A pilot study of the human chorionic gonadotrophin test for ovarian hyperandrogenism

A controlled clinical study was designed to investigate the value of human chorionic gonadotrophin (HCG) challenge as a test for functional ovarian hyperandrogenism. Dexamethasone administration was followed by 5000 IU HCG and blood samples for steroid hormone assay were obtained 0, 8, 16, and 24 h thereafter. Study subjects were normal women (n = 13); women with functional ovarian hyperandrogenism, defined by androgen excess, amenorrhoea and an increased 17-hydroxyprogesterone response to nafarelin (n = 6); and normal men (n = 4). The responses of 17-hydroxyprogesterone, androstenedione and testosterone to HCG in women with functional ovarian hyperandrogenism were significantly greater than in normal women. However, the 17-hydroxyprogesterone response to HCG in functional ovarian hyperandrogenism was significantly lower after HCG than after nafarelin. The oestradiol response was also significantly lower after HCG than nafarelin, although oestradiol concentration more than doubled in normal women as well as in women with functional ovarian hyperandrogenism. The responses to HCG confirm that functional ovarian hyperandrogenism abnormalities are luteinizing hormone (LH)-dependent. Therefore, the 17- hydroxyprogesterone response to HCG could represent a useful test for the diagnosis of ovarian hyperandrogenism. The lower 17- hydroxyprogesterone response to HCG than to nafarelin in functional ovarian hyperandrogenism suggests that a follicle-stimulating hormone (FSH)-responsive factor modulates thecal 17-hydroxyprogesterone secretion. The oestradiol response to HCG is consistent with HCG directly stimulating the oestradiol secretion by thecal cells.      

1141753263Amniochorion secretes chemotactic signals for leukocytes during human labor

Objective:  Leukocytes arriving to choriodecidua during labor are capable to secrete cytokines and collagenases that may play a role in extracellular matrix degradation leading to the rupture of amniochorion. The aim of this work was to study the role of amniochorion in the active recruitment of leukocytes through production of specific chemokines during labor.
Methods:  Amniochorion explants were obtained from women at term with spontaneous labor ( n  = 4) and subjected to cesarean section without labor ( n  = 4). Explant cultures were carried out during 24 hr and a homogenate including the culture media was made after this period. Cell free extracts were tested in Boyden chambers for chemotaxis using leukocytes from maternal blood obtained from women with ( n  = 2) and without labor ( n  = 2). Attracted cells were analyzed by flow cytometry for count and immunophenotype. Chemokines were identified in the extracts using a commercial chemiarray.
Results:  All tested amniochorion extracts induced chemotaxis for leukocytes; however, those from labor tissues induced a higher chemotactic activity than the correspondent non-in-labor tissues ( P  = 0.003). Chemotactic effect was higher over leukocytes from labor women ( P  = 0.001). More than 80% of the attracted cells were polymorphonuclear cells in all cases. IL-8 was the main chemokine found in all extracts; however its concentration was increased in extracts from labor.
Conclusions:  Fetal membranes induced chemotaxis for leukocytes and this condition is enhanced by the presence of labor. Amniochorion under active labor secretes IL-8 which induces a preferential chemotaxis for polymorphonuclears. Infiltration of these cells in choriodecidua during labor may play a role in the amniochorion degradation associated to rupture.     

Ultrasonographic changes in malignant neck nodes during radiotherapy in head and neck squamous carcinoma

Limited information is available about the sonomorphological changes in metastatic neck nodes during radiotherapy. The aim of this study was to evaluate the pattern of sonomorphological changes in metastatic neck nodes with radiotherapy. The study population consisted of 16 consecutive patients planned for radical radiotherapy to the head and neck. All patients were subjected to four ultrasound examinations: before therapy, at 46 Gy, at the conclusion of radiation and at first follow up. A total of 59 ultrasound examinations were performed on 16 patients. The difference between the mean number of nodes detected per patient before (10.6) and after (7.8) radiation was significant (P = 0.05). Sixteen nodes were categorized as malignant at first sonography, half of which reverted back to normal by the end of radiation. Changes in the sonomorphology of malignant cervical lymph nodes occur with radiotherapy with more that half demonstrating reversion to normal pattern. Future studies correlating this with histopathology should be considered.     

Einstweiliger Rechtsschutz bei Off-Label-Use

Abstrakt 1. Bei der im Verfahren des einstweiligen Rechtsschutzes gebotenen summarischen überprüfung kann ein Anordnungsanspruch schon dann zu bejahen sein, wenn jedenfalls mehr dafür als dagegen spricht, dass die Voraussetzungen für einen Off-Label-Use nach der Rechtsprechung des BSG vorliegen. 2. Defizite des Arzneimittelrechts sollen nicht dazu führen, dass dem Versicherten der gesetzlichen Krankenversicherung unverzichtbare und erwiesenerma?en wirksame Therapien vorenthalten bleiben, obwohl die betreffenden Medikamente au?erhalb der Krankenversicherung in der nicht zugelassenen Indikation verordnet werden und verordnet werden dürfen. (Leits?tze des Bearbeiters)     

Psychotherapeutengesetz; vorübergehende Zulassung und Ermächtigung

Ohne Zusammenfassung     

胸腺蛋白口服溶液治疗消化性溃疡的多中心研究

胸腺蛋白口服溶液（商品名欣洛维）是从动物胸腺中提取的一种蛋白质，是一种新型的胃粘膜保护剂，它通过营养局部受损的粘膜，促进内皮细胞、成纤维细胞ＤＮＡ合成，使创面局部组织再生修复加快，从而促进溃疡愈合［１，２］。为进一步研究该药治疗消化性溃疡的临床疗效，我们采用多中心的研究，通过了Ⅱ、Ⅲ期临床试验。现将观察的２５１６例消化性溃疡的治疗结果报道如下。材料和方法一、病例选择经胃镜证实有活动性胃和十二指肠溃疡，溃疡的大小应＜２ｃｍ，＞０．３×３ｃｍ，溃疡数不超过２个者，已排除恶性病变，无溃疡并发症，无严重…     

Kürzung der Abschlagszahlung durch Krankenkasse im Hinblick auf Selektivvertrag rechtswidrig

Zusammenfassung  1. Leistungen für Selektivvertr?ge berechtigen die Krankenkassen nicht, die Gesamtvergütung an die KV kraft Gesetzes zu mindern 2. Durch den wirksamen Abschluss von Selektivvertr?gen entsteht ein Anspruch der Krankenkasse, die Gesamtvergütung in dem gesetzlich und vertraglich vorgesehenen formalen Verfahren zu bereinigen. 3. Zu bereinigen sind die Gesamtvergütung bzw. der Behandlungsbedarf und die Regelleistungsvolumina 4. Nach der Gesetzesbegründung zu § 73b SGB V ist eine pauschale Bereinigung – etwa nur auf der Basis der Zahl der Versicherten und der beteiligten ?rzte – gesetzlich ausgeschlossen. (Leits?tze des Bearbeiters)     

Zulässiger Umfang einer Nebenbeschäftigung bei Psychotherapeuten

Ohne Zusammenfassung