Nationales Reanimationsregister

Within the scope of the symposium “Rescue Medicine in Germany” (held at the Reisensburg near Ulm in 2002), the need for a standardized data acquisition set for prehospital cardiac arrest patients was identified. Therefore, the working group “Emergency Medicine” of the German Society of Anesthesiology and Intensive Care Medicine (DGAI) created a nationwide data acquisition system for primary medical care in prehospital cardiac arrest patients treated with cardiopulmonary resuscitation procedures. The system is in full accordance with the “Utstein style.” Integration of this data acquisition system, for example into the “Dortmund protocol,” is providing a standardized data web base of all acquired prehospital data analyze and to compare processing and structural quality. As additional modules for this nationwide data web base system, an inhospital module “further clinical treatment” and a “long-term follow-up” module are currently in the developmental process.     

New surface modification for Ti-6Al-7Nb alloy: oxygen diffusion hardening (ODH)

PVD-TiN coating and N+ implantation of Ti-6Al-7Nb alloy resulted in surface hardening to a depth of less 3 microns. The new oxygen diffusion hardening (ODH) treatment increased the hardness gradually to 50 microns. PUD-TiN showed an improvement in the tribological properties, while N+ implantation increased the PE wear rate. The wear rate of the ultrahigh-molecular-weight as well as the friction coefficient were reduced to one-half of the values achieved with the combination of CoCrMo-alloy when paired against the ODH-treated surface. In pairing with ZrO2-containing bone cement the ODH-treated surface showed only a minimal reaction.     

Pathogenesis and changes in the aetiology of arterio-venous fistulae

There has been a marked shift in the causes of arterio-venous fistulae. Gunshot and stab wounds used to be the most frequent cause but iatrogenic fistulae, especially those arising as a result of reconstructive skeletal operations or following diagnostic and therapeutic procedures, are now becoming increasingly common. If morphological vascular changes have not yet occurred and cardiac volume overloading has not led to permanent damage, a recently established arterio-venous fistula can be easily corrected by resection and oversewing of the artery and vein. The special cases of arterio-venous fistulae arising as a result of catheter procedures in the groin have to be identified in terms of cause and morphology in order to facilitate early surgical correction.     

Vollzähligkeitsschätzungen von Krebsregisterdaten in Deutschland

In 1995, a federal cancer registry law became effective in Germany obliging all federal states to set up epidemiological cancer registries. As a result,numerous cancer registries have been established. However, it is essential to know the degree to which all relevant cases are recorded within a registry—particularly for those registries established recently—as only a high degree of completeness can prevent variations in the efficacy of registry procedures from distorting comparative studies. In this study, the completeness of the cancer registries was evaluated indirectly. Incidences for geographical areas covered by a cancer registry were estimated using incidence/mortality ratios of another registry known to have complete data sets. Log-linear models, successfully applied in a separate study, were fitted to incidence/mortality ratios using both the age and sex-specific data of the reference registry. These estimates were then compared with the actual data collected by the newly established registry, allowing the level of completeness to be assessed. The German Epidemiological Cancer Registry Study Group has agreed to this method and the "Dachdokumentation Krebs"—as a member of this group—performs the analyses. The first results of the study are presented in this contribution.     

Cryotherapy in rectal cancer. A palliative local tumor treatment]

Cryotherapy was applied to 182 rectal cancer patients in the Department of General Surgery, University of Ulm, between 4/1982 and 4/1991. Recipients of this tumor freezing therapy were patients whose general condition was bad, patients with an advanced inoperable carcinoma, patients with tumor recurrence and patients refusing operation. Rectal carcinomas, mostly in an advanced stage, were usually freezed several times. Only 4 patients with general inoperability reached the survival time margin of 5 years. In 18 patients local tumor destruction was possible by application of cryotherapy. In 80% of cases disagreeable tumor symptoms like tenesma, mucous discharge and oozing hemorrhages could be reduced or completely removed. Perianal pain and intense tumor bleeding could be relieved temporarily or definitely in only 50% of patients. An artificial anus could be avoided in 80% of cases by local tumor destruction/reduction or arrest of tumor growth. The mean survival time of patients with tumor recidivation was 11 months after onset of the recurrence. Tumor progression, incontinence and iatrogenic rectal perforation made an artificial anus necessary in 14 patients.     

Induction of mediator release from human glomerular mesangial cells by the terminal complement components C5b-9.

Exposure of cultured human glomerular mesangial cells (GMC) to normal human serum and an activator of the complement system results in rapid uptake of the terminal complement proteins C5b-9 by the cells. This 'innocent bystander' complement attack, however, does not result in cell killing, but in the stimulation of the GMC to release prostaglandin E (PGE), interleukin 1 (Il-1) and tumor necrosis factor (TNF). Endogenously synthesized Il-1 in turn activates PGE release, indicating that the C5b-9 attack initiates an autocrine feedback stimulation. Together with the fact that C5b-9 is found in many forms of glomerulonephritis, the data point to a role of the terminal complement proteins in the initiation and perpetuation of an inflammatory response.     

Coping strategies and individual meanings of illness.

Every person has a subjective understanding of their own illness. The personal attitude towards disease and the corresponding coping mechanisms go beyond biomedical factors to influence the course of the disease. Lipowski described eight different disease concepts which were supplemented by the theory of control conviction (external-internal control). Several hypotheses about disease concepts, coping strategies and psychopathology were globally confirmed in a study of 205 chronic patients: Ability to control and acceptance lead to a more active and problem-related coping, whereas emotional coping modi occur more often in persons who do not accept their illness or do not consider it to be controllable. Results confirm the necessity of a differentiated analysis.     

Amitriptyline pharmacokinetics and clinical response: II. Metabolic polymorphism assessed by hydroxylation of debrisoquine and mephenytoin

A subgroup of 16 out of 30 endogenous depressive inpatients (cf. part I), treated for 3 weeks with 150 mg amitriptyline (AT) daily, participated in a pharmacogenetic study: all were phenotyped with debrisoquine and 3 of them with mephenytoin. Four patients were found to be poor metabolizers (PMs) of debrisoquine and one of mephenytoin. Plasma levels of AT + NT (nortriptyline) were highest in the PMs of debrisoquine, but the ratio of hydroxylated metabolites to the parent compounds appeared to be lower in these subjects. From these data, it is speculated that, in the PM of mephenytoin, the demethylation of AT is impaired. In 12 patients, free plasma 10-hydroxy-AT (ATOH) and 10-hydroxy-NT (NTOH) were found to be bound to a similar extent to plasma proteins, but not so firmly as their parent compounds, by a factor of 6 and 4 respectively. While mean total plasma ATOH reached only 15% of the value of AT, total plasma NTOH was as high as NT. ATOH correlated significantly with its parent compound, but NTOH did not correlate with NT. No drug plasma levels/clinical relationship was found in this small group of patients, even when the hydroxylated metabolites were taken into account. Both poor and extensive metabolizers of debrisoquine responded to treatment. The debrisoquine-test appears to be a useful clinical tool for detecting in patients a genetic deficiency in the hydroxylation of AT-type drugs.