Die Hygiene der Schulen in Russland

Ohne Zusammenfassung     

Neoadjuvante und perioperative Therapie des Magenkarzinoms

During the past two decades, relevant steps were taken in the treatment of adenocarcinomas of the stomach and gastroesophageal junction. This was shown for palliative (chemotherapy) therapies and for perioperative treatment strategies applied with curative intent. The administration of preoperative and postoperative chemotherapy has clearly demonstrated a statistically significant and clinically relevant difference in disease-free and overall survival of approximately 10–14% compared with surgery alone, without increasing postoperative morbidity and mortality. Based on these results, perioperative chemotherapy should be regarded as the treatment of choice for patients with locoregional tumors that are defined as uT2–uT4 by endoscopic ultrasound. The potential role of preoperative chemoradiation remains to be determined. Available study results strongly indicate that this treatment strategy is effective. This appears to be especially true for adenocarcinomas of the gastroesophageal junction and distal esophagus. To date, postoperative (adjuvant) chemotherapy after R0 resection cannot be recommended. With this treatment strategy, a relevant survival benefit could not be shown in Western trials, and postoperative chemoradiation cannot be generally recommended. However, it is a meaningful approach for patients whose operations did not fulfill oncological surgical criteria.     

Methotrexate for systemic lupus erythematosus: a retrospective analysis of 17 unselected cases.

We report a retrospective study of 17 patients with systemic lupus erythematosus who were treated with oral methotrexate given as a mean weekly dose of 8.47 +/- 1.72 mg. Methotrexate treatment resulted in symptomatic improvement in 57% of patients and allowed the reduction of the mean daily dose of prednisone from 16.66 mg initially to 8.99 mg at one year follow-up. Twelve of 17 patients (70.6%) experienced at least one episode of toxicity. Factors which might be associated with toxicity are analyzed. Because of its potential as a corticosteroid-sparing agent, controlled studies of methotrexate for the treatment of systemic lupus erythematosus are indicated.     

Outcome of first-trimester exposure to low-dose methotrexate in eight patients with rheumatic disease

PURPOSE: Methotrexate (MTX), when used to treat malignancy or psoriasis, has been implicated in anecdotal reports as a teratogen or abortifacient in the first trimester of pregnancy. We are unaware of any previous reports that describe the course of gestation and the effect on subsequent offspring in patients treated with low-dose oral MTX for rheumatoid arthritis, and therefore present our experience. PATIENTS AND METHODS: We report on eight women experiencing 10 pregnancies. Mean number of weeks of gestation while taking MTX was 7.5 (range 2 to 20 weeks). Outcome of pregnancies included five full-term babies (FTB), three spontaneous abortions (SAB), and two elective abortions. RESULTS: There were no significant differences in either the FTB or SAB group when considering risk factors including smoking, alcohol, concomitant medications, and age. One of three in the SAB group had recurrent abortions prior to MTX therapy. All five of the FTB group had uncomplicated pregnancies and deliveries. All offspring were of normal height and weight at birth with no physical abnormalities. All children reached growth, development, and intellectual stages normally, and their present mean age is 11.5 years. No observed learning disabilities or medical abnormalities have occurred in any of these children. CONCLUSION: In this uncontrolled study we failed to demonstrate tertogenicity of MTX. However, the possibility of abortion due to MTX use remains.     

Genetic variation for oviposition behavior inDrosophila melanogaster. I. Quantitative genetic analysis of insertion behavior

The genetic basis of egg insertion behavior was analyzed in twoDrosophila melanogaster strains (N and E strain), which were homozygous for theSlow allele of the alcohol dehydrogenase locus. The E strain had been selected for increased tolerance to ethanol. This study originated from the observation that nearly all of the eggs laid by females of the E strain were inserted, while in the control strain (N strain) which was kept on regular food, considerable variation for egg insertion occurred. Crosses between the E and the N strains were made, and quantitative genetic tests were performed. It was shown that the inheritance of egg insertion is polygenic, some of the genes are probably sex linked, and in-laying is partly dominant over on-laying. The heritability of the trait, derived from mother-daughter regression analysis, was .59±.18. The repeatability was high. Bidirectional selection in the E strain was unsuccessful, but an asymmetrical response to selection was obtained in the N strain and in lines derived from crosses between the N and the E strains. Selection for in-laying was more successful than for on-laying. The realized heritability in the former lines was .35±.10.     

Das saysche gesetz im gesundheitswesen: schafft sich das ärztliche leistungsangebot seine eigene nachfrage?

Informationsasymmetrien zwischen Patienten und Ärzten ermöglichen es letzteren, die Nachfrage nach ihren eigenen Leistungen über das effiziente Ausmaβ hinaus auszudehnen. Die diesen Sachverhalt beschreibende These der ?angebotsinduzierten Nachfrage“ wird empirisch mit deutschen Paneldaten untersucht. Die Ergebnisse zeigen, dass kaam von einer statistisch signiflkanten Beziehung zwischen der Arztdichte und der Inanspruchnahme ambulanter ärztlicher Leistungen gesprochen werden kann. Die möglichen wirtschaftspolitischen Implikationen werden im Schlussteil des Beitrags diskutiert.