Severity of chronic kidney disease did not influence bleeding during treatment of acute coronary syndromes

We assessed the influence of CKD on bleeding in 200 patients with ACS via retrospective chart analysis. Using K/DOQI guidelines to stratify patients based on GFR, no differences in documented bleeding or antithrombotic utilization were observed among the groups. Due to increased mortality risk of patients with CKD from cardiovascular disease, assessing benefit-to-risk ratios of various medical interventions is crucial.     

Novel tumortropic ester derivatives of 99mTc(V) mesodimercapto succinic acid with low affinity for bone tissue

Starting from our previous finding that 99mTc(V) dimercaptosuccinic acid (99mTc(V)-DMSA), a useful agent for the localization of osteosarcoma and bone metastases, loses its bone affinity when one ester group is introduced into the complex we studied the impact of esterification in more detail. This paper reports on the evaluation of various ester complexes of 99mTc(V)-DMSA in rats and tumour-bearing nude mice with regard to their tumour retention and improvement of the tumour to tissue ratios. The distribution patterns of the complexes [99mTcO(DMSA)2]- (A), [99mTcO(DMSA/DMSEt)]- (B) and [99mTcO(DMSEt)2]- (C) are gradually changed with the number of ester groups in the anionic complex. However, the asymmetric diester complex [99mTcO(DMSA/DMSEt2)]- (D) is very slowly cleared, especially from the blood of nude mice. Moreover, this complex differs significantly from the symmetrical complex C in its elimination behaviour from the liver and kidneys. The tumour uptake is maintained with complexes that contain one or two non-hydrolysable ester functions. Preliminary biodistribution studies of the monoethyl and diethyl ester complexes B, C and D in comparison with A in tumour-bearing nude mice showed similar uptake into the human squamous cell carcinoma (FaDu) as well as into the human colonic cell carcinoma (HT29) of nude mice. The low bone accumulation of B, C and D results in excellent tumour-to-bone ratios, e.g., approx. 3:1 for the ester complex B compared to approx. 1:2 for complex A. Differences were observed in the accumulation and elimination behaviour of the complexes A and B in various bone structures of rats. The age-dependent uptake of A and B was compared in long bone (femur) and in cranial bone of rats. The results suggest that 99mTc(V)-DMSA complexes that contain a functional ester, and their 188Re analogues, may be superior to 99mTc(V)/188Re(V)-DMSA in diagnostic and therapeutic nuclear medicine.     

Präoperative Nahrungskarenz

Zusammenfassung Die Anordnung einer strikten Nahrungskarenz nach Mitternacht vor operativen Eingriffen in Narkose ist die geläufige Praxis in chirurgischen Einrichtungen in Deutschland. Das damit verfolgte Ziel ist eine Reduktion des perioperativen Aspirationsrisikos. Seit mehreren Jahren wird die wissenschaftliche Grundlage dieser Verfahrensweise zunehmend kritisch diskutiert. Insbesondere für die präoperative Einnahme von Wasser und klarer Flüssigkeit zeigen experimentelle wie klinische Untersuchungen, dass von einer vollständigen Magenpassage innerhalb von 2 h sicher ausgegangen werden kann und das Risiko nach begrenztem Trinken bis 2 h vor elektiven Operationen in Allgemeinanästhesie nicht erhöht ist. Zudem sind perioperative Aspirationszwischenfälle sehr selten, haben eine gute Prognose und sind eher auf Faktoren wie mangelnde Narkosetiefe oder unzureichende Atemwegsprotektion zurückzuführen als auf den Nüchternheitsstatus des Patienten. Folglich haben zahlreiche nationale anästhesiologische Gesellschaften im Sinne eines verbesserten perioperativen Wohlbefindens der Patienten ihre offiziellen Leitlinien zur präoperativen Nüchternheit geändert und empfehlen unter Berücksichtigung definierter Einschränkungen und Kontraindikationen einen gelockerten Umgang mit der Einnahme flüssiger wie fester Nahrung vor elektiven Eingriffen. Die vorliegende Arbeit gibt eine zusammenfassende Übersicht über die Hintergründe, auf denen diese national erstellten Leitlinien beruhen, mit der Absicht auch für Deutschland eine Empfehlung zur Lockerung der präoperativen Nüchternheit für klare Flüssigkeiten vorzuschlagen.     

Increased endothelial injury in septic patients with coronary artery disease

STUDY OBJECTIVE: Recently, it was proposed that soluble intercellular adhesion molecule (sICAM)-1 plasma levels may allow subgroup identification of patients at risk for cardiovascular complications during sepsis. However, the impact of preexisting coronary artery disease (CAD) on these results has not yet been tested. The aim of this study was to investigate whether plasma levels of adhesion molecules, nitric oxide, and cytokines differ between septic patients with or without preexisting CAD. DESIGN: Prospective study. SETTING: Surgical ICU. PATIENTS: Forty-four septic patients, 24 of whom met the criteria of CAD. MEASUREMENT: Hemodynamic measurements were performed and blood samples were taken within 12 h after onset of sepsis (early sepsis) and again 72 h thereafter (late sepsis). Soluble adhesion molecules and cytokines were determined using commercially available enzyme-linked immunosorbent assay kits, cyclic guanosinomonophosphate (cGMP) by competitive radioimmunoassay, and nitrite/nitrate photometrically by Griess reaction. RESULTS: In CAD patients, sICAM-1 (p < 0.02) was significantly elevated in early and late sepsis, whereas soluble endothelial-linked adhesion molecule (sE-selectin; p < 0.01) and cGMP (p < 0.03) were only increased in late sepsis. Oxygen consumption did not significantly differ between groups. Oxygen delivery and mixed venous oxygen saturation during early and late sepsis were significantly diminished and the oxygen extraction ratio significantly increased in the CAD group (p < 0.05). CONCLUSIONS: Increased endothelial injury may be indicated by the elevated levels of sICAM-1, sE-selectin, and cGMP in septic patients with preexisting CAD. These parameters, however, failed to serve as predictors for unknown CAD or chances for survival in early sepsis.     

Dietary Supplementation Before,During and After Pregnancy: Results of the Cluster-Randomized GeliS Study

Introduction The nutritional status of women before, during, and after pregnancy plays an important role in the health of mother and child. In addition to a balanced mixed diet, the increased need for folic acid and iodine should be met and ensured with supplements. The aim of this study was to assess dietary supplementation in the context of pregnancy and to investigate the effect of targeted counselling on supplementation behavior during and after pregnancy. Methods In the context of the “Gesund leben in der Schwangerschaft” (GeliS; “Healthy living in pregnancy”) trial, women in the intervention group (IG) received four structured lifestyle counselling sessions during pregnancy as well as postpartum, during which they were informed about appropriate dietary supplementation. The women in the control group (CG) received routine prenatal care. The intake of dietary supplements was recorded at different points using a questionnaire. Results In total, 2099 women were included in the analysis. Prior to conception, 31.3% of the women in the IG and 31.4% of the women in the CG took folic acid supplements. Prenatally, about half of the women took folic acid (IG: 54.1%; CG: 52.0%) and iodine (IG: 50.2%; CG: 48.2%). Statistically significant differences between the groups with regard to supplementation behavior could not be observed, neither prior to inclusion in the study nor during the intervention. During pregnancy, 23.0% of all women took docosahexaenoic acid (DHA) supplements and 21.8% iron supplements. 49.4% of the women additionally took vitamin D supplements. A higher educational level (p < 0.001), advanced age (p < 0.001), primiparity (p < 0.001), and a vegetarian diet (p = 0.037) were all associated with a higher level of dietary supplementation. Conclusion The GeliS lifestyle counselling did not significantly improve the supplementation behavior of women during and after pregnancy. Women should be informed about adequate dietary supplementation early on within the scope of gynecological prenatal care. Key words: dietary supplementation, folic acid, iodine, pregnancy, postpartum     

Cranial and peripheral neuropathies.

An acute polyneuropathy developing over days to several weeks is most likely to be Guillain-Barré syndrome or a toxic neuropathy, although vasculitis can also present acutely. This presentation should be referred immediately for further investigation. A subacute to chronic (ie, developing over months) neuropathy with significant proximal weakness and prominent loss of reflexes is highly suggestive of chronic inflammatory demyelinating polyradiculoneuropathy. If there is a clear stepwise onset of symptoms, suggestive of multiple mononeuropathies, or significant asymmetry, vasculitic neuropathy should be considered, even in the absence of systemic vasculitis. Idiopathic chronic axonal neuropathy is an indolent, predominantly sensory neuropathy that typically occurs in older patients. Neuropathies occurring in young or middle age or with more subacute onset always warrant further investigation.     

Characterization of two cell lines, derived from two malignant fibrous histiocytomas

We have investigated the phenotype and ultrastructure of tumour cells from two cell lines each derived from a malignant fibrous histiocytoma (MFH) as a means of studying the histogenesis of this group of tumours. The first MFH (MFH-I) was of the pleomorphic subtype, with a predominantly histiocytic appearance, the second was of the pleomorphic subtype associated with myxoid and storiform areas (MFH-II). In vitro tumour cells from both neoplasms showed aberrant growth properties. Xenografts in nude mice from both neoplasms showed a similar histology to that of the original tumour. Both tumours showed hyaluronidase sensitive alcian blue staining. Phenotypic studies of the two cell lines and of the tumour tissues demonstrated that the cells differed in the presence of collagen types I and III. They did not show evidence of histiocytic, endothelial, leiomyoblastic, rhabdomyoblastic, lipoblastic of schwannian origin. Ultrastructurally, the two cell lines were found to be different. In vitro and in xenografts the cell type of MFH-I resembled a primitive mesenchymal cell. Whereas that of MFH-II resembled a fibroblast-like cell. We concluded that the group of MFH is heterogeneous and is probably derived from more than one progenitor cell.