi-square tests, and odds ratios (ORs). RESULTS: Overall, 37.4% of patients (1,590 of 4,252) received PT at the end of a yearly follow-up. The most frequently used type of PT was lymphatic drainage (n = 1,061, 36.8%), followed by exercise therapy (n = 1,047, 36.3%) and heat therapy (n = 689, 23.9%). More than three-fourths of treated patients (82%) received 1 or 2 different forms of PT simultaneously. The prescription of PT was associated with the extent of skin fibrosis as measured by the modified Rodnan skin thickness score (<10 [41.8% of patients], 11-20 [55.8% of patients], and >21 [63.9% of patients]; P < 0.001). Patients with musculoskeletal involvement (e.g., arthritis, muscle weakness, joint contractures, tendon friction rubs) had a higher chance of receiving PT than patients without these symptoms, with corresponding ORs ranging from 1.96 (95% confidence interval [95% CI] 1.69-2.28) for joint contractures to 3.83 (95% CI 2.89-5.08) for arthritis. When comparing the type of PT prescription across the initial and all follow-up visits from 2003 to 2017, significant alterations with a decreasing frequency of patients receiving PT could be observed (P = 0.001). CONCLUSION: To our knowledge, this is the first study reporting the use of PT in patients with systemic sclerosis (SSc) in a large cohort. Although SSc is characterized by considerable disability and restriction of motion, <40% of patients received PT.

Egg marketing in national supermarkets: egg quality--part 1.

Two surveys were conducted to determine the quality of eggs offered to consumers in large supermarkets in various regions of the US. The first survey was conducted in California (CA) in 1994 and included 38 samples of large (L) and extra large (XL) white eggs in 15 markets. Individual eggs were weighed, candled, and broken out for Haugh unit (HU) determination. Regional differences in age of eggs, the number of eggs below 55 HU, and the percentage of cracked eggs were observed. The second survey was conducted in California (CA), Illinois (IL), Pennsylvania (PA), Texas (TX), North Carolina (NC), and New England (NE). This study included brown and white eggs and samples from 115 stores in 38 cities. Significant age, egg weight, HU, and cracked egg differences were observed between states. Brown and white eggs were different relative to age and HU, but egg weights and cracked eggs were statistically the same. The two surveys, 1994 and 1996, within CA demonstrated very similar measurements when L-white eggs were compared.

[20 years orthograde venous bypass for infrainguinal arterial reconstruction]. / 20 Jahre orthograder Venen-Bypass für infrainguinale arterielle Rekonstruktionen.

During a 20-year period (1973-1993) a series of 684 orthograde vein bypass procedures with the translocated greater (or lesser) saphenous vein was performed in 629 patients (422 male, 207 female) of whom 221 (35%) were diabetics. There were 499 femoro-popliteal grafts to the infrageniculate popliteal artery, 158 femoro-crural and 27 popliteo-crural grafts. Indication for surgery was rest pain and/or tissue necrosis in 404, claudication in 277 and asymptomatic popliteal artery aneurysm in 3 extremities. All patients received long-term oral anticoagulation and were followed at regular intervals. At the concluding follow-up (01-06/1993) graft function was investigated by colour flow duplex scanning and/or arteriography. Cumulative patient survival at 1, 5, 10 and 15 years was 90.6%, 62.8%, 38.6% and 27.1%. Multivariate analysis (Cox-model) proved that preoperative clinical status (rest pain and tissue necrosis vs. claudication and asymptomatic popliteal artery aneurysm) (p < 0.0001) and diabetes (p < 0.001) were significant factors for survival. The 30-day patency rate was 93%, and the secondary cumulative patency rates (life-table method) were 85.7%, 78.6%, 73.8% and 65.9% at 1, 5, 10 and 15 years. Only the preoperative clinical status was a weak prognostic factor (Mantel p < 0.029) whereas diabetes or the level of proximal and distal anastomosis were without importance for graft performance. Cumulative limb salvage rates (life-table method) at 1, 5, 10 and 15 years were 91.2%, 85.6%, 83.4% and 79.9% for the 404 legs operated for rest pain and or necrosis; and they were 100%, 98.8%, 97.7% and 94.9% for the 277 legs with claudication.(ABSTRACT TRUNCATED AT 250 WORDS)

[Diagnosis and results of treatment in appendicitis]. / Diagnose und Behandlungsergebnisse der Appendicitis.

In a period of 5 years 3455 appendectomies were performed because of appendicitis. Acute appendicitis (i.e. gangrenous appendicitis, appendiceal abscess, perforated appendicitis) was found in 30% of all appendectomies. Histological finding, sex, age, symptoms, duration of illness until operation, technique of operation and postoperative complications were documented in a form suitable for computer input and analyzed. The lethality of appendectomy was 0.38%.

Pump light distribution in a laser rod pumped exfocally in a rotational ellipsoid.

In a rotational ellipsoidal exfocal pumping system the linear lamp is arranged between vertex and nearest focus, and the laser rod is aligned between the second focus and the other vertex along the major axis of a rotational ellipsoidal mirror. For this optical pumping system, a calculation of the pump light distribution in the laser rod was performed on a computer by use of a ray tracing procedure. The calculations take account of reflection losses, multiple reflections, and shadowing at the end faces of the laser rod and the lamp. A series of diagrams presents the results of the computer calculations, which are also compared with experimental results.