[Diabetes mellitus--risk factor for atrial fibrillation. Potential therapeutic implications]. / Diabetes mellitus--Risikofaktor für Vorhofflimmern. Potenzielle therapeutische Implikationen.

The relationship between atrial fibrillation and diabetes mellitus type 2 is controversial, and various studies have demonstrated conflicting results. However, the majority of larger prospective studies published during recent years demonstrated a positive correlation. After multivariate adjustment diabetes increased the risk for atrial fibrillation at least two fold. This combination is associated with substantially increased risks of death and cardiovascular events (stroke and heart failure). Atrial fibrillation in patients with diabetes mellitus type 2 identifies individuals who are likely to obtain greater benefits from glycemic control and anticoagulants as well as antihypertensive therapy.

[Quality of OR planning. Avoiding operating room underutilization or overutilization]. / Qualität der OP-Planung. Vermeidung von Unter- oder Uberauslastung des OP-Bereiches.

BACKGROUND: Accurate scheduling of operations is essential for an efficiently used OR. The aim of this investigation was to describe the quality of OR scheduling in the analyzed OR. Furthermore suggestions for avoiding underutilization or overutilization through optimized OR planning should be addressed if possible. METHODS: The planned duration, the real duration and the differences in minutes of 10,831 operations were analyzed. The statistical distribution was determined and the median, the quartiles, the interquartile range and the number of operations with a real duration lasting longer than planned were calculated. All operations were grouped in ascending order from the shortest planned duration. All planning groups were analyzed statistically and the results were compared. RESULTS: The planned OR durations did not show a normal distribution and 34% of all operations showed a real duration lasting longer than planned. The median of the differences was 10 min indicating that 50% of all operations were finished within 10 min earlier than planned. Operations with planned longer durations (>150 min) showed significantly more frequently a real duration lasting longer than planned. Furthermore, the differences between planned and real durations were additionally larger when planned durations were longer than 150 min. CONCLUSION: Prognosis of operations with longer planned duration (>150 min) should be improved in the OR area analyzed. Scheduling of these operations at the beginning of the OR list or with a sufficient time interval towards the end of the appointed OR block time within the OR list can avoid or at least minimize underutilization and overutilization of the OR.

Papillary fibroelastomas of the heart.

Cardiac papillary fibroelastomas (CPFs), the second most common primary cardiac tumor, are benign endocardial papillomas predominantly affecting the cardiac valves. Although CPFs are rare and benign tumors, they may result in life-threatening complications. Early diagnosis of this condition is important, since it represents a surgically correctable cause of systemic embolism, myocardial infarction, stroke, acute valve dysfunction, and sudden cardiac death. This review summarizes the significance and clinical approach for the diagnosis of this cardiac entity. The differential diagnosis, histological characteristics of CPF and current treatment strategies are also discussed.

Tracheal allograft transplantation in rats: the role of different immunosuppressants on preservation of respiratory epithelium.

BACKGROUND: Bronchiolitis obliterans is the most significant complication adversely affecting the survival of lung allograft recipients. Injury and loss of epithelium are associated with obliteration of the airway lumen. The aim of this study was to examine the effects of various immunosuppressants on airway epithelium. METHODS: Tracheae from Brown Norway donors were heterotopically transplanted into the greater omentum of Lewis (allografts) or Brown Norway (isografts) animals. Recipients were treated for 28 days with FK778 (20 mg/kg), tacrolimus (4 mg/kg), or sirolimus (2 mg/kg). Tracheal segments were evaluated for the degree of luminal occlusion as well as the type and percent of luminal epithelial cell coverage. RESULTS: All agents inhibited peritracheal infiltration and luminal obliteration. Tacrolimus- more than sirolimus-treated recipients showed partial preservation of the luminal epithelial coverage, whereas animals that received FK778 showed no respiratory epithelium. The epithelial loss was accompanied by the appearance of fibrous tissue, which replaced the mucosa. CONCLUSIONS: Tacrolimus as well as sirolimus effectively prevented the development of obliterative airway disease whereas tacrolimus and, to a lesser degree, sirolimus preserved epithelial cells as a source of protective cytokines. With FK778 significant airway obliteration was suppressed despite complete epithelial loss. Thus, FK778-treated animals displayed an epithelial-independent inhibitory effect on myofibroblast proliferation.

Sexual enjoyment and orgasm postpartum: sex differences and perceptual accuracy concerning partners' sexual experience.

The sexual relations of parents at the postpartum stage have been researched relatively often, but still there exist serious research deficits (for example, neglect of male partners, of the later postpartum stages beyond the third month, and neglect of sexual feelings, enjoyment and orgasm). The aim of this study was to gain more knowledge about German couples' sexual enjoyment and orgasm with regard to non-genital tenderness, French kissing, breast stimulation, manual-genital stimulation, cunnilingus, fellatio, vaginal intercourse, anal intercourse and masturbation at seven months postpartum. As part of a larger longitudinal study 60 women and men (30 couples) answered a newly developed Sexual Preferences Questionnaire (SPQ), which assesses sexual activity and enjoyment. Descriptive data about sexual enjoyment, sex/gender differences and perceptual differences between self-report and reports of partners' enjoyment are analyzed and SPQ data are validated with interview and other questionnaire data (PFB-tenderness). Both genders find the same activities most pleasant (tenderness, vaginal intercourse, receiving manual-genital stimulation) and most exciting (intercourse, receiving manual-genital and oral-genital stimulation) and reach orgasm most easily through intercourse, masturbation and receiving manual-genital stimulation. But men generally describe a higher sexual enjoyment and overestimate their partners' enjoyment, especially with regard to female orgasm through intercourse. The results are critically discussed with regard to limitations and strengths of the sample and the method.

Sexuality in patients with noninvasive mechanical ventilation due to chronic respiratory failure.

In patients with chronic respiratory failure (CRF) noninvasive mechanical ventilation (NMV) improves quality of life. We studied some basic issues concerning sexuality in patients with NMV. In 383 patients with NMV for CRF (age, > 40 yr) physiologic data (lung function, blood gases, and exercise) were taken from within the 6 mo period before enrollment. The questionnaire was focused on sexuality after initiation of NMV. Of the patients, 54.3% sent back the questionnaire. NMV was used for 41.1 +/- 27.0 mo. A total of 34.1% of patients were sexually active. Compared with patients receiving NMV, control persons had a higher rate of sexual activity (84%, p < 0.0001) and masturbation rate (13 versus 40%). Sexually active patients had greater VC (2.1 versus 1.8 L), higher FEV(1) (1.4 versus 1.1 L), higher Pa(O(2)) at rest (64.0 versus 60.4 mm Hg), a higher maximal work load (72.0 versus 58.8 W), were younger, and most of them were married or had sexual partners. Changes in sexual activity after NMV initiation were reported to be as follows: "Nothing changed," 46.3%; "less active," 35.8%; "more active," 12.6%; and "fantasy increased," 10.5%. Increased sexual fantasy predominated in men. "Sexually active" patients with NMV had sexual intercourse 5.4 +/- 4.8 times per month. Sexuality in patients receiving NMV for CRF is markedly reduced compared with normal subjects. In half of the patients, sexual activity is influenced by initiation of NMV.

The natural course of cannabis use, abuse and dependence over four years: a longitudinal community study of adolescents and young adults.

OBJECTIVES: To determine incidence and patterns of natural course of cannabis use and disorders as well as cohort effects in a community sample of adolescents and young adults. METHOD: Cumulative incidence and patterns of cannabis use and disorders were examined in a prospective longitudinal design (mean follow-up period=42 months) in a representative sample (N=2446) aged 14-24 years at the outset of the study. Patterns of cannabis use, abuse and dependence (DSM-IV) were assessed with the Composite International Diagnostic Interview (M-CIDI). RESULTS: (1) Cumulative lifetime incidence for cannabis use (at second follow-up): 47%; 5.5% for cannabis abuse, 2.2% for dependence. (2) Men used and abused cannabis more often than women. (3) The majority of the older participants (18-24 years at baseline) had reduced their cannabis use at follow-up, while younger participants (14-17 years at baseline) more often had increased their use and developed abuse or dependence. (4) The younger birth cohort (1977-1981) tended to start earlier with substance (ab)use compared to the older birth cohort (1970-1977). (5) Cannabis use was associated with increasing rates of concomitant use of other licit and illicit drugs. CONCLUSIONS: Cannabis use is widespread in our sample, but the probability of developing cannabis abuse or dependence is relatively low (8%). The natural course of cannabis use is quite variable: about half of all cannabis users stopped their use spontaneously in their twenties, others report occasional or more frequent use of cannabis.

[Pair bonding and attachment. A meta-analysis of 63 studies published between 1987 and 1997]. / Paarbeziehung und Bindung. Eine Meta-Inhalts-Analyse von 63 Studien, publiziert zwischen 1987 und 1997.

UNLABELLED: Starting with Hazan and Shaver (1987) [8] a new field of research has been opened, couple relationship and attachment, which is attracting increasing interest worldwide. METHOD: 63 primary studies, published between 1987 and 1997, on partner relationship and adult attachment were systematically content analysed with regard to their methodology (samples, designs, methodology of data-collection with regard to attachment status and to couple relationship) and their results (demographic data and sex/gender effects; concordance of attachment classifications within couples; correspondence between one partner's AAI and the other's CRI; associations between attachment and relationship stability/relationship satisfaction/partner related explanations/couple interaction/psychophysiological data/sexuality; relationship specific effects; interactions of attachment, sex/gender and relationship quality). Conceptual and methodological problems with regard to the measurement of adult attachment are critically discussed (the two "camps": AAI-researchers and self-report questionnaire researchers; categorical versus dimensional assessments; global trait or relationship specific construct; conscious or unconscious) and research conclusions derived.

Sexual activity during pregnancy and after childbirth: results from the Sexual Preferences Questionnaire.

The sexual relations of expectant and young parents have been researched relatively often, but most studies are restricted to female participants, samples from the USA, a short postpartum period and a reductionist view of sexuality as equivalent to intercourse. The aim of this study is to gain more knowledge about sexual activity of German couples with regard to non-genital tenderness, French kissing, breast stimulation, manual-genital stimulation, cunnilingus, fellatio, vaginal intercourse, anal intercourse and masturbation during pregnancy and the first 6 months postpartum. As part of a larger longitudinal study, 60 women and men (30 couples) answered a newly developed Sexual Preferences Questionnaire (SPQ) which assesses sexual activity and enjoyment. The frequency of most heterosexual activities declined during pregnancy, reached almost zero in the first 3 months postpartum, and then began to increase; male masturbation remained relatively constant. Agreement between the two members of each couple was assessed and SPQ data were validated with other questionnaire data and interview data. The results are discussed with regard to limitations of the sample. Future research should broaden the range of questions investigated, the range of research methods applied (questionnaires and interviews) and the range of persons researched (both partners).

[Homocysteine, endothelial dysfunction and cardiovascular risk: pathomechanisms and therapeutic options]. / Homocyst(e)in, endotheliale Dysfunktion und kardiovaskuläres Risiko. Pathomechanismen und therapeutische Optionen.

Elevated homocyst(e)ine plasma concentrations are an independent risk factor for cardiovascular disease. Hyperhomocyst(e)inaemia is common in patients with peripheral arterial occlusive disease, coronary heart disease, cerebrovascular disease, carotid artery stenosis and venous thromboembolism. Endothelial dysfunction may be one underlying cause leading to proatherogenic effects associated with hyperhomocyst(e)inaemia. However, the mechanisms which lead to impaired endothelial function in hyperhomocyst(e)inaemia are not fully understood. Recent evidence suggests that homocyst(e)ine may interact with physiological mediators of the endothelial matrix. Oxidative mechanisms and decreased biological activity of endothelium-derived nitric oxide (NO) may also contribute to homocyst(e)ine-associated endothelial dysfunction. B vitamins are essential cofactors in the metabolism of homocyst(e)ine to methionine via the remethylation-pathway (vitamin B12, folic acid) and to cystathionine via the transsulphuration-pathway (vitamin B6). Dietary deficiencies of folic acid, vitamin B12, and vitamin B6 appear to be common among elderly people in the western world and represent one pathogenic factor related to the incidence of hyperhomocyst(e)inaemia. Several studies have demonstrated that dietary supplementation with folic acid and the vitamins B12 and B6 is an efficient means to decrease plasma homocyst(e)ine. No clinical studies are available to date to prove whether reducing homocyst(e)ine levels to the normal range by supplementary B vitamins will also beneficially affect vascular function or cardiovascular risk. Furthermore it is unknown whether moderately elevated homocyst(e)ine concentrations per se may predispose to development of vascular disease, or whether homocyst(e)ine is an indirect marker of cardiovascular disease. Further investigations will be necessary to elucidate the causal relationship between elevated homocyst(e)ine plasma concentrations and the incidence of cardiovascular events, especially since the therapeutic strategies in hyperhomocyst(e)inaemia would differ depending on the underlying pathophysiological mechanisms.

LDL cholesterol upregulates synthesis of asymmetrical dimethylarginine in human endothelial cells: involvement of S-adenosylmethionine-dependent methyltransferases.

Asymmetrical dimethylarginine (ADMA) is an endogenous nitric oxide synthase inhibitor. It is formed by protein arginine N-methyltransferases (PRMTs), which utilize S-adenosylmethionine as methyl group donor. ADMA plasma concentration is elevated in hypercholesterolemia, leading to endothelial dysfunction and producing proatherogenic changes of endothelial cell function. Four different isoforms of human PRMTs have been identified. Because the release of ADMA from human endothelial cells is increased in the presence of native or oxidized LDL cholesterol, we investigated the potential involvement of PRMT activity and gene expression in this effect. We found that the production of ADMA by human endothelial cells is upregulated in the presence of methionine or homocysteine and inhibited by either of the methyltransferase inhibitors S-adenosylhomocysteine, adenosine dialdehyde, or cycloleucine. This effect is specific for ADMA but not symmetrical dimethylarginine. The upregulation of ADMA release by native and oxidized LDL is abolished by S-adenosylhomocysteine and by the antioxidant pyrrollidine dithiocarbamate. Furthermore, a methyl-(14)C label is transferred from S-adenosylmethionine to ADMA but not symmetrical dimethylarginine, in human endothelial cells. The expression of PRMTs is upregulated in the presence of native or oxidized LDL. Our data suggest that the production of ADMA by human endothelial cells is regulated by S-adenosylmethionine-dependent methyltransferases. This activity is upregulated by LDL cholesterol, which may be due in part to the enhanced gene expression of PRMTs. In concentrations reached by stimulation of methyltransferases (5 to 50 micromol/L), ADMA significantly inhibited the formation of (15)N-nitrite from L-[guanidino-(15)N(2)]arginine. These findings suggest a novel mechanism by which ADMA concentration is elevated in hypercholesterolemia, leading to endothelial dysfunction and atherosclerosis.

Plasma concentration of asymmetric dimethylarginine, an endogenous inhibitor of nitric oxide synthase, is elevated in monkeys with hyperhomocyst(e)inemia or hypercholesterolemia.

Hyperhomocyst(e)inemia is associated with endothelial dysfunction. Mechanisms responsible for endothelial dysfunction in hyperhomocyst(e)inemia may involve impaired bioavailability of endothelium-dependent nitric oxide. We tested the hypothesis that hyperhomocyst(e)inemia is associated with an elevated plasma concentration of asymmetric dimethylarginine (ADMA), an endogenous inhibitor of nitric oxide synthase. One group of adult cynomolgus monkeys was fed either a control or hyperhomocyst(e)inemic diet for 4 weeks in a randomized crossover design. The second group was fed an atherogenic diet that produces both hyperhomocyst(e)inemia and hypercholesterolemia for 17 months, followed by an atherogenic diet supplemented with B vitamins for 6 months to decrease plasma homocyst(e)ine concentration. Human endothelial cells were used to study the effects of methionine and homocysteine in the presence or absence of B vitamins or the methylation inhibitor S-adenosylhomocysteine on the formation of ADMA and its inactive stereoisomer, symmetric dimethylarginine. The hyperhomocyst(e)inemic diet produced 2- to 3-fold increases in plasma levels of homocyst(e)ine and ADMA (both P<0.05). The atherogenic diet also produced elevated plasma levels of homocyst(e)ine and ADMA (both P<0. 05). Supplementation of the atherogenic diet with B vitamins decreased the plasma levels of homocyst(e)ine but did not affect the plasma levels of ADMA or endothelial function. There was a strong correlation between plasma ADMA and homocyst(e)ine and a strong inverse correlation between ADMA and carotid artery relaxation to acetylcholine. ADMA release by cultured endothelial cells was significantly increased in the presence of methionine or homocysteine. This effect was blocked by S-adenosylhomocysteine but not by B vitamins. We conclude that plasma levels of ADMA are elevated in hyperhomocyst(e)inemia. Because ADMA acts as a competitive inhibitor of endothelial nitric oxide synthase, these findings suggest a novel mechanism for impaired endothelial function in hyperhomocyst(e)inemia.

[Sexuality of older women. The effect of menopause, other physical and social and partner related factors]. / Die Sexualität älterer Frauen. Der Einfluss von Menopause, anderen körperlichen sowie gesellschaftlichen und partnerschaftlichen Faktoren.

Research on female sexuality in middle and old age (50-90 years) is reviewed. The descriptive results of the studies published up to now are summarized according to the dimensions of sexual activity (e.g. intercourse, tenderness, masturbation) and interest. The influence of various factors on female sexuality in middle and old age is critically discussed, namely health/body (health; general changes in sexual reactions; menopause), society (population structure; "double standard of aging"; historical-biographical influences) and couple relationship. Altogether, female sexuality is highly variable. The most prevalent psychosexual problems of older women are not the classic medical complaints (e.g. dyspareunia, insufficient lubrication) but a lack of tenderness and of sexual contact. The effect of the hormonal changes of the menopause is smaller than the effect of psychological, society- and partner-related factors. The so-called "Hormone replacement therapy" does not have significant effects on most sexual dimensions.

Sexuality during pregnancy and after childbirth: a metacontent analysis of 59 studies.

The aim of this study is to gain a systematic overview of all existing studies on parental sexuality during pregnancy and the postpartum period (months 1-6). Investigations of psychological and medical data banks and cross-references revealed 59 relevant studies published in English or German between 1950 and 1996. These primary studies were metacontent analyzed, according to the following categories: methodology (samples, designs): type of descriptive data researched (sexual activity, interest, enjoyment, orgasm, problems); and type of correlational data researched (sexual variables and pregnancy outcome, maternal physical and psychological health, sociodemographic data, biographical data, partnership data). On average, female sexual interest and coital activity declines slightly in the first trimester of pregnancy, shows variable patterns in the second trimester, and decreases sharply in the third trimester. Most couples do not practice intercourse for about 2 months around the delivery. Afterwards, sexual interest and activity tends to be reduced for several months as compared with the prepregnancy level, and sexual problems occur relatively often. But most remarkable is the interindividual variability concerning sexual responsiveness, orgasm, activity, and enjoyment. Descriptive research is focused on coital activity of (expectant) mothers. Data about fathers, noncoital activities, and sexual feelings are scarce. Data analysis is focused on three questions: (1) Does sexual activity in pregnancy harm the fetus? (if there are no risk factors: no); (2) Are physical and mental symptoms or data about the delivery and sexual variables correlated? (in some cases: yes); (3) Are sociodemographic data and sexual variables correlated? (mostly not). Research deficits (e.g., conceptual reductionism "sexuality=intercourse," neglect of the male partners, validity, reliability, neglect of the nonsexual partnership and of biographical influences) are critically discussed. Medical, counseling, and psychotherapeutic implications are derived.

Attitudes toward psychotherapists, psychologists, psychiatrists, and psychoanalysts. A meta-content analysis of 60 studies published between 1948 and 1995.

Sixty studies, published between 1948 and 1995, on attitudes toward mental health professionals, particularly psychotherapists, were systematically content analyzed. Descriptive results concerning the topics status, expertise, personality attributes, physical appearance, sex/gender, psychotherapeutic settings, and interactions between therapists and clients are presented. Public-image problems of psychotherapists, research deficits, methodological problems, and sex/gender issues are critically discussed.

Female sexuality and historical time: a comparison of sexual biographies of German women born between 1895 and 1936.

Ninety-one German women ages 50 to 91 years (birth cohorts: 1895 to 1936) were interviewed in-depth about their sexual development through the life span. This article presents the results on the historical change in female sexuality during childhood, puberty, and young marriage. The sample was divided into four subgroups, according to the year of birth, which were compared to each other. In contrast to the older groups, a higher percentage of women in the younger cohorts had experience in childhood sexual play, masturbation, "real" and faked orgasm, with historical time only having a slight influence on marital sexuality and fertility experiences. Data indicate that subjects born later were not only more experienced sexually but changed intraindividually more often in sexual matters, whereas the older women mostly "conserved" the sexual morals and habits learned in youth. Subjective sexual experience of the interviewees is illustrated by quotations.

Quantification of the negative feedback mechanism between pituitary and thyroid in subjects with normal thyroid function.

Using sufficiently sensitive and precise assays, we systematically investigated the correlation between thyrotropin, thyroglobulin, index of free thyroxine and index of free triiodothyronine after different doses of thyroxine (25, 50, 100, 150 micrograms), which were administered daily for 10 days to individuals with normal thyroid function and in a control group. Analysis of the data using relative median values expressing changes to basal values before administration of thyroxine yielded the following results: (i) thyrotropin and thyroglobulin decreased monoexponentially, depending on the doses of thyroxine administered; (ii) the extent of their decrease showed a linear correlation with the dose of thyroxine administered and was greater for thyrotropin than for thyroglobulin; (iii) the relative velocity of their decrease increased monoexponentially with the dose of thyroxine and did not differ between thyrotropin and thyroglobulin. These results provide strong evidence for a clear quantitative reaction of the feedback mechanism and confirm that the secretion of thyroglobulin is a physiological process dependent on thyrotropin. The high intra-individual variations obtained for thyrotropin were probably due to its pulsatile secretion.