Zur Serologie der Tuberkulose

Ohne Zusammenfassung     

CHANGES IN THE NUMBER OF SMALL LYMPHOCYTES OF THE BLOOD FOLLOWING LIGATION OF THE THORACIC DUCT

This report has attempted to analyze the changes in the absolute number of small lymphocytes in the blood stream of the cat following the intrathoracic ligation of the thoracic duct. Such a ligation produced an immediate decrease in the number of small lymphocytes to the extent of 56 per cent, but it was found that the preoperative level was again reached at about the end of 3 weeks. One is led to believe that the gradual return of the number of small lymphocytes to the preligation level took place pari passu with the establishment of the collateral circulation of the thoracic duct, although there is no absolute proof of this. Yet it is definite that the thoracic duct is an important avenue for the entrance of small lymphocytes into the blood stream, and that it is the pathway through which at least half of the small lymphocytes reach the circulating blood in the cat.     

Corticosteroids and Inhaled Salbutamol in Patients with Reversible Airway Obstruction Markedly Decrease the Incidence of Bronchospasm after Tracheal Intubation

Background: In patients with bronchial hyperreactivity, airway instrumentation can evoke life-threatening bronchospasm. However, the best strategy for the prevention of bronchospasm has not been defined. Therefore, in a randomized, prospective, placebo-controlled study, the authors tested whether prophylaxis with either combined salbutamol-methylprednisolone or salbutamol alone (1) improves lung function and (2) prevents wheezing after intubation.

Methods: Thirty-one patients with partially reversible airway obstruction (airway resistance > 180%, forced expiratory volume in 1 s [FEV1] < 70% of predicted value, and FEV1 increase > 10% after two puffs of salbutamol), who were naive to anti-obstructive treatment, were randomized to receive daily for 5 days either 3 x 2 puffs (0.2 mg) of salbutamol alone (n = 16) or salbutamol combined with methylprednisolone (40 mg/day orally) (n = 15). Lung function was evaluated daily. Another 10 patients received two puffs of salbutamol 10 min before anesthesia. In all patients, wheezing was assessed before and 5 min after tracheal intubation.

Results: Within 1 day, both salbutamol and salbutamol-methylprednisolone treatment significantly improved airway resistance (salbutamol, 4.3 +/- 2.0 [SD] to 2.9 +/- 1.3 mmHg [middle dot] s [middle dot] l-1; salbutamol-methylprednisolone, 5.5 +/- 2.9 to 3.4 +/- 1.7 mmHg [middle dot] s [middle dot] l-1) and FEV1 (salbutamol, 1.79 +/- 0.49 to 2.12 +/- 0.61 l; salbutamol-methylprednisolone, 1.58 +/- 0.66 to 2.04 +/- 1.05 l) to a steady state, with no difference between groups. However, regardless of whether single-dose salbutamol preinduction or prolonged salbutamol treatment was used, most patients (8 of 10 and 7 of 9) experienced wheezing after intubation. In contrast, only one patient receiving additional methylprednisolone experienced wheezing (P = 0.0058).     

Weiterer Beitrag zur Lehre von der pupillotonischen (Adie) und pituitären (Oppenheim-Cushing) Pseudotabes

Ohne Zusammenfassung     

Does Additional Doxorubicin Chemotherapy Improve Outcome in Patients with Hepatocellular Carcinoma Treated by Liver Transplantation?

The aim of this prospective randomized study was to determine whether additional doxorubicin chemotherapy improves outcome in patients with hepatocellular carcinoma (HCCA) treated by liver transplantation. Stratification parameters were tumor stage (UICC I-IVa), gender, age 50 years, α-fetoprotein 20 ng/mL, cirrhosis and HbsAg status. For pre-operative chemotherapy doxorubicin (15 mg/m²) was given biweekly, intra-operative chemotherapy was a single dose administered before surgical manipulation. Post-operative chemotherapy from day 10 was as given preoperatively for a total dosage of 300 mg/m². Outcome parameters were overall survival (OS) and disease-free survival. Of the 75 consecutive patients who received liver transplantation for treatment of HCCA, 62 patients were enrolled. Thirty-four patients were randomized in the chemotherapy group; 28 patients were in the control group and transplanted only. OS rates at 5 years were 38% in the chemotherapy group and 40% in the control group, disease-free survival rates at 5 years 43% and 53%, respectively. Tumor stage and vascular invasion were identified as independent risk factors for recurrence of disease. Doxorubicin chemotherapy did not improve organ survival and disease-free survival in patients undergoing liver transplantation for HCCA.     

Rezensionen

Ohne Zusammenfassung     

Bilateral carcinomas of the breast with local recurrence: analysis of genetic relationship of the tumors.

Local recurrence of bilateral breast carcinomas is rare, but of biological interest, since it is unclear as to which tumor the local recurrence is related to, the ipsilateral or the contralateral, or whether it is an independent neoplasm. The aim of this study was to investigate the genetic relationship of bilateral breast carcinomas to each other and to their local recurrences. Eight cases of bilateral breast carcinomas, five with and three without local recurrence were analyzed using a microsatellite assay for 13 microsatellite loci. The presence of loss of heterozygosity and microsatellite instability in the various tumors was used for clonal analysis. All eight bilateral breast carcinomas showed divergent alterations in at least two microsatellite loci, which ruled out a genetic relationship. Four of five local recurrences were genetically related to the ipsilateral tumor and unrelated to the contralateral tumor. Only one local recurrence that occurred 11.8 years after the surgery of an infiltrative lobular carcinoma simultaneously with distant metastases was genetically related to the contralateral breast carcinoma. Although the number of cases in our study is limited, there is evidence that local recurrence of bilateral breast carcinoma frequently arises from the ipsilateral tumor.     

Der akute schwere Asthmaanfall

Acute dypnoea due to an acute asthma attack is a frequent cause of emergency treatment. Alternative diagnosis can be acute left heart failure with pulmonary edema, lung emboli, acute exacerbations of COPD and foreign body aspiration. Fatal asthma attacks are rare compared to the number of asthma attacks treated and due to underestimation of the severity of the attack. Cornerstones of acute treatment are oxygen, β₂-adrenergic agonists, systemic corticosteroids and parasymaptholytics. The addition of theophylline has not been shown to add any bronchodilatory but more side effects. Additional pharmacological options are magnesium, volatile anesthetics, lidocaine, ketamine, and propofol. Depending on the clinical development mechanical ventilation might be necessary. However, endotracheal intubation per se might cause an increase in bronchoconstriction with side effects like overdistension, compression atelectasis, pneumothoraces, and hemodynamic depression. Overall, with intensive pharmacological treatment severe asthma attacks can be significantly improved within 24 hours. Thus, fatal asthma attacks seem to be avoidable with early and intensive treatment.