[Diploma of continuing education from the Society of Physician of Thüringia].

The diploma of continuing medical education (DCME) gives the possibility to describe and document the effort of the physicians to accomplish continuing medical education and quality assurance which is a claim of the professional rules for physicians. Stimulation of the physicians to participate lectures is a further goal of the DCME. The DCME which can't be used as a title, is supposed to be for physicians, who finished their specialisation.

[Experiences in organization of medical graduate and continuing education in the new German country (Thüringen)].

The switch from a state controlled to a self responsible continuing medical education could be completed in Thuringia within the first years after the reunification. Higher performances demonstrated by the just mentioned analyses can be observed quantitatively as well as qualitatively. This concept of our academy concerning a professional and regional decentralization in combination with centralized offers for further education has been proved.

Collagen peptidase and type III procollagen peptide serum levels in chronic liver diseases.

The concentration of the N-terminal peptide of procollagen III and the activity of collagen peptidase (PZ-peptidase) were measured in sera from 92 patients with chronic liver disease. In patients with liver cirrhosis and chronic hepatitis with transformation of liver structure, high values were found for both variables compared with hepatoses and chronic hepatitis without transformation. The concentration of procollagen III peptide and the activity of collagen peptidase in serum increased with increasing degrees of fibrosis and, even more markedly, with increasing degrees of mesenchymal activity in the liver.

[Biotransformation in liver damage].

Xenobiotics may produce liver damages. Vice versa primary liver diseases influence metabolism and elimination of drugs. The activity of the isoenzymes of the monooxygenase system which catalyze biotransformation reactions in the liver can be tested by model substances (Cyt P-450Pb: Metamizol, Cyt P-450MC: Caffeine, Cyt P-450db1: Debrisoquine).

[Simultaneous administration of various model substances for characterizing in vivo biotransformation in chronic liver diseases].

16 patients with different chronic liver diseases were given single doses of the model substances caffeine, metamizol, sufamethacine and debrisoquine. This was followed by the simultaneous administration of all these substances as a "cocktail". A comparison between the single and the "cocktail" dosage did not reveal any significant differences in the pharmacokinetic parameters.

[The internist--responsibilities, professional practice and self concept. An introduction].

An analysis of claim and reality causes doubt about the fact whether the internal medicine as a basic clinical subject may at present fully meet its commission. The working group "ethics" of the GDR Society of Internal Medicine has worked out a material concerning the questions of the tasks, the activity and the self-appreciation of the internal specialists and puts it under discussion.

[Biotransformation in patients following Depressan-induced hepatitis].

In 17 patients who more than 1 year ago had suffered from a dihydralazine induced hepatitis the biotransformation velocity was investigated and compared with a healthy control group. 15 out of the 17 patients and 5 out of the 10 volunteers are slow acetylators. All slow acetylators eliminate sulfamethazine more slowly than rapid acetylators.

[NMR research on blood plasma for tumor detection--a method for mass screening?].

Recently, a simple NMR test was proposed to distinguish patients with and without malignant diseases by line-width analysis of methyl and methylene lipoprotein resonances in human plasma (4). We have reevaluated this proposed cancer detection technique at 250 MHz (magnet field strength 5.9T).

[Resorption and biotransformation of model substances in primary idiopathic hemochromatosis (siderophilia)].

In 12 patients with primary idiopathic haemochromatosis absorption and biotransformation were measured by model substances. Aim of the investigation was the correlation of the biotransformation of the liver with the degree of liver injury and the clinical picture. We determined in patients and compared with control group: elimination of metamizol in urine, absorption and elimination of caffeine in serum, serum concentrations and elimination of sulfamethazin in urine, absorption of xylose, - In patients with haemochromatosis accompanied with slight liver damage only demethylation of metamizol was slackened.

[The internist--generalist or specialist?].

Also after the elimination of certain subjects and after the development of subspecialisations internal medicine has remained the central clinical basic speciality. The synoptic medical thinking and acting with a coordination of all special examinations to a coherent view and treatment of the patients is incumbent on the internal specialist as "general internal specialist" or so-called "generalist". The central point of the intermedical care of the population lies in the work of the internal specialist.

Enzyme activities of collagen peptidase (CP), monoaminoxidase (MAO) and N-acetyl-beta-D-glucosaminidase (beta-NAG) as fibrosis marker in chronic liver diseases.

The activities of enzymes collagen peptidase (CP), monoaminoxidase (MAO) and N-acetyl-beta-D-glucosaminidase (beta-NAG) in the serum are related to the development of hepatic fibrosis. These enzymes were determined in the sera of 121 liver-biopsied patients who were subdivided by morphological criteria into 4 different grades of fibrosis (0 to greater than or equal to 3). CP shows the best correlation with the extent of fibrosis.

[Platelet spreading in diabetes mellitus].

In 162 test persons divided into healthy control persons and diabetics of type I and type II the thrombocyte spreading was investigated according to the method of Breddin. Age, sex, degree of seriousness of retinopathy, duration of diseases, present level of blood sugar and HbA1 concentration were taken into account. Spread thrombocyte forms were increasingly found in old age, in diabetics of both types and a close relation to the extent of retinopathy was evident.

Results of treating stage III and IV malignant non-Hodgkin's lymphomas (NHL).

Malignant non-Hodgkin's lymphoma (NHL) patients were enrolled and analyzed retrospectively in 2 successive study groups. The first group consisted of 57 patients divided into low- and high-grade malignant NHL according to the Kiel classification, the second one included 104 patients divided into low-, intermediate-, and high-grade malignant NHL. The more individualized and more intensive polychemotherapy of the 2nd group yielded clearly better treatment results compared to the first group, especially in high-grade malignant NHL.

[Early detection and follow-up of solid tumors].

The early recognition of solid tumours as presymptomatic diagnostics is only reasonable, when it leads to a gain of survival time and survival rate. The evidence of effectiveness by randomized studies (apart from carcinoma of the cervix) was proved up to now only for the carcinoma of the breast (mammography) and the carcinoma of the colon (occult blood in the stools). The target-specific screening within well defined risk groups is to be recommended, when the subsequent chain of investigations and the therapy chain is ascertained.

[Value of alpha 1-fetoprotein (AFP) determination with an ultramicro-ELISA immunoassay in chronic liver diseases with special reference to hepatocellular cancer].

920 determinations of alpha 1-fetoprotein were performed in 564 patients with mainly hepatological diseases. For AFP determination double antibody sandwich technique with 10 microliter final volume was used. The ultramicro-ELISA-method, which meets all criteria of a screening parameter, is simple and far more economic than RIA or a commercial enzyme immunoassay.

[Panmyelopathy and myeloproliferative syndrome].

From the viewpoint of a territorial haematological centre with a certainly preselected number of patients the initial symptom of bi- or pancytopenia in 3/4 of the cases proves as first reference to a myeloproliferative or myelodysplastic syndrome. Of these cases 62.5% transferred into a crisis of blasts; that is, they must be regarded as real preleukemia.

[Colchicine therapy of fibrosing liver diseases--report of a randomized double-blind study].

It is reported on results of a double blind study of colchicine therapy in fibrotic liver diseases over a period of three years. The study includes 74 probands; 37 of them had been treated after randomization for five days a week with 4 X 0,25 mg/d colchicine, 37 with placebo. 53 probands attained the 12th month of treatment, 43 of them 24th, 24 probands were in the study for 36 months.

[Epidemiology of hormone dependent malignant tumors--ovulation inhibitors and liver tumors].

Since the first descriptions of liver tumours associated with the intake of steroid contraceptives, the literature has presented an increasing number of case reports as well as epidemiological studies on the relationship between benign liver tumours and the utilization of these drugs. We report 11 benign cases and one malignant case of liver tumours in connection with the intake of these steroid preparations.

Pharmacokinetics and pharmacodynamic effects of furosemide in patients with liver cirrhosis.

Ten patients with compensated cirrhosis of the liver, 7 patients with portal decompensated cirrhosis of the liver and 10 patients with intact liver function were investigated. After intravenous injection of 40 mg furosemide elimination half-life, total and excretory clearance were not significantly different in the 3 groups investigated, but renal clearance was enhanced in the 2 cirrhosis groups and nonrenal clearance diminished in patients with decompensated cirrhosis of the liver. In those patients distributional volumes were significantly higher than in the control group.

[Emergency endoscopy in chronic liver diseases].

Emergency endoscopy has to be regarded as a method of high diagnostic value. Based on the resulting therapeutic consequences and with allowance for the prerequisites and contraindications, emergency endoscopy in chronic liver diseases is to be considered a purposeful method. If endoscopic treatment possibilities in bleedings of the gastrointestinal tract continue to improve, the demonstration of an improvement in prognosis by emergency endoscopy seems to be merely a question of time.

[Causes of gastrointestinal hemorrhages in chronic liver diseases].

356 patients with chronic liver diseases hospitalized in our clinic during the period from January 1, 1981, to December 12, 1983, were enrolled in a retrospective study. Of them 55 had been admitted for acute gastrointestinal hemorrhage. It appears that gastroscopy is the only method allowing to localize the origin of the bleeding with high certainty.

[Behavior of fibrinogen in diabetic patients in comparison with objective vascular measurements in the ocular fundus].

Objective measurements of vessels were performed in vivo in 10 patients affected with diabetes mellitus, the fibrinogen concentrations in the venous blood being determined simultaneously. Whereas the ensured correlations with fibrinogen concentration could be recognized from the diameter of arteries and veins and from the flow velocity, a linear correlation could be found to exist between the fibrinogen level and the volume flowing through a retinal artery. These findings prove that the very existence of a hyperfibrinogen anemia does not justify the assumption of the blood volume flow being decreased.