Disclosure behaviour and experienced reactions in patients with HIV versus chronic viral hepatitis or diabetes mellitus in Germany.

Disclosure is a prerequisite to receive disease-specific social support. However, in the case of a stigmatised disease, it can also lead to discrimination. We aimed to assess disclosure rates of HIV patients and the reactions they encountered in comparison to patients with chronic viral hepatitis or diabetes mellitus and patients' general perception of disease-specific discrimination. We constructed a self-report questionnaire, anonymously assessing the size of the social environment, the persons who had been informed, and the experienced reactions as perceived by the disclosing patients, to be rated on 1-4 point Likert scales. In addition, patients were asked whether they perceive general discrimination in Germany. One hundred and seventy-one patients were asked to participate. Five rejected, thus questionnaires from 83 patients with HIV, 42 patients with chronic viral hepatitis B (n = 9) or C (n = 33), and 41 patients with insulin-dependent diabetes mellitus (type I n = 14, type II n = 27) were analysed. Whereas the size of the social environment did not differ, HIV-infected patients were least likely to disclose their disease (60.7%, SD ± 31.9) to their social environment as compared to patients with chronic viral hepatitis (84.2 ± 23.3%, p<0.0001), or diabetes mellitus (94.4 ± 10.3%, p<0.0001), respectively. Within the HIV patient group, the mean disclosure rate was highest to partners (90.9%), followed by the public environment (65.2%), friends (59.4%) and family members (43.8%). HIV patients experienced supportive reactions after 79.3 ± 26.4% of disclosures, which was the case in 91.4 ± 19.6% and 75.7 ± 36.1% of patients with hepatitis or diabetes mellitus, respectively. 69.5% of HIV patients stated to perceive general discrimination in Germany. We conclude that HIV patients had experienced supportive reactions after the majority of disclosures, but the low rate points out that their information strategy had been very selective. Societal discrimination of HIV patients is still an issue and needs to be further addressed.

An efficient synthesis of (-)-chloramphenicol via asymmetric catalytic aziridination: a comparison of catalysts prepared from triphenylborate and various linear and vaulted biaryls.

[reaction--see text] The antibiotic (-)-choramphenicol has been synthesized in only four steps from p-nitro-benzaldehyde in optically pure form from an asymmetric catalytic aziridination reaction with a chiral catalyst prepared from triphenylborate and the (R)-VAPOL ligand. Catalysts generated from the VAPOL and VANOL ligands give much higher asymmetric induction than do catalysts prepared from 6,6'-diphenylVAPOL, BINOL, and BANOL ligands.

Convergent synthesis of fully functionalized ring C allocolchicinoids. Benzannulation approach.

[reaction: see text]. A novel convergent approach to fully functionalized ring C allocolchicinoids is developed which is based on the benzannulation reaction of Fischer carbene complexes with alkynes. The efficacy of this strategy was established with the conversion of bromide 1a (R1 = Me, R2 = H) to the biaryl phenol 3a (R = Me, R(L) = Pr, R(S) = H) via the carbene complex 2a. Bromide 1b (R1 = t-Bu, R2 = OMe) was then used for the analogous preparation of the diastereomeric allocolchicinoids 3b (R = Me, R(L) = Pr, R(S) = H).

Novel [1,5] sigmatropic rearrangements of cyclohexadienones generated from Fischer carbene complexes. A new strategy for installing the C-20 angular ethyl group in Aspidospermidine alkaloids.

[formula: see text] We report here the first examples of a [1,5] sigmatropic rearrangement in a 4a-alkyl-4a-hydrocarbazol-4-one to yield a 3-alkylcarbazol-4-one with a re-aromatized indole nucleus. The reaction of 1-methyl-3-substituted-indole-2-carbene complexes 1 with terminal alkynes yields 3,4a-dialkyl-1-methoxy-9-methylcarbazol-4-ones 2. These 4a-substituted carbazolones thermally rearrange to cleanly give the more highly aromatic 3,3-dialkyl-1-methoxy-9-methylcarbazol-4-ones 3. This reaction provides a convenient entry to the Aspidosperma family of alkaloids, which contain a 3,3-disubstituted carbazole nucleus.

Patients' attitude to subcutaneous immunoglobulin substitution as home therapy.

INTRODUCTION: Since 2003, immunoglobulin preparations have been approved for subcutaneous (s.c.) use in Germany. Although all our adult patients on intravenous (i.v.) substitution were offered to switch to s.c. home therapy, approximately half of them refused to change. METHODS: To evaluate patients' attitude towards s.c. home therapy, a questionnaire was developed and sent to 125 patients. Questions had to be answered by ticking numbers on a Likert scale from 1 (not at all) to 8 (very much). Four scales of the Freiburg Personality Inventory (FPI) were added. From the 70 questionnaires returned (56%), 61 could be analysed (i.v. n = 28, s.c. n = 33). RESULTS: The i.v. treated patients were afraid of being more busy with self-administration (6.9 +/- 2.1). This was not a serious concern in the s.c. treated group (3.6 +/- 1.8, p < 0.001). Many i.v. treated patients worried about severe adverse reactions at home (4.7 +/- 2.8), but patients in the s.c. group did not (1.7 +/- 1.0, p < 0.001). The statement "I dislike to puncture myself" reached 5.3 +/- 2.7 points in the i.v. treated group, but only 2.0 +/- 1.1 (p < 0.001) in the s.c. treated patients. As main reason, patients on i.v. substitution considered s.c. therapy as inconvenient (48%). Secondly, they were afraid of side effects (31%). All patients on s.c. therapy appreciated the new treatment (7.2 +/- 1.0). Main advantage for them was an increase of flexibility (6.6 +/- 1.6). The FPI displayed lower values for s.c. treated patients in the scales "Physical Complaints" and "Emotional Lability". CONCLUSION: Those patients who had changed to s.c. therapy were highly satisfied. However, others preferred to stay on i.v. treatment for different reasons. Perception of inconvenience, anxiety of side effects, but also personal traits may play a role.

[A modified approach to opening of abdominal wall for gynaecological operations (author's transl)]. / Eine moditizierte Methode der Bauchdeckeneröffnung bei gynäkologischen Operationen.

Described in this paper is a modified method to open the abdominal wall for gynaecological operations, and it is compared for postoperative formation of haematoma with the two most common conventional methods. The modified method and lower median incision so far have been performed on a comparatively small group of patients, when compared to Pfannenstiel's incision. Therefore, no unambiguous conclusion can be drawn as yet. The validity of the method should be confirmed by a larger number of operations. The method should be tried by more hospitals to enable large-scale comparison with other techniques.

[Description of a new modified clamp for the parametrium in abdominal hysterectomies (author's transl)]. / Mitteilung über eine neue, modifizierte Parametriumklemme.

A new modified clamp for the parametrium is presented which facilitates abdominal hysterectomy in large myomatous uteri. The curbed clamp has a blunt angle of 160 degrees to its handle and permits clamping of the parametrium parallel to the longitudinal axis of the cervix. The clamp appears to be an enrichment of the available instruments for abdominal hysterectomies.

The effect of patella preparation for total knee arthroplasty on patellar strain: a comparison of resurfacing versus inset implants.

This study was conceived to quantify variables in surgical technique that may lead to patellar fracture after total knee arthroplasty. Anterior surface strain on load-bearing cadaveric patellae was measured before and after patellar resurfacing or inset prosthesis placement. Variables studied were i) the type of prosthesis (resurfacing vs inset), ii) the depth of reaming or osteotomy during surface preparation, and iii) the overall thickness of the polyethylene/patella composite after implantation. Comparison of measured patellar surface strain patterns for the different prosthesis styles, which were implanted at varying depths, provided statistically significant data from which the following clinically relevant conclusions can be made: i) Patellar resurfacing is superior to inset prosthesis placement when comparing postoperative patellar strain (22% vs 28% increase in strain compared with preoperative values). ii) Osteotomy for patellar resurfacing is more tolerant to error by excess cutting than is reaming for inset prosthesis placement (25% vs 42% increase in strain with a 2-mm error). iii) If the ideal depth of cut or reaming is surpassed, attempts to re-create the original patellar thickness by using a thicker prosthesis are mechanically detrimental. Key words: patella, strain, resurfacing, complications.

Delayed phototoxic effects of 8-methoxypsoralen, khellin, and sphondin inAedes aegypti.

At concentrations up to 6.7 ppm, 8-methoxypsoralen, sphondin, and khellin are not toxic to first-instar larvae of the mosquitoAedes aegypti. The irradiation of sensitized larvae with long-wavelength ultraviolet light did not always produce any immediate toxicity enhancement, but delayed effects were clearly visible. These were observed over the development of the organisms from first-instar larvae to adults. No adverse effects were noted when larvae were irradiated in the absence of sensitizers, or when they were placed in solutions of sensitizers which had been previously irradiated with the same light sources. 8-Methoxypsoralen was slightly more phototoxic than its isomer sphondin. Khellin, recently reported to undergo photoinduced cyclization with DNA components, showed minimal phototoxicity in the concentration range used.