Biochemical markers of bone turnover in seronegative spondylarthropathy: relationship to disease activity

To investigate bone turnover in patients with seronegative spondylarthropathy, a bone formation marker, type 1 procollagen carboxy- terminal propeptide (P1CP), and resorption markers, the pyridinium cross-links of collagen [urinary free (f) PYR and DPYR], were measured. The median f-PYR, f-DPYR and P1CP (+/-interquartile range) were 15.8 (6.00) nmol/mmol creatinine, 3.8 (2.2) nmol/mmol creatinine and 101.5 (38) micrograms/1, respectively. There was a positive correlation between resorption markers and acute-phase reactants such as C-reactive protein (r = 0.42 for PYR, r = 0.42 for DPYR, P < 0.05), and a negative correlation observed between P1CP and the erythrocyte sedimentation rate (r = -0.64, P < 0.05). In the subgroup of patients with an elevated CRP concentration, the concentration of PYR and DPYR was significantly increased (f-PYR 25.7 vs 15.8 and f-DPYR 6.6 vs 3.8, P < 0.01 for f-PYR, P < 0.05 for f-DPYR). This study suggests than an elevation in acute-phase response in patients with seronegative spondylarthropathy is associated with increased concentration of bone resorption markers with a tendency for reduction in bone formation markers. This may represent uncoupling of bone formation and resorption, leading to bone loss in such patients.      

Haftung des Zahnarztes für Fremdlabor

Abstrakt 1. Wird ein Fremdlabor vom Zahnarzt mit Reparaturarbeiten beauftragt, so ist es dann nicht Verrichtungsgehilfe des Zahnarztes, wenn es an dem für die Zurechnung erforderlichen Abhängigkeitsverhältnis zwischen Arzt und Labor fehlt.2. Fehlt es an einem Weisungsrecht des Zahnarztes gegenüber dem Labor, so ist eine Haftung für das Labor als Verrichtungsgehilfe selbst dann ausgeschlossen, wenn der Zahnarzt das Labor im eigenen Namen und auf eigene Rechnung beauftragt hat. (Leitsätze des Bearbeiters)     

Postappendectomy fluid collections in children: incidence, nature, and evolution evaluated using US

At the authors' medical center, most patients with postappendectomy fluid collections are treated conservatively. Thirty-two (15%) of 216 children underwent postoperative sonography following appendectomies. In ten patients (31%), a total of 16 fluid collections were found on the initial postoperative sonogram. In the seven patients (70%) whose fluid collections were confined to the pelvis, the condition was treated conservatively and it resolved in 2-9 weeks. In three patients, fluid collections required surgical drainage and proved to be abscesses. In two of the three patients, abscesses were multiple and widely distributed in the abdomen, and the patients were clinically ill. The authors conclude that clinically symptomatic fluid collections develop postoperatively in approximately 5% of children who have undergone appendectomy for acute appendicitis and that the size and course of the fluid collection can be objectively monitored using sonography. Such fluid collections confined to the pelvis ultimately resolve with conservative, nonoperative therapy, although resolution may take up to 2 months.     

Beta-glucuronidase-producing bacteria in bile from the common bile duct in patients treated with endoscopic papillotomy for gallstone disease

This paper reports the occurrence of beta-glucuronidase-producing bacteria in the bile in gallstone patients treated with endoscopic papillotomy (EPT). The study included 36 patients--18 women and 18 men, aged 43-87 years, with a median of 72.5 years. Bile sampling was done with an endoscopic technique. All bacterial strains were tested for beta-glucuronidase activity with a rapid chromogenic tablet test, using 4-nitrophenyl-beta-D-glucuronic acid as substrate. Bacterial growth was found in the bile in 35 patients. Of 103 strains isolated, 30 produced beta-glucuronidase. Twenty-five of the patients had at least one beta-glucuronidase-producing strain in the bile. All 26 strains of Escherichia coli were producing the enzyme. Both strains in the Bacteroides fragilis group and one out of two strains of Clostridium perfringens were producing beta-glucuronidase. The activity of the bacterial beta-glucuronidase was found within the pH range of the bile in these patients. A relationship between the presence of beta-glucuronidase-producing bacteria in the bile and pigment gallstone is suggested.     

Honorarzahlungspflicht bei Nichterscheinen des Patienten

Ohne Zusammenfassung     

Keine Weiterabe zurückgenommener Medikamente in der Arztpraxis (Anm.: M. Riemer)

Ohne Zusammenfassung     

Adult-onset Still''s disease with atypical cutaneous features

INTRODUCTION: The diagnosis of adult-onset Still's disease (AOSD) can be very difficult. There are no specific tests and reliance is usually placed on a symptom complex and the well described typical rash seen in most patients. In recent years, however, other cutaneous manifestations of AOSD have been reported but these are not so well known. OBSERVATIONS: We report a patient with urticaria and fixed plaques and review the other 'atypical' cutaneous findings associated with AOSD. CONCLUSIONS: The diagnosis of AOSD can be made in the absence of the typical Still's rash but in the presence of other atypical cutaneous features.     

Psychotherapie-Vergütung nach Ablehnung durch die GKV

Abstrakt Ein Vertragsarzt darf seine psychotherapeutischen Leistungen bis zur H?he der EBM-Betr?ge bei dem Kassenpatienten liquidieren, wenn die Krankenkasse die erforderliche Zustimmung versagt und der Patient in Kenntnis der Ablehnung die Therapie fortführt. (Leitsatz des Bearbeiters)