[Direct costs of diabetes mellitus in Germany: first estimation of the differences related to educational level]. / Direkte Krankheitskosten von Diabetes mellitus in Deutschland: erste Abschätzung der Unterschiede zwischen Bildungsgruppen.

OBJECTIVE: There are many studies on health inequalities, but these are rarely combined with cost-of-illness analyses. If the cost-of-illness were to be calculated for the individual status groups, it would be possible to assess the economic potential of preventive measures aimed specifically at people from low status groups. The objective of this article is to demonstrate for the first time the preventive potential by taking the example of diabetes mellitus (DM) from an economic perspective. METHODS: Based on a systematic literature review, the average direct costs per patient with DM were assessed. Then, the prevalence of DM among adults with different educational levels was estimated based on the nationwide survey 'German Health Update' (GEDA), conducted by the Robert Koch-Institute in Germany in 2009. Finally, the cost and prevalence data were used to calculate the direct costs for each educational level. RESULTS: The direct costs of DM amount to about 13.1 billion € per year; about 35% of these costs can be attributed to patients with a low educational level. Thus, their share of the total costs is about 67% higher than their share of the total population. If the prevalence in the group with 'low educational level' (14.8%) could be reduced to the prevalence in the group with 'middle educational level' (7.9%), this would save about 2.2 billion (about 16.5%) € of direct costs. DISCUSSION: The analysis provides a first estimate of the potential savings from an effective status specific prevention programme. However, the direct costs per patient used were only an average for all people with DM, as a breakdown by educational level was not available. Since education can also affect health behaviour and compliance, which are also determinants of cost, the analyses presented here are probably conservative.

Essential fatty acid depletion of renal allografts and prevention of rejection.

A central hypothesis in transplantation biology is that resident leukocytes expressing class II histocompatibility antigens may determine the immunogenicity of an organ. By means of a novel method to deplete the kidney of resident leukocytes, essential fatty acid deficiency (EFAD), this hypothesis was tested in an intact, vascular organ. Kidneys subjected to EFAD and thus depleted of resident Ia-positive macrophages survived and functioned when transplanted across a major histocompatibility antigen barrier in the absence of immunosuppression of the recipient. Control allografts were rejected promptly. Allografts from donors subjected to EFAD normalized their lipid composition and were repopulated with host macrophages by 5 days. Administration of Ia-positive cells at the time of transplantation established that the resident leukocyte depletion induced by EFAD was responsible for the protective effect. These observations may provide insights into the mechanisms underlying tissue immunogenicity and the population of normal tissues with resident leukocytes.

Inverted-U incision for exploration of the distal phalanx.

A representation of a modified inverted-U incision over the dorsal aspect of the distal phalanx is presented. The incision consists of a curved, proximally based U-shaped flap and provides direct exposure of the extensor terminal tendon and distal joint articulation. Since the flap is proximally based, there is no danger of vascular compromise. It gives an excellent exposure without having to struggle with retractors, and it can be performed without the aid of an assistant. In our series, there has not been a single incident of complication, and the favorable appearance after healing makes this incision one of our favorites.

Effects of furosemide on the plasma and urinary concentrations and the excretion of fentanyl: model for the study of drug interaction in the horse.

The effects of furosemide (0.55 mg/kg IV) on the plasma and urinary fentanyl (PFE UFE) concentrations were studied during steady-state conditions. The PFE during the steady-state period was 0.31 +/- 0.027 ng/ml, with no significant changes occurring, even though the rate of excretion of fentanyl (EX) increased during the 1st hour from 112.0 +/- 21.6 to 534.5 +/- 82.9 ng/minute. The EX returned to control levels within 3 hours, as did the UFE. The injection of furosemide increased glomerular filtration rate from 1.97 +/- 0.21 to 3.81 +/- 0.75 ml/kg/min. The fractional reabsorption decreased from a control of 70.3 +/- 6.2% to 25.2 +/- 2.3% during the 1st hour, returning to control levels at 3 hours after furosemide was given. The total body clearance of fentanyl increased slightly during the peak period of diuresis. The return of EX, fractional reabsorption, UFE, and clearance of endogenous creatinine to control levels occurred before the return of urine specific gravity, indicating the ability of the kidney to concentrate fentanyl before its water concentrating capacity had returned.

Isolated rupture of the tibialis anterior tendon associated with a fracture of the tibial shaft: a case report.

A case is presented wherein a 19-yearold woman sustained a spontaneous rupture of the tibialis anterior tendon following the fracture of her distal tibia in a motorcycle accident. The details of the operative procedure are described, as well as a discussion of the historic and contemporary treatment modalities for this injury. Subsequent to the tendon reconstruction, the patient underwent a vigorous physical therapy program to correct the dorsiflexion deficit. This effort resulted in the patient walking and running without discomfort, and the achievement of excellent range of motion and dorsiflexion of the injured leg.

[Risk pregnancies and how to treat them]. / Risikoschwangerschaften und deren Therapie.

UNLABELLED: Recurrent abortions are a common problem. A therapy with low-molecular- weight heparin is usual in deep vein thrombosis with thrombophilia, in woman with recurrent abortions or other risks, like EPH-gestosis or HELLP-Syndrom. PATIENTS, METHOD: The efficacy of a mono-therapy with LMWH (3000-16000 daily) in women with risk pregnancies has been examined prospectively. The dates of 676 pregnant women have been analysed and compared to the current literature about live birth rates without therapy and tot he results of other, similar studies. The live birth rate has been the target variable. RESULTS: We obtained main a live birth rate of 98.6%. There has been no record of serious adverse effects. We obtained a live birth rate of 95.8% if NMH therapy starts early, and a live birth rate of 100% if NMH therapy starts between week 20 and 25. For the live birth rate the existence of thrombophilic gene polymorphisms is irrelevant. CONCLUSION: The high live birth weight is depended on early starting the therapy with NMH. For the late risk it is favourable to start the therapy with heparin between week 20 and 25 week of pregnancy.

[Accuracy of fit of the denture base depending on various jaw geometries. Biotechnical analysis]. / Passgenauigkeit der Prothesenbasis in Abhängigkeit unterschiedlicher Kieferkammformen. Eine biotechnische Analyse.

Good function of full dentures is closely related to an accurate fit of the denture bases. The shape of these bases depend again on the polymerization technique applied. Methods of biotechnical analysis were employed to determine the effects of the alveolar ridge, defined as an angle with the vertical plane, on the accuracy of fit. Both the expansion of castings and the curing contraction of acrylics were taken into consideration in this analysis. The relationships between an increase or reduction of the full denture base and the mechanism of adhesion to the denture-bearing area were computed and their practical implications are discussed.

[Dorsal border of denture base after SR-Ivocap polymerization]. / Dorsale Randspaltbildung an Gaumenplatten nach Polymerisation im SR-Ivocap-Verfahren.

The amount of dorsal borderspace of upper-plates after polymerisating in different dental laboratories has been measured and compared by statistically methods. This result showed a conspicuously small deviation. The overall average was to be found in the range of only 227 microns +/- 10.5 microns after water-laging for 4 weeks. This amount is conformable to the results of Marx. There is no interpretation of the high values measured by Peroz recently. This present results confirm on the contrary the clinically verification of the SR-Ivocap-polymerisating equipment.

Heterotopic renal transplantation in the rat: an advanced microsurgical training exercise.

Microsurgical training programs have instructed trainees from many surgical specialties with the expansion of these techniques into all areas of clinical surgery and experimental research. Most programs employ the rat femoral vessel model in microsurgical training. A more complex and less frequently used model, the rat renal transplantation procedure, can be used for advanced training in microsurgical and microurological techniques and offers several advantages over other microsurgical models. In the heterotopic renal transplant model, the left kidney from a donor rat is transferred to the inguinofemoral region of a syngeneic recipient. The method of revascularization can be varied from end-to-end repairs of vessels of equal diameter to those of unequal diameter. In addition to the variety of possible vascular repairs, an advantage of this model over others is that the kidney graft can be harvested by a technician, thus reducing the time commitments of the trainee. This model is ideal for microsurgeons, immunologists, and urologists, since it affords the opportunity for developing technical skills while preparing an experimental model that can be used for further research. We describe the model, the operative techniques, and the variations one can employ in performing the vascular repairs.

Replantation of a transmetacarpal amputation. A case report.

A case is presented of a 23-year-old male who sustained a traumatic transmetacarpal amputation of his nondominant hand. The injury consisted of complete severance of structures distal to the midpalm. Microsurgical reconstruction involved the primary repair of arteries, veins, nerves, extensor and flexor tendons, and metacarpal fractures. Skeletal reconstruction also employed a primary Swanson prosthesis for the fifth metacarpophalangeal (MP) joint. Early postoperative range-of-motion exercises were encouraged, with the achievement of a functionally capable replanted extremity. The general management of an amputation injury is also discussed, as it applies to a community hospital environment.

Arteriovenous shunt construction for vascular access in the rat.

A method is described that allows high-frequency venous and arterial blood sampling in the laboratory rat. After distal ligation and division of the external jugular vein and carotid artery, sections of Teflon intravenous catheters are inserted and secured with circumferential ligatures. Between these Teflon segments, a vascular circuit is maintained with the interposition of silicone tubing. The silicone tube segment has been filled with heparinized saline, divided in half, and joined at its center by another segment of the catheter. This in situ arteriovenous (AV) shunt system is secured in the neck of the host animal by creating a subcutaneous tunnel and externalization of a portion of the shunt loop. The shunt facilitates repetitive blood sampling from the conscious rat. The procedure time is approximately 45 minutes, and patency can be assured over several days. Additional uses of the system include pretreatment injection protocols and postoperative drug therapy.

[Breaking susceptibility of Ultralite-foil crowns for molars]. / Bruchsicherheit der Ultralite-Folienkrone für Kauflächenzähne.

Proceeding on the assumption that the use of massive cast gold constructions is an important factor in the question of economical dentistry a new technique of crownwork construction is presented. Ultralight construction is a method used in engineering for the production of load-bearing elements from embossed metal foils. Based on the new Ultralite-foil-crown the mechanical strength of the Ultralite-molar-crown is tested. Following the principles in construction with this new technique the results of breaking load tests of the ceramometallic Ultralite-molar-crown are discussed.

[Primary accuracy limits of Isosit 10 composite after laboratory preparation]. / Die primäre Genauigkeitsgrenze von Isosit 10 Komposit nach labortechnischer Herstellung.

A modern technique of restoring the anatomical shape of teeth by composite-onlays (Isosit-IO) has been investigated by electronic equipments and the results has been described. The border crevice produced by shrinkage due to polymerisation was found to be extremely small. Significant differences were found in the occlusal and vertical plane with 30 microns as average measuring value. Consequently the high clinically importance of this technique results of the material quality.

Use of small-caliber polytetrafluoroethylene (Gore-Tex) grafts in microsurgical training.

We present the use of polytetrafluoroethylene (PTFE) graft material as a microsurgical training model that better simulates live vessel repairs. PTFE grafts have mechanical advantages over polyethylene or silicone tubing in that they better mimic the "feel" of an arterial vessel wall, thus allowing the student to perfect counterpressor maneuvers before attempting live vessel repairs. Saving the PTFE "repairs" for later comparison and study provides the student with positive feedback that is not possible with living models. This cost-effective model has helped to shorten our directed teaching program and has reduced the use of laboratory animals.

[Long-time follow-up studies of Isosit composite for conical veneer crowns]. / Nachuntersuchungen zur Langzeitbewährung des Komposites Isosit bei Konusverblendkronen.

The long-term resistance of veneers in conical-crowns is a predominant fact of ästhetics in using this system of anchorage. 158 concical-crowns, veneered by composite ISOSIT were tested and measured after wearing 3 and 12 years. The results are: repeadings 3.2%, insufficient colour 8.9%, borderlinespace 12.1%, visible skeleton 7.6% and gross damages only 3.2%. This results may confirm the hitherto existing clinically experience in veneering conical-crowns by composites ISOSIT.