[Dysphagia: definition]. / Dysphagie: definition.

Dysphagia is a terminus which describes problems during the action of swallowing of fluids and/or food. The diagnosis is made by a detailed history according to a standard questionnaire, which then allows to distinguish between oropharyngeal and esophageal dysphagia.

[Picture of Paracelsus, the physician--and we today]. / Das Arztbild des Paracelsus--und wir heute.

This article features the question whether Paracelsus and his dark, sometimes contradictory doctrine still includes some messages for modern physician. The lonely, pugnacious fighter from Central Switzerland remains today 'confused between favour and hatred from the parties'. Some contradictory examples shall outline controversies lasting for centuries. Subsequently Paracelsus' picture of nature, man and medicine is outlined, particular his meaning of nature and work of a good physician, but also his furious often unjustified overwhelming criticism about those physicians who went astray "in the labyrinthus medicorum". Sheep-physicians and wolf-physicians are confronted mercilessly and in a black and white scheme by this Lutherus medicorum. This likewise strange as well as also fascinating picture of a physician by this man of Hohenheim does not imply a clearly conceived temple inviting for an easy academic stroll. The sketch of a temple, however, serves as a symbol for the paracelsic science of healing: Philosophy, astronomy and alchemy are the three columns for the physician. These three columns are founded on virtue, the ethos of the physician. Religion the love for god, serves as a celestial roof. Finally the author expresses his opinion, that even today 500 years later, a modern, scientifically educated physician may profit from the philosophic and ethic principles of Paracelsus, who himself was a contemporary of a time of change like we are in our days.

[Medical and psychological problems of smoking]. / Medizinische und psychologische Probleme des Rauchens.

In the medical part of this review the devastating role of the "modern plague" smoking is exposed. The numerous and variable diseases of this habit or dependence are depicted. The most serious consequences of smoking concern--next to pulmonary diseases--the vascular system. Smokers are at risk for ischemic heart disease, cerebrovascular insults, peripheral arterial occlusive disease and thoracic and abdominal aortic aneurysms. The pathogenic mechanisms promoting atherosclerosis and thrombosis are reviewed: smoking promotes atherogenesis on one hand, on the other hand it initiates thrombotic and spastic vascular occlusion. Sympathico-adrenergic and hemostatic mechanisms thus affect the coronary system, partly in a reversible manner. This view is supported by the high incidence of mainly acute coronary events (infarction, instable angina, ventricular fibrillation) in smokers with rapidly improved prognosis after tobacco withdrawal. In the psychologic part of the review smoking is viewed as self-medication, and the attempt is made to depict the various types of smokers and their psychologic profiles.

[Medicine between technique and ethics]. / Die Medizin zwischen Technik und Ethik.

In modern medicine technical and ethical questions develop continuously into a tension-loaded relationship. The actual controversy between technical and ethical imperative concerns primarily the fundamental dichotomy and dialectics of modern medical technology. In a second part the ethical challenge for physicians and nurses operating in our increasingly perfect hospitals is analysed. An outlook for future conditions for more harmony between medical technology and ethics is finally presented. A new medical spirit is needed to animate medical technology and to expand it to real art of healing.

[Therapy of angina pectoris--state of the art]. / Therapie der Angina pectoris--State of the Art.

A rational therapy of angina pectoris has to consider two recent pathophysiologic insights: 1. Not only in patients with instable but also with stable angina a dynamic, vasospastic component in addition to stenosis plays an important role. Stable angina is often a mixed form of disease. 2. In many patients stable angina is complicated by silent ischemia. Therapy of stable angina has 3 goals: 1. prevention or alleviation of angina; 2. reduction of silent ischemia episodes (number, extent); 3. cardioprotection i.e. prevention of instable angina, infarction and sudden death. The pharmacotherapeutic cornerstones are the nitrates, beta-blocking agents and calcium channel blockers. Their generally equivalent efficacy in short and longterm use is clinically and hemodynamically proven without doubt. Mode of action, pharmacokinetic aspects and recent as well as controversial questions regarding this group of drugs are reviewed. The pharmacotherapy of first choice should be determined for each patient individually and not according to schematic prescription. It should encompass pathogenesis of ischemia, specific indications for or adverse effects of the 3 drug classes, the question of induction of tolerance, possible cardioprotective benefit, side effects, compliance problems and finally cost of treatment. The rational aspects of combination therapy (nitrates and beta-blockers, beta-blockers and calcium antagonists) are explained and the therapeutic procedures for instable angina are outlined.

[Goethe's struggle with depression]. / Goethes Ringen mit der Depression.

Goethe was subjected during his whole life to extraordinary psychic threats and polar tensions often to the limits of destruction. For long periods of life he travelled in the mist of depression. By steady patience, constant endurance, disciplined diligence, self-control and self-denial as well as restless activity inward and outward he resisted serious depressive threats and did not get paralyzed. He rather faced his spiritual sorrow creatively and forced it into curative poetry. While being completely uncommon, his wise but old-fashioned recipes on ways to master one's depression are a psychotherapeutic bequest and remain valuable up to our days as complement to our modern concepts.

[The clinical diagnosis of lung embolism]. / Die klinische Diagnose der Lungenembolie.

The clinical classification, pathophysiology and often difficult diagnosis of acute pulmonary embolism are reviewed. The diagnostic power of subjective and objective clinical symptoms and the diagnostic procedures (electrocardiogram, chest X-ray, echocardiography, pulmonary arteriography, pulmonary scintigraphy, determination of arterial blood gases) are evaluated and an actual investigative plan outlined. Diagnostic problems and frequent pitfalls are discussed. The often non characteristic and masked course in acute and chronically recurrent pulmonary embolism is emphasized.

[Complementary realities of physicians]. / Die komplementäre Wirklichkeit des Arztes.

The patient expects his doctor on one hand to be a reliable expert on the other hand to be an empathetic partner. Union of both polar qualities is fundamental for a doctors complementary reality. Global medicine of tomorrow is only possible if modern doctors successfully achieve a fourfold synthesis: 1. synthesis in harmony between a cortical-rational attitude (mathematical reason) and a cordial-emotional devotion (reason of the heart) 2. equal promotion of science and humanity 3. equilibrated use and culture of medical technics and medical diction and 4. increasing harmony between male values and female norms. Future medicine has to follow complemental calls expressed by technological know-how and by reliable partnership. Exemplary physicians of former times and today may guide us to such synthesis.

[Therapy of chronic heart failure]. / Therapie der chronischen Herzinsuffizienz.

Symptoms of chronic cardiac failure depend on four determinants: The initial event concerns a decrease in contractility. The resulting complex neurohumoral regulatory mechanisms are essentially sympathicomimetic and stimulate the renin-angiotensin system. Accordingly, pre- and afterload will increase and symptoms may become aggravated by dys- or arrhythmias. Symptomatic pharmacotherapy of cardiac failure is directed to these four determinants. The actual rationale for its use is presented, putting emphasis on the renewed controversy on digitalis and on the importance of vasodilators, in particular ACE inhibitors. The relevance of diagnostic evaluation before and during treatment is indicated. The adaptation of treatment according to different causative disorders leading to cardiac failure is outlined. Finally, open questions and unsolved problems are brought up.