Prognostic factors for surgical resection in patients with multidrug-resistant tuberculosis.

Although surgical lung resection could improve prognosis in some patients with multidrug-resistant tuberculosis (MDR-TB), there are no reports on the optimal candidates for this surgery. The aim of the present study was to elucidate the prognostic factors for surgery in patients with MDR-TB. Patients who underwent lung resection for the treatment of MDR-TB between March 1993 and December 2004 were included in the present study. Treatment failure was defined as greater than or equal to two of the five cultures recorded in the final 12 months of treatment being positive, any one of the final three cultures being positive, or the patient having died during treatment. The variables that affected treatment outcomes were identified through univariate and multivariate logistic regression analysis. In total, 79 patients with MDR-TB were included in the present study. The treatment outcomes of 22 (27.8%) patients were classified as failure. A body mass index <18.5 kg x m(-2), primary resistance, resistance to ofloxacin and the presence of a cavitary lesion beyond the range of the surgical resection were associated with treatment failure. Low body mass index, primary resistance, resistance to ofloxacin and cavitary lesions beyond the range of resection are possible poor prognostic factors for surgical lung resection in multidrug-resistant tuberculosis patients.     

Renal Allograft Biopsies with Borderline Changes: Predictive Factors of Clinical Outcome

The clinical outcome and appropriate management for patients showing 'borderline changes' on allograft biopsy after renal transplantation is still controversial. In an attempt to identify predictive factors of clinical outcome of patients with such lesions, we reviewed the clinical course of 91 patients with borderline changes. Multivariate analysis revealed significant and independent effects of histological stage (i + t < or = or > 2) and time to borderline changes (< or = or > 3 months after transplant) on serum creatinine levels at 1 year from borderline changes episodes (respectively, p = 0.04 and p = 0.02) and only a significant effect of time to borderline changes on serum creatinine levels at 2 years (p = 0.005). Renal function at 1 year and 2 years as 5- and 8-year graft survival were not significantly different in the group of patients treated with antirejection therapy (T group, n = 49) compared with the untreated group (UT group, n = 42). This study strongly suggests that borderline changes with histological score (i + t) > 2 and late episodes of borderline changes should be considered to be of poor prognosis.     

The floating hip injury: which should we fix first?

In floating hip injuries, the priority of the steps in fixation has not been well described. We have treated these patients in accordance with the following protocols. In patients with pelvic ring fractures, the external fixation should be performed first, and in patients with acetabular fractures, the femoral fractures should be internally fixated first. The purpose of the present study was to review our experience with these fracture treatments to evaluate our strategy. For 8 years, 31 patients with femoral fractures associated with ipsilateral fractures: 26 unstable pelvic ring fractures and 7 unstable acetabular fractures were surgically treated at our level 1 trauma center. We reviewed the admission, operation, and follow-up records retrospectively and evaluated the order of the fixation and the complications. Two patients with acetabular fractures failed to follow our protocol outlined at the preoperative planning stage. There were no surgical difficulties other than two patients with the hemipelvis dislocated proximally who required traction of the fixated femur. The complications that were thought to be related to our protocol were one fat embolism syndrome and one pubic fracture displacement. One heterotopic ossification seemed to occur due to using a single approach for both fractures. We believe our protocol to be generally effective, however, in patients with acetabular and vertical shear type pelvic ring fractures, the internal or external fixation of the femur should be performed before the internal fixation of the pelvis.     

Wirkung und Wirkfaktoren von psychodramatischem Coaching — Eine experimentelle Evaluationsstudie

Zusammenfassung Diese Studie untersucht, wie Erfolg im Einzelcoaching entsteht und was Psychodrama dazu beitragen kann. Dabei werden zun?chst die vier Berner Wirkfaktoren dargestellt, die im Rahmen einer allgemeinen psychologischen Coachingkonzeption die vier m?glichen Erfolgsstrategien darstellen. über Videoauswertung und schriftliche Befragung aller Beteiligten wurden 35 Einzelsitzungen evaluiert. Dabei zeigten sich die vier Wirkfaktoren tats?chlich als elementar in kurz- und mittelfristig erfolgreichen Coachingprozessen. In dem experimentellen Vergleich wurde das psychodramatische Coaching zudem wesentlich besser bewertet als das Vergleichscoaching, was durch den Ressourcen- und Wachstumsfokus sowie die sehr gute Beziehungskompetenz der Psychodramatiker erkl?rt werden kann. Des Weiteren zeigen die Auswertungen, dass ein dosierter und gezielter Einsatz des psychodramatischen Methodenrepertoires fruchtbarer zu sein scheint als der zeitlich umfassende Einsatz des Psychodramas als Hauptinterventionsmethode.

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Summary The present study investigates the process of success development in one-to-one-coaching and examines how the method of psychodrama can contribute to this process. First the four change factors are presented. They represent the four success strategies in a general psychological coaching approach that can be chosen by the coach. Second 35 one-to-one-coaching sessions are evaluated by a video-based rating-system and questionnaires that were filled in by all coaches, clients and employees of the clients. In these analyses the four change factors were shown to be critical for short- and medium-term success. In an experimentally designed assessment the psychodramatic coachings had a considerably better result than the comparative coaching. This outcome could be explained by the focus on resources and growth and the high competence of the psychodramatic coaches to set up an appreciative coaching relationship. The analyses demonstrate furthermore that the well-aimed and specific use of psychodrama methods is more fruitful than its time-extensive use as the main intervention method.

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Peter Behrendt geb. 1977, Dipl. Psych., ausgebildeter Psychodrama-Therapeut und Mediator, seit 2004 freiberuflich Coaching, Moderation sowie Konzeption und Durchführung von Fortbildung und Trainings. Er konzipierte und leitete die Evaluationsstudie, die diesem Artikel zugrunde liegt.     

Ex Vivo Application of Carbon Monoxide in University of Wisconsin Solution to Prevent Intestinal Cold Ischemia/Reperfusion Injury

Carbon monoxide (CO), a byproduct of heme catalysis, was shown to have potent cytoprotective and anti-inflammatory effects. In vivo recipient CO inhalation at low concentrations prevented ischemia/reperfusion (I/R) injury associated with small intestinal transplantation (SITx). This study examined whether ex vivo delivery of CO in University of Wisconsin (UW) solution could ameliorate intestinal I/R injury. Orthotopic syngenic SITx was performed in Lewis rats after 6 h cold preservation in control UW or UW that was bubbled with CO gas (0.1-5%) (CO-UW). Recipient survival with intestinal grafts preserved in 5%, but not 0.1%, CO-UW improved to 86.7% (13/15) from 53% (9/17) with control UW. At 3 h after SITx, grafts stored in 5% CO-UW showed improved intestinal barrier function, less mucosal denudation and reduced inflammatory mediator upregulation compared to those in control UW. Preservation in CO-UW associated with reduced vascular resistance (end preservation), increased graft cyclic guanosine monophosphate levels (1 h), and improved graft blood flow (1 h). Protective effects of CO-UW were reversed by ODQ, an inhibitor of soluble guanylyl cyclase. In vitro culture experiment also showed better preservation of vascular endothelial cells with CO-UW. The study suggests that ex vivo CO delivery into UW solution would be a simple and innovative therapeutic strategy to prevent transplant-induced I/R injury.