[Reflections on the reflections of V. Grenzner on "Family medicine and waiting lists"].
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In chronic venous insufficiency, phlebodynamometry by invasive venous-pressure measurement demonstrates a reduced pressure drop and an accelerated pressure rise, resulting from the action of the ankle-joint-calf muscle "pump". On the other hand, light-reflexion rheography and photoplethysmography can measure only the duration of the refilling period. Simultaneous measurements were made on 47 legs after phlebography (normal: 8; side-arm varicosities: 17; long-saphenous insufficiency: 15; postthrombotic syndrome: 7). Refilling time by photoplethysmography correlated better with that measured invasively than by light-reflexion rheography. Refilling half-time cannot be measured accurately with either noninvasive method. Sclerosing treatment of single side-branch varicosities in ten legs demonstrated that merely measuring refilling time (invasively or noninvasively) was not sufficient, because this value did not indicate any improvement in haemodynamics even after successful treatment.
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Two experiments were designed to examine the effects of attentional demands on the electroencephalogram during cognitive and emotional tasks. We found an interaction of task with hemisphere as well as more overall parietal alpha for tasks not requiring attention to the environment, such as mental arithmetic, than for those requiring such attention. Differential hemispheric activation for beta was found most strongly in the temporal areas for emotionally positive or negative tasks and in the parietal areas for cognitive tasks.
Although there is clear face validity that structural damage is related to outcome, it is difficult to prove this. Recently, more evidence became available that structural damage, as assessed on plain films, is indeed related to disease activity in clinical trials and therefore can be used to assess the effect of treatment. Also, a relationship between structural damage and outcome, mainly defined as physical disability, was established. Several examples of findings in recent publications are presented which lead to the following conclusions. There is a relation between the response to treatment measured as clinical disease activity and measured as radiographic progression in most clinical therapeutic trials. A strong relation between local inflammation and progression of damage in the individual joint is present. This is robust evidence for the hypothesis that inflammation leads to structural damage. There is a good relation between the damage in small and large joints as assessed on plain films. Damage measured in small joints is a good substitute for overall damage. Disease activity is always strongly correlated with functional disability throughout the disease course. There is an increasing relation between disability and structural damage with increasing disease duration.
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The European Atherosclerosis Society (1) and the Expert Panel of the US National Cholesterol Education Program (2) have issued detailed guide values for recognition and management of hyperlipidaemia in adults. In these guidelines, the diagnosis of dyslipidaemia based on the measurements of total cholesterol, triacylglycerols, HDL and LDL cholesterol plays an important role. A prerequisite for the desired success of interventive measures is the reliability of the analytical data. The aim of this study was to investigate the precision and accuracy of Reflotron Cholesterol, a method based on the dry chemistry principle. Accuracy was assessed by establishing the correlation with the standardized automated methods used in routine lipid diagnosis. In addition, it was also examined whether the Reflotron Cholesterol results in plasma and blood are comparable. The Reflotron cholesterol (sample: blood) showed a good correlation with the CHOD/PAP method on a Hitachi 737 instrument (sample: plasma). The median value of the differences of the test results was -0.4%. Similarly, the method comparison of Reflotron Cholesterol (sample: blood) versus CHOD/PAP method on a SMAC instrument (sample: plasma) showed that Reflotron produces slightly (1.8%) higher results. The Reflotron Cholesterol values obtained from blood samples were slightly lower than those from plasma samples (median value of the differences: -2.2%). The results suggest that for routine purposes Reflotron Cholesterol provides results which are in good agreement with those obtained by standardized wet chemistry methods.
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