[Significance of regional variations in the prevalence and treatment of depressive disorders and implications for health-care research]. / Stellenwert regionaler Variationen in der Prävalenz und Behandlung depressiver Erkrankungen und Implikationen für die Versorgungsforschung.

Providing mental health care to patients with depressive disorders is accompanied by deficits in the diagnostics and in the access and adequacy of treatment. Analyzing regional variations in mental health care is of increasing importance in order to detect and explain these supply shortfalls. This paper discusses different explanatory approaches to the regional variations in diagnosed depressive disorders and their treatment. Differences in demographic structures and in patients' attitudes toward mental disorders as well as in their preferences in the choice of treatment may explain regional variation. Furthermore, the number and distribution of care providers between regions may have an effect on variation. In addition to the density and availability of care givers, the quality of care may differ because of factors such as sensitivity to the detection of depressive disorders, coding quality of diagnosis and treatment, guideline-oriented treatment, as well as treatment outcome. Small-area analyses should consider all perspectives in order to understand the complexity of regional variation in the provision of health-care services and to derive recommendations for health-care services that meet people's needs.

Imaging precessional motion of the magnetization vector.

We report on imaging of three-dimensional precessional orbits of the magnetization vector in a magnetic field by means of a time-resolved vectorial Kerr experiment that measures all three components of the magnetization vector with picosecond resolution. Images of the precessional mode taken with submicrometer spatial resolution reveal that the dynamical excitation in this time regime roughly mirrors the symmetry of the underlying equilibrium spin configuration and that its propagation has a non-wavelike character. These results should form the basis for realistic models of the magnetization dynamics in a largely unexplored but technologically increasingly relevant time scale.

Blocking of impulse conduction in peripheral nerves by local cooling as a routine in animal experimentation.

Small thermodes, cooled by the Peltier effect and heated by transistor dissipation, were developed for reversible nerve blocking. Temperature control is achieved by an electronic feedback circuit for two thermodes independently. This enables simple operation of the cooling system during animal experimentation. Any nerve temperature between 0 and 37 degrees C can be obtained within 90 s and maintained within 0.2 degree C. The instrument can be used both as a stand alone apparatus or under computer control. Effects of local cooling of the cervical vagus nerve of the rabbit on the A-wave of the compound action potential and on spontaneous activity are given as examples of application of the cooling system in biological experiments.

Dynamic activity of bladder neck and external sphincter in ejaculation.

The bladder neck shows a typical electromyographic pattern in ejaculation. It consists of periods of heightened activity rhythmically alternating with intervals of reduced activity signifying muscular contraction and relaxation. This behavior of the bladder neck is confined to its ventral part. Concurrently, the external sphincter shows a short period of increased activity before the typical rhythmical pattern which corresponds to that of the ventral bladder neck.

Vesicourethral continuity in bladder neck activity.

Electromyographic study of the bladder neck during vesical filling and emptying was performed in anesthetized dogs. Increased electrical potentials denoting active contraction of bladder neck were obtained on vesical filling. The bladder was then completely divided just above the vesical orifice, and the resulting apertures were closed to form two separate compartments. Still increased electrical potentials of bladder neck were recorded on filling the proximal compartment. We conclude that vesical neck activities are not directly dependent on the detrusor or on any anatomic continuity between bladder and urethral muscles.

Iomeprol versus iopromide for intravenous urography.

Iomeprol (B16880) is a new non-ionic tri-iodinated radiographic contrast medium. It was the aim of this double blind randomized phase III clinical trial to compare the local and systemic tolerance of iomeprol-300 (300 mg I ml-1) with the commercially available iopromide-300 (300 mg I ml-1) in a group of 198 patients needing intravenous urography. The contrast medium was injected rapidly into an antecubital vein within 2-3 min in most cases, using a standard dosage of 1 ml kg-1 body weight. The proportion of patients with an allergic diathesis was 25% in the iomeprol group and 17.3% in the iopromide group. There were no life-threatening adverse reactions. Eight patients (8%) receiving iomeprol and 6 (6.1%) receiving iopromide had a sensation of heat related to the injection of contrast medium. Only one patient (1%) in the iomeprol group and two patients (2%) in the iopromide group noted pain on injection. Although the incidence of all other side-effects was relatively high (7% after iomeprol and 11.2% after iopromide) these reactions were generally harmless. The most common symptom was nausea and/or vomiting, which occurred with the same incidence (5%) in both groups. Only one patient in each group developed urticaria or erythema. Vital parameters remained essentially unchanged in all patients. The results suggest that iomeprol is a safe contrast medium, with a tendency to produce fewer side effects than iopromide, which is known to be particularly well tolerated.

Digastric muscle response as a function of knowledge of the task to be performed.

Whether the motor programme executed by the digastric muscles during a forceful bite is modified according to a subject's expectation that the resistance between the teeth will change was investigated. There were two experimental conditions: (1) tracking a ramp (drawn on an oscilloscope screen) by biting (isometrically) on a force transducer and holding it at 120 N, and (2) tracking the same ramp with a sudden unloading at 100 N. There were two groups of experiments: (1) control experiments in which subjects underwent a sudden and unexpected unloading of the jaw, and (2) experiments in which subjects were previously informed whether or not there was to be an unloading. In all experiments the subjects co-contracted their digastric muscles during the bite as compared to the state at rest. The subjects' responses fell into the three different types: (i) those who varied the level of tonic digastric activity only as a function of the experimental condition, (ii) those who co-contracted the digastric muscles at the same time as the masseter muscles, and (iii) those who changed the contraction pattern of the digastric muscles as a function of the experimental condition. If modulation of the digastric muscles occurred this is a 'feedforward' strategy mainly based on immediate past performance.

[Hazards of electrosurgery]. / Gefahren der Lektrochirurgie

Burn accidents due to the use of electrosurgical instruments (electrotomy, electrocoagulation) are uncommon but generally serious: explosion of inflammable anaesthetics or antiseptics, local tissue necrosis by an uncontrollable current or coagulation necrosis by a high current. An appropriate use of electrosurgical instruments based on the correct range of indications is the basis for the prevention of accidents.

[Disorders of bladder function in the elderly]. / Blasenfunktionsstörungen im Alter.

Voiding dysfunction in elderly patients is not a uniform disease entity. Diseases of the cerebrospinal system, metabolic imbalances, detrusor degeneration and bladder outlet obstruction or sphincter impairment can all result in disabilities such as urinary retention and/or urinary incontinence. Although the urodynamic pattern of an uninhibited neuropathic bladder resulting from a poorly functioning corticoreticular system may seem to be normal in these elderly subjects, many of them have lost control of the micturition reflex: the warning to void occurs suddenly at full bladder capacity, and the abrupt sensation that urination is imminent cannot be controlled appropriately. Classifying these symptoms under a simple common denominator, such a detrusor instability can be misleading, because the therapeutic approach in these patients should be more highly differentiate. Detrusor overactivity may be symptomatic and associated with curable diseases of the lower urinary tract, such as bladder outlet obstruction, urinary tract infection or bladder cancer. On the other hand, some of the underlying causes of so-called idiopathic detrusor overactivity have been disclosed recently by Elbadawi et al. (1993), relating detrusor impairment to detrusor degeneration characterized morphologically by a dysjunction pattern. In this setting, it cannot be overemphasized that better knowledge of the underlying disease will result in more successful treatment of the voiding disability in such patients. Urinary incontinence in elderly patients is not always due to an incompetent urinary sphincter, and urinary retention in this age group is not always the result of a bladder outlet obstruction.(ABSTRACT TRUNCATED AT 250 WORDS)

[Drug therapy of detrusor dysfunction]. / Medikamentöse Therapie von Detrusordysfunktionen.

In a urodynamic study, the effect of carbachol, distigmine and prostaglandin-F2 alpha on neuropathic detrusor areflexia and on the non-contracting detrusor as well as the effect of scopolamine, emepronium bromide and flavoxate on the idiopathic unstable bladder and neuropathic detrusor hyperreflexia were examined. Carbachol and distigmine do not have any effect on detrusor contractility but reduce the bladder capacity by decreasing the detrusor compliance. The instillation therapy by prostaglandin-F2 alpha provokes detrusor contractions in some cases of non-contracting detrusor. Emepronium bromide and flavoxate therapy of the idiopathic unstable bladder and neuropathic detrusor hyperreflexia showed improvement of the subjective symptoms, but not of the urodynamic findings. The oral therapy of scopolamine has no effect on overactive detrusor function. Treatment of the idiopathic unstable bladder by prolonged detrusor distension with the aid of peridural anaesthesia showed satisfactory results in more than 50%.

[Urinary retention in herpes zoster]. / Harnverhaltung bei Herpes zoster.

We report on 4 cases of transient neurogenic dysfunction of the urinary bladder caused by herpes zoster. All patients noticed a slow urinary stream leading to complete urinary retention and loss of sensation following the vesicular stage of herpes zoster, necessitating the insertion of a suprapubic tube. Urodynamic evaluations revealed a detrusor acontractility, cystoscopic findings included a unilateral cystitis. Symptoms and residual urine spontaneously disappeared after 2 to 3 weeks. The cause is a sacral meningo-radiculitis with herpes zoster virus leading to a transient neuromotoric paralysis of the urinary bladder.

[Ileocystodynamics: urodynamic studies of the continent ileal bladder]. / Ileozystodynamik: Urodynamische Untersuchungen der kontinenten Ileumblase.

The continent ileal bladder represents a combination of the Kock-Pouch and enterocystoplasty (Couvelaire-Camey): a continent intestinal urinary reservoir with antirefluxive nipple-ureteroileostomy and continence providing ileourethrostomy. Urodynamic investigations demonstrate the time dependent increase of maximal capacity and compliance reaching "normal"-bladder values in comparison to corresponding age groups within 4 months. The continent ileal bladder meets all requirements for bladder substitution including low-pressure reservoir function with reflux prevention, maintained continence and controlled voiding per viam naturalem.

[Ureter replacement operations]. / Ureterersatz-Operationen.

Reviewing the recent literature and own clinical experiences, the possibilities of replacement of the ureter by isolated bowel segments, alloplastic prostheses and xenoplastic or autoplastic transplants are shown and evaluated. Although used only in single cases, the interposition of the appendix vermiformis into larger defects of the ureter seems to render the best results. The interposition of bowel segments in the urinary tract has been applied more often, the results, however, have been variable. Numerous modifications have been proposed. The use of alloplastic prostheses and free autologic transplants have--up to now--led to no satisfying long-term results. Only human deep frozen umbilical veins as xenotransplants seem to be suitable as ureter replacements.

[A urological x-ray study table with a 36-cm x-ray image intensifier]. / Ein urologischer Röntgenuntersuchungstisch neuer Konzeption mit 36 cm-Röntgenbildverstärker.

The described urological table with 14" (36 cm) image intensifier represents a new concept. Instead of the conventional technique, i.e. fluoroscopy with a 9" (23 cm) image intensifier and radiography with film-screen combinations in a cassette, all X-ray diagnostic work is done with a 14" (36 cm) image intensifier and a 100 mm spot film camera. Field size of the X-ray image intensifier as well as spot film image quality are satisfactory to replace the conventional radiographic technique. The radiation exposure of patient and examiner is reduced significantly by the spot film technique. Omission of conventional radiographic technique allows reduction of table length to 100 cm instead of the conventional 140 cm. Furthermore, the new urological table facilities the anaesthesist's access to the patient.

[Disorders of bladder function in Parkinson syndrome]. / Blasenfunktionsstörungen bei Parkinson-Syndrom.

Urodynamic evaluation was performed in 18 patients with clinically manifest Parkinson syndrome and symptomatic bladder dysfunction. Detrusor hyperreflexia was diagnosed in 10 patients (56%), 9 of whom were incontinent. A bladder outlet obstruction was found in 5 of these 9 incontinent patients. In 8 out of the 18 Parkinson patients (44%), urodynamic assessment revealed a significant bladder outlet obstruction due to a non-contractile detrusor, with large volumes of residual urine. On the basis of our results, we conclude that bladder outlet obstruction, particularly in male patients, should be relieved early, even in patients with a small prostate adenoma or sphincter sclerosis, before secondary bladder dysfunction occurs.

[The physiology of penile erection. I. Hemodynamics of penile erection]. / Die Physiologie der penilen Erektion. I. Hämodynamik der penilen Erektion.

Arterial and venous flow and pressure studies of the corpora cavernosa were performed to elucidate the hemodynamics of canine penile erection. Being able to induce erection by electrical stimulation we were able to study the functionally relevant parameters at different stages of penile erection. From our results we conclude that penile erection can be subdivided in 5 phases: (1) latent-, (2) tumescence-, (3) erection-, (4) rigidity- and (5) detumescence phase. Furthermore, a differentiation of these subdivisions is made by observing at the mechanism of the 5 different stages: phase 1 to 4 is an active phenomenon, the detumescence phase is passive only.

[The physiology of penile erection. II. Neurophysiology of penile erection]. / Die Physiologie der penilen Erektion. II. Neurophysiologie der penilen Erektion.

Selective cavernous and pudendal nerve stimulation enabled us to study the neurophysiologic-/neurovascular mechanisms of penile erection in 6 monkeys. Corporeal pressure recordings during different neurostimulation patterns demonstrated that tumescence and erection are controlled by the autonomic nervous system (Nn. cavernosi) and has to be understood as the vascular phase of erection. However, rigidity is related to the muscle tone of the striated bulbospongiosus and ischiocavernosus muscles which are innervated by somatomotoric fibers of the pudendal nerve. This mechanism is defined as the muscular phase of penile erection.

[Heat development during tur. experiments with thermoelectric urethra model (author's transl)]. / Wärmeentwicklung bei TUR: Untersuchungen am thermo-elektrischen Harnröhrenmodell.

With the help of a new urethra phantom temperatures caused by leak currents during TUR have been measured. Quantitative analysis indicates the demand for maximum output power of 120 W during TUR.

[Panurography -- a new method of combination excretory and micturitional urography]. / Panurographie - eine neue Methode der kombinierten Ausscheidungs- und Miktionsurographie.

To diagnose a vesicoureteral reflux, a new examination X-ray procedure was developed avoiding bladder catheterization: panurography. Panurography is a combination of excretion and micturition urography which for screening purposes can be performed in a single investigation without bladder catheterization. Recent advances in uroradiological imaging techniques with growing application of low-dose large-format image intensifier urography (14" image intensifier) not only reduce radiation exposure to less than 20% of that in conventional film-screen radiography, but also permit obtaining voiding cystograms which include the whole urinary tract from the kidneys to the urethra in children. Voiding conditions are improved by means of a comfortable micturition seat coupled with a uroflowmeter which automatically triggers exposures by a 10 cm-camera at preselected intervals as long as a measurable urine flow exists.

[Neurotherapy of the hyperactive bladder]. / Neuraltherapie der hyperaktiven Blase.

Results in the treatment of non-neurogenic bladder hyperactivity are unsatisfactory. However, the first promising results from neurostimulation and our own findings in the neuroanatomy and neurophysiology of the lower urinary tract have led us to consider peripheral neurostimulation of the S2 - dorsal root or dorsal nerve of the penis for treating patients with hyperactive bladder dysfunction. We report on the first 14 cases treated by peripheral neurostimulation and S2-dorsal root blockade with local anesthesia for bladder hyperactivity. The bladder function became normal, and the bladder capacity increased up to 400% under neurotherapy. The methods, results and complications are discussed.