Pharmacokinetics of salicylates administered with metoprolol

The widely used acetylsalicylic acid (ASA, Colfarit) was administered in combination with metoprolol (Lopresor) during 7 days. Plasma concentrations of total salicylates (ASA and salicylic acid (SA) and metoprolol were monitored during the treatment period, on day 7 urinary excretion was also investigated. The kinetic data of the compounds were compared to those of the metoprolol and ASA control periods. Metoprolol kinetics remained uninfluenced whereas the maximal plasma concentrations of the salicylates were significantly higher than in the ASA control period.     

Stereoselective disposition of carprofen, flunoxaprofen, and naproxen in rats.

The stereoselective dispositions of carprofen, flunoxaprofen, and naproxen were studied in rats after i.v. administration of racemate (11 mumol/kg) or enantiomer (5.5 mumol/kg). The total clearances of the (R)-enantiomers of carprofen and flunoxaprofen were significantly greater than those of the (S)-enantiomers. The clearance of (S)-naproxen was similar to the value for (R)-naproxen. There were no marked differences in steady-state volume of distribution between (R)- and (S)-enantiomers for carprofen, flunoxaprofen, or naproxen. The (R)- to (S)-enantiomer inversion ratio for flunoxaprofen in rats was 0.54. The ratios for naproxen and carprofen were 0.02 and 0.003, respectively. Biliary excretion of (R)-carprofen and of its glucuronide were higher than those of the (S)-enantiomer and its glucuronide. In contrast, biliary excretion of the (S)-enantiomers of flunoxaprofen, naproxen, and of their glucuronides were greater than those of their antipodes. Insignificant amounts of the parent enantiomers and of the glucuronides of these three drugs were excreted in urine. These results indicate that there is a wide variation in the extent of inversion at a chiral center for these three 2-arylpropionates and in the stereoselective disposition of their acyl glucuronides.     

How valid is the arthroscopic diagnosis of cartilage lesions? Results of an opinion survey among highly experienced arthroscopic surgeons

Aim  In general, arthroscopy is considered the “gold standard” for the evaluation of cartilage lesions. In this multicenter survey, we ascertained the general opinion of surgeons regarding arthroscopic cartilage diagnoses. Method  A total of 301 highly experienced arthroscopists (instructors of the AGA, the German-speaking society of arthroscopy) were contacted in writing with a request to complete the survey. Results  The data from 105 respondents (34.8% of those contacted) were used for the investigation. In the grading of the cartilage lesions, the Outerbridge classification was most frequently used (n = 87), followed by the ICRS protocol (n = 8) and the Insall score (n = 3). The majority (61%) of the arthroscopic surgeons felt that differentiation between healthy cartilage and low-grade cartilage lesions was simple. For differentiation between grade I and grade II lesions, and for differentiation between grade II and grade III lesions, 41.9 and 51.4%, respectively, thought that there was a “need for improvement”. In the case of grade IV lesions, 70.5% of the surgeons thought that the diagnosis was valid. The respondents also judged the utility of incorporating objective measurements (e.g., intraoperative biomechanical tests): 13.3% (n = 14) responded that such measurements would be “very useful” and 61.9% (n = 65) responded that they would be “somewhat useful”. Conclusions  Among surgeons, arthroscopy was not perceived to be as reliable as a “gold standard” for the diagnosis of cartilage lesions. The majority of experienced arthroscopists felt unsure of the results in general, or at least in some cases. A universal and definitive grading system for lesions appears to be needed. For questionable cases, measurement devices are needed for objective cartilage grading.     

Nierentransplantation und Harnableitung

For patients with end-stage renal disease and dysfunctional or absent lower urinary tract, complex therapeutic strategies are necessary combining kidney transplantation and – if possible – continent urinary diversion. In this concept urinary diversion is the first step in a two-stage procedure followed by renal transplantation. Meticulous preoperative diagnostics, careful patient selection and life-long close surveillance are critical for the success of this concept. The published data concerning long-term graft and patient survival are promising.     

Iatrogenic recto-urethral fistula: perineal repair and buccal mucosa interposition

OBJECTIVE

To present a new and promising technique for repairing recto‐urethral fistulae (RUF) using a perineal approach and buccal mucosa graft interposition, as RUF are rare but severe complications of rectal or urinary tract surgery, radiation treatment, trauma or inflammation, and the repair of recurrent or persistent RUF is particularly difficult when previous surgical attempts have failed, resulting in high recurrence rates.

PATIENTS AND METHODS

Between 2004 and 2006, five men (aged 61–67 years) with iatrogenic RUF had the perineal fistula closed using a buccal mucosa graft interposition. The RUF had developed after laparoscopic or retropubic radical prostatectomy in four patients and after radical cystectomy and ileal neobladder in the fifth. Four of the patients had had at least one failed RUF repair before their referral to our institution.

RESULTS

Four of the five RUF were repaired successfully using the perineal approach and buccal mucosa graft interposition. Failure occurred in one patient who had developed a RUF after laparoscopic radical prostatectomy followed by two unsuccessful attempts at closure. The failure was most probably due to a previously undetected postoperative perineal haematoma with infection.

CONCLUSION

Our perineal approach for repairing RUF, combined with buccal mucosa graft interposition, is a simple technique fulfilling all the requirements for successful fistula closure, especially in repeat surgery.     

Psychosomatischer Liaisondienst am Universitätsklinikum

BACKGROUND: Little is known about the complex decision-making process involving recognition of psychosocial stress, its diagnosis, and psychotherapeutic intervention within the framework of a psychosomatic consulting and liaison service. PATIENTS AND METHODS: Psychosocial stress was recorded using a psychometric questionnaire for 392 patients on admission to hospital, the estimated need of psychotherapeutic treatment, and the application of a psychosomatic liaison service. RESULTS: Of the examined patients, 44% presented with at least one mental disorder requiring treatment according to ICD-10 criteria. According to the expert opinions, a need for psychotherapeutic treatment was present in 41%, while 54% were themselves motivated for at least one of the psychotherapeutic treatments offered. Psychotherapy was actually received by 35% of the patients. While mental disorders and emotional distress were significant predictors of the need for treatment as rated by experts, they played no genuine role in determining indication or whether a patient accepts the use of psychotherapy CONCLUSION: Psychotherapeutic interventions in the liaison service are not always effective or related to the indication.     

Coagulopathy in multiple trauma: new aspects of therapy

Coagulopathy after trauma is a major cause for uncontrolled hemorrhage in trauma victims. Approximately 40% of trauma related deaths are attributed to or caused by exsanguination. Therefore the prevention of coagulopathy is regarded as the leading cause of avoidable death in these patients. Massive hemorrhage after trauma is usually caused by a combination of surgical and coagulopathic bleeding. Coagulopathic bleeding is multifactorial, including dilution and consumption of both platelets and coagulation factors, as well as dysfunction of the coagulation system. Because of the high mortality associated with hypothermia, acidosis and progressive coagulopathy, this vicious circle is often referred to as the lethal triad, potentially leading to exsanguination. To overcome this coagulopahty-related bleeding an empiric therapy is often instituted by replacing blood components. However, the use of transfusion of red blood cells has been shown to be associated with post-injury infection and multiple organ failure. In the management of mass bleeding it is therefore crucial to have a clear strategy to prevent coagulopathy and to minimize the need for blood transfusion.     

Whole-Organ Arthroscopic Knee Score (WOAKS)

Background  

To describe a semi-quantitative score for multi-feature, whole-organ evaluation of the knee in osteoarthritis based on the results of arthroscopic evaluation.