Beobachtungen an H?mothoraxf?llen

Zusammenfassung 1. Bei Untersuchung der Punktionsflüssigkeit bei 2 F?llen von menschlichem H?mathorax ergab sich v?llige Gerinnungslosigkeit, rasches Absinken des Gesamteiwei?es, das fast ausschlie?lich auf Rechnung der Globulinverminderung zu setzen ist, w?hrend H?moglobin- und Erythrocytenwerte damit nicht gleichen Schritt halten. 2. Bei künstlichem H?mothorax bei Kaninchen fanden wir im gro?en und ganzen die gleiche Tendenz. 3. Sektionsbefunde bei letzteren ergaben eine Auflagerung von fibrin?hnlichen Gerinnseln auf die Pleura. 4. Deshalb wird die Anschauung vertreten, da? die Gerinnungshemmung durch Plasmaeiwei?ver?nderungen bedingt ist, da die Konzentrationsverminderung nicht allein durch Einstr?men von Gewebsflüssigkeit, sondern haupts?chlich durch Ausf?llung und Autolyse erkl?rt werden mu?. 5. Bei Kaninchen wird der H?mothorax rascher resorbiert als beim Menschen. 6. Wegen der Unwahrscheinlichkeit, da? unversehrte Blutk?rperchen aus der Pleura ins str?mende Blut gelangen k?nnen, wird der im Schrifttum auftauchende Vorschlag einer intrapleuralen Bluttransfusion schon aus diesem Grunde abgelehnt.     

Vaccination against hepatitis B in liver transplant recipients: pilot analysis of cellular immune response shows evidence of HBsAg-specific regulatory T cells.

After liver transplantation for hepatitis-B-related diseases, patients currently receive lifelong treatment with hepatitis B immunoglobulin to prevent endogenous reinfection with hepatitis B virus (HBV). Active immunization with hepatitis B vaccine would be a preferable alternative; however, most attempts to immunize these patients with standard vaccine have failed. A recent study with a new adjuvanted hepatitis B vaccine was exceptionally successful, leading to a high-titered long-lasting antibody response in 80% of all vaccinees. To identify the immunological mechanisms behind these unexpected results, the successfully vaccinated participants were tested for hepatitis B surface antigen (HBsAg)-specific T and B cells, and their cellular responses to revaccination with conventional vaccine were studied. HBsAg-specific CD4(+) T lymphocytes could be detected in 13 of 16 patients after immunization with the new vaccine. Unexpectedly, these T cells produced almost exclusively interleukin (IL)-10 and had a CD4(+)/CD25(+) phenotype. They were functionally active, suppressing cytokine secretion in HBsAg-specific (Th1) cells, thus representing antigen-specific regulatory T cells (T(Reg)). Following a booster dose with conventional vaccine 22-31 months after completion of the initial vaccination series, the T-cell pattern in the revaccinated individuals changed substantially: 7 days after revaccination 9 of 11 individuals showed a switch to a Th1-type immune response with HBsAg-specific T cells secreting IL-2, interferon gamma and tumor necrosis factor alpha as observed in healthy controls. Four weeks after the booster, 4 patients still showed a Th1-type cytokine pattern, whereas in 5 patients only IL-10-secreting cells were detectable. After 1 year, in 3 of 4 revaccinated individuals only IL-10-secreting cells could be found, whereas the specific T cells of the fourth patient still showed a Th1-type of response. HBsAg-specific T(Reg) cells could be demonstrated in HBV-positive liver transplant recipients successfully immunized with a new adjuvanted vaccine. Revaccination led to immediate disappearance of the these cells and the appearance of HBsAg-specific T cells with a Th1-type cytokine profile, which in most cases were replaced by the IL-10-secreting regulatory cells during the following months. The specific induction of T(Reg) cells could contribute to the poor response of liver transplant recipients to conventional vaccine. In conclusion,, for successful vaccination of these patients, a vaccine with a strong inhibitory effect on T(Reg) cells would be desirable.     

Immunoadsorption in Severe C4d-Positive Acute Kidney Allograft Rejection: A Randomized Controlled Trial

Antibody-mediated rejection (AMR) frequently causes refractory graft dysfunction. This randomized controlled trial was designed to evaluate whether immunoadsorption (IA) is effective in the treatment of severe C4d-positive AMR. Ten out of 756 kidney allograft recipients were included. Patients were randomly assigned to IA with protein A (N = 5) or no such treatment (N = 5) with the option of IA rescue after 3 weeks. Enrolled recipients were subjected to tacrolimus conversion and, if indicated, 'anti-cellular' treatment. All IA-treated patients responded to treatment. One death unrelated to IA occurred after successful reversal of rejection. Four control subjects remained dialysis-dependent. With the exception of one patient who developed graft necrosis, non-responders were subjected to rescue IA, however, without success. Because of a high graft loss rate in the control group the study was terminated after a first interim analysis. Even though limited by small patient numbers, this trial suggests efficiency of IA in reversing severe AMR.     

Thromboembolic and inflammatory complications of knee joint alloplasty with cemented endoprostheses]

In the presented paper the authors evaluate the long-term results of treatment for inflammatory and thromboembolic complications in knee joint alloplasty with cemented endoprostheses. The clinical material spanning the years 1998-2003 are 15 patients with analysed complications, it determine 9% of all operated. They have evaluated achieved results using the HSS knee rating scale in their own modification. As far as the authors are concerned, venographic examination is a prerequisite for appropriate care of the patients following knee joint alloplasty who might have deep venous thrombosis. It is necessary to provide similar treatment when developing infections are suspected in the perioperative period and in cases of late infections. Consequently, antibiotic therapy and a possible quick bacteriological checkup for healing a postoperative wound is a prerequisite for successful treatment. Achieved results induce statement, that thromboembolic and inflammatory complications caused at most operated chronic vein insufficiency, deficit of range of motion at operated joint and gait insufficiency. Thromboembolic complications was always related with inflammation of knee joint alloplasty in our own material.     

Tubal manometry: the question of normal values, values in chronic mesotympanic purulent middle ear infections

We investigated tubal function by equalization manometry in 68 patients with unilateral traumatic perforation of the tympanic membrane, and in 116 patients with chronic mesotympanic suppuration (85 dry and 31 discharging ears). Our criterion of normal tubal function is the ability to equalize a difference in pressure of +/- 30 hPa by means of at most 7 swallowings. This result was achieved in only 25% of the dry perforations and in none of the patients with discharging ears. Normal tubal function may only be expected in 25% of patients with chronic otitis media.     

Intraoperative radiotherapy (IORT) is an option for patients with localized breast recurrences after previous external-beam radiotherapy

Background  

For patients suffering of recurrent breast cancer within the irradiated breast, generally mastectomy is recommended. The normal tissue tolerance does not permit a second full-dose course of radiotherapy to the entire breast after a second breast-conserving surgery (BCS). A novel option is to treat these patients with partial breast irradiation (PBI). This approach is based on the hypothesis that re-irradiation of a limited volume will be effective and result in an acceptable frequency of side effects. The following report presents a single center experience with intraoperative radiotherapy (IORT) during excision of recurrent breast cancer in the previously irradiated breast.     

Role of rufinamide in the management of Lennox-Gastaut syndrome (childhood epileptic encephalopathy)

Rufinamide, a triazole derivative that is structurally distinct from currently marketed antiepileptic drugs (AEDs), is in development for the adjunctive treatment of Lennox-Gastaut syndrome (LGS) in children and adults. Rufinamide is well absorbed after oral administration, demonstrates low protein binding, and is metabolized by enzymatic hydrolysis without involvement of cytochrome P450 enzymes, conferring a low drug interaction potential. In a randomized, double-blind trial involving 138 adult and pediatric patients with LGS, compared with placebo, rufinamide 45 mg/kg/day resulted in significantly superior reductions in drop attacks (median change −42.5% vs +1.4% with placebo) and total seizures (−32.1% vs −11.7% with placebo), accompanied by significantly higher responder rates. These results are comparable with findings reported for other AEDs in randomized, controlled clinical trials in patients with LGS. Rufinamide produced statistically significant seizure reduction which was maintained during long-term therapy and accompanied by good tolerability. The most frequently reported adverse events from a pooled safety database evaluating short- and long-term therapy were headache (22.9% and 29.5%), dizziness (15.5% and 22.5%) and fatigue (13.6% and 17.7%). Rufinamide therefore presents a favorable efficacy and tolerability profile and is a promising candidate for the adjunctive therapy of LGS.