Pseudomonas aeruginosa als Erreger opportunistischer Infektionen

Zusammenfassung Pseudomonas aeruginosa ist ein ubiquitär vorkommender Mikroorganismus, der aber als Bestandteil der endogenen mikrobiellen Flora gesunder Individuen nur selten isoliert wird. Die Hospitalisierung, die Krankenhausverweildauer erhöhen die Kolonisationsrate insbesondere bei immunsupprimierten Patienten signifikant. Eine Antibiotikatherapie oder -prophylaxe wie auch invasive diagnostische Maßnahmen begünstigen ebenfalls eine Besiedlung und Infektion der Patienten mitP. aeruginosa. Immundefekte der Patienten sowie eine negative Interaktion vonP. aeruginosa mit dem Immunsystem wirken infektbahnend. Somit begünstigen eine Vielzahl exogener wie endogener Faktoren und deren Wechselwirkungen das Auftreten vonP. aeruginosa-Infektionen.

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Opportunistic infections caused by pseudomonas aeruginosa

Summary Pseudomonas aeruginosa, in spite of being an ubiquitous microorganism, rarely colonizes healthy individuals. Hospitalization, as well as the length of time spent in hospital, significantly increase the rate of colonization, especially in immunocompromized patients. Antibacterial chemotherapy or prophylaxis together with invasive diagnostic procedures favour colonization and infection withP. aeruginosa. Immune deficiencies and adverse interactions ofP. aeruginosa with the immune system facilitate infection. Thus, a number of exogenous as well as endogenous factors and their interactions favour infection of patients withP. aeruginosa.

     

Hyperprolactinaemia and sexual function in the male

Although an uncommon cause of sexual dysfunction, hyperprolactinaemia is almost invariably associated with loss of libido and impotence in men. The finding of hyperprolactinaemia should prompt a systematic search for an underlying cause, particularly prolactin-secreting pituitary adenomas; in this condition, sexual dysfunction may antedate other complications of the pituitary tumour by many years.     

Curative local excision of rectal adenocarcinoma

The records of all 28 patients with rectal adenocarcinoma treated by potentially curative local excision by one surgeon (A.M.C.) between 1970 and 1984 were reviewed. Patient age, sex, tumour size, site, degree of differentiation and level of invasion are reported. The procedure was associated with no mortality and minimal morbidity. Twenty-two patients, followed for an average of 51 months, have either died of other causes or remain free of recurrent or disseminated malignancy. Six patients have required further surgery for local recurrence. Of these, one patient has had a repeat local excision while the remaining five patients have had an abdominoperineal excision of the rectum. All six patients, followed since the second operation for an average of 50 months, are free of further recurrent or disseminated disease. The results reported in this review suggest that in a selected group of patients with rectal adenocarcinoma curative local excision may offer a safe alternative to more radical forms of surgery.     

Ileoanal reservoir for ulcerative colitis and familial polyposis

Although total proctocolectomy with permanent ileostomy is regarded as the definitive therapy for ulcerative colitis and familial polyposis, psychologic and physical complications with this operation have stimulated the development of the operation of total abdominal colectomy, mucosal proctectomy, ileal reservoir, and ileoanal anastomosis as an alternative surgical procedure. Since 1980, 104 of these operative procedures have been completed with no operative mortality; experience has been gained with both the J- and S-type reservoirs. Despite an appreciable number of postoperative complications, satisfactory function of the reservoir has been achieved in 86 of 91 patients followed up for at least three months after closure of the ileostomy. The remaining five patients have required reinstitution of fecal diversion. Functional results have not differed between two-limbed and three-limbed reservoirs. This operation must be considered a viable alternative in patients with ulcerative colitis and familial polyposis.     

Use of high-frequency jet ventilation in vertical partial surgery of the larynx

High-frequency jet-ventilation (HFJV) was applied to 30 patients undergoing vertical partial surgery of the larynx for carcinoma of the vocal cords. This technique gave good surgical conditions as it interfered little with the air-ducts. It was carried out with a catheter of only 3 mm external diameter; control of ventilation during surgery was adequate, the average PaO2 being 27.9 +/- 5.6 kPa (209.3 +/- 4.2 mmHg) and the average PaCO2 5.4 +/- 1.4 kPa (40.5 +/- 10.5 mmHg). It avoided also the need for a tracheotomy. In the past, anaesthetic techniques were local anaesthesia combined with neuroleptanalgesia, endotracheal intubation or preoperative tracheotomy. None of these methods being satisfactory, our practice now includes first a nasotracheal intubation with an armoured tube at the beginning of the surgical procedure, followed by HFJV during the removal of the vocal cord, the tracheal tube being slightly pulled out. The tracheal tube is then put back in place before the thyroid cartilage is closed. The contra-indications are the same as those of HFJV. There are two types of complications: complications of HFJV itself, and postoperative complications due to the absence of tracheotomy. No accidents were observed. The only incidents seen were related to the lack of tracheotomy: subcutaneous oedema of the neck during the postoperative period in eight patients and moderate tracheobronchial congestion in five patients.     

Maintaining family planning acceptance levels through development incentives in Northeastern Thailand

The results of a two-year longitudinal study of the effect that development program incentives have upon family planning in Northeastern Thailand are presented. These incentives, implemented by the Population and Community Development Association, Thailand, included animal raising and agricultural, home industry, and environmental activities. An experimental design including baseline and follow-up surveys supplemented by a continuous monitoring system was utilized to test hypotheses on the family planning impacts of the incentives. Findings indicate that the incentives contributed significantly to the maintenance of high levels of family planning practice through the program period 1982-1984.     

Effect of feeding peptic digest of soy protein isolate on rat serum cholesterol

Growing rats were fed ad libitum soy protein isolate (SPI) or its peptic (SPI-P) or tryptic digest (SPI-T) for a month and their sera were examined for cholesterol and triglyceride levels and enzyme activities such as cholinesterase, glutamate-pyruvate transaminase (GPT) and alkaline phosphatase. The rats fed SPI-P or SPI-T were inferior in growth to those fed SPI. Similarly, the serum glyceride level was lower in the SPI-P and SPI-T groups than in the SPI group. On the other hand, a significant difference was found in the serum cholesterol level between the SPI-P and SPI or SPI-T groups but not between the SPI and SPI-T groups. A similar tendency was observed for serum GPT and alkaline phosphatase activities, although there were no significant differences among dietary groups in small intestinal enzyme activities. As for the atherogenic index being a risk factor inducing atherosclerosis, the order of its value was SPI-P less than SPI less than SPI-T.     

Prognostic factors in neuroblastoma

Between 1951 and 1978 88 patients under 15 years of age were admitted with the diagnosis of neuroblastoma or ganglioneuroblastoma to the Helsinki University Central Hospital for treatment. The relative importance of various prognostic factors for survival was investigated by the use of the Cox regression analysis and by comparison of adjusted survival curves. In regression analysis prior to classification of the patient sample, stage emerged as the overwhelmingly most significant prognostic variable, while histology and age showed a weaker effect and chemotherapy did not display any effect in this setting. Adjusted comparison of survival curves showed significantly improved survival for patients under one year of age in combined stages III and IV, and for stage III patients treated with combination chemotherapy following non-radical surgery. Thus, while stage is the strongest overall prognostic factor, the effect of age is seen especially in the more advanced cases and the beneficial effect of chemotherapy in the cases where radical operation has not been possible.