Polyhexanide and hydrogen peroxide inhibit proteoglycan synthesis of human chondrocytes

The use of local antiseptics is a common method in septic joint surgery. We tested polyhexanide and hydrogen peroxide, two of the most frequently used antiseptics with high efficacy and low toxicity. The purpose of this study was to evaluate the effects of both antiseptics on the extracellular cartilaginous matrix synthesis of human chondrocytes. Chondrocytes were isolated from donated human knee joints, embedded in alginate beads, and incubated for 10 and 30 minutes with polyhexanide (0.04%), hydrogen peroxide (3%), or phosphate-buffered saline (PBS) for control. Cartilaginous matrix production was quantified through light microscopic analysis of Alcian blue staining. Cell number and morphology were detected by histological analysis. Chondrocytes showed a decreased intensity of blue colouring after antiseptic treatment versus PBS. In contrast to that, neither the cell number per view field nor the cell morphology differed between the groups. Polyhexanide has more toxic potential than hydrogen peroxide. Based on the fact that the cell number and morphology was not altered by the substances at the examined concentrations, the lower intensity of Alcian blue staining of treated chondrocytes indicates a decreased cartilage-specific matrix synthesis by polyhexanide more than by hydrogen peroxide and control.     

Sicht der Klassiker: Der Affekt in den Psychosekonzepten von Emil Kraepelin und Eugen Bleuler

Der Beitrag geht auf zwei für die Entwicklung unseres Faches wesentliche Psychosekonzepte ein, n?mlich diejenigen Emil Kraepelins (1856 – 1926) und Eugen Bleulers (1857 – 1939). Kraepelins Nosologie war auf die Entdeckung „natürlicher Krankheitseinheiten“ gerichtet und vertrat mit dem Konzept der „Dementia praecox“ eine klinisch-verlaufsorientierte, prognostisch pessimistische, eher „enge“ Position. Bleuler nahm den erkenntnistheoretischen Anspruch etwas zurück und sprach, begrifflich deutlich „breiter“, von der „Gruppe der Schizophrenien“, der er gesamthaft eine markant bessere Prognose zuerkannte als Kraepelin. Gemeinsamkeiten und Unterschiede der Ans?tze werden herausgearbeitet. Einig waren sich beide Autoren, wenn auch mit anderer Akzentsetzung, darin, dass der affektive Bereich – gerade bei den vermeintlich „nicht-affektiven“ Psychosen des schizophrenen Formenkreises – ein zentrales Element darstellt. Dies ist ebenso Konsens in der aktuellen psychiatrischen Forschung, die von der früher lange geübten Trennung von Kognition und Affekt zunehmend Abstand nimmt und darüber hinaus die alleinige Orientierung an diagnostischen Entit?ten zugunsten eines syndrom- oder gar symptomorientierten Zugangs verl?sst („Denosologisierung“).     

Colonoscopy without Sedation

The results of ambulatory 24-h esophageal pH monitoring in 67 patients with gastroesophageal reflux symptoms (endoscopic esophagitis, n = 44; normal endoscopy, n = 23) were compared with those of 27 normal subjects without reflux symptoms. Patients with reflux symptoms had significantly increased gastroesophageal reflux compared with normal subjects. Acid reflux time was significantly (p < 0.001) correlated with the severity of endoscopic esophagitis. Linear discriminant analysis was used to differentiate, for each reflux variable, between patients and controls. When the percentage of overall time at pH below 4 was used as a single determinant of gastroesophageal reflux, the sensitivity and specificity were 81% and 85%, respectively, with 4% as upper limit of normal. Pathologic reflux was found in 61% of the patients with negative endoscopy. Long-term ambulatory pH-metry is of clinical value in detecting pathologic reflux in symptomatic patients with negative endoscopy.     

Maximal strength training improves walking performance in peripheral arterial disease patients

Peripheral arterial disease (PAD) patients have reduced muscle strength and impaired walking ability. The aim of this study was to examine the effects of maximal strength training (MST) on walking economy and walking performance in PAD patients. Ten patients with mild to moderate‐severe claudication, classified as Fontaine stage II PAD and with functional limitations from intermittent claudication were recruited and went through an 8‐week control period followed by an 8‐week, three times a week, MST period. The patients performed four sets of five repetitions dynamic leg press with emphasis on maximal mobilization of force in the concentric action and with a progressive adjusted intensity corresponding to 85–90% of one repetition maximum (1 RM). After the MST period, leg press 1 RM significantly increased by 35.0±10.8 kg (31.3%). Dynamic rate of force development, measured on a force plate installed on the leg press, increased by 1424±1217 N/s (102.7%). The strength improvements led to a significant increase in walking economy of 9.7% when walking horizontally, and to a significant increase in walking performance of 13.6% measured on an incremental treadmill test to exhaustion. No changes were apparent after the control period. No changes in body mass or peak oxygen uptake were observed. MST increases strength in Fontaine stage II PAD patients and leads to improved walking economy. These results suggest that application of MST could accompany aerobic endurance training as a part of the treatment of PAD patients with mild to moderate‐severe claudication.     

Patient tolerance of colonoscopy without sedation during screening examination for colorectal polyps

BACKGROUND: The administration of sedative drugs at colonoscopy has its drawbacks such as increases in the rate of complications and cost. Our aim was to study how individuals, drawn from a population registry and invited to undergo screening colonoscopy for colorectal polyps, experienced the procedure without conscious sedation. METHODS: Four hundred fifty-one individuals underwent the screening examination (median age 67 years, range 63 to 72). The cecum was intubated in 369 (82%). Fourteen days after the examination, 429 of the attendees received a questionnaire designed to evaluate their tolerance of the procedure. RESULTS: Four hundred nine participants (95%) replied.Twenty-one (5%) of these individuals found the examination very uncomfortable, 184 (45%) found it moderately uncomfortable, and 204 (50%) did not find it uncomfortable. A larger proportion of women than men, 110 (63%) versus 79 (41%), found the procedure very or moderately uncomfortable (p<0.001). Three hundred sixty-eight (90%) individuals stated that they would undergo repeat colonoscopy in 5 years. CONCLUSION: In this screening setting, routine use of conscious sedation did not seem to be necessary, as most participants found the examination to be only moderately uncomfortable or not at all uncomfortable. Colonoscopy without conscious sedation may, however, reduce the rate of intubation of the cecum and increase the risk of missing adenomas and cancers.     

Bedrest after elective cardiac catheterisation

Haematoma formation and bleeding at the femoral puncture site are the most common complications after cardiac catheterisation. Reducing the length of bedrest for patients after this procedure in one unit aimed to reduce discomfort and increase the number of patients treated. No significant clinical changes took place in the occurrence of haematoma formation or early bleeds as a result of shorter bedrest.