Gutachterliche Probleme der Osteoporose

Osteoporosis is not merely a disease of advanced age but also affects many individuals during their active life. Patients of 30–40 years of age with marked osteoporosis may no longer be able to do their job. An assessment by criteria of social medicine is required. Their capacity to work or to practice their profession and their degree of disability must be evaluated. During therapy it is almost always forgotten to carry out a clinical evaluation of osteoporosis. Two case reports are presented to illustrate this problem.     

Zur Rolle von Kindern bei der Ausbreitung von Influenza Ein Diskussionsbeitrag

During the last few years there has been an increasing debate on the impact of children on the spread of influenza and possible consequences for control strategies. The present paper focuses on the discussion of some recent publications that have sparked the current debate. There is consensus regarding the role of children as accelerators for the spread of influenza infections. The effects of interventions – i.e. vaccination of children – on other groups of the general population (risk groups, etc.) remain unclear. Further studies on today's population and possibly new predictive models are necessary to gain a better understanding of the dynamics that govern the transmission of influenza between several population groups and to determine how specific features of each group affect the transmission process. Based on insights of this kind one could explore the development of optimal control strategies.     

Akrodysostose

Zusammenfassung Die Akrodysostose geh?rt zu den seltenen Formen einer peripheren Dysostose. Die Vererbung ist autosomal-dominant. In ca. 70% der F?lle findet sich eine mentale Retardierung. Die genetische Ursache ist noch unbekannt. Falldarstellung: Wir berichten über eine 8 5/6 Jahre alte Patientin mit Akrodysostose. Klinisch imponierten eine prominente Stirn, eine Mittelgesichtshypoplasie sowie auffallend kurze H?nde und Fü?e. Beide Gro?zehen erschienen hyperplastisch. Die R?ntgendiagnostik ergab eine Brachymetakarpie und -tarsie sowie eine Brachyphalangie. Das Knochenalter war akzeleriert. ?hnliche k?rperliche und radiologische Befunde ergaben sich bei der Mutter der Patientin. Die mentale Entwicklung des M?dchens ist altersentsprechend. Diskussion: Die Abgrenzung dieses Krankheitsbilds gegenüber der heredit?ren Albright-Osteodystrophie war im vorliegenden Fall eindeutig.      

Perivalvular leakage 25 years after initial mitral valve replacement with a Björk-Shiley prosthesis

An 80-year-old woman had undergone initial mitral valve replacement using a Björk-Shiley mechanical valve owing to mitral stenosis 25 years earlier. Suddenly, she had anemia and an increased lactic dehydrogenase (LDH) level. Transesophageal echography (TEE) showed perivalvular leakage. In a redo operation, two side-by-side stitches of the valve on the posterior annulus were loosened without cutting and the sewing cuff at that site was floated over the annulus, leading to the perivalvular leakage. The valve was easily removed; and round, hard, degenerative calcified tissue composed of remnant mitral valve in the suture site during the initial operation was found just under the sewing cuff. After resection of this calcified round tissue, a 25-mm bioprosthesis was put in place. Her postoperative recovery was uneventful, and 47 days after surgery she was discharged without perivalvular leakage or anemia.     

Pulmonary and thymic lymphoid hyperplasia in primary Sjögren’s syndrome

Pulmonary and thymic lymphoid hyperplasia with characteristic clinicoradiological manifestations were seen in a 71-year-old woman who was diagnosed with primary Sjögren’s syndrome. A hazy opacity 12 mm in diameter and an anterior mediastinal nodule 20 mm in diameter were incidentally detected on computed tomography. Thoracoscopic biopsy revealed lymphoid hyperplasia in the lung accompanying thymic lymphoid hyperplasia. Immunohistochemically, the pulmonary lesion was considered to be nodular lymphoid hyperplasia (NLH), not lymphoma. A previously undescribed finding in the NLH was the hazy opacity containing an air bronchiologram, not a solid nodule. This finding might suggest a common causal relation for NLH, thymic hyperplasia, and primary Sjögren’s syndrome.     

Chemische Synthese und gaschromatographischer Nachweis von Alkylglucuroniden

The chemical synthesis of alkyl glucuronides, which appear as metabolites in urine after the consumption of beverages containing congeners of ethanol, is described. Glucuronides of the following alcohols were synthesized: methanol, d₅-ethanol, propanol, isopropanol, butanol, isobutanol, R-(–)-2-butanol, S-(+)-2-butanol, isopentanol and S-(–)-2-methylbutanol. The retention indices of acetyl, pentafluorpropyl (PFP) and trimethylsilyl (TMS) derivatives are given and discussed in relation to the chemical structures. Mass spectra of homologous derivatives were shown to be very similar but some fragments were specific for the chain length of the alkyl moiety and can be used for identification and a quantitative estimation of glucuronides in urine samples.     

Lippen-Kiefer-Gaumen-Spalten

Zusammenfassung Hintergrund. Unter den orofazialen Strukturfehlbildungen sind die Spaltbildungen von (Ober-)Lippe, Kiefer und/oder Gaumen am h?ufigsten. Die genetischen Ursachen der Spaltbildung werden seit langem als sehr heterogen eingesch?tzt. Für die nicht syndromgebundene Spaltbildung wird ein komplexer Erbgang angenommen. Diskussion. Die verschiedenen Zugangswege zu den genetischen Hintergründen dieser multifaktoriell bedingten Erkrankung werden diskutiert. M?glichkeiten, aber auch Grenzen der humangenetischen Beratung von Betroffenen, Risikopersonen sowie deren Angeh?rigen werden erl?utert. Online publiziert: 12 Juli 2001     

Dokumentationsverfahren in der Geriatrie – Zur Unschärfe alltagsnah erhobener Klinikdaten

Zusammenfassung Anhand der Datens?tze von 532 Klinikpatienten wurde retrospektiv ein Vergleich von ?rztlichen und administrativen Angaben zur Verweildauer vorgenommen. Dabei konnte ermittelt werden, da? nur 74,25% der zur Qualit?tssicherung eingesetzten ?rztlichen Dokumentationsb?gen eine mit der Verwaltungsdatenbank übereinstimmende Verweildauer enthielten. Fehlerm?glichkeiten, Voraussetzungen und Umfang geriatrischer Klinikdokumentation werden hinsichtlich ihrer Validit?t und Proze?qualit?t genauer untersucht werden müssen – insbesondere wenn weniger eindeutige Daten, z.B. zum funktionellen Status, valide erhoben werden sollen. Eingegangen: 29. Juli 1998, Akzeptiert: 30. November 1998     

Reversible bilaterale kortikale MRT-Veränderungen infolge einer Anfallsserie

Neuroimaging may detect structural and functional changes following seizures. Magnetic resonance imaging (MRI) studies showed increased signal intensities in T2- and diffusion-weighted images, especially in the temporal cortex. We report a patient with reversible symmetrical signal abnormalities of the insular cortex after seizures. In addition, the frontal paramedian cortex and the central region were involved. There was no leptomeningeal or parenchymal enhancement on contrast-enhanced T1-weighted images, suggesting an intact blood-brain barrier. Upon follow-up examination 12 days later, the signal abnormalities resolved completely. Reversible hyperintensities on T2-weighted images are due to different causes leading to increased water content, such as demyelinisation or edema. According to published data, cytotoxic edema caused by excessive glutamate concentration and other noxious substances is assumed to be the most probable cause for these findings.     

Ulcus ventriculi und duodeni als Ursache des plötzlichen, unerwarteten Todes

A retrospective review of 6962 autopsies carried out at the Institute of Legal Medicine (University of Hamburg) during 1991–1997 was performed to identify previously unknown peptic ulcer disease as the cause of sudden, unexpected death. During this period 25 cases (58%) of fatal acute bleeding, 16 cases (37%) of fatal peptic ulcer perforation and 2 cases of coincident bleeding and perforation occurred. The following aspects are emphasized: as the cause of sudden, unexpected death peptic ulcer disease mainly affects elderly people (average of the afflicted in the reviewed autopsy series 62.2 y), members of social fringe groups and addicts (predominately alcoholics). In cases of absent or atypical symptoms, preceding false medical appraisal of the life-threatening severity of the disease and insufficient diagnoses can be frequently found.