Stellenwert der Rektoskopie und Koloskopie für den Internisten

The endoscopic examination of the large intestine can be considered today a routine examination in internal medicine. Since the introduction of flexible videoendoscopy, evaluating diseases in the distal colon using rectoscopy has become less important. Ano-proctoscopy is an obligatory component for a complete colon diagnostic after a flexible ileo-colonoscopy has been performed. Colonoscopy has improved significantly the diagnosis and therapy of diseases in the large intestine since it has been introduced more than 30 years ago. By introducing modern videocolonoscopy in addition to other instruments, there is today a broad spectrum of diagnostic and therapeutic indications available. Specifically, due to its frequency and prognostic relevance, colonoscopy has become the most powerful and important procedure in the early detection and prevention of colon cancer.     

Epstein-Barr virus latent and replicative gene expression in oral hairy leukoplakia

Oral hairy leukoplakia is an epithelial lesion of the tongue associated with productive infection by Epstein-Barr virus (EBV). However, no data concerning the pattern of EBV latent gene expression have been reported, and it remains unresolved whether true latent infection occurs in basal cell layers of oral hairy leukoplakia. We have studied six cases of oral hairy leukoplakia using monoclonal antibody immunohistology for EBV latent--EB nuclear antigen (EBNA) 1, EBNA 2 and latent membrane protein 1 (LMP 1); immediate-early (BZLF1); and replicative (EA, VCA, MA) proteins, and for the EBV-receptor (CD21 antigen). EBV DNA was demonstrated by nucleic acid in situ hybridization. Mid- to upper-zone keratinocytes contained EBV DNA and co-expressed EBNA 1, EBNA 2 (5 of 6 cases), LMP 1, BZLF1 protein, EA, VCA and MA. No EBV genome or gene expression could be demonstrated in basal or parabasal cells. Spinous keratinocytes were labelled by anti-CD21 antibodies HB5 and B2, but did not express the EBV-receptor as defined by reactivity with OKB7. The co-expression of latent and replicative infection-associated antigens is striking, indicating possible functional roles for latent proteins during the productive cycle. Our results suggest that oral hairy leukoplakia is caused by repeated direct infection of upper epithelial cells with virus from saliva or adjacent replicatively infected cells, rather than by a latent EBV infection of basal epithelial cells with a differentiation-dependent switch to productive infection as previously proposed.     

Assessment of Women for Partner Abuse

Nearly 4 million women in the United States were physically hurt by their husbands or boyfriends in 1994. The health and well-being of these women and their children, as well as the women who are overlooked in these statistics, are jeopardized by past and current experiences with abuse within intimate relationships. Strategies for nurses in women's health care settings to screen women for current or past abuse within their intimate personal relationships, guidelines for effective responses to disclosure of abuse, and supportive interventions are described.     

Asbestos-related focal lung masses: manifestations on conventional and high-resolution CT scans

In 260 asbestos-exposed individuals evaluated by means of computed tomography (CT), 43 unsuspected pulmonary masses were found in 27 individuals. The masses included fissural pleural plaques (n = 10), dense fibrotic bands (n = 3), round atelectasis (n = 11), carcinomas (n = 3), and other presumed benign masses (n = 16). The most helpful features in the diagnosis of rounded atelectasis with CT were (a) contiguity to areas of diffuse pleural thickening, (b) a lentiform or wedge-shaped outline, (c) evidence of volume loss in the adjacent lung, and (d) a characteristic "comet tail" of vessels and bronchi sweeping into the margins of the mass. Less advanced areas of focal atelectasis had fewer classic features. Intrafissural pleural plaques were readily identified with high-resolution CT. In asbestos-related masses, the demonstration of stability over time is necessary. Careful interpretation of CT and high-resolution CT features and close surveillance can obviate the need for biopsy in the majority of instances.     

Work at sea: a study of sleep,and of circadian rhythms in physiological and psychological functions,in watchkeepers on merchant vessels

Summary Daily diary records of sleep and activity, and 4-h measurements of body temperature, performance and subjective alertness were collected on board ship from 15 watchkeepers on the 4-on/8-off system, and from 28 dayworkers, on both westward and eastward transatlantic voyages. The data from a balanced sample of the subjects were analysed over selected 8-d periods of the voyages where four or five time zones were crossed. During these periods the average amount of daily sleep obtained by dayworkers on the eastward voyage was more than 1 h less than that on the westward voyage, and its quality was rated lower. Watchkeepers' main sleep was also shorter when travelling eastward, but this reduction was partially compensated for by a slightly longer secondary sleep. With the exception of subjective alertness on the eastward voyage, the basic phase of the circadian rhythms in the measured variables adjusted appropriately to the clock changes associated with the time zone crossings. The normal shape of the average daily curves was, however, altered differentially in the two directions of travel; as a result, morning levels of all variables were lower on the eastward voyage than on the westward, but evening levels were higher. These distortions of rhythm waveforms, which probably arose from a combination of endogenous and exogenous factors, add another dimension to the basic problem caused by the effects of circadian rhythms on operational efficiency in the shipboard situation. This problem can only be solved by the development of alternative watchkeeping systems which take full account of these rhythms.Partly supported by a grant from the West German Ministry for Technology and Research, Project Schiff der Zukunft, Part ET 83b     

Work at sea: a study of sleep,and of circadian rhythms in physiological and psychological functions,in watchkeepers on merchant vessels

Summary Sleep length and sleep quality scores were collected on board ships over periods of up to two weeks from 38 watchkeepers working a 4-on/8-off routine and 29 dayworkers. All watchkeepers exhibited fragmented sleeping patterns, which indicated a lack of adaptation of the sleep/wakefulness cycle to the hours of work. There were only slight differences in total sleep length between watchkeepers and dayworkers, however, both groups did not obtain an adequate amount of sleep. Within the watchkeeping crews the 3rd Officers had by far the shortest sleep length. Concerning sleep quality, daytime sleep was generally given the lowest ratings, whereas sleep starting before midnight was on average evaluated as the best, both by watchkeepers and dayworkers. Watchkeeping personnel do not normally have any days off during a voyage so that missed sleep might even amount to a sleep deficit. A solution for this problem could perhaps be a new, stabilized system that allows a single uninterrupted sleep, which is required for full recuperation, to be taken each day.Dedicated to Professor J. Aschoff on the occasion of his 75th birthdayPartly supported by a grant from the Ministry for Technology and Research, Federal Republic of Germany, Project Schiff der Zukunft, Part ET83b