Risk of human immunodeficiency virus (HIV) transmission by anti-HIV-negative blood components in Germany and Austria

In order to estimate the residual risk of transfusion-transmitted HIV infection we have analyzed the data from two transfusion centers in Austria (Vienna) and Germany (Göttingen) from 1985 to 1994. In Vienna, an incidence of 142000 positive anti-HIV tests in repeat donors and a prevalence of 17000 in first-time donors were found in 1993. In Göttingen, the indicence was 167000 and the prevalence 17900 from 1985 to 1993. Based on a mathematical model which takes (a) the window period and (b) the false-negative rate of anti-HIV tests, as well as (c) human and operational errors into consideration, we have calculated the residual risk of HIV infection. The residual risk (third generation anti-HIV test) was found to be 1520000 (95% confidence interval 11340000-1210000), and 1900000 (95% confidence interval 12340000-1380000) for Vienna and Göttingen, respectively, in 1993. Look-back studies from 1985 till 1994 revealed transfusion-transmitted HIV infections in three recipients (for 1.9 million donations in Vienna) and one recipient (for 160000 donations in Göttingen) of blood components. Based on our model, as well as on prevalence and incidence rates of HIV infection, it is also possible to predict the efficacy of additional measures introduced to further decrease the risk of transfusion-transmitted HIV infection through blood components.     

Effects of short-term high dose intake of evening primrose oil on plasma and cellular fatty acid compositions, α-tocopherol levels,and erythropoiesis in normal and Type 1 (insulin-dependent) diabetic men

Summary In addition to their usual diet, nine Type 1 (insulin-dependent) diabetic men and ten male control subjects took 20 g d,ga-tocopheryl acetate enriched evening primrose oil (14.45 g 182c,6, 1.73g 183c,6, 400 mg d,-tocopheryl acetate) daily for one week. At start, diabetic patients had more 140, 150 and 18 2c,6, and less 160, 161c,7, 181c,7, 183c,6, 203c,9, 203c,6, 204c,6 and 226c,3 in plasma, erythrocytes and/or platelets. Furthermore, they had lower 161c,7/160, 181c,7/160, and 204c,6/203c,6 ratios and a higher 203c,6/183c,6 ratio. In diabetic patients, -tocopherol levels in erythrocytes were lower, whereas those in plasma were normal. In both groups, oil intake changed fatty acid profiles. Most markedly, 203c,6 increased, whereas the ratios 203c,6/ 183c,6 and 204c,6/203c,6 decreased. 204c,6 increased in control subjects, but not in diabetic patients. Erythrocytes and platelets responded differently in their fatty acid profiles, -tocopherol rose in plasma and, although less for diabetic patients, in erythrocytes. In diabetic patients as well as in control subjects, erythrocyte count, haemoglobin level, mean corpuscular haemoglobin content and concentration increased and glycosylated haemoglobin percentage decreased without an apparent decline in blood glucose levels. Plasma -thromboglobulin and platelet factor 4 decreased, especially in diabetic patients. In conclusion, diabetic patients had abnormal fatty acid patterns, suggesting an impaired 9, 6 and 5 desaturation and an enhanced chainelongation, and had lower erythrocyte a-tocopherol levels; and short-term high dose intake of evening primrose oil increased 203c,6 in both groups, but 204c,6 only in control subjects, gave fatty acid responses which were different for erythrocytes and platelets, enhanced erythropoiesis, and lowered indices of in vivo platelet activation.     

Effect of polyinosinic-polycytidylic acid on chemically induced tumorigenesis by methylcholanthrene in mice

Summary Polyinosinic-polycytidylic acid administered intraperitoneally inhibits the formation of chemically induced tumors by methylcholanthrene in mice. The experiments show that poly (IC) is an effective suppressor of tumor formation when given simultaneously with the cancerogenic compound, or soon thereafter (before 4 weeks). Once the tumorigenesis was started (after 8 weeks), poly (IC) treatment becomes ineffective.The mechanism of inhibition of tumor formation by poly (IC) was studied by measuring the immune response of treated mice. Mice treated with methylcholanthrene alone exhibit a 50% inhibition of the immune response towards sheep red blood cells. Animals injected with poly (IC) after the methylcholanthrene treatment did not show any significant change. However, a pretreatment with poly (IC) causes a complete reversal of immunosuppression caused by methylcholanthrene.

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Zusammenfassung Polyinosin-Polycytidylsäure (Poly IC), intraperitoneal verabreicht, hemmt die Bildung von chemisch induzierten Tumoren durch Methylcholanthren in Mäusen. Die Versuche zeigen, daß Poly (IC) ein wirksamer Hemmstoff der Tumorbildung ist, wenn es gleichzeitig mit Methylcholanthren oder bald danach (vor Ablauf von 4 Wochen) gegeben wird. Wenn die Tumorgenese einmal begonnen hat (nach 8 Wochen), wird die Poly (IC)-Behandlung unwirksam.Der Hemmungsmechanismus der Tumorbildung durch Poly (IC) wurde durch Messung der Immunantwort von behandelten Mäusen untersucht. Nur mit Methylcholanthren behandelte Mäuse zeigen eine 50%ige Hemmung der Immunantwort in Gegenwart von Schaferythrocyten. Behandelt man die Tiere zuerst mit Methylcholanthren und anschließend mit Poly (IC), so bleibt die Immunantwort unbeeinflußt. Ändert man diese Reihenfolge, indem das Poly (IC) vor Methylcholanthren eingespritzt wird, so wird die immunsuppressive Wirkung des Methylcholanthrens vollkommen aufgehoben.

     

Different ratio of myosin heavy chain isoforms in arterial smooth muscle of spontaneously hypertensive rats

Summary The relative proportion of the two putative heavy chains of smooth muscle myosin (MHC1 and MHC2) was determined in the caudal and femoral arteries of spontaneously hypertensive rats (SHR) and normotensive (WKY) rats at 16 weeks of age. The heavy chain polypeptides with M_r 204000 and 200000 were resolved electrophoretically under denaturing conditions in porous polyacrylamide gels. Both proteins reacted strongly with a monoclonal antibody (2C4) to smooth muscle MHC. In caudal arteries the ratio of MHC1/MHC2 was 3.11 in SHR rats compared with 1.81 in WKY rats (p<0.005) and similarly in femoral arteries, 2.81 vs 1.51 (p<0.001). In the portal vein there was no significant difference, 1.71 vs 1.51. The possibility that the higher MHC ratio in the SHR is the genetically mediated defect in arterial smooth muscle cells leading to the hypertension is discussed as an alternative to the elevated systemic blood pressure causing the altered MHC ratio.     

Effect of β-adrenergic stimulation on free fatty acid content in subepicardial and subendocardial layers of the dog heart in situ. Separation and assay by capillary gas chromatography

Summary The effects of -adrenergic stimulation produced by an infusion of isoproterenol (1 g·kg^–1 min^–1, 30 min) were studiedin situ in the anaesthetized dog placed under a total cardiopulmonary bypass. Samples of the subepicardial and the subendocardial layers were homogenized separately prior to the extraction and methylation of free fatty acids (FFA). Gas chromatography on Carbowax 20 M capillary columns was used for the quantitation of myristic (C 140), palmitic (C 160), palmitoleic (C 161), stearic (C 180), oleic (C 181), linoleic (C 182), and arachidonic (C 204) acids.Within 5 min, isoproterenol decreased the tissue content of FFA significantly. The decrease was more pronounced in the endocardial layer where the FFA concentration reached its minimum at the 5th or the 15th min. In the epicardial layer, all the FFA reached their minimal concentration at the 30th min of the isoproterenol infusion. In both layers, lactate content remained unchanged at 5 and 15 min and rose at the 30th min only and content in phosphorylated compounds (ATP, creatine-phosphate—CP) did not show any significant variation during the -stimulation period. A significant correlation was found between the chronotropic effect of isoproterenol and the reduction of FFA concentration.With the technical assistance of Agnès Bacconin.     

The ability of heat stress and metabolic preconditioning to protect primary rat cardiac myocytes

Primary rat cardiocytes were subjected to either thermal preconditioning for 30 min at 43°C or 20 min metabolic preconditioning (10 mM deoxyglucose, 20 mM lactate, pH 6.5). Eighteen hours later cells were analysed either for hsp 70i expression or subjected to a subsequent lethal heat stress or simulated ischaemia (10 mM deoxyglucose, 20 mM lactate, 0.75 mM sodium dithionite, 12 mM potassium chloride, pH 6.5) for 2 hours and assessed for survival by trypan blue exclusion.Hsp 70i was induced over 100 fold by thermal preconditioning and 30 fold by metabolic preconditioning (p<0.001, p<0.05), hsp 90 was induced 2.71 fold and 2.24 fold (p<0.001, p<0.001) by thermal and metabolic preconditioning respectively, while hsp 60 was not induced by either treatment. Preconditioned cultures had improved survival against subsequent lethal heat stress or simulated ischaemia: Thermal preconditioning reduced death from 69.22% to 52.46% upon subsequent lethal heat stress and from 49.13% to 36.66% upon subsequent lethal simulated ischaemia. Metabolic preconditioning reduced cell death from 51.29% to 33.8% against subsequent lethal heat stress, and from 69.09% to 55.61% upon subsequent lethal simulated ischaemia. A second marker of cell death, the release of lactate dehydrogenase activity into the culture media, was reduced to 65% and 60% of control values for thermally preconditioned cells subjected to lethal heat or lethal simulated ischaemia respectively. Metabolically preconditioned cells demonstrated lactate dehydrogenase activity of 59% and 51% that of control values, when subjected to lethal heat or lethal simulated ischaemia respectively.Abbreviations hsp heat stress protein - hsp 70i inducible 70 kDa heat stress protein - LDH lactate dehydrogenase - PBS phosphate buffered saline     

Inactivation of HIV in plasma derivatives by β-propiolactone and UV irradiation

Summary The inactivation of HIV in human plasma and plasma derivatives by combined treatment with -propiolactone and UV-irradiation was investigated. -propiolactone inactivated 3.5 log₁₀ and UV 2.8 log₁₀ HIV in plasma and -propiolactone 3.5 log₁₀ in cryoprecipitate and UV irradiation 4.5 log₁₀ in factor VIII concentrate.

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Inaktivierung von HIV in Plasmaderivaten durch -Propiolacton in Kombination mit UV-Bestrahlung

Zusammenfassung Untersucht wurde die Inaktivierung von HIV in humanem Plasma und Plasmaderivaten durch die kombinierte Behandlung mit -Propiolacton und UV-Bestrahlung. HIV wurde durch -Propiolacton um 3,5 log₁₀ und UV um 2,8 log₁₀ in Plasma und durch -Propiolacton um 3,5 log₁₀ in Kryopräzipitat bzw. durch UV um 4,5 log₁₀ in Faktor VIII-Konzentrat inaktiviert.

     

Additional value of thallium-201 SPECT to a conventional exercise test for the identification of severe coronary lesions after an episode of unstable coronary artery disease

The additional value of thallium-201 SPECT to a conventional exercise test for the identification of patients with severe coronary lesions was evaluated in 170 men, one month after an episode of unstable coronary artery disease. Severe coronary lesions at coronary angiography — defined as three vessel disease, left main stenosis or proximal left anterior descending artery stenosis as part of two vessel disease — were observed in 45.9%. In the SPECT image, the left ventricular myocardium was divided into nine segments and each segment was classified as either normal (=0), reduced uptake (=1) or uptake defect (=2). The sum of gradings in all segments post-exercise was denoted SPECT score. The patients were divided into nine different groups regarding ST-depression during exercise (no ST-depression, ST-depression in 1–2 leads or 3 leads) and SPECT score (no SPECT score, 1–3 scores or 4 scores). Severe coronary lesions were, in 68% identified by SPECT score 4 and in 65% by ST-depression in 1 lead at exercise test. The specificity for identification of severe coronary lesions was, for both tests, 65%. SPECT score 4 and/or ST-depression in 3 leads identified 82% of the patients with severe coronary lesions with a specificity of 63%. Furthermore, SPECT score 3 identified more patients with isolated proximal left anterior descending artery stenosis than ST-depression alone at exercise test.     

Early and Late QRS Morphology and Width in Biventricular Pacing: Relationship to Lead Site and Electrical Remodeling

48 patients (40 Male), mean age 68 ± 8 years, in III–IV class, with intraventricular conduction delay, received a biventricular pacemaker. Heart failure aetiology was non-ischemic in 60%. Left ventricular lead positioning was inferior in 5 patients (10%), posterior in 12 (25%), lateral in 18 (37%) and anterior in 13 (27%). QRS duration and axis were evaluated in sinus rhythm, and during right ventricular pacing, left ventricular pacing and biventricular pacing, the last early after implant and late after 8.8 ± 4.3 months. QRS duration (ms) was 154 ± 29 in sinus rhythm, 175 ± 28 during right ventricular pacing, 196 ± 31 during left ventricular pacing, 122 ± 23 during biventricular pacing early and 120 ± 18 during biventricular pacing late. All the differences were statistically significant, but not between early and late biventricular pacing. Mean QRS axis (°) was –27 ± 32 in sinus rhythm, –75 ± 4 during right ventricular pacing, 112 ± 41 during left ventricular pacing, –82 ± 51 during biventricular pacing early and –80 ± 42 during biventricular pacing late. Only the difference between left ventricular pacing and all the other groups was statistically significant. QRS axis did not significantly differ according to left ventricular lead site during left and biventricular pacing. Late compared with early biventricular pacing axis showed variation >30° in 35% of patients, in spite of no significant changes in QRS duration and x-ray positioning. Conclusion: Biventricular pacing significantly reduced QRS width, which persisted long-term. Left and biventricular pacing axis was poorly related to left ventricular lead positioning. Biventricular pacing axis variability over time may suggest a role of electrical remodeling.     

Comparative and combined effects of transforming growth factors α and β, interleukin-1 and interferon-γ on rheumatoid synovial cell proliferation,glycolysis and prostaglandin E production

Summary Enhanced cell proliferation, glycolysis and prostaglandin E production are all characteristic features of rheumatoid synovial tissue. The interrelationships of these three cellular parameters have been examined using rheumatoid synovial fibroblasts and their responses to specific cytokines in vitro. Transforming growth factor (TGF) caused a more than threefold increase in synovial cell proliferation whilst transforming growth factor (TGF), interleukin-1 (IL-1) and interferon- (IFN-) produced only marginal changes. The combined addition of IL-1 with TGF resulted in an enhanced proliferative response comparable with that produced by TGF. Glycolysis, estimated by glucose utilisation and measurements of the glycolytic regulatory metabolite fructose 2,6-bisphosphate was significantly stimulated by TGF, IL-1 and IFN-, but less so by TGF. Prostaglandin E production was significantly increased by IL-1 to an extent much greater than that produced by TGF or TGF, although the combined addition of IL-1 with either TGF or resulted in a synergistic increase in PGE production, a response partly diminished by the addition of IFN-. These findings suggest that the extent to which a cytokine stimulates glycolysis is not consistently related to its mitogenicity, and that cytokine combinations which stimulate high levels of PGE production (a growth inhibitor) will not necessarily be associated with a reduced rate of cellular proliferation in cultured, adherent, rheumatoid synovial fibroblasts.     

Serum cytokines in patients with rheumatoid arthritis

Serum cytokines such as interleukin 1 (IL-1), interferon (IFN-), and tumor necrosis factor (TNF) were measured in 40 patients with rheumatoid arthritis (RA). In the 40 patients studied, serum IL-1 was detected in 5 patients, IFN- in 10 patients, and TNF in 20 patients. The IL-1-positive group showed increased values of activity indices compared to the IL-1-negative group. Values of serum IFN- correlated well with the number of peripheral blood lymphocytes and CD3⁺ cells and with the percentage of CD3⁺ CD26⁺ cells. Values of serum TNF correlated positively with the number of peripheral blood monocytes and the percentage of CD3⁺ HLA-DR⁺ and CD3⁺ CD25⁺ cells. These results indicated that serum IL-1 in RA patients reflects the activity of RA, while the serum IFN- and TNF in RA patients may be related to circulating activated lymphocytes and monocytes, respectively.     

Large-bowel cancer in the young: A national survival study

Large-bowel cancer in young patients is reported to be a more aggressive and advanced disease at presentation and is believed to be associated with a relatively poor prognosis. Of 2420 patients registered in New Zealand (1968 to 1970), 131 were under 40 years of age and 2289 were over 40 years of age. The annual average incidence of treatable colorectal cancer in patients under 40 years of age was 2.36 per 100,000 and 82.93 in patients over 40 year of age. There were predominantly more females in both age groups with colonic tumors, 5044 (femalemale), and 759652 (femalemale). The rectal tumor male-to-female ratio of 10.68 in those over 40 years of age was reversed in those under 40 years of age (12.08). There was no significant difference in the subsite distribution of colorectal cancers between the two groups. There was a higher proportion of Stage 1 tumors in those under 40 years of age and a correspondingly higher proportion of Stage 2 tumors in those over 40 years of age. The overall crude and relative five-year survival rates for patients under 40 years of age were both 60 percent, whereas the crude rate for older patients was 42 percent, with a corresponding relative rate of 53 percent. Ten-year survival rates were generally higher in younger patients. From this study, there was no evidence to suggest that younger patients (less than 40 years old) with colorectal cancer had worse prognoses and did not survive as long as older patients (40 years and over).Poster presentation at the meeting of The American Society of Colon and Rectal Surgeons, Anaheim, California, June 12 to 17, 1988.     

In vivo and in vitro test for growth potential of liver cells from rats during early stage of hepatocarcinogenesis by 3′-methyl-4-dimethylaminoazobenzene

Summary A rapid increase in the fraction of small liver cells was observed in the liver of rats during the early stage of hepatocarcinogenesis by 3-methyl-4-dimethylaminoazobenzene (3-Me-DAB). The change in cell population was represented by the decrease in glucose-6-phosphatase activity and by the increase in number of -glutamyltranspeptidase-positive cells. When DNA synthesis of liver cells from rats fed 3-Me-DAB was measured by autoradiography in primary culture, it began to increase 2 weeks after the start of the carcinogen feeding, reaching a plateau level after 3 weeks. Liver cells from rats fed 3-Me-DAB for 2 weeks or over demonstrated a remarkable resistance to the cytotoxic effect of the carcinogen (0.24 mM) in primary culture. Furthermore, liver cells from rats fed 3-Me-DAB for 3 weeks or over proliferated in the presence of the carcinogen in primary culture. When liver cells from 3-Me-DAB-fed and control rats were transplanted into syngeneic rat spleens, the former cells proliferated more vigorously than did the latter. The growth potential of liver cells from 3-Me-DAB-fed rats tended to be enhanced with time in the carcinogen feeding. Hepatocellular carcinomas developed in the host spleens implanted with liver cells from a rat fed 3-Me-DAB for 8 weeks. As described above, liver cells from rats fed 3-Me-DAB demonstrated much greater proliferative ability than normal control cells in vivo and in vitro.Abbreviations used HCC hepatocellular carcinoma - 3-Me-DAB 3-methyl-4-dimethylaminoazobenzene - GGT -glutamyltranspeptidase     

Triplication (/ααα<Superscript>Anti3.7</Superscript>) or deletion (-α<Superscript>3.7</Superscript>/) association in Argentinian β-thalassemic carriers

Prevalence of alpha gene triplication or deletion in -thalassemia carriers was studied in 109 unrelated individuals in Rosario, Argentina. In different populations -^3.7 allele presents a higher prevalence than ^anti3.7; thus, -thalassemia associated with -thalassemia is more frequently observed. Nevertheless, this event was detected in only one case (0.9%), while the association with alpha triplication was present in two subjects (1.8%).     

Effects of Piclamilast,a Selective Phosphodiesterase-4 Inhibitor,on Oxidative Burst of Sputum Cells From Mild Asthmatics and Stable COPD Patients

Oxidative stress associated with increased presence of neutrophils is an important feature of inflammatory airways diseases like asthma or chronic obstructive pulmonary disease. We studied the in vitro effect of piclamilast (RP73401), a selective phosphodiesterase (PDE)-4 inhibitor, compared to theophylline and prednisolone, on respiratory burst of sputum cells from mild asthmatics and COPD patients. Sputum cells were harvested from mild asthmatics and stable COPD patients and treated with piclamilast, theophylline or prednisolone. Respiratory burst was assessed by luminol-dependent chemoluminescence after stimulation with 10 M n-formyl-met-leu-phe (FMLP). Piclamilast inhibited FMLP-induced respiratory burst of sputum cells in a concentration-dependent manner (asthma: EC₅₀ approximately 100 nM, max. inhibition: 97.5±5% at 100 M; COPD: EC₅₀ approximately 1 M, max. inhibition: 70.6±4.5% at 100 M), whereas maximal inhibition observed with theophylline (asthma: max. inhib. 27±15%; COPD: 6±2%, both p < 0.05 vs. piclamilast) and prednisolone (asthma: 16±6%; COPD: 7.8±6.2%, both p < 0.05 vs. piclamilast) was weaker. Inhibition by piclamilast was largely reversed through pretreatment of cells with the adenylcyclase inhibitor SQ22536. We concluded that piclamilast, a selective PDE-4 inhibitor, attenuates the respiratory burst of sputum cells from mild asthmatics and COPD patients in vitro. These data underline the potential of PDE-4 inhibition as a novel therapeutic approach to inflammatory airway diseases like asthma or COPD.     

Gaucher disease (type 1): Physical and kinetic properties of liposomal and soluble ‘acid’ β-glucosidase

Acid -glucosidase of human spleen, from either normal controls or patients with type 1 (adult) Gaucher disease, was incorporated into phosphatidylcholine liposomes. The non-incorporated (soluble) Gaucherenzyme had a higher apparent molecular weight than had the corresponding control. Liposomal acid -glucosidase prepared from Gaucher-spleen was more thermostable than was the corresponding normal enzyme; it was also stimulated by acidic lipids to a much lesser extent. The results suggest that the genetic mutation in type 1 (adult) Gaucher disease has multiple effects on the glycoprotein form of acid -glucosidase.     

Single Capacitive Discharge Utilizing an Auxiliary Shock in the Coronary Venous System Reduces the Defibrillation Threshold

Auxiliary shocks (AS) from electrodes sutured to the left ventricle (LV) prior to primary biphasic shocks (PS) have been shown to reduce defibrillation thresholds (DFT). Two capacitors are required to generate these waveforms. We investigate delivery of AS from one capacitor using a novel waveform. The epicardial surface of the LV is accessed transvenously via the middle cardiac vein (MCV) avoiding a thoracotomy. Methods: A defibrillation electrode was placed in the right ventricle (RV) and superior vena cava (SVC) in 12 pigs (37±2kg). A 50×1.8mm electrode was inserted in the MCV through a guide catheter. A can was placed in the left pectoral region. A monophasic AS (100F, 1.5J) was delivered along one pathway before switching to deliver a biphasic waveform (40% tilt, 2ms phase 2) along another. DFTs (PS+AS) were assessed using a binary search. Two configurations not incorporating AS acted as controls. DFTs were compared using repeated measures analysis of variance. Results: DFTs of the four novel configurations (AS/PS) were: RVCan/MCVCan=14.9±3.7J, MCVCan/RVCan=17.2±5.7J, RVSVC+Can/MCVSVC+Can=13.4±4.6J, MCVSVC+Can/RVSVC+Can=17.1±5.9J. Delivering AS in the RV followed by PS in the MCV reduced the DFT (RVCan (19.9±7.3 J, P<0.01) and RVSVC+Can (19.2±6.0 J, P<0.05)). Conclusions: Delivering AS prior to PS in the MCV reduces the DFT by up to a third compared to conventional configurations of RVCan and RVSVC+Can. This is possible using only a single capacitor and an entirely transvenous approach to the LV.     

Die sogenannten funktionellen Krankheiten des kardiovaskulären Systems als Syndrome der neurokardiovaskulären Inadaptation betrachtet

Ohne ZusammenfassungHerrn Prof. Dr.B. Kisch zum 70. Geburtstage gewidmet.Professor für Kardiologie in der Escuela Nacional de Medicina del Trabajo. Chef der Kardiologie-Abteilung in dem Ambulatorio Matias Montero des (S.O.E.) und des Instituto Nacional de Medicina del Trabajo in Madrid.     

Vorbestehendes Risikoprofil und Dekubitalulzera im intensivmedizinischen Bereich

Zusammenfassung In diesem Beitrag werden die Risikofaktoren zu Beginn des Krankhausaufenthaltes bei Patienten, die auf Intensivstationen ein Dekubitalulkus entwickelten, mit denen der Patienten verglichen, die auf Normalstationen ein Dekubitalulkus entwickelten.Im Rahmen einer prospektiven Erhebung wurde durch das Pflegepersonals von April 2003 bis April 2004 bei jedem Patienten am Tag der Aufnahme ein 29 Punkte umfassendes Risikoprofil dokumentiert. Ingesamt umfasst die Auswertung 49 904 Behandlungsfälle, von denen 5073 (10,2%) mindestens einen Tag auf einer Intensivstation verbrachten. Insgesamt entwickelten 94 Patienten während eines Intensivaufenthaltes ein neues Dekubitalulkus und 186 Patienten ohne einen Aufenthalt auf einer Intensivstation.Patienten, die auf einer Intensivstation ihr Druckulkus entwickelten, unterschieden sich im Alter, der Geschlechterverteilung und der Krankenhausverweildauer nicht von den Patienten, die ihr Druckulkus ohne Intensivaufenthalt entwickelten. Der Anteil der operierten Patienten war mit 72% nur gering höher als mit 60% bei den nicht intensivmedizinisch betreuten Patienten (p=0,046). Die mittlere Anzahl von Risikofaktoren zu Beginn des Krankenhausaufenthaltes war mit 10,0±5,7 im Vergleich zu 7,5±4,9 bei den Patienten, die ihr Druckulkus auf Normalstation entwickelten, erhöht (p=0,001).Bei den Intensivpatienten waren bereits bei Aufnahme die Risikofaktoren stark sedierende Medikamente, gefäßverengende Medikamente, Op-Dauer >60 Minuten, Fieber, Sepsis, Stuhl- und Urininkontinenz, Druckgefährdung durch Ableitungssysteme oder Fixierung, Störung des Druck-, Schmerz- oder Temperaturempfindens häufiger als bei Patienten, die unabhängig von einem Intensivaufenthalt ein Druckulkus entwickelten.Die vorgestellten Daten zeigen, dass Patienten, die während eines Aufenthalts auf einer Intensivstation ein Dekubitalulkus entwickelten, schon bei Aufnahme ins Krankenhaus ein erhöhtes Risiko aufweisen.für das Interdisziplinäre Dekubitus-Projekt     

A prospective study of local recurrence after resection and low stapled anastomosis in 183 patients with rectal cancer

Local recurrence is the most serious complication of anterior resection for rectal cancer, usually occurring during the first two years after surgery. Over a five-year period, from 1981 to 1986, 183 patients underwent anterior resection for rectal carcinoma at the Surgery Ward of the University of Ferrara. Patients were followed for two years postoperatively. All operations were performed with staplers and classified according to Dukes, with 43 cases of Dukes' A; 83 cases of Dukes' B; and 57 cases of Dukes' C. In the first 24 months after surgery, the tumor recurred locally in 44 of the 183 patients (24 percent. Dukes' stage, grading distal resection margin, and histopathologic differentiation of the distal rectal ring left in the stapler after anastomosis were assessed to determine a prognostic indicator for the recurrence of the tumor. The stage:recurrence ratio was as follows: A, 1 (2 percent); B, 21 (25 percent); and C, 22 (39 percent). The grading:recurrence ratio was: G1, 1351 (25 percent); G2, 24110 (22 percent); and G3, 722 (32 percent). The ratio between distal rectal resection margin and recurrence was: 0 to 2 cm, 1527 (56 percent); 2 to 4 cm, 1674 (22 percent); and over 4 cm, 1382 (15 percent). Histopathologic examination of the distal rectal ring was negative for all patients. These data confirm the direct relationship between class and local recurrence and indicate histologic grade and distal resection margin as significant prognostic parameters only when interpreted in the light of staging.