Managing Traps and Pitfalls During Initial Steps of an ECMO Retrieval Program Using a Miniaturized Portable System: What Have We Learned From the First Two Years?

The aim of this study was to provide early and mid‐term results of the newly established extracorporeal membrane oxygenation (ECMO) retrieval service in a tertiary cardiothoracic center using the miniaturized portable Cardiohelp System (Maquet, Rastatt, Germany). A particular attention was paid to organizational and logistic specifics as well as challenges and pitfalls associated with initial phase of the program. From January 2015 until January 2017 a heterogenic group of 28 consecutive patients underwent ECMO implantation in distant hospitals for acute cardiac, pulmonary or combined failure as a bridge‐to‐decision and were subsequently transported to our institution. Each cannulation was performed bedside on intensive care units (ICU) using the Seldinger's technique. Early outcomes and mid‐term overall survival with up to two‐year follow‐up along with the impact of ongoing cardiopulmonary resuscitation (CPR) on outcome were presented. Also, changes in hemodynamics and tissue perfusion factors 24 h after ECMO implantation were evaluated. ECMO implantations were performed in 15 distant departments with the median distance of 23(10;40) (maximum 60) km. A total of 15 patients (54%) were cannulated under CPR with the median duration of 30(20;110) (maximum 180) min. After 24 h of support there were significant improvements in SvO₂ (P = 0.021), mean arterial pressure (P = 0.027), FiO₂ (P = 0.001), lactate (P = 0.001), and pH (P < 0.001). The mean ECMO support duration was 96 ± 100 (maximum 384) hours, whereas 11 patients (40%) were weaned off support and discharged from hospital. Overall cumulative survival in patients without the need for CPR was 61.5% at one week and 38.5% at 1 month, 6 month, and 1 year, whereas patients requiring CPR survived in 40% at one week, and 33.3% at 1 month, 6 month, and 1 year (Log‐Rank (Mantel‐Cox) P = 0.374, Breslow (Generalized Wilcoxon) P = 0.162). Our initial experience shows that launching new ECMO retrieval programs in centers with sufficient ICU capacities and local ECMO experience can be feasible and associated with acceptable “real world” results despite the initial learning curve. Rapid logistical organization and team flexibility are the key points to ensure comparable survival of patients requiring prolonged CPR.     

Treatment of Bendamustine and Prednisone in patients with newly diagnosed multiple myeloma results in superior complete response rate, prolonged time to treatment failure and improved quality of life compared to treatment with Melphalan and Prednisone—a randomized phase III study of the East German Study Group of Hematology and Oncology (OSHO)

Purpose: This randomized phase III study compared bendamustine and prednisone (BP) to standard melphalan and prednisone (MP) treatment in previously untreated patients with multiple Myeloma (MM). Patients and Methods: To be included, patients had to have histologically and cytologically proven stage II with progressive diseases or stage III MM. They were randomly assigned to receive BP (n=68) or MP (n=63). The primary endpoint was the time to treatment failure (TTF). Secondary endpoints included survival, remission rate, toxicity and quality of life. Results: The overall response rate was 75% in the BP and 70% in the MP group. A significantly higher number of patients treated with BP achieved a complete remission than did patients receiving MP (32 vs. 13%; P=0.007), and the maximum response was achieved more rapidly in patients treated with BP compared to those receiving MP (6.8 vs. 8.7 cycles; P<0.02). TTF and remission duration were significantly longer in the BP group. Patients receiving BP had higher QoL scores and reported pain less frequently than patients receiving MP. Conclusion: BP is superior to MP with respect to complete remission rate, TTF, cycles needed to achieve maximum remission and quality of life and should be considered the new standard in first-line treatment of MM patients not eligible for transplantation.     

Chemotherapie beim metastasierten Mammakarzinom

Ohne Zusammenfassung     

Cancer of the large intestine--a sequela of ureterosigmoidostomy

Carcinoma or polyps of the colon as a late complication of ureterosigmoidostomia (USS) have been reported with increasing frequency. Three patients are presented, two of them developed a signet-ring cell carcinoma after USS; one patient showed, 6 years after rediversion of the ureter, a carcinoma at the anastomotic site. Changes in the secretion patterns of sialo- and sulphomucines of the tumor and mucosa are histochemically demonstrated and, together with an appraisal of etiologic factors, discussed. We suggest a careful follow-up of patients with USS, particularly of those performed many years ago.     

Compromised integrity of excised porcine intestinal epithelium obtained from the abattoir affects the outcome of in vitro particle uptake studies.

Excised porcine intestinal tissue obtained from the local abattoir was studied for its suitability to examine the uptake and transport of poly(lactic-co-glycolic acid) (PLGA) nanoparticles in Peyer's (PP) and non-Peyer's patch (NPP) tissue in vitro. Incubation of such tissue with fluorescent PLGA and polystyrene particles revealed negligible uptake into the intercellular space with no noticeable difference between PP and NPP tissue. Similarly, yeast cells, which were used as a positive control for selective uptake into PP tissue, were found in the subepithelial area of both PP and NPP tissue. Therefore we examined the morphological integrity of the tissue for the duration of the experiments. For this purpose, excised intestinal tissue from the abattoir transported to the laboratory was examined for morphological changes by light microscopy and compared to intestinal tissue from freshly slaughtered piglets. Already after 25 min postmortem, we observed lysis and defoliation of the epithelial cell layer followed by a complete loss of villus architecture and, consequently, resulting in a complete loss of the integrity of the intestinal tissue. This may explain the limited and non-selective particle uptake when using excised intestinal tissue from the abattoir. It is suggested to avoid small intestine obtained from the abattoir and to use tissue from freshly sacrificed animals within a few minutes postmortem. Experiments should then be performed under adequate oxygenation of the excised intestinal tissue.     

Measles-mumps vaccination in the FRG: an empirical analysis after 14 years of use. II. Tolerability and analysis of spontaneously reported side effects

Four hundred and thirty-three reports of suspected side effects following measles-mumps vaccination had been received at Behringwerke by the end of December 1989. The analysis of the data shows that no new risks of the vaccination could be identified and that the frequency of side effects is in good agreement with the findings of other authors. It therefore can be assumed that the relative risks of the vaccination continue to be distinctly outweighed by the benefits. The findings clearly demonstrate once more that it is necessary to carry out a thorough differential diagnosis before one can assume that the symptoms observed are causally related to the vaccination. In addition the analysis shows the importance of the epidemiological approach to the assessment of rare side effects.     

Survival of operated bronchus carcinoma patients: a prospective study

Maximum diameter, tumour volume, and inflammatory response of host tissue in 282 surgical specimens with primary carcinoma of the bronchus were measured. Cell type, pT- and pN-stage, maximum diameter and volume of the primaries, and inflammatory response of host tissue were analyzed in respect to survival of the patients. Date of death was evaluated by quarterly communications with the house physicians. Survival rates were computed by use of Kaplan-Meier estimation. Mean survival of all patients was calculated at 480 days. Lymph node involvement and tumour volume were found to have a major influence on survival. In accordance with the weak contribution of maximum diameter of the tumour to survival, no major differences in survival between pT1- and pT2-stage were found. If severe inflammatory response at the tumour boundary was noted, patients showed slightly increased survival in all tumour stages. Cell type and tumour grading were found to be of minor influence in respect to survival.     

Biometrical aspects in the design and analysis of chimpanzees trials assessing hepatitis virus inactivation

Hepatitis virus safety of products derived from blood is achieved by screening of individual blood donations and by production processes efficient in eliminating and inactivating residual amounts of hepatitis viruses. A quantitative measure of process inactivation efficiency is the inactivation factor derived from process overchallenging experiments. A product is safe if the corresponding process inactivation factor is as high as the one of a product whose safety has been clinically established. Reliable information on hepatitis safety cannot be obtained by testing commercial end product samples in chimpanzees.     

Acne conglobata-like exacerbation of acne vulgaris following administration of anabolic steroids and vitamin B complex-containing preparations

This article reports the aggravation of preexisting acne vulgaris in a 21-year-old male patient due to the abuse of anabolic drugs during body-building training. After cessation of anabolic drugs the acne healed, leaving hypertrophic scars. This case report shows that the acute aggravation of an acne vulgaris should cast suspicion on the use of hormone preparations.     

Postoperative Endoskopie zur Diagnose und Therapie von Komplikationen

Verschiedene endoskopische Verfahren sind wesentlicher Bestandteil der diagnostischen Sicherung und Therapie unterschiedlicher Komplikationen nach viszeral- sowie thoraxchirurgischen Operationen. Typische Indikationen für endoskopische Interventionen sind Nahtinsuffizienzen, Stenosen, Blutungen, Gallenwegsl?sionen und funktionelle Probleme nach Operationen. Am h?ufigsten zur Anwendung kommende Verfahren sind Fistelklebungen, Dilatationen und Bougierungen, Blutstillungstechniken, Gallenwegsinterventionen und Stentplatzierungen. Bei insgesamt sehr guten Erfolgsraten k?nnen mithilfe endoskopischer Techniken in der Mehrzahl der F?lle operative Reinterventionen vermieden und langwierige Verl?ufe abgekürzt werden. Führen die endoskopischen Bemühungen nicht zum Erfolg, sind keine Nachteile für anschlie?ende konventionell operative Ma?nahmen zu befürchten.