Treatment of premenstrual syndrome with a phytopharmaceutical formulation containing Vitex agnus castus.

A multicentric noninterventional trial (open study without control) to investigate the efficacy and tolerance of a drug in a large number of patients under routine medical conditions was performed for a new solid preparation from an extract of the fruit of Vitex agnus castus (VAC, Vitex, chaste tree, Chasteberry) in 1634 patients suffering from premenstrual syndrome (PMS). A specific questionnaire was developed for determining the effect of Vitex on psychic and somatic complaints, on the four characteristic PMS symptom complexes depression, anxiety, craving, and hyperhydration (DACH), and on single groups of symptoms. After a treatment period of three menstrual cycles 93% of patients reported a decrease in the number of symptoms or even cessation of PMS complaints. To a certain extent, this effect was observed within all symptom complexes and correlated with the global assessment of therapeutic efficacy. Whereas 85% of physicians rated it as good or very good, 81% of patients assessed their status after treatment as very much or much better. Analysis of frequency and severity of mastodynia as the predominant symptom revealed that complaints still present after 3 months of therapy were mostly less severe. Ninety-four percent of patients assessed the tolerance of Vitex treatment as good or very good. Adverse drug reactions were suspected by physicians in 1.2% of patients, but there were no serious adverse drug reactions. Hence, the risk/benefit ratio of the new Vitex preparation can be rated as very good, with significant efficacy for all aspects of the multifaceted and inhomogeneous clinical picture of PMS, with a safety profile comparable to other Vitex preparations.

[Voluntary proof of continuing education--what is the purpose?]]. / Freiwilliger Fortbildungsnachweis--bringt das etwas?

The proof of continuing medical education (CME) is necessary. Uptill now doctors have had the chance to solve this problem themselves and to participate voluntarily in the certification and evaluation of CME and to document their efforts to the benefit of the patients. The experience more and more doctors' societies will gain trough their projects to prove CME will show ways for a common system of certification in Germany, compatible in all of Europe.

[Continuing medical education--a necessity, with or without proof?]. / Arztliche Fortbildung--eine Notwendigkeit, mit oder ohne Nachweis?

The proof of continuing medical education (CME) ist necessary. Until now, physicians have the chance to solve this problem by themselves and to participate voluntarily at certification and evaluation of CME and to document their efforts to the benefit of the patients. The experiences, which medical societies will gain by undertaking projects to proof CME, will show ways for a common system of certification in Germany being compatible in whole Europe.

[Electrophysiologic studies of fecal incontinence in the woman]. / Elektrophysiologische Untersuchungen bei einer Stuhlinkontinenz der Frau.

The cause of urinary or fecal incontinence may be a complex one. A central or peripheral neurogenic lesion is frequently found to be accounting for the problem. The diagnosis should be specified by neurologic examinations and adequate neurophysiologic workup prior to any conservative or surgical treatment. Of particular expressiveness are, neurological history, both neurography of the pudendal nerve and electromyography of the external anal sphincter. Additional measures such as recording of the motor or sensory potentials, determination of reflex latencies and an electromyogram of other striated muscles of the pelvic floor may be taken as needed. Close co-operation of gynecologists, proctologists, and neurophysiologically trained neurologists will help to improve the prospects of treatment and avoid inappropriate therapeutic approaches.

[Ultrasound of the knee joint: normal values and changes in rheumatoid arthritis]. / Sonographie des Kniegelenks: Normalbefunde und Veränderungen bei rheumatoider Arthritis.

The bursa suprapatellaris, infrapatellaris, the patella tendon, condylar cartilage, menisci and fossa poplitea were examined sonographically in 56 healthy persons in defined sections. References for normal findings are given. The examination of 22 patients with rheumatoid arthritis revealed joint effusions, Baker cysts, synovial hypertrophy, intraarticular septae and changes in the echogenicity of the synovial fluid.

[Value of physical parameters and digital signal processing in tissue differentiation]. / Der Stellenwert physikalischer Parameter und digitaler Signalverarbeitung in der Gewebedifferenzierung.

It was the aim of this study to improve tissue characterization using ultrasonic scatter signals and image processing procedures by computer. Analysis of various tissue probes and phantoms showed that structures can be differentiated by scatter as a function of frequency and angle of scatter. The application of this method as an imaging system was realised by a reconstruction algorithm to compute scatter images. By means of analysing images of the thyroid and prostate we found that the detection rate of computerised texture analysis is much higher than that of visual evaluation.

Staphylococcus aureus--toxic shock syndrome toxin-1 antibody titers in serum of German women.

In a prospective study the distribution of Toxic-1 (TSST-1) antibody titers was proved by 236 menstruating, tampon using volunteers. They are divided in 7 different age groups. Up to 11% of the volunteers under 25 years had no TSST-1 antibody-titers at all. Over 25 years of age this could be detected. In the group over 40 years of age 98% were found with antibody-titers up than 1:100. So it may be suggested that there is no general causal relationship between any type of tampon on TSS.

[Qualification and quality control in sonography]. / Qualifikations- und Qualitätskontrolle in der Sonographie.

On the basis of guidelines issued by the Kassenärztliche Vereingung Hessen, some criteria for the application of sonographic examinations are presented. Minimal requirements for sonographic equipment in certain specialties are mentioned, and it is pointed out how not only case history and clinical examination but also one's own sonographic evidence are important for a accurate sonographic diagnosis.

[Quantitative technics in ultrasonic diagnosis]. / Quantitative Verfahren bei der Ultraschalldiagnostik.

This paper presents techniques for computer-aided analysis of medical ultrasonic images. Methods of image processing, feature extraction and a classification algorithm for tissue characterization are described. Based on these techniques a pattern recognition system for semi-automatic analysis of ultrasonic images has been developed and proved within three clinical studies, which aimed to improve the ultrasound diagnosis of the prostate, the thyroid and the female breast. The results show that computer analysis of ultrasonic images is capable of providing a quantitative diagnosis as well as of differentiating tumor lesions by sonography.

[Clinical importance of routine sonographic studies in gynecology]. / Klinische Bedeutung routinemässiger sonographischer Untersuchungen in der Frauenheilkunde.

In a prospective study, the authors screened a total of 2.070 patients. Of these, 213 showed unexpected sonographic findings. 96 of these patients were women. Gynaecological diseases or changes in the minor pelvis were least represented. This proportion is so small that routine sonography does not appear worth while as far as gynaecology is concerned. For, if we take the incidence of adnexal tumours into account, relevant chance findings can be expected in only 2.8 cases out of one million, which makes the screening process uneconomical.

[Double images in B-mode sonography due to acoustic dispersion lenses]. / Doppelbilder bei der B-Bild-Sonographie durch akustische Zerstreuungslinsen.

Clinical observations revealed that duplication artifacts in B-mode-ultrasound depend on rib cartilage in the sound field. The in-vivo conditions were imitated by watertank experiments with an acrylic glass magnifier which has the properties of an acoustic dispersing lens. With this the duplication artifacts proved to be caused by acoustic dispersing lenses, in-vivo due to rib cartilage, for example.

[Sound beam dimensions as the cause of artifacts in B-mode sonography]. / Schallkeulendimensionen als Artefaktursache bei der B-Bild-Sonographie.

In B-mode-sonography artifacts arise because the beam dimensions are reduced to a single line with limited depth. Real-time range ambiguities, bow-shaped artifacts, and slice-thickness artifacts are important in clinical ultrasound examinations.

[Computer-assisted evaluation of ultrasound images of the prostate]. / Computergestützte Auswertung von Ultraschallbildern der Prostata.

The prostate was examined by sonography to diagnose tumourous changes in the organ. Several visual parameters were found to interpret the pictures. The ultrasonic images can be prepared and improved by means of image-processing algorithm were computed while evolving a method for the automatic evaluation of ultrasonic images. The value of this method and its results are discussed.

[Clinical testing and improvement of an ultrasound method for detection of pathologic changes in the breast]. / Klinische Erprobung und Weiterentwicklung einer Ultraschallmethode zur Erkennung pathologischer Veränderungen der Mammae.

Recent years have seen rapid advances in ultrasound techniques, increasing the chances of early diagnosis of changes in the female breast, irrespective of the presence of signs or symptoms. Sonography is excellent for the observation of breast tissue changes. However in common with other medical imaging techniques, it does not provide qualitative data--it is only a diagnostic guide. The article, therefore, includes a list of criteria which are useful in differential diagnosis of benign and malignant tissue changes.

[Prerequisites for offering ultrasound services in general practice]. / Voraussetzungen für die Erbringung von sonographischen Leistungen in der Praxis.

In the course of the past few years, sonography has become firmly established in clinical practice. The accuracy of the investigations does not only depend on the quality of the equipment used but also to a considerable degree on the standards of investigator training. To reduce the discrepancy between the number and quality of the investigations in the German Federal Republic, the "Kassenärztliche Vereinigung" has released guidelines requiring the users of sonographic equipment to undergo theoretical and practical training. These guidelines are reviewed and commented.