[Basic principles and clinical application of retinal laser therapy]. / Grundlagen und klinische Anwendung der Lasertherapie an der Netzhaut.

The scientific background of laser photocoagulation of the ocular fundus was studied extensively by several investigators in the 1970 s and 1980 s. The basic principles were successfully resolved during that time and clinical consequences for proper application of the laser photocoagulation for various diseases were deduced. The present paper gives an overview about the physical basics of laser-tissue interactions during and after retinal laser treatment and the particular laser strategies in the treatment of different retinal diseases. Thus, it addresses the issue of the impact on tissue of laser parameters as wavelength, spot size, pulse duration and laser power. Additionally, the different biological tissue reactions after laser treatment are presented, such as, e. g., for retinopexia or macular treatments as well as for diabetic retinopathies. Specific laser strategies such as the selective laser treatment of the RPE (SRT) or the transpupillary thermotherapy (TTT) are presented and discussed.

Benign prostatic hyperplasia.

Benign prostatic hyperplasia (BPH) is the most common cause of bladder outlet obstruction and voiding symptoms in elderly men. The pathogenesis is not fully determined but a combination of androgens and age are needed for development of BPH. Symptoms of BPH are divided into obstructive and irritative symptoms but large interpersonal variability is found and no specific BPH symptom exists. Treatment modalities include surgery (TURP, TUIP, open prostatectomy, laser ablation, balloon dilatation, hyperthermia and thermotherapy, and urethral stents) and medical therapy. TURP is the gold standard treatment and TUIP is a safe and effective alternative to TURP in patients with smaller prostates. Laser ablation, hyperthermia and thermotherapy, and urethral stents are at the present time under investigation. Balloon dilatation is FDA-approved but not often used because of low efficacy and poor long-term results. Medical treatment includes alpha-blocker or finasteride treatment and is indicated in patients with moderate to severe symptoms of BPH without a strong indication for surgery.

[Shortening diclofenac therapy by B vitamins. Results of a randomized double-blind study, diclofenac 50 mg versus diclofenac 50 mg plus B vitamins, in painful spinal diseases with degenerative changes]. / Verkürzung der Diclofenac-Therapie durch B-Vitamine. Ergebnisse einer randomisierten Doppelblindstudie, Diclofenac 50 mg gegen Diclofenac 50 mg mit degenerativen Veränderungen.

The use of nonsteroidal anti-inflammatory drugs (NSAID) such as diclofenac for treatment of degenerative rheumatic disorders of the lumbar spine is of great significance in orthopedic practice. Clinical studies have shown that concomitant treatment with vitamins B1, B6, B12 and diclofenac provides more efficient pain relief than treatment using diclofenac alone. This study was undertaken in order to determine whether the duration of treatment with diclofenac for lower back pain can be shortened by adding B-vitamins to the therapeutic regimen. From September through December of 1986, 256 patients participated in a multicenter, controlled, randomized double-blind trial which compared the clinical efficacy of diclofenac (50 mg) with a combined therapy of diclofenac (50 mg) and vitamins B1, B6, and B12 (thiamine nitrate, pyridoxine hydrochloride, and cyanocobalamine, resp.; in dosages of 50 mg, 50 mg, and 0.25 mg, resp.). Patients were treated with 3 X 1 capsule daily for a maximum of two weeks, having the option to terminate participation in the trial after 1 week in the event of total pain relief. The data of 238 patients were able to be included in the evaluation. 29 patients opted to discontinue therapy due to remission on symptoms. Nineteen (65.6%) of these patients belonged to the combined therapy group, the other 10 (34.4%) having taken diclofenac alone; this difference is statistically significant (p less than 0.05). An important aspect in the evaluation of therapy was the patient response regarding the improvement of painful symptoms which, in addition to their subjective feedback, was reflected in the test results of the "Hoppe Pain Questionnaire (HPQ)." All parameters used as a measure of pain relief indicated superior results with the B-vitamin supplemented therapy when compared with results obtained with diclofenac alone. Moreover, after 3 days of therapy the "sensory" pain factor "sharpness" improved significantly. Undesirable side-effects were documented with 39 patients, 14 of them having discontinued therapy for this reason. No statistically significant difference could be determined within this group with regard to therapy. The study results document the positive influence of B-vitamins on painful symptoms and indicate that less NSAID is needed for pain relief when combined with B-vitamins.

Human auditory on- and off-potentials of the brainstem.

Brainstem auditory evoked potentials (BAEP) elicited by bursts of white noise and 2 kHz sine waves were investigated in 3 subjects with normal hearing. The effects of Gaussian-shaped envelopes of varying half-width on the BAEP for stimulus on- and offset are demonstrated. The concept of "virtual trigger time, amplitude or energy" of the acoustic stimulus is proposed for an understanding of the effects of different envelope characteristics on the BAEP. Apart from potentials due to stimulus onset, we also found consistent potential changes after signal switch-off both for bursts of white noise and sinewaves. In the case of white noise these potentials appear to be related to a synchronized decrease in the firing rate of the cochlea and the auditory nerve. In the case of tone-bursts the potentials appear to be related to transient spectral components which elicit a new On-potential during acoustic stimulus offset.

[Behavioral rehabilitation of nonspecific symptoms occuring after craniocerbral trauma (author's transl)]. / Verhaltenstherapeutische Rehabilitation nach Schädelhirntrauma.

The purpose of this study was to develop a behavioral rehabilitation program for patients with long-term nonspecific symptoms following craniocerebral trauma. In 47 patients we analyzed symptoms typical of "illness behavior" (e.g. complaining tendency, depression, irritability, psychosomatic pain, problems in job performance and social interaction) as possible targets for behavior modification. We then developed a behavioral training program to teach the patients various techniques of self-control (relaxation, desensitization, self-image training, analysis and control of illness behavior, assertiveness, performance techniques), our program being based on studies in the U.S.A. using similar approaches. For a preliminary testing two groups of 8 and 6 patients each were treated by different therapists. The patients worked through a section of the program manual prior to each group session. During the sessions proper (a total of 8 weekly two-hour sessions) the different techniques were practiced under the therapist's supervistion. In both groups a significant reduction in illness behavior as indicated on questionnaires and in 3-month follow-up was found. These encouraging results need to be further substantiated by controlled outcome studies.