[What motivates patients with atopic diseases to search the internet-a focus group study on expectations and demands]. / Was motiviert Patienten mit atopischen Erkrankungen zur Suche nach Informationen im Internet? Ergebnisse einer Fokusgruppenstudie zu Erwartungen und Anforderungen.

BACKGROUND: People affected by allergies with mild-to-moderate symptoms are often not treated adequately, despite the availability of prevention and self-therapy measures. Given their good and quick accessibility when seeking information, evidence- and web-based services that are user-friendly may strengthen a more independent way of handling an allergy and may also increase health literacy. In order for such services to be found and read, developers and providers need to know about information needs, demands and users' behavior. OBJECTIVES: On which occasions does the target group search for allergy-specific information? Which preferences and demands do affected persons have regarding a web-based service? MATERIALS AND METHODS: Three individual interviews and four focus groups with 37 participants (19-81 years; hay fever, n = 30; asthma, n = 17; eczema, n = 15) were conducted in four German cities. These were recorded and transcribed verbatim. A multiprofessional team developed a system for coding the texts (two independent encoders, MAXQDA analysis software). RESULTS: Those who are affected usually seek information only in case of a concrete need for action. Impulses are, among others, symptoms, suggestions from the social environment, the beginning of the allergy season or an allergy-related contact with the health system. A web-based service should primarily include information about treatment options, provide individualized support for everyday life action strategies, and promote adequate self-management skills. DISCUSSION: In order to promote self-management skills, a web-based service should focus on allergy symptoms, treatment options and day-to-day help.

Implementation and evaluation of a nurse-led decision-coaching program for healthy breast cancer susceptibility gene (BRCA1/2) mutation carriers: a study protocol for the randomized controlled EDCP-BRCA study.

BACKGROUND: Female BRCA mutation carriers have an increased lifetime risk for breast and ovarian cancer compared to the general population. Women who carry this mutation have several options to deal with their cancer risk, such as risk-reducing surgeries or intensified breast cancer screening. Previous research has shown that preferences in this scenario are highly dependent on affected women's personalities and value systems. To support these women in the decision-making process, a structured decision support consisting of decision coaching combined with a decision aid might be helpful. METHODS/DESIGN: A randomized controlled trial will be conducted in order to compare usual care with structured decision support alongside usual care. The decision support program entails nurse-led decision coaching as well as an evidence-based patient decision aid. Nurses are qualified by a 4-day training program in informed decision-making and decision coaching. Six centers for Familial Breast and Ovarian Cancer in Germany will be included in the study, with a planned sample size of 398 women. The primary outcome is the congruence between the preferred and the actual played role in the decision-making process as measured by the Control Preferences Scale. It is hypothesized that the structured decision support will enable women to play the preferred role in the decision-making process. Secondary outcomes include the knowledge and attitudes about preventive options, decisional conflict, depression and anxiety, coping self-efficacy, impact of event, and self-concept. A process evaluation will accompany the study. DISCUSSION: The EDCP-BRCA study is the first study to implement and evaluate decision coaching combined with a decision aid for healthy BRCA mutation carriers worldwide. TRIAL REGISTRATION {2A}: DRKS-ID: DRKS00015527. Registered 30 October 2019.

Atrial natriuretic peptide in severe primary and nonprimary pulmonary hypertension: response to iloprost inhalation.

OBJECTIVES: The goal of this study was to assess atrial natriuretic peptide (ANP) levels during inhalation of iloprost in severe primary (PPH) and nonprimary pulmonary hypertension (NPPH). BACKGROUND: The ANP system is activated in pulmonary hypertension and may help protect from right ventricular (RV) decompensation. It is unknown if ANP regulation is the same in severe PPH and NPPH and if the dynamic regulation is intact in a highly activated ANP system. METHODS: In 11 patients with PPH and seven patients with NPPH, right heart catheter investigations were performed. Pulmonary and systemic artery ANP and cyclic guanosine monophosphate (cGMP) levels as well as hemodynamics were measured before and after iloprost inhalation. RESULTS: The baseline hemodynamics of patients with PPH and patients with NPPH were comparable (mean pulmonary artery pressure [mPAP]: 61 +/- 5 mm Hg vs. 52 +/- 5 mm Hg, pulmonary vascular resistance [PVR]: 1,504 +/- 153 dyne.s.cm(-5) vs. 1,219 +/- 270 dyne.s.cm(-5). Atrial natriuretic peptide and cGMP levels were increased about tenfold and fivefold compared with controls in both PPH and NPPH. Iloprost inhalation significantly decreased mPAP (-9.1 +/- 2.5 mm Hg vs. -7.9 +/- 1.5 mm Hg), PVR (-453 +/- 103 dyne.s.cm(-5) vs. -381 +/- 114 dyne.s.cm(-5)), ANP (-99 +/- 63 pg/ml vs. -108 +/- 47 pg/ml) and cGMP (-4.6 +/- 0.9 nM vs. -4.2 +/- 1.6 nM). Baseline ANP including all patients significantly correlated with PVR, right atrial pressure, cardiac index, RV ejection fraction, mixed venous oxygen saturation and cGMP. CONCLUSIONS: The ANP system is highly activated in patients with severe PPH and NPPH. Atrial natriuretic peptide levels are significantly correlated with parameters of RV function and pre- and afterload. Iloprost inhalation causes a rapid decrease in ANP and cGMP in parallel with pulmonary vasodilation and hemodynamic improvement.

Superfetation occurring in connection with gamete intrafallopian transfer: a case report.

This observation reports a case of susperfetation which occurred in connection with gamete intrafallopian transfer (GIFT). The macroscopic and histological examination of a spontaneous abortion from a 33-year-old woman (15th week of pregnancy) revealed the existence of two embryos with a monochorionic diamniotic placenta (developmental age approximately 41 days) and two fetuses and a fetal remnant with a trichorionic and triamniotic placenta (developmental age approximately 98 days). The large developmental age difference of embryos and fetuses cannot be explained by retardation, because the embryos showed adequate development with the development of their placenta. Moreover, the usual causes of intrauterine growth retardation could be excluded as could retention of the embryos since the tissues showed no autolytic changes. Consequently the large developmental age difference is explained by assuming that the embryos developed from successive ovulations. A second nidation of blastocysts had occurred after the GIFT concurrently with the clinically reported hyperstimulation syndrome.

Experimental anastomosis of the rabbit fallopian tube using fibrin glue.

Experimental end-to-end anastomosis was performed in 20 rabbits with biologic tissue adhesive allogenic fibrinogen, after removal of 1 to 2 cm of the isthmus. A standardized insemination procedure was undertaken to achieve pregnancies in the animals upon which operations were performed. Without any intervention, the fertility rate was 80% after repeated inseminations in ten nonexperimental rabbits. After anastomosis of the fallopian tube using fibrin glue, the patency rate was 75% (30 of 40 fallopian tubes), and the subsequent pregnancy rate was 60% (12 of 20 animals). No spontaneous recanalization nor subsequent pregnancy was observed in the control group after removal. Histologic findings demonstrated mild to moderate tissue reactions, comparable to those observed when microsutures were used.

The effect of follicle-stimulating hormone therapy on sperm quality: an ultrastructural mathematical evaluation.

We investigated the effect of follicle-stimulating hormone (FSH) administration on the ultrastructure of spermatozoa in order to evaluate the potential of FSH therapy for improving sperm quality. Forty-six patients exhibiting idiopathic oligoasthenoterato-zoospermia who attended the intrauterine insemination (IU), in vitro fertilization (IVF), or intracytoplasmic sperm injection (ICSI) program at our clinic received FSH in daily dosages of 150 IU over a period of 12 weeks. Using transmission electron microscopy, the ultrastructural analysis of spermatozoa was performed prior to the start of FSH therapy, after the treatment had been finished, and 6 weeks posttherapy. Applying a mathematical formula based on submicroscopic characteristics, we calculated the number of morphologically normal spermatozoa. After the FSH treatment, the examined subcellular organelles achieved a higher percentage of integrity. Follicle-stimulating hormone treatment leads to a higher number of morphologically normal spermatozoa. The electron microscopic findings indicate that treatment with pure FSH may be an effective way to improve sperm quality in cases with oligoasthenoterato-zoospermia. Applying the mathematical analysis based on the whole complex of the selected sperm characteristics, we obtained a way to evaluate the success of therapy for the first time.

[Pseudocystic metastases of carcinoma of the uterine cervix mimicking polycystic liver disease]. / Métastases d'allure kystique d'un carcinome du col utérin simulant une polykystose hépatique.

Pseudocystic liver metastases are rare and mainly described in neuroendocrine or ovarian tumors. We report the case of a 46-year-old woman who presented with multiple hepatic metastases mimicking polycystic liver disease. Carcinoma of the uterine cervix had been diagnosed 9 years earlier, and initially treated by radiumtherapy and surgery. Although histological post mortem examination of the pseudocystic liver metastases was not characteristic, they were related to the uterine cervix carcinoma for the following reasons: no other primary tumor was discovered, especially carcinoid or ovarian tumors: immunostains were positive for epithelial cells and negative for the neuroendocrine panel: the cystic cerebellum metastasis had a typical histologic aspect. Uterine cervical carcinoma must thus be included in the list of tumors which may form cystic hepatic metastases.

Self-reported physical activity is associated with cognitive function in lean, but not obese individuals.

Convergent evidence demonstrates that greater physical activity is associated with better cognitive functioning across many patient and healthy samples. However, this relationship has not been well examined among obese individuals and remains unclear. The present study examined the relationship between performance-based measures of attention/executive function and self-reported physical activity, as measured by the International Physical Activity Questionnaire, among lean (n = 36) and obese (n = 36) college students. Lean individuals performed better than obese individuals on measures of attention/executive function. No significant differences in self-reported physical activity emerged between weight groups. Higher self-reported physical activity was related to faster reaction time in lean individuals but slower reaction time in obese individuals. Additionally, in lean individuals, higher levels of self-reported physical activity were related to more errors on a task of speeded inhibitory control. The results are consistent with previous research demonstrating that greater physical activity is associated with faster attention and executive function abilities in healthy samples and highlight the importance of examining reaction time and accuracy indices separately on these measures. The lack of association among obese individuals may be due in part to inaccurate self-report in the current study. Additionally, the cognitive consequences of obesity may outweigh the benefits of physical activity in this group. Future work should investigate these associations in obese individuals using physical activity interventions, as well as a combination of self-report and objective measures to investigate discrepancies in reporting.

[Therapy of pulmonary arterial hypertension]. / Medikamentöse Therapie der pulmonalen Hypertonie.

New drugs for pulmonary arterial hypertension have shown efficacy in randomized controlled trials. Endothelin receptor antagonists (ERA) and prostanoids are most important for clinical practice. Bosentan represents the first approved orally active therapy for PAH. Besides its hepatotoxicity it is mostly well tolerated. The first approved prostanoid, epoprostenol, is currently first choice only for decompensated right heart failure in PAH. It has to be delivered continuously intravenously and is prone to complications, side effects and very high costs. Alternatively, subcutaneous treprostinil can be applied. It is less risky and expensive but may cause local pain at the infusion site. Inhaled iloprost combines the features of a prostanoid with pulmonary and intrapulmonary selectivity. Alternatively, iloprost is being used as continuous intravenous infusion. The phosphodiesterase-5 inhibitor sildenafil was effective in two randomized controlled trials but has not been approved for PAH therapy.

[Differential indications for surgical technics in reproductive medicine--microsurgery, in vitro fertilization and embryo transfer, gamete intrafallopian transfer and tubal embryo transfer]. / Zur differenzierten Indikationsstellung der operativen Techniken in der Reproduktionsmedizin--Mikrochirurgie, IVF und ET, GIFT und TET.

The birth of the first baby following in-vitro fertilisation and embryo transfer (IVF/ET) in 1978 and the introduction of gamete intrafallopian transfer (GIFT) in 1984 have increased the treatment modalities in operative reproductive medicine. In tubal pathology, there are besides micro-surgery now so-called additive methods available for treating infertility. With regard to the indications, there has been severe confusion, and it is therefore imperative to define special indications for IVF/ET, microsurgery and GIFT. We do not consider these treatment modalities as alternative methods. Reproductive centres should offer all these treatments to guarantee an appropriate individual programme for each couple. Therefore, knowledge of pregnancy rates is a prerequisite for the doctor. The aim of this paper is, to define the optimal therapy while taking into account the individual problems of each couple.

Selection of patients for IVF therapy or alternative therapy methods.

Microsurgery is the treatment of choice for most patients with a tubal factor. In-vitro fertilization--embryo transfer (IVF-ET) is performed in patients with the so-called classical indications: bilateral salpingectomy and tubal damage which is not correctable by means of microsurgery. We also discuss IVF in patients who have not conceived within 1 to 2 years following microsurgery. In women with tubal re-occlusion IVF should be performed. In patients with patent tubes following microsurgery, gamete intra-Fallopian transfer (GIFT) forms part of a controlled clinical study. More clinical experience can perhaps solve the dilemma whether it is beneficial to perform GIFT or to offer IVF primarily to these patients. In patients with andrological infertility, GIFT is offered after six unsuccessful attempts of intrauterine insemination (IUI). In long-standing infertility, GIFT is performed when IUI with ovarian stimulation fails. Patients with genital pathology (patent tubes) are treated with GIFT unless it is not technically feasible. In these cases microsurgery or IVF should be discussed.

[Long-term effects of endoscopic tubal sterilization: 750 cases]. / Effets eloignes de la sterilization tubaire endoscopique: 750 cas.

PIP: This article analyzes long-term side effects, especially sexual side effects, of tubal endoscopic sterilization. A retrospective study was conducted on 251 cases representative of a group of 400 sterilized women. Only 1.9% of women complained of pain after the intervention, and 1.7% still feared pregnancy. 17% who presented gynecological disorders prior to intervention declared that their problems had disappeared, but 19.1% complained of new problems, usually pain. Sexual life was unchanged for most patients; 28.7% experienced increased libido, and 9.4% decreased libido; frequence of copulation remained unchanged, and 36.6% of patients signaled an improvement in family life after the intervention. Only 2.4% regretted the intervention. Age and parity should be carefully considered in a patient seeking sterilization, as well as psychiatric indications. The marital situation of the couple also should be investigated; indeed a decision about sterilization should be taken by the couple, and not by the woman alone. Requests for sterilization should be examined by a doctor and by a psychologist, and very often an alternate method of contraception should be offered instead of sterilization.^ieng

[Tyndallometry in patients with diabetic macular edema before and after central laser coagulation]. / Tyndallometrie bei Patienten mit diabetischem Makulaödem vor und nach zentraler Laserkoagulation.

BACKGROUND: It is known that the breakdown of the blood-retina-barrier (BRB) as well as the blood-aqueous-barrier (BAB) is one of the earliest pathopysiological changes in the diabetic eye. Some previous studies confirmed a statistically significant increase of flare values of the aqueous humor in eyes with diabetic retinopathy which is lineary correlated with the protein concentration. This study investigated the effect of a central laser photocoagulation in eyes with clinically significant macular edema on the permeability of the blood-aqueous-barrier (BAB). PATIENTS AND METHODS: We included 22 eyes of 22 patients with diabetes mellitus suffering from clinically significant macular edema determined by fluorescence angiography giving an indication for central laser treatment. Two measurements of aqueous flare were taken, the first before laser photocoagulation (grid with about 100 coagulations) and the second 6 to 8 weeks after treatment. RESULTS: The flare values before treatment were 11.4 +/- 4.1 phc/ms (4.9-23.8) and after treatment 10.0 +/- 3.5 phc/ms (5.7-16.7). There was a significant difference between both measurements (p = 0.039). CONCLUSIONS: The protein concentration of the aqeoues humor is a parameter which allows to characterize the permeability of the BAB. The central laser photocoagulation seems to seal the vessels.

[Intratubal gamete transfer--results of 219 treatment cycles in idiopathic sterility, andrologic subfertility and selected forms of genital pathology]. / Intratubarer Gametentransfer--Ergebnisse von 219 Behandlungszyklen bei idiopathischer Sterilität, andrologischer Subfertilität und ausgewählten Formen von Genitalpathologie.

Gamete Intra Fallopian Transfer was performed in 175 patients in 219 treatment cycles during the period July 1985 to December 1986. This resulted in a total of 82 clinical pregnancies. Multiple pregnancy occurred in 16 cases, two of which were triplet pregnancies and one a quadruplet pregnancy. There were 16 abortions and five pregnancies were extrauterine. Besides presenting the technique of intratubal transfer of gametes, the authors give detailed information (with discussions) on pregnancy rates in idiopathic sterility, on andrological subfertility and on selected forms of genital pathology.

[Intratubal gamete transfer]. / Intratubarer Gametentransfer.

Three years' experience with gamete intrafallopian transfer (GIFT) are reported. Between June 1985 and July 1988, 173 clinical pregnancies were achieved in 357 patients over 488 cycles; 34 biochemical pregnancies achieved have not been included. There were 44 spontaneous abortions (25.4%) and 13 ectopic pregnancies (7.5%). Multiple pregnancy occurred in 13.9%. In the group with long-standing sterility without successful treatment, a clinical pregnancy rate of 43.3% was achieved; in cases with andrological subfertility 29.6%; and in cases with genital pathology the pregnancy rate achieved was 31.7%.