Outcomes of direct pulp capping: interrogating an insurance database.

AIM: To evaluate the effectiveness of direct pulp capping under general practice conditions. It was hypothesized that direct pulp capping is an effective procedure in the majority of cases and prevents the need for root canal treatment or extraction. METHODOLOGY: Claims data were collected from the digital database of a major German national health insurance company. Only patients who had been insurance members for the entire 3 year period 2010 to 2012 were eligible. Kaplan-Meier survival analyses were conducted for all teeth with direct pulp capping. Success was defined as not undergoing root canal treatment. Survival was defined as not undergoing extraction. Differences between survival functions were tested with the log rank test. RESULTS: A total of 148 312 teeth were included. The overall success rate was 71.6% at 3 years. The overall survival rate was 95.9% at 3 years. The success rates for single-rooted teeth (71.8%) and multirooted teeth (71.5%) were similar although significantly different (P < 0.001). Best 3-year success rates were found at low (79.7%; <18 years.) and very high age (81.8%; >85 years.). CONCLUSIONS: After direct pulp capping, more than two-thirds of the affected teeth did not undergo root canal treatment within 3 years. Although this study has the typical limits of a claims data analysis, it can be concluded that direct pulp capping is an effective intervention to avoid root canal treatment and extraction in a general practice setting.

[Anamnesis, Pathological Assessment, Therapeutic Features and Course of Disease: Retrospective Study on Clinical-Based Factors for Prediction of Cancer-Specific Survival of 378 Patients with Stage pT1 Urothelial Bladder Carcinoma]. / Anamnese, pathologische Originalbefunde, Therapie bezogene Parameter und Krankheitsverlauf: retrospektive Analyse von klinisch basierten Faktoren für die Prognose des tumorspezifischen Überlebens von 378 Patienten mit pT1-Harnblasenkarzinom.

BACKGROUND: Urothelial carcinoma of the bladder (UBC) at stage pT1 is a heterogenous disease. Established criteria for prognosis prediction are not suitable for every patient. Choosing the right therapeutic strategy for the individual patient thus remains a challenge. The aim of the present study was to identify clinical parameters regarding cancer-specific survival (CSS) in patients with pT1 UBC. MATERIALS AND METHODS: A retrospective analysis of clinical parameters of all patients with a pT1 UBC between 1989 and 2012 from a single centre was performed. Treatment consisted of transurethral resection, second resection followed by initially bladder sparing treatment. Anamnestic data, histopathological reports and clinical course were assessed with CSS being defined as primary endpoint. Kaplan-Meier analysis, uni- and multivariate analysis were performed using SPSS (Version 22, IBM). RESULTS: 378 patients (78% male, median age 72 years) were included, median follow-up was 35 months. Pathological stage pT1G3 (66 vs. 91%, p<0.001), lack of instillation therapy (66 vs. 83%, p<0.001), presence of a second malignoma (41 vs. 77%, p=0,004), diagnosis after 2000 (75 vs. 76%, p=0,018) and tumour progress (42 vs. 85%, p<0.001) were associated with a worse CSS in univariate and Kaplan-Meier analysis. Multivariate analysis revealed the presence of a second malignoma (HR 2.267; CI 95% 1.143-4.497, p=0.019), pathological stage pT1G3 at initial diagnosis (HR 4.567; CI 95% 2.040-10.22, p<0.001) and tumour progress (HR 3.742; CI 95% 1.544-9.069, p=0.003) as independent negative predictors of CSS. Instillation therapy was a prognostic factor for improved CSS (HR 0.368; CI 95% 0.212-0.638, p<0.001). CONCLUSION: The present study identified the presence of a second malignoma, pathological stage pT1G3 and tumour progress as negative predictive factors for CSS. Maintenance instillation therapy after reresection was associated with an improved CSS.

[Assessment of the inter- and intraobserver variability for sonographical measurement of intestinal wall thickness in dogs without gastrointestinal diseases]. / Inter- und Intraobserver-Variabilität bei der sonographischen Bestimmung der Darmwanddicke von Hunden ohne gastrointestinale Erkrankungen.

OBJECTIVE: The aim of the present study was to determine inter- and intraobserver agreement for transabdominal ultrasonographic measurements of the intestinal wall in dogs without gastrointestinal diseases. MATERIAL AND METHODS: This prospective study included 30 dogs diagnosed with a non-gastrointestinal disease and were evaluated using a transabdominal ultrasound scan in our clinic. Transverse ultrasonographic images for each segment (duodenum, jejunum, colon descendens) were obtained. These images were masked, randomized and imported as DICOM files in the OsiriX® version 5.0 program for Mac Os X. Two observers independently determined the intestinal wall thicknesses using the software inherent measurement tools. The measurements were repeated five times for each segment in all patients on 4 consecutive days. Therefore, each observer performed 1800 measurements, and 3600 measurements in total were analyzed. RESULTS: The mean values for each intestinal segment were comparable to those in the literature. The statistical analyses showed a significant positive correlation (p  <  0.01) for the inter- and intraobserver measurements at all intestinal locations. There was very high intraobserver repeatability for the measurements, with deviations of <  10%. In addition, the study displayed good interobserver reproducibility for the measurements of all intestinal segments, with variances of <  20% for the duodenum and jejunum, and <  50% for the colonic wall thickness. Even with these variances the interobserver variability for all segments was much less than the mean deviance between normal and diseased dogs. CONCLUSION AND CLINICAL RELEVANCE: Transabdominal ultrasonography is a practicable tool to assess intestinal wall thickness and integrity in small animal medicine. Our results are comparable to established reference ranges for the normal canine intestinal wall thickness. In addition, we found a good inter- and intraobserver agreement for the measurements of the canine wall thicknesses in dogs without gastrointestinal diseases.

What can ecological data tell us about reasons for divergence in health status between West Central Scotland and other regions of post-industrial Europe?

BACKGROUND: The link between the effects of de-industrialization (unemployment, poverty) and population health is well understood. Post-industrial decline has, therefore, been cited as an underlying cause of high mortality in Scotland's most de-industrialized region. However, previous research showed other comparably de-industrialized regions in Europe to have better and faster improving health (with, in many cases, a widening gap evident from the early to mid-1980s). OBJECTIVES: To explore whether ecological data can provide insights into reasons behind the poorer, and more slowly improving, health status of West Central Scotland (WCS) compared with other European regions that have experienced similar histories of post-industrial decline. Specifically, this study asked: (1) could WCS's poorer health status be explained purely in terms of socio-economic factors (poverty, deprivation etc.)? and (2) could comparisons with other health determinant information identify important differences between WCS and other regions? These aims were explored alongside other research examining the historical, economic and political context in WCS compared with other de-industrialized regions. STUDY DESIGN AND METHODS: A range of ecological data, derived from surveys and routine administrative sources, were collected and analysed for WCS and 11 other post-industrial regions. Analyses were underpinned by the collection and analysis of more detailed data for four particular regions of interest. In addition, the project drew on accompanying literature-based research, analysing important contextual factors in de-industrialized regions, including histories of economic and welfare policies, and national and regional responses to de-industrialization. RESULTS: The poorer health status of WCS cannot be explained in terms of absolute measures of poverty and deprivation. However, compared with other post-industrial regions in Mainland Europe, the region is distinguished by having wider income inequalities and associated social characteristics (e.g. more single adults, lone parent households, higher rates of teenage pregnancy). Some of these distinguishing features are shared by other UK post-industrial regions which experienced the same economic history as WCS. CONCLUSION: From the collection of data and supporting analyses of important contextual factors, one can argue that poor health in WCS can be attributed to three layers of causation: the effects of de-industrialization (which have impacted on health in all post-industrial regions); the impact of 'neoliberal' UK economic policies, resulting in wider inequalities in WCS and the other UK regions; and an as-yet-unexplained (but under investigation) set of factors that cause WCS to experience worse health outcomes than similar regions within the UK.

Accuracy of radiological tumour size assessment and the risk for re-excision in a cohort of primary breast cancer patients.

BACKGROUND: Re-operations after breast conserving surgery (BCS) are necessary, when specimen margins are not free of breast cancer cells. This study explored the accuracy of preoperative tumour size assessment and its influence on the rate of re-excisions and mastectomies. METHODS: The study included 1591 patients with invasive breast cancer, who were planned for BCS. Patient, staging and tumor characteristics were evaluated concerning their influence on re-excision and mastectomy rates. Patient and tumor characteristics comprised histopathological tumour size, HER2 status, multifocality, in situ component, grading (G), nodal status and hormone receptor (HR) status. Staging characteristics included deviation from pathological tumour size as measured by clinical examination, sonography and mammography. RESULTS: In 1316 patients (83%) sufficient treatment was possible with one operation. 275 patients (17%) had to undergo at least one further surgery as a result of positive specimen margins. In 138 patients (9%) mastectomy was ultimately necessary. In patients with a positive HER2 status, a larger tumour size, underestimation by ultrasound, an in situ component and multifocality, the risk for a re-operation was about doubled. Tumour size deviation in the mammogram or the clinical tumour size assessment did not have significant influence to the re-excision rates. CONCLUSION: Tumour size and accurate presurgical assessment of the tumour size itself are independent predictors for the need of a second surgery or even a mastectomy in patients for whom a primary BCS was planned.

New diagnostic criteria in real-time elastography for the assessment of breast lesions.

PURPOSE: Elastography is a new ultrasonographic method that has been examined as a diagnostic tool for breast lesions. This study was intended to create and define new elastographic criteria allowing assessment of whether breast lesions are malignant or benign. MATERIALS AND METHODS: 217 patients with a total of 245 breast lesions of unknown malignancy underwent ultrasound examination. The new eSie Touch Elasticity Imaging technology (Siemens, Erlangen, Germany) was used with a 10-MHz linear transducer (Acuson Antares). Lesions were examined using B-mode and real-time elastography (RTE). Each lesion was histologically assessed by core biopsy. Five RTE characteristics were examined: elasticity proportion (EP), different location on RTE in comparison with B-mode (MV), different contrast patterns (SOS), dorsal lesion limitation visibility and different size on RTE in comparison with B-mode. RESULTS: 54 malignant lesions (54 %) appeared inelastic, in contrast to the benign control group (34.5 %; P = 0.001). A completely elastic pattern was visible in 10 malignant (10 %) and 39 benign lesions (26.9 %). MV was identified in 23 cases, with 22 of the lesions being malignant and one benign. The SOS was negative in 89 malignant lesions (89 %) and positive in 100 benign lesions. The dorsal lesion limitation was visible on RTE without B-mode in 88 malignant lesions (88 %) and 27 benign lesions (18.6 %). The size was assessed as larger in 45 malignant lesions (45 %) and seven benign lesions (4.8 %). CONCLUSION: SOS and a larger tumor size on RTE are specific characteristics of malignant breast lesions. EP, MV and distal mass border are further helpful signs to assess the malignancy of tumors.

[Vitiligo. Diagnosis, differential diagnosis, and current patient management]. / Vitiligo. Diagnose, Differenzialdiagnose und aktuelle Therapieempfehlungen.

Vitiligo is characterized by patches of depigmented skin in a localized to generalized distribution. Up to now, vitiligo is not curable and mostly has a chronic and progressive course. The disorder may be part of a polygenic, multifactorial transmitted disease with an increased disposition to autoimmune disorders, which should be screened for. Depending on the age of the patient, the psychological strain, the location, the body surface area involved, and the disease activity, several conservative as well as surgical therapeutic options may be partially successful. How long the induced repigmentation remains and the effect of the available therapeutic options on the natural history of vitiligo remain to be clarified.

An assessment of herpesvirus co-infections in patients with CMV disease: correlation with clinical and virologic outcomes.

The effect of herpesvirus co-infections (HHV-6, HHV-7) on cytomegalovirus (CMV) disease and its response to therapy is unknown. We prospectively analyzed herpesvirus co-infections in transplant recipients with CMV disease. All patients received 3 weeks of antiviral therapy. Samples were collected at baseline (day 0) and then day 3, 7, 14 and 21 poststart of therapy. Viral load testing for CMV, HHV-6 and HHV-7 was done using quantitative PCR assays in 302 patients of whom 256 had documented symptomatic CMV viremia. In this subset, day 0 HHV-6 co-infection was present in 23/253 (9.1%) and HHV-7 in 17/253 (6.7%). Including those positive at any time point raised the prevalence to 79/256 (30.9%) for HHV-6 and 75/256 (29.3%) for HHV-7. Viral co-infection did not influence the response of CMV disease to antiviral therapy. Baseline CMV viral loads, time to eradication and risk of recurrence were similar in patients with and without HHV-6 or HHV-7 co-infection. Ganciclovir and valganciclovir had no clear effect on HHV-6 and HHV-7 viremia. In conclusion, herpesvirus co-infections are common in patients with CMV disease but with standard antiviral therapy, no clear clinical effects are discernable. Routine monitoring for viral co-infection in patients with CMV disease is not indicated.

Perfusion and molecular diffusion-weighted MR imaging of the brain: in vivo assessment of tissue alteration in cerebral ischemia.

The combined use of perfusion imaging (PI) and diffusion-weighted imaging (DWI) is opening a new window into the processes that occur during the first hours of ischemia. DWI detects changes in molecular diffusion associated with cytotoxic edema. PI characterizes the degree of regional hypoperfusion. Regions showing mismatches between DWI and PI, i.e. hypoperfused areas with normal diffusion behavior are considered potentially salvageable. We present results of 11 patients with an occlusion of the middle cerebral artery stem and spontaneous stroke evolution. Whereas the infarct was clearly visible on initial DWI and PI, surrounding tissue at risk of infarction was marked in all patients by an increased blood volume and transit time, but only in a subgroup (n = 3) where alteration were more pronounced this tissue at risk was progressively infarcted. These human DWI and PI data show alterations in the area of tissue at risk which correlates with infarct progression.

Use of the alkaline comet assay for industrial genotoxicity screening: comparative investigation with the micronucleus test.

We evaluated the suitability of the alkaline comet assay as a screening test in industrial routine testing of new chemicals. Thirty-six pharmaceutical compounds with unknown genotoxic potential were tested comparatively in the comet assay and micronucleus test (MNT) using V79 Chinese hamster cells. The comparison of results is generally based on at least two independent experiments, each with two replicate cultures at a minimum of three concentrations. We found a high degree of concordance between results of the comet assay and MNT. All compounds with negative MNT results were also negative in the comet assay. All positive compounds in the comet assay were also positive in the MNT. However, 16 of 38 positive MNT results were negative in the comet assay. Some of the contrary findings may be due to aneugenic effects, which are detected in the MNT but not in the comet assay. However, the majority of the contrary results may be a consequence of cytotoxicity, which can induce elevated micronucleus frequencies but may not lead to positive effects in the comet assay. Additional data of 39 compounds tested in the Ames test and the comet assay were compared. Four of these compounds that were Ames positive were also positive in the comet assay. However, the comet assay also detected 16 compounds that were negative in the Ames test. We believe that the comet assay in vitro is a useful, fast screening system in mammalian cells that can be used in a test battery during drug development.

Effects of fluvastatin on cardiac events in renal transplant patients: ALERT (Assessment of Lescol in Renal Transplantation) study design and baseline data.

BACKGROUND: Recent clinical trials of primary and secondary prevention of cardiovascular disease have demonstrated that lowering plasma cholesterol with 3-hydroxy-3-methylglutaryl coenzyme A (HMG CoA) reductase inhibitors ('statins') reduces morbidity and mortality from coronary heart disease in diverse patient populations. STUDY AIMS: The aim of the present ALERT (Assessment of Lescol in Renal Transplantation) study is to determine whether renal transplant recipients would also benefit from statin therapy. ALERT is a multicentre, randomized, double-blind, placebo-controlled trial to assess the effect of fluvastatin in renal transplant recipients with mild-to-moderate hypercholesterolaemia. The primary objective is to investigate the effects of fluvastatin on major adverse cardiac events (MACE). In addition, the effects on cardiovascular and all-cause mortality, as well as renal function, will be addressed. STUDY POPULATION: The study population contains patients with functioning renal allografts of more than 6 months' duration, recruited from 75 centres in Northern Europe and Canada. Patients of both sexes, aged 30-75 years, with a total cholesterol level of 4.0-9.0 mmol/l (155-348 mg/dl) were included, except for those with a history of myocardial infarction, where the upper limit for inclusion was 7.0 mmol/l (270 mg/dl). STUDY DESIGN: A total of 2100 patients were recruited by the end of October 1997 and will be followed for up to 6 years. This report presents the design features of the study (recruitment, follow-up, sample size, data analysis and study organization), along with baseline results. ALERT is the first large-scale prospective, randomized, double-blind study to address the prevention of cardiovascular mortality in renal transplant patients receiving an HMGCoA reductase inhibitor.

Determinants of resource utilization in the treatment of brain arteriovenous malformations.

BACKGROUND AND PURPOSE: Preoperative embolization of arteriovenous malformations (AVMs) is thought to improve outcome following surgical resection of these lesions. The purpose of this study was to examine the cost associated with preoperative embolization and different surgical risk categories in the surgical treatment of brain AVMs. METHODS: In a review of 126 patients treated surgically for resection of AVMs, we noted the total days spent in the hospital and calculated the associated costs (from hospital and estimated professional fees). Surgical risk category was determined using the Spetzler-Martin grading system. We examined the effect of risk category, preoperative embolization, and outcome (Rankin score) on cost and inpatient days. RESULTS: Preoperative embolization and greater surgical risk were independently associated with higher total costs. Average adjusted cost for embolization and surgery was $78,400 +/- $4,900 versus $49,300 +/- $5,800 for surgery alone. Patients ranged in preoperative risk category from Spetzler-Martin grades II through V, with an average increase of $20,100 in total cost per Spetzler-Martin grade (95% CI, $13,500 to $28,100). Higher surgical risk category was also associated with more days spent in hospital, with an average increase of 6 days per increment in Spetzler-Martin grade (95% CI, 4 to 8). After surgical resection of an AVM, new neurologic deficits were associated with large differences in cost: $68,500 +/- $6,100 and 15 +/- 2 days in hospital for patients who were neurologically worse after surgery, versus $44,700 +/- $3,900 and 10 +/- 1 days for patients who were unchanged. CONCLUSION: Preoperative embolization in the treatment of AVMs is associated with higher cost but not more days in the hospital. Patients with higher Spetzler-Martin grade AVMs utilize more hospital resources, in part because they have poorer neurologic outcome, and postoperative deficits are associated with higher costs and more days in the hospital.

[Model for cost-benefit relations of amblyopia screening]. / Modell für das Nutzen-Kosten-Verhältnis des Amblyopie-Screenings.

BACKGROUND AND PURPOSE: In Germany, 750,000 children are born per year who should be screened for developmental visual defects in the age range 24-48 months. However, the established pediatric screening program is not sufficient to prevent amblyopia. The purpose of this study was to examine the cost-effectiveness of alternatives for amblyopia and microtropia screening. METHODS: Three options were compared: (1) an orthoptic screening carried out in the field, for instance in kindergartens, (2) an examiner-independent objective apparatus-based screening, and (3) a complete ophthalmological and strabismological examination carried out in a practice. The costs of screening, follow-up examinations and of the treatment were modelled for prevalences of 1% (microtropia) and 5% (amblyopia). The benefit due to treatment was calculated as the result of an avoided whole-person impairment of 3% and 1%. The income related, increased tax and health care payments were used to cover the costs. RESULTS AND CONCLUSIONS: In options (1) and (2) there were favorable cost-effective ratios. The practice-based option 3 was economically less promising. The higher the prevalence was, the higher the resulting cost-effectiveness.

[Association of hypertension and diabetes mellitus with microangiopathic cerebral infarct patterns]. / Assoziation von Hypertonie und Diabetes mellitus mit mikroangiopathischen Hirninfarktmustern.

OBJECTIVE: To test the hypothesis of a positive association of hypertension and diabetes mellitus with cerebral small-vessel disease infarct patterns. METHODS: Using a prospective stroke database, the 152 patients with computertomographic signs of small-vessel disease (lacunes and/or leucoaraiosis)--including as a subgroup of 85 cases with multiple lacunes and/or leucoaraiosis-were compared with 106 patients featuring pial artery infarcts. Statistical analyses of the rates of hypertension and diabetes included univariate tests (odds ratios) and a logistic regression model comprising the additional variables hypercholesterolemia, cigarette smoking, carotid stenosis, atrial fibrillation, and left cardiac thrombus. RESULTS: Multivariate testing revealed a significant association of hypertension and diabetes with multiple lacunar infarcts and/or leucoaraiosis (hypertension: odds ratio 2.0; 95% confidence interval 1.04-3.7; diabetes: odds ratio 1.9; 95% confidence interval 1.01-3.8), whereas for the total group of patients with small-vessel disease lesions no such effect was found. Among the other tested variables, only atrial fibrillation/left cardiac thrombus showed a significant negative association (odds ratio 0.5; 95% confidence interval 0.2-0.9) with lacunes/leucoaraiosis. CONCLUSION: Independent of other risk factors and other possible causes of stroke, both hypertension and diabetes appear to be strong determinants of multiple lacunar infarcts and/or leucoaraiosis.

[Critical shortage of personnel in nephrology. Assessment of causes of the crisis and suggestion for solution]. / Bemanningskrise i nefrologien. Beskrivelse av årsaken til krisen og forslag til løsning.

The heavier work load for qualified nephrologists in Norway over the last ten years is described and compared with the number of positions. The increase in the number of dialysis treatments, care of renal transplant patients and other tasks performed by qualified nephrologists is roughly doubled from 1985 to 1995. By contrast the number of employed qualified nephrologists to pursue the work has only increased by 20% over the same period. As of today there is a lack of capacity to educate new nephrologists to fill up forthcoming vacancies. When the actual need for nephrologists is taken into account, the discrepancy is much more serious and will become even more so over the next ten years if no immediate action is taken. We suggest the establishment of six new educational positions. Altogether, these six new positions will provide the capacity to educate a reasonable number of trained nephrologists to meet future challenges, to the benefit of patients.

["The most ill go into psychoanalytic treatment"? Critical comments on an article in Report Psychologie]. / "Die Kränkesten gehen in eine psychoanalytische Behandlung"? Kritische Anmerkungen zu einem Artikel in Report Psychologie.

Thomas and Schmitz claim that they "deliver a proof for the effectiveness of humanistic methods" (p. 25) with their study. However, they did not or were not able to verify their claim due to several reasons: The authors did not say if and if so to what extent the treatments carried out within the framework of the TK-regulation were treatments using humanistic methods. The validity of the only criterium used by the authors, the average duration of the inability to work, must be questioned. The inferential statistical treatment of the data is insufficient; a non-parametrical evaluation is necessary. Especially missing are personal details concerning the treatment groups (age, sex, occupation, method, duration and frequency of therapy), which are indispensable for a differentiated interpretation. In addition there are numerous formal faults (wrong quotations, mistakes in tables, unclear terms etc.). In view of this criticism we come to the conclusion that the results are to a large degree worthless, at least until several of our objections have been refuted by further information and adequate inferential statistical methods. This study is especially unsuitable to prove a however defined "effectiveness of out-patient psychotherapies", therefore also not suitable to prove the effectiveness of those treatments conducted within the framework of the TK-regulation and especially not suitable to prove the superiority of humanistic methods in comparison with psychoanalytic methods and behavioural therapy.

[Alcohol, occupational accidents and their sequelae]. / Alkohol, Berufsunfälle und ihre Folgen.

Alcohol is a considerably more important risk factor for non occupational accidents than for occupational accidents, but somatic and psychosocial consequences of chronic alcohol consumption can also have very negative influences on the course of healing and professional rehabilitation. Three cases illustrate the importance of the primary and secondary prevention. They did charge the workers' compensation account of the companies involved with more than one million francs, with corresponding increases in workers' compensation premiums.

[Multiparametric analysis using radionuclide ventriculography in the assessment of left ventricular function following heart transplantation]. / Multiparameteranalyse mittels Radionuklidventrikulographie in der Beurteilung der linksventrikulären Funktion nach Herztransplantation.

Left ventricular systolic and diastolic performance was evaluated by radionuclide angiography in 17 patients following cardiac transplantation and compared with normal persons. Both groups performed supine bicycle exercise during the investigation, the control group at 102 +/- 73 W and the transplanted patients at 61.2 +/- 15 W. The ejection fraction increased in the normal persons from 61 +/- 8 to 69 +/- 10% whereas in the transplanted patients it did not increase significantly. There were no relevant changes in systolic parameters during exercise in the transplant recipients. The changes in diastolic parameters were significantly smaller in transplant patients than in normals. After correction for heart rate-induced changes a significantly different time course of the systolic-diastolic sequence during the cardiac cycle became evident in the transplanted group at rest. During exercise the systolic-diastolic sequence during the cardiac cycle became similar in both groups. It is concluded that the reduced exercise capacity of patients in the late phase after cardiac transplantation is partially due to the absence of an EF increase and a limitation of diastolic reserve during exercise.

[Concept: occupational medicine 2000]. / Konzept: Arbeitsmedizin 2000.

The group of physicians practising occupational medicine in Switzerland is actually still small, and it will need a very important development to reach, on a nation-wide base and not only within a few large companies, a standard of occupational medicine which satisfies from a social security as well as from an economical point of view. The occupational medicine has, therefore, to elucidate to the social partners and to the public the benefit for health and public welfare of its preventive activity at the workplace. The following goals are thus to be pursued: Further development of a legal basis in Switzerland equal to the standard of the neighbouring countries of the European Community Provision of sound models assuring occupational medical care of all business, in particular of the small and middle-sized business Promotion of student's education, specialist formation and continuative schooling in occupational medicine Provision of an adequate university teaching and research capacity with firm links to the practice A more powerful and competent representation of occupational medical aspects in actual discussions of health legislation and social legislation.

Low oxygen cost of carbonic anhydrase-dependent sodium reabsorption in the dog kidney.

To examine the oxygen requirement of carbonic anhydrase-dependent sodium reabsorption in the proximal tubule, 18 anaesthetized dogs were studied under conditions of saturated distal NaCl reabsorption; the latter was accomplished by volume expansion (all groups) combined with infusion of loop diuretics (groups 1 and 3). Acetazolamide reduced HCO3- reabsorption by 602 +/- 32 mumol min-1 (55%, group 1) and by 777 +/- 103 mumol min-1 (66%, group 2). This was accompanied with a reduction in sodium reabsorption and oxygen consumption in a molar delta Na/delta O2 ratio of about 45 in both groups of dogs. The delta HCO3/delta O2 ratio averaged 16 +/- 1, which was not significantly different from the theoretical value of 18 expected for transcellular sodium transport by Na+, K+-ATPase. Mannitol (group 3) reduced NaCl reabsorption by 37 +/- 2% without affecting NaHCO3 reabsorption or oxygen consumption significantly. We conclude that carbonic anhydrase-dependent NaCl reabsorption in the proximal tubules is passive, and that NaHCO3 reabsorption is the only important active sodium transport which is sensitive to inhibition of carbonic anhydrase.