[Use of the S3 guidelines for early detection of prostate cancer in urological practices]. / Anwendung der S3-Leitlinie zur Prostatakrebsfrüherkennung in urologischen Praxen.

OBJECTIVES: The German S3 guideline on prostate cancer gives recommendations on early detection of prostate cancer. In this study we analyzed the adherence of urologists in private practice from the administrative district of Münster, Germany to this guideline. METHODS: Data were collected through a semistructured survey of 22 urologists based on the COREQ checklist (Consolidated criteria for reporting qualitative research) in four focus groups consisting of five or six urologists in private practice. We developed 23 questions relating to 12 recommendations of the paragraphs of the S3 guidelines dealing with early detection of prostate cancer and prostate biopsy. The recommendations of the guideline are subdivided in nine "strong", one "optional recommendation" and two "statements". The adherence to the guideline was investigated by using frequency and qualitative content analysis (Mayring) based on a mixed methods design. RESULTS: The urologists follow six of the nine "strong recommendations" of the guideline and deviate from three. Reasons for deviations from "strong recommendations" are the following: information about advantages and disadvantages of early detection for prostate cancer, recommendation of a prostate biopsy in case of PSA level ≥4 ng/ml, and indication for repeat biopsy. CONCLUSION: Most of the "strong recommendations" are followed by the interviewed urologists of the administrative district of Münster. Contextually relevant deviations from "strong recommendations" are justified, e. g., the only limited transferability of the PSA threshold of 4 ng/ml derived from population-based studies of asymptomatic men to men presenting in a urologist's office.

[Conversional and endoscopic procedures following bariatric surgery]. / Konversionseingriffe und endoskopische Revisionsverfahren nach erfolgter bariatrischer Chirurgie.

The Roux-en-Y gastric bypass (RYGB) is the therapy of choice in bariatric surgery. Sleeve gastrectomy and gastric banding are showing higher rates of treatment failure, reducing obesity-associated morbidity and body weight insufficiently. Moreover, gastroesophageal reflux disease (GERD) can occur refractory to medication. Therefore, a laparoscopic conversion to RYGB can be reasonable as long as specific conditions are fulfilled.Endoscopic procedures are currently being applied to revise bariatric procedures. Therapy failure following RYGB occurs in up to 20 % of cases. Transoral outlet reduction is the minimally invasive method of choice to reduce gastrojejunal anastomosis of the alimentary limb. The diameter of a gastric sleeve can be unwantedly enlarged as well; that can be reduced by placement of a longitudinal full-thickness suture.Severe hypoglycemic episodes can be present in patients following RYGB. Hypoglycemic episodes have to be diagnosed first and can be treated conventionally. Alternatively, a laparoscopic approach according to Branco-Zorron can be used for non-responders. Hypoglycemic episodes can thus be prevented and body weight reduction can be assured.Conversional and endoscopic procedures can be used in patients with treatment failure following bariatric surgery. Note that non-invasive approaches should have been applied intensively before a revisional procedure is performed.

Glycaemic and insulinaemic responses to mechanical or thermal processed barley in horses.

This study was conducted to evaluate the effects of different barley processing techniques on the glycaemic and insulinaemic responses in horses. It was hypothesized that the changes in pre-caecal starch digestibility caused by barley processing would affect metabolic responses. Six horses were fed in random order: whole (WB), finely ground (FGB), steamed (SB), steam-flaked (SFB) and popped barley (PB). The total barley intake was adjusted to 630 g starch/horse/day (1.2-1.5 g starch/kg BW/day). During a 10-day stabilization period, the horses also received 6 kg grass hay/horse/day. On the blood collection day, the horses were fed their test diet (exclusively barley), and blood samples were taken at defined times for glucose and insulin analysis. The degree of starch gelatinization (DG) in the untreated or thermally processed barley was analysed using the glucoamylase method. In general, barley feeding resulted in a significant increase in mean plasma glucose and insulin concentrations within 30-45 min after feeding. While the highest glucose and insulin responses occurred after intake of SFB with a DG of 28.7%, the changes in glucose and insulin were more pronounced with PB with a DG of 95.6%, with SB (DG: 22.2%), FGB (DG: 14.9%) and WB (DG: 14.9%). The peak plasma glucose varied between 5.72 +/- 0.67 mmol/l with FGB and 6.52 +/- 0.64 mmol/l with SFB (treatment p < 0.05). These results confirm the post-prandial changes in plasma glucose and insulin after intake of the different barley products, but also show that there was no association of the highest degree of gelatinization in the different barley diets with the most pronounced glycaemic or insulinaemic response.

Effects of corn processing on the glycaemic and insulinaemic responses in horses.

This study was conducted to evaluate the effects of different corn processing techniques on the glycaemic and insulinaemic responses in horses. It was hypothesized that the changes in pre-caecal starch digestibility caused by various types of corn processing would alter the post-prandial glycaemic and/or insulinaemic response. Six horses were fed in random order: untreated, finely ground, steamed, micronized, steam-flaked and popped corn. The total corn intake was adjusted to 630 g starch/horse/day (1.2-1.5 g starch/kg BW/day). During a stabilization period of 10 days, horses also received 6 kg grass hay/horse/day. At blood collection day horses were fed their test diet (exclusively corn), and blood samples were taken at defined times. Corn feeding resulted in a significant increase in mean plasma glucose and insulin concentration, but glucose and insulin peaks as well as areas under the curve (AUC) were not clearly influenced by corn processing. The glycaemic index (in which each test diet's plasma glucose AUC was expressed relative to untreated corn) varied between 91.4 +/- 9.4% (steamed corn) and 108.4 +/- 11.8% (popped corn, treatment n.s.), the insulinaemic index (in which each test diet's plasma insulin AUC was expressed relative to untreated corn) ranged between 98.2 +/- 12.6% (steamed corn) and 121.0 +/- 29.9% (micronized corn, treatment n.s.). However, the well-established improvement in pre-caecal starch digestibility was not reflected by differences in the glucose or insulin responses.

Effects of oat processing on the glycaemic and insulin responses in horses.

This study was conducted to evaluate the effects of different oat processing techniques on the plasma glucose and insulin response in horses. In a cross-over design, six horses (ages 4-15 years, mean body weight+/-SD: 450+/-37 kg) were fed in random order: untreated oats, finely ground, steam-flaked and popped oats. The total oat intake varied between 1.05-1.5 kg/day, and the amount of diet was adjusted to a starch content of 630 g starch per day and horse (1.2-1.5 g starch/kg BW/day). During the stabilization period of 10 days, horses additionally received 6 kg grass hay. Following this adaptation period, plasma glucose and insulin responses to the respective dietary treatments were tested. Horses were fed their test diet (exclusively oats), and blood samples were collected at defined times to determine glycaemic and insulin response. Oat feeding resulted in a significant increase in mean plasma glucose and insulin concentration. However, glucose and insulin peaks as well as their respective areas under the curves were not clearly influenced by oat processing. The glycaemic index varied between 94.7+/-11.2% (steam-flaked oats) and 102.6+/-14.5% (finely ground oats, n.s.), the insulin index ranged between 93.8+/-18.9% (popped oats) and 150.0+/-77.6% (finely ground oats, n.s.). The insulin reaction to oat feeding showed a high variability between the horses. The results of this study indicate that the glucose and insulin responses are not clearly altered by the different types of oat processing. However, the glucose and insulin responses tended to be lower in thermally treated oats when compared with untreated or finely ground oats.

[Fungal involvement of the tongue and feces in dialysis-dependent patients]. / Hefepilzbefall von Zunge und Faeces bei dialysepflichtigen Patienten.

38 patients regularly receiving dialysis and 3 patients with a renal transplant were investigated with regard to possible colonization of yeasts. The tongue and stool were directly examined with Kimmig agar, the resulting yeasts were then differentiated by means of rice agar and an auxanogram. Candida albicans was the germ most frequently found both on the tongue (47.5%) and in the stool (50%). We discuss the significance of our results.

Studies on the yeast flora in patients suffering from psoriasis capillitii or seborrhoic dermatitis of the scalp.

In 65 patients with scalp psoriasis or seborrhoic dermatitis of the scalp, stool specimens, tongue swabs and scalp scales were examined for yeasts. The stool specimens showed in 70.8% of the patient group massive and in 7.7% moderate yeast colonization. Yeasts were found in 47.7% of the tongue cultures and in 12.5% of the scalp scales. Candida albicans was the predominant pathogen in the faeces and on the tongue. In comparison with a control group, frequency of yeasts in faeces and on the tongue in patients with psoriasis capillitii and seborrhoic dermatitis of the scalp could be shown to be significantly higher.

[Local therapy of pityriasis versicolor with 3 imidazole derivatives--results of a therapeutic study. Studies of the rate of recurrence]. / Lokale Therapie der Pityriasis versicolor mit drei verschiedenen Imidazolderivaten--Ergebnisse einer therapeutischen Studie. Untersuchungen zur Rezidivquote.

In a clinical study from October 1985 to July 1987, we tested the efficacy of 3 different imidazole compounds in 112 male patients suffering from pityriasis versicolor. The diagnosis was made according to clinical criteria and confirmed by microscopical investigation. Our results prove the necessity of daily treatment over a period of at least 2 weeks. After 2 weeks, the microscopical examination should be repeated. Sprays and shampoos seemed equally effective. The relapse rate turned out to be rather high. The symptom-free interval between therapy and relapse could not be correlated to any of the forms of treatment. Those patients who had to be treated for more than 2 weeks were most likely to develop a relapse within a shorter period.