Intrathorakale Organfixierung durch Tieffrierung

Zusammenfassung Zur exakten Darstellung der Topographie der intrathorakalen Organe wird die von Kaiserling und Ponfick angewandte Methode der Einfrierung des Thorax durch eine Tiefkühlung bei – 20° C modifiziert.Verglichen mit den gebräuchlichen Methoden der Flüssigkeitsfixation ist die Tiefkühlung sauber und einfach zu handhaben. Die Fixation kann in kurzer Zeit erfolgen.Besonders gut eignet sich dieses Verfahren einmal zur Darstellung traumatischer, zum anderen aber auch chronisch destruierender Veränderungen des Brustraums, da die Retraktion der Lunge vollkommen verhindert wird und somit das pathologisch veränderte Organ in seiner Beziehung zu den Nachbarorganen situsgerecht erfaßt werden kann.Von weiterem Vorteil ist die absolute Farbtreue der Präparate.

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Summary The precise topography of the intrathoracic organs may be demonstrated by freezing the entire chest, as described by Kaiserling and Ponfick. This method was modified by deep-freezing at – 20° C. By comparison with conventional liquid fixations deep-freezing is clean and simple and can be carried out in a short period of time. This method is particularly advantageous for the demonstration of traumatic changes within the chest as well as for the demonstration of chronic destructive processes. Deep-freezing avoids retraction of the lung, thereby better preserving anatomic relationships. An additional advantage of this method is the preservation of the original colors of the specimen.

     

Bladder cancer and drinking water: a population-based case-control study in Washington County, Maryland (United States)

A population-based case-control study was conducted in WashingtonCounty, Maryland (United States) to explore the association between incidentbladder cancer and exposure to drinking water from chlorinated surfacesources. Cancer cases were White residents, enumerated in a 1975 countycensus and reported to the Washington County Cancer Registry (n = 294)between 1975 and 1992. White controls, frequency matched by age (± 5 years)and gender, were selected randomly from the census (n = 2,326). Householdsreceiving municipal water, which generally derived from chlorinated surfacewaters, were treated as having high exposure and all others, as lowexposure. Duration of exposure to type of drinking water was based on lengthof residence in the census household prior to 1975. Odds ratios (OR) werecalculated using logistic regression methods, adjusting for age, gender,tobacco use, and urbanicity. Bladder cancer risk was associated weakly in thegeneral population with duration o f exposure to municipal water. Theassociation was limited to those who had smoked cigarettes. In ever-smokerscompared with never-smokers with low exposure, the adjusted ORs for bladdercancer risk with increasing exposure were 1.3, 1.4, 1.4, 1.7, 2.2, 2.8,respectively, for 0, 1-10, 11-20, 21-30, 31-40, > 40 years' exposureduration. The ORs in smokers were not diminished after adjusting for smokinghistory and intensity.     

Effects of 5-fluorouracil,leucovorin, and glucarate in rat colon-tumor explants

Summary In a previous study, we showed that 5-fluorouracil (FU) is active against the dimethylhydrazine-induced colon tumor in rats; a 7-day infusion of FU at 30 mg/kg daily produced 85% tumor-free cures. The present study examined the effects of FU alone and in combination with leucovorin (LV) ord-glucarate (GT) using an ex vivo system that maintained the growth of the rat colon-tumor explants on collagen gels. The labeling index (LI) was determined by the incorporation of [³H]-thymidine and autoradiography. The mean LI of the untreated control was 64.8%±19.8%. The IC₅₀, IC₉₀, and IC₉₅ values following a 7-day exposure to FU were 0.36, 0.75, and 1.22 m, respectively. In comparison, the steady-state FU concentration required to produce 67% tumor-free cures in rats following a 7-day infusion is 1.54 m. LV alone did not produce any antiproliferative effect at concentrations as high as 10 m. The addition of LV at concentrations of 0.001–10 m did not significantly reduce the IC₅₀ of FU. The lack of effect of LV may have been due to tissue saturation with folate provided in the culture medium. GT alone reduced the tumor LI by 20%–30% at concentrations of 0.1–10 m. GT enhanced the effect of FU. As compared with FU alone, the addition of GT at concentrations of 0.1 and 1.0 m reduced the IC₅₀ of FU by 47% and 60% to 0.21 and 0.16 m, respectively. Assessment of the potentiation of the inhibitory effect of FU by GT using two-way analysis of variance and the isobologram method indicated a significant synergistic interaction between FU and GT. This interaction occurred within the FU concentration range of 0.08 and 0.4 m. In summary, these data indicate that (a) the IC values for FU are comparable in tumor explants and in rats, suggesting that the effects in cultured tumors reflect those in intact animals; (b) GT alone showed antitumor activity, albeit relatively minor as compared with FU; (c) FU and GT exhibited synergistic activity, which was most pronounced at FU concentrations that produced submaximal activity (<30% inhibition of tumor LI); and (d) GT and LV had different effects on the growth inhibition by FU, suggesting that GT acts by a mechanism different from the thymidylate synthase-directed effect of FU and LV.Abbreviations FU 5-Fluorouracil - LV leucovorin - GT d-glucarate - LI labeling index - IC inhibitory concentration - IdR thymidine Supported in part by research grants RO1 CA-43365 and RO1 CA-51757 and by Research Career Development Award K04 CA-01 497 (to J. L.-S. A.) from the National Cancer Institute, NIH, DHHS. The work of the senior author (T. D. S.) was supported in part by a fellowship from the Berlex Corporation     

The effectiveness of single and multiple applications of triple dye on umbilical cord separation time

The effectiveness of single and multiple applications of triple dye for umbilical cord care in the umbilical cord separation time (UCST) was evaluated in 180 neonates. Seven neonates were excluded, three where the cord stump separation time was uncertain and four to whom contact was lost. The participating neonates were randomly assigned to two groups. Group 1, 101 neonates, were treated with a regimen of a single application of triple dye. Group 2, 79 neonates, were treated with multiple applications of triple dye. Complete information was obtained from 97 neonates (96.2%) in group 1 and 76 (96%) in group 2. The UCST was 12.6 ± 0.45 (mean ± SE) days in group 1 and 16.68 ± 0.65 days in group 2 (P < 0.0001) and showed no significant association with infants' gender, mode of delivery, gravidity, gestational age, birth weight, or hospital stay. Conclusion A single application of triple dye may be a more favourable regimen with a similarly antimicrobial effect, a shorter UCST and may be more cost effective than multiple applications of triple dye in umbilical cord care. Received: 4 September 1997 / Accepted in revised form: 8 April 1998     

Does bisphosphonate-based anti-osteoporosis medication affect osteoporotic spinal fracture healing?

Summary

Effects of bisphosphonate on fracture healing were prospectively investigated for osteoporotic spinal fracture. Although there were no significant differences in clinical outcomes, the presence of intravertebral cleft was related to the medication use. These results suggest that suspension of bisphosphonate use should be considered during the fracture healing period.

Introduction

The purpose of this prospective study is to investigate whether bisphosphonate-based anti-osteoporosis medication affects fracture healing and clinical outcomes of conservatively treated osteoporotic spinal fractures (OSFs).

Methods

A total of 105 patients who were diagnosed with acute OSFs were prospectively enrolled. According to their previous medication history, the patients were allocated into group I (n?=?39, no history of bisphosphonate use) or group II (n?=?66, history of bisphosphonate use). Clinical outcomes were assessed using visual analogue scale (VAS), and Oswestry disability index (ODI). Radiographic parameters including changes in height loss and kyphotic angle at the index vertebra were measured, and radiographic findings suggesting impaired fracture healing such as the intravertebral cleft (IVC) sign and fracture instability were evaluated. Univariate and multivariate regression analyses were used to identify related factors.

Results

There were no significant differences in the last VAS and ODI between groups. There were also no significant differences in the radiographic parameters. Although the IVC sign was seen more commonly in group II (30.3 %) than in group I (20.5 %), fracture instability combined with IVC was noted in the same number of cases. On multiple regression analysis, medication history showed no significant relationship with the clinical parameters. However, the presence of the IVC sign was related to medication history (odds ratio 4.8; 95 % confidence interval [CI] 1.02–22.69).

Conclusions

Bisphosphonate use does not significantly affect the clinical results during conservative treatment for OSFs. However, the occurrence of the IVC sign was related to medication history. Although further studies are needed to verify our findings, these results suggest that suspension of bisphosphonate use should be considered during the fracture healing period for acute OSFs.

     

HDQLIFE: the development of two new computer adaptive tests for use in Huntington disease,Speech Difficulties,and Swallowing Difficulties

Purpose

Huntington disease (HD) is an autosomal dominant neurodegenerative disease which results in several progressive symptoms, including bulbar dysfunction (i.e., speech and swallowing difficulties). Although difficulties in speech and swallowing in HD have a negative impact on health-related quality of life, no patient-reported outcome measure exists to capture these difficulties that are specific to HD. Thus, we developed a new patient-reported outcome measure for use in the Huntington Disease Health-Related Quality of Life (HDQLIFE) Measurement System that focused on the impact that difficulties with speech and swallowing have on HRQOL in HD.

Methods

Five hundred and seven individuals with prodromal and/or manifest HD completed 47 newly developed items examining speech and swallowing difficulties. Unidimensional item pools were identified using exploratory factor analysis and confirmatory factor analysis (EFA and CFA, respectively). Item response theory (IRT) was used to calibrate the final measures.

Results

EFA and CFA identified two separate unidimensional sets of items: Speech Difficulties (27 items) and Swallowing Difficulties (16 items). Items were calibrated separately for these two measures and resulted in item banks that can be administered as computer adaptive tests (CATs) and/or 6-item, static short forms. Reliability of both of these measures was supported through high correlations between the simulated CAT scores and the full item bank.

Conclusions

CATs and 6-item calibrated short forms were developed for HDQLIFE Speech Difficulties and HDQLIFE Swallowing Difficulties. These measures both demonstrate excellent psychometric properties and may have clinical utility in other populations where speech and swallowing difficulties are prevalent.

     

HDQLIFE: development and assessment of health-related quality of life in Huntington disease (HD)

Purpose

Huntington disease (HD) is a chronic, debilitating genetic disease that affects physical, emotional, cognitive, and social health. Existing patient-reported outcomes (PROs) of health-related quality of life (HRQOL) used in HD are neither comprehensive, nor do they adequately account for clinically meaningful changes in function. While new PROs examining HRQOL (i.e., Neuro-QoL—Quality of Life in Neurological Disorders and PROMIS—Patient-Reported Outcomes Measurement Information System) offer solutions to many of these shortcomings, they do not include HD-specific content, nor have they been validated in HD. HDQLIFE addresses this by validating 12 PROMIS/Neuro-QoL domains in individuals with HD and by using established PROMIS methodology to develop new, HD-specific content.

Methods

New item pools were developed using cognitive debriefing with individuals with HD, and expert, literacy, and translatability reviews. Existing item banks and new item pools were field tested in 536 individuals with prodromal, early-, or late-stage HD.

Results

Moderate to strong relationships between Neuro-QoL/PROMIS measures and generic self-report measures of HRQOL, and moderate relationships between Neuro-QoL/PROMIS and clinician-rated measures of similar constructs supported the validity of Neuro-QoL/PROMIS in individuals with HD. Exploratory and confirmatory factor analysis, item response theory, and differential item functioning analyses were utilized to develop new item banks for Chorea, Speech Difficulties, Swallowing Difficulties, and Concern with Death and Dying, with corresponding six-item short forms. A four-item short form was developed for Meaning and Purpose.

Conclusions

HDQLIFE encompasses both validated Neuro-QoL/PROMIS measures, as well as five new scales in order to provide a comprehensive assessment of HRQOL in HD.

     

Absence of carcinogenic effects of chronic feeding of snuff in inbred Syrian hamsters

Fifty male inbred Syrian hamsters, aged 60–90 days, received a diet reduced in caloric content by 20% methylcellulose, or a diet containing 20% snuff (powdered tobacco), or 50 (5 mg) gavages of 20-methylcholanthrene (MC) in addition to chow, or 50 (0.5 mg) gavages of MC (assumed to be a noncarcinogenic dose) with a cellulose-containing diet, or 50 (0.5 mg) gavages of MC with a diet containing 20% snuff. These chronic feeding studies failed to reveal any carcinogenic or cocarcinogenic effects of snuff. Presence in serum of cotinine derived from nicotine, together with food consumption and body weight studies, showed adequate snuff intake. Tumors in the MC-fed animals demonstrated the susceptibility of the two inbred lines of Syrian hamsters used in this study. The only effect of snuff noted was a slower growth of the animals in one of the inbred lines but not in the other. The conclusion is warranted that 20% snuff in the diet is neither carcinogenic nor cocarcinogenic for these animals.