Hormonersatztherapie Nutzen und Risiken

Zwei placebokontrollierte Interventionsstudien mit kombinierter Hormontherapie hatten eine Diskussion hinsichtlich einer Neubewertung des Nutzen-Risiko-Profils der Hormonersatztherapie ausgelöst, da erhöhte Risiken für Brustkrebs, Herzinfarkte, Thrombosen und Hirninsult berechnet wurden. Bei vorbestehender Disposition müssen diese Risiken stets beachtet werden. Insgesamt sind bei individueller Bilanzierung diese jedoch gegenüber dem erreichbaren Nutzen zu relativieren. Die klassischen Indikationen wie vasovegetative und Urogenitale Beschwerden waren nie angezweifelt worden, die Osteoporoseprävention wurde bestätigt. Auch eine Prävention von kolorektalen Karzinomen scheint möglich. Bei individualisierter, niedrigdosierter, indizierter und kontrollierter Anwendung der Hormonersatztherapie ist davon auszugehen, dass der Nutzen die Risiken überwiegt, insbesondere bei frühem Behandlungsbeginn und bei alleiniger Behandlung mit Östrogenen. So zeigte sich in der WHI-Studie für Frauen unter 60 Jahren nur das bekannte Risiko für Venenthrombosen, die Risiken für Herzinfarkte, Brustkrebs, kolorektale Karzinome und Osteoporose waren um 20–40% reduziert.     

Effect of chlorhexidine on genital microflora, Neisseria gonorrhoeae, and Trichomonas vaginalis in vitro

BACKGROUND: Chlorhexidine is a disinfectant that has been used in skin and mouth washes and as a preservative in some vaginal lubricants. A gel containing 0.25% chlorhexidine gluconate has been found to be effective against Chlamydia trachomatis in vitro and in animal models. Applied vaginally, 5 g of this gel could achieve vaginal fluid concentrations of < or = 1250 microg/ml. GOAL: To test the in vitro activity of chlorhexidine in a gel over a pH range of 4 to 8 in the presence or absence of blood. STUDY DESIGN: Organisms were exposed to chlorhexidine for 30 minutes to 2 hours, and the minimum cidal concentration (MCC) was calculated. RESULTS: The MCC for Neisseria gonorrhoeae was 25 microg/ml at 30 minutes and 12.5 microg/ml at 1 to 2 hours of exposure, whereas the MCC for Trichomonas vaginalis was 1250 microg/ml. Chlorhexidine was more active at pH 8 than pH 4, and less active in the presence of blood. The MCC for Lactobacillus crispatus was 1250 microg/ml at pH 4 and only 125 microg/ml at pH 8. CONCLUSIONS: Based on its in vitro activity, chlorhexidine may be an appropriate topical microbicide for prevention of gonorrhea, but not for prevention of trichomoniasis. This study suggests that the presence of blood and pH affect the activity of chlorhexidine against genital pathogens and commensals.     

A randomised controlled trial of delayed cord clamping in very low birth weight preterm infants

This study was carried out to assess the feasibility of late cord clamping of 45 s in preterm infants delivered mainly by caesarean section and the effects on post-partal adaptation and anaemia of prematurity. Prior to delivery, 40 infants of <33 gestational weeks were randomised to either 20 s or 45 s of late cord clamping. After the first shoulder was delivered, oxytocin was given intravenously to the mother in order to enhance placento-fetal transfusion while the infant was held below the level of the placenta. The 20 infants in group 1 (20 s) had a mean birth weight of 1070 g and a mean gestational age of 29 + 4/7 weeks versus 1190 g and 30 weeks in group 2 (45 s). On day 42 of life there were ten infants without transfusions in group 2 versus three in group 1 (P < 0.05). Out of the 20 infants in group 1, 19 and 15/19 in group 2 were delivered by caesarean section. There were no significant differences in Apgar scores, temperature on admission, heart rate, blood pressure and requirements for artificial ventilation. Conclusion Delayed cord clamping of 45 s is feasible and safe in preterm infants below 33 weeks of gestation. It is possible to perform the procedure at caesarean section deliveries and it should be performed whenever possible. It reduces the need for packed red cell transfusions during the first 6 weeks of life. Received: 10 February 2000 / Accepted: 12 April 2000     

The incidence of birth trauma among live born term neonates at a referral hospital in Rafsanjan, Iran.

BACKGROUND: Some special problems of neonates are related to the adverse effects of delivery such as birth trauma with high mortality and morbidity. The aim of this study was to determine the incidence of birth trauma and related risk factors in a referral hospital in Rafsanjan, a city in the south of Iran. MATERIALS AND METHODS: In this cross-sectional study, we reviewed medical records of all 3340 live neonates that were born between March 2004 and March 2005 at Nicknafs maternity center. Special questionnaires of study were completed and data was analyzed. RESULTS: Among all neonates, 0.8% of them had birth trauma. The most common types of trauma were cephalohematoma 37.03%, massive hematoma 37.03%, and clavicular fracture 11.2%. The incidence of brachial plexus injury and clavicular fracture was higher in macrosomic neonates, whereas cephalhematoma, skin injury and massive hematoma were more prevalent in microsomic neonates. Neonatal birth trauma was more frequent in vaginal delivery than cesarean section (1.3% vs 0.1%, p = 0.0001). However, the incidence of birth trauma in instrumental delivery and normal vaginal delivery were similar (2.8% vs 1.3%, p = 0.303). CONCLUSION: The incidence of birth trauma in this region is 0.8% and birthweight and normal vaginal delivery are strong predictors for birth injuries.     

Ein seltener Kollateralkreislauf zwischen der Arteria maxillaris und der Arteria carotis interna

Zusammenfassung Es wird über einen 42jährigen Mann berichtet, bei dem durch direkte Punktion der Arteria carotis communis ein extrakranieller Verschluß der Arteria carotis interna angiographisch nachgewiesen wurde. Das Angiogramm zeigt einen seltenen Kollateralkreislauf, der aus einem Netz erweiterter Gefäße zwischen der Arteria maxillaris und der Arteria carotis interna besteht. Anlaß der Untersuchung war ein Bagatelltrauma des Kopfes, bei dem der Patient kurze Zeit unter Schwindel und Flimmern vor den Augen litt. Tage danach traten langsam zunehmende Kopfschmerzen auf, die den Patienten 6 Monate nach dem Unfall zur Untersuchung in die Klinik führten. Neurologisch und psychopathologisch ergaben sich regelrechte Befunde. Gefäße der dargestellten Art kommen im normalen Angiogramm nicht vor. Es wird vermutet, daß ihr Vorhandensein entwicklungsgeschichtlich zu verstehen ist und daß der Gefäßverschluß in früher Kindheit eingetreten ist.

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A rare collateral circulation between the maxillary and internal carotid artery

Summary In a 42-year-old man an extracranial occlusion of the internal carotid artery was detected through angiography by direct puncture of the common carotid artery. The angiogram revealed a rarely seen collateral circulation consisting of a network of dilated vessels between the maxillary artery and the internal carotid artery. The reason for the examination arose when he suffered a minimal head trauma associated with a short episode of dizziness and flickering vision. A few days later he developed headaches which grew gradually worse to make the patient finally come to the hospital 6 months after the trauma. Neurological and psychopathological findings were normal. The described alterations of blood vessels are not seen on a normal angiogram and presumably represent a developmental abnormality; the extracranial occlusion of the internal carotid artery has possibly occurred in early childhood.

     

Prognostic value of chromosome 1 and 8 copy number in invasive ductal breast carcinoma among iranian women: An interphase FISH analysis

Breast cancer is amongst the leading causes of death in women worldwide and the most common cancer amongst Iranian women. Unfortunately, the current clinical and histological criteria can only help 60 percent of women with breast cancer in diagnosis and long-term treatment. Therefore, genetic markers both at single gene and chromosomal level can play an important role in improving the diagnosis and prognosis of breast cancer patients. The aim of this retrospective study was to investigate the role of chromosome 1 and 8 copy number assessed by interphase fluorescence in situ hybridization (FISH), as prognostic parameters in 50 Iranian women, aged 35 to 64 years, with sporadic invasive ductal breast carcinoma. Chromosome 1 and 8 copy numbers were evaluated in relation to established clinicopathological parameters, the immunohistochemical markers ER, PR, P53 and cathepsin D, DNA index by flow cytometry, age and survival status of the patients. FISH using centromeric probes for chromosomes 1 and 8 was applied to interphase cell suspensions prepared from archived, Carnoyfixed tumor cells and selected paraffin-embedded tumor sections. Aneusomy for chromosomes 1 and 8 was present in all 50 patients to different levels. The total abnormality rate for chromosome 1 was 33.92 percent (4.24 percent monosomy and 29.68 percent polysomy), whereas for chromosome 8 this rate was 28.30 percent (6.48 percent monosomy and 21.82 percent polysomy). Statistically significant association (p<0.05) was demonstrated between monosomy 1 and patients’ age below 50 years, and between monosomy 1 and poor survival, respectively. Disomy 8 was significantly associated with P53 expression. A borderline significant correlation was demonstrated between polysomy 8 and diploid DNA content, as well as between disomy 1 and disease-free status of the patients. Chromosome 1 and 8 copy numbers may be considered as useful prognostic markers in invasive ductal carcinoma of the breast.     

Oxidative stress in radiology staff

Excessive production of reactive oxygen species has been observed following acute and chronic exposure to radiation in animal models which can lead to several detrimental and irreversible outcomes in vital organs. Aim of this study was to determine the oxidative stress status in radiology unit workers which are exposed to persistent low-dose radiation. METHODS:: A group of 32 radiology unit employees along with 32 sex- and age-matched hospital workers, not exposed to low-dose radiation were recruited from two separate hospitals for the study. Exposed subjects showed higher levels of lipid peroxidation (P=0.009), total antioxidant capacity (P=0.0006) and thiol groups (P=0.03). It is concluded that occupationally exposed individuals are oxidatively stressed and precautions such as antioxidant therapy seems reasonable.