[Diagnosis and treatment of osteoporosis and rheumatoid arthritis in accordance with German guidelines. Results of a survey of patients, primary care physicians and rheumatologists]. / Diagnostik und Behandlung der Osteoporose bei rheumatoider Arthritis vor dem Hintergrund der Leitliniennutzung. Ergebnisse einer Befragung von Patienten, Hausärzten und Rheumatologen (ORA-Studie).

In a cross-sectional study the prevalence of osteoporosis and osteopenia in patients with rheumatoid arthritis (ORA study) was investigated. Additionally, patients, their family doctors and rheumatologists were surveyed on their awareness of osteoporosis in RA, prevention, diagnosis, treatment and use of guidelines.In the years 2005 and 2006 a total of 532 patients with RA (98 men, 434 women) aged 23-87 years were consecutively recruited from 9 German centers for rheumatology. Clinical examination included a detailed documentation of osteoporosis medication. Dual-energy X-ray absorptiometry (DXA) was used to measure bone mineral density (BMD) at the lumbar spine and neck of the femur. Questionnaires on osteoporosis were sent to 119 family doctors (87 men, 32 women) and 44 rheumatologists (30 men, 14 women).The survey showed that rheumatologists had a higher awareness of osteoporosis in RA and compared to family doctors they estimated a higher frequency and tested RA patients more often for osteoporosis. In line with osteoporosis guidelines rheumatologists and family doctors saw an indication for densitometry in RA patients on steroid therapy and/or low intensity trauma fractures. In contrast to the 2006 recommendations of osteoporosis guidelines 50% of family doctors and rheumatologists preferred bisphosphonate off-label-therapy for premeopausal women with RA and comorbid glucocorticoid-induced osteoporosis. On the other hand 50% of premenopausal RA patients with osteoporosis did not receive any osteoporosis medication.The survey revealed a high degree of guideline compliance in diagnosing osteoporosis in RA but deficits were observed in the administration of osteoporosis medication, especially in premenopausal women.

[Prophylaxis and treatment of osteoporosis in patients with rheumatoid arthritis (ORA study)]. / Medikamentöse Osteoporoseprophylaxe und -Therapie bei Patienten mit Rheumatoider Arthritis (ORA-Studie).

OBJECTIVE: The aim of this study was to examine bone mineral density (BMD), frequency of osteopenia and osteoporosis in a representative sample of patients with rheumatoid arthritis (RA) and to describe chemoprophylaxis and treatment of osteoporosis compared to evidence-based guidelines. PATIENTS AND METHODS: In 2005 and 2006, 532 patients with RA (98 men, 434 women) aged 23-87 years were recruited from 9 German rheumatology centers. Clinical examination included a detailed documentation of osteoporosis medication. Dual-energy X-ray absorptiometry (DXA) was used to measure BMD at the lumbar spine and femoral neck. Osteopenia and osteoporosis were defined according to the criteria of the World Health Organization. RESULTS: Of the RA patients 29% had normal BMD at the spine and femoral neck, 49% of the patients had osteopenia and 22% met the criteria for osteoporosis at any site. Of the patients 60% were receiving medication for prophylaxis or therapy of osteoporosis, 38% calcium/vitamin D alone, 20% as combinations mostly of calcium/vitamin D + bisphosphonate, 1% received bisphosphonate only and 1% hormone replacement therapy. Although the frequency of osteoporosis showed no significant differences between male and female patients, women with RA used osteoporosis medication more often than men (63% versus 49%, χ²-test, p <0.05). A total of 101 RA patients (83 menopausal women, 6 premenopausal women, 12 men) received corticosteroids in a daily dose of 7.5 mg or less for at least 3 months and had DXA T-scores below -2.0 at any site. In this patient group 41% of the menopausal women, 17% of the premenopausal women and 42% of the male patients were reported to receive medication with calcium/vitamin D + bisphosphonate. Calcium/vitamin D was used by 35% of the menopausal women, none of the premenopausal women and 50% of the male patients and 18% of the menopausal women, 67% of the premenopausal women and 8% of men received no prophylaxis or treatment for osteoporosis. CONCLUSION: According to the DVO (German Society for Osteoporosis) guidelines for osteoporosis (2009) menopausal women with corticosteroid therapy < 7.5 mg per day for at least 3 months and DXA T-scores below -2.0 should receive treatment with bisphosphonate and calcium/vitamin D. The data show that there were still deficits concerning prophylaxis and treatment of osteoporosis in RA.

Toxicologic properties of fluorescent whitening agents.

From the collection of toxicologic data, it is seen that the fluorescent whitening agents are a well-investigated class of compounds. Only in one of the groups of compounds investigated did it appear advisable to discontinue the use of a particular product on the basis of the toxicologic findings. In the large number of the other cases, the findings indicate that there is a considerable degree of toxicologic safety in the use of the FWAs in soap and detergent products.

[Initial clinical experiences with mechanical heart stimulation]. / Erste klinische Erfahrungen mit der mechanischen Herzstimulation.

Rhythmical extrathoracic mechanical stimulation can produce cardiac systoles. The study was designed to determine the usefulness of this procedure in bridging the time gap between the occurrence of asystole or symptomatic bradycardia and the beginning of temporary cardiac pacing or the restoration of a sufficiently high spontaneous heart rate. The mechanical stimulator was used on 31 patients. In 10 patients sufficient circulation with palpable pulse in the femoral artery could be restored. Five patients needed temporary electrical pacing. Five of the patients successfully treated mechanically died within 24h of terminal circulatory collapse or electromechanical dissociation. Five patients could be dismissed from hospital, with only one of them needing permanent cardiac pacing. Twenty of the 21 patients who could not be stimulated mechanically died. Seventeen of those showed electromechanical dissociation when treated with transvenous endocardiac stimulation, three suffered from terminal circulatory collapse. In one patient with an instable thorax sufficient circulation could be obtained by extrathoracic mechanical stimulation. Four patients were not stimulated electrically because of old age and polymorbidity. Problems in using the extrathoracic mechanical stimulation are discussed and compared with endocardiac and extrathoracic electrical stimulation.

Studies on the reaction of skin when exposed to fluorescent whitening agents.

In hand washing tests with detergents containing fluorescent whitening agents (FWAs), the amounts of whitener left on both hands were determined by TLC spectrophotometry: they varied from 0.06 mg to 0.17 mg. Whiteners of different chemical constitutions behaved in a very similar manner. After 24 hours the skin of the treated hands was virtually free of whitener.

[Routine sonography in suspected appendicitis. A trial of 24-hour screening at a general hospital]. / Routinesonographie bei Verdacht auf Appendizitis. Versuch eines 24-Stunden-Screenings im Allgemeinkrankenhaus.

A prospective study was conducted to determine the diagnostic value of sonography in suspected acute appendicitis. From September 1987 until May 1988, the end of the study, 152 patients suspected of having "acute appendicitis" were admitted to hospital. In contrast to other recently published studies conducted by a few highly qualified examiners, we dimed at determining whether this method is useful as a 24-hour-screening performed ba y number of more or less qualified examiners. In the beginning, the patients were examined with a 3.5 MHz scanner, later on exclusively with 5 MHz linear and sector scanners. 150 cases could be evaluated, 96 of which underwent surgery. We found 35 sonographically correct results, 89 correctly negative, 4 false positive and 13 false negative diagnoses. This means a sensitivity of 73% and a specificity of 96% for the sonographical diagnostic method. In 20 cases (13%) sonography led to other diagnoses. A large majority of these findings can be detected by less experienced examiners. The goal of a 24-hour-screening could not be reached because there a competent examiner was not always available at night. It became clear that clinically obvious cases do not require sonographic conformation. The value of sonography lies with doubtful cases of appendicitis: if the ultrasound examination is negative, appendectomy can be postponed; if sonography leads to other differential diagnoses, appropriate therapy can be started immediately.

[Thromboses of the subclavian vein and jugular vein and superior vena cava: sonographic diagnosis and control of treatment using tissue-type plasminogen activator therapy]. / Thrombosen von Vena subclavia und Vena jugularis sowie Vena cava superior: Sonographische Diagnostik und Therapiekontrolle bei TPA-Lysetherapie.

In the suspected diagnosis "superior influx congestion" sonography performed with the 5 MHz linear scanner is suitable as a non-invasive method for the primary diagnosis of thrombotic occlusions of the vena subclavia and vena jugularis interna, and for follow-up monitoring under thrombolytic therapy. In successful lysis it is possible to verify a sonomorphological and Doppler sonographic sequence of stages from the freshly formed, stratified stage via the high-echo to the low-echo thrombus with formation of lacunae, as well as the recanalisation that is seen at first only at the margins and eventually becomes complete with a flow that varies with the respiration.

Autoantibody profile in progressive systemic sclerosis as markers for esophageal involvement.

We investigated the relationship between the severity and extent of esophageal involvement in patients with progressive systemic sclerosis (PSS) and the autoantibody profile. We studied 37 consecutive patients with PSS and compared their results to 25 healthy volunteers. Patients with PSS were separated into three subgroups: group 1 (antinuclear antibody [ANA] [+/-], anti-Sc170 antibody [Scl70] [-], and anticentromere antibody [ACA] [-]), group 2 (ANA [+], Scl70 [+], and ACA [-]), and group 3 (ANA [+], Scl70 [-], and ACA [+]). The lower esophageal sphincter pressure and the mean proximal esophageal amplitude were significantly lower in group 3 when compared with group 1, group 2, and the healthy controls. Distal esophageal aperistalsis was noted in 85% of group 3, 40% of group 2, and 30% of group 1. An involvement of esophageal motility was found in 100% of the patients with ACA. Our results suggest that esophageal involvement is more pronounced in patients with PSS with ACA as compared with patients with only Sc170 or ANA.

[Gastrointestinal involvement in progressive systemic scleroderma]. / Gastrointestinale Beteiligung bei progressiv-systemischer Sklerodermie (PSS).

The complained gastrointestinal symptoms in PSS are probably caused by several complex disturbances like intestinal transit disturbances (ITD), bacterial overgrowth of the small intestine caused malabsorption of bile acids and altered kinetics of intestinal hormones. 25 patients with PSS and eleven healthy controls were tested for the existence of ITD by use of the metal-detector test (MDT). Twelve patients were also tested for a malabsorption of primary bile acids by radioimmunological measurement of clolylglycine serum levels before and after a meal. In addition serum concentrations of gastrin (nine patients) and plasma concentrations of cholecystokinin (CCK) (eight patients) and motilin (eleven patients) were measured by radioimmunoassay pre- and postprandial. Interdigestive gastric emptying was accelerated in patients with PSS (53 +/- 3 min. vs. 73 +/- 7 min.; p<0.01). Small intestinal transit times were similar in both groups (115 +/- 17 min. vs. 121 +/- 13 min.). Colonic transit in patients with PSS was significant prolonged (63 +/- 6 h vs. 39 +/- 5 h; p<0.05). There were no significant differences between the two groups concerning the pre- and postprandial levels of cholylglycin. Basic and postprandial levels of gastrin, CCK and motilin were higher in the PSS group. In contrast to scintigraphic studies using semisolid meals gastric emptying of the copper pellet in PSS was accelerated. A general malabsorption of primary bile acids was not found. Prolonged colonic transit times correlate well with frequently complained obstipation. Gastric hypacidity could be the reason of elevated gastrin levels. The high motilin-levels in PSS could be due to a lack of the feed-back inhibition as a result of diminished phase-III activity of the interdigestive migrating motor complex. The elevation of CCK-levels could reflect compensation of neurogenic or myogenic disturbances of gallbladder contraction.