Das neue österreichische Patientenverfügungsrecht

Austria’s new Living Wills Act (Patientenverfügungsgesetz, or PatVG) that came into effect on 1st of June 2006, is the first law in Austria to regulate the controversial issue of living wills. The PatVG provides for a right to refuse future medical treatment by making an advance directive in the form of a living will that is either binding or “to be taken into consideration”. However, the establishment of a binding living will is governed by strict criteria as regards form and content, and both a medical doctor and a legal expert must be involved. Compliance with a living will is not allowed where there is a legal obligation to give medical treatment. There is also a legal obligation to give medical treatment in emergency situations where the time involved in looking for a living will could seriously endanger the health or the life of a patient.     

Straßenverkehrsrecht und Rettungsdienst

Legal uncertainties for emergency vehicle drivers can be avoided when fundamental rules are established. In particular, differentiation of special rights and rights of way is essential. Inherent in both is the urgency necessary to save human lives. The right of way signaled by flashing blue lights and siren does not however justify traffic violations but signifies rather a request to other traffic participants. In contrast, special rights require no announcement and constitute a justifiable reason for traffic violations. Even so they do not allow that other traffic participants be endangered or harmed. Adherence to these basic principles can prevent legal misinterpretations as well as rigid adoption of inflexible standards of behavior.     

Dynamics of anti‐human leukocyte antigen antibodies after renal transplantation and their impact on graft outcome

The purpose of this study was to sequentially monitor anti‐HLA antibodies and correlate the results with antibody‐mediated rejection (AMR), graft survival (GS), and graft function (GF). We collected sera from 111 kidney transplant recipients on transplant days 0, 7, 14, 30, 60, 90, 180, and 360 and analyzed PRA levels by ELISA. DSAs were analyzed by single‐antigen beads in rejecting kidneys. At pre‐transplant, 79.3% of the patients were non‐sensitized (PRA = 0%) and 20.7% were sensitized (PRA > 1%). After transplant, patients were grouped by PRA profile: no anti‐HLA antibodies pre‐ or post‐transplant (group HLApre?/post?; n = 80); de novo anti‐HLA antibodies post‐transplant (group HLApre?/post+; n = 8); sensitized pre‐transplant/increased PRA post‐transplant (group HLApre+/post↑; n = 9); and sensitized pre‐transplant/decreased PRA post‐transplant (group HLApre+/post↓; n = 14). De novo anti‐HLA antibodies were detected at 7–180 d. In sensitized patients, PRA levels changed within the first 30 d post‐transplant. Incidence of AMR was higher in HLApre?/post+ and HLApre+/post↑ than in HLApre?/post?, and HLApre+/post↓ (p < 0.001) groups. One‐yr death‐censored GS was 36% in group HLApre+/post↑, compared with 98%, 88% and 100% in groups HLApre?/post?, HLApre?/post+, and HLApre+/post↓, respectively (p < 0.001). Excluding first‐year graft losses, GF and GS were similar among the groups. In conclusion, post‐transplant antibody monitoring can identify recipients at higher risk of AMR.     

Cyclosporine as prophylaxis for graft-versus-host disease: a randomized study in patients undergoing marrow transplantation for acute nonlymphoblastic leukemia

Seventy-five patients, 13 to 49 years of age, with acute nonlymphoblastic leukemia in first remission were treated with cyclophosphamide, fractionated total body irradiation, and marrow transplantation from an HLA-identical sibling and randomized to receive either cyclosporine (CSP) (n = 36) or methotrexate (MTX) (n = 39) as prophylaxis for graft-v-host disease (GVHD). All patients engrafted, and 22 who were given CSP and 21 who were given MTX, are alive at 20 to 47 (median, 35) months (P = .5). Engraftment as assessed by granulocyte recovery (P less than .0005) and platelet transfusion requirement (P = .01) was faster in patients on CSP. Twelve patients (33%) on CSP and 22 (56%) on MTX developed acute GVHD of grades II through IV (P = .07) and 15 of 30 on CSP and 14 of 32 on MTX that were at risk developed chronic GVHD. The most frequent causes of death were interstitial pneumonitis and marrow relapse of leukemia, which occurred with similar frequency in both groups. Beneficial effects observed in patients on CSP included less severe mucositis and shorter duration of hospitalization; adverse effects included renal function impairment and hypertension. These data confirm that CSP is a useful immunosuppressant in patients undergoing marrow transplantation but fail to show a significant improvement in survival as compared with the standard regimen of MTX.     

Active surveillance is superior to radical nephrectomy and equivalent to partial nephrectomy for preserving renal function in patients with small renal masses: Results from the DISSRM registry

Purpose

We compared renal function outcomes among patients in the surveillance and intervention arms of the DISSRM registry.

高压培养对血管内皮细胞t-PA和PAI-1的影响及卡托普利干预的效果

目的：高血压常伴有纤溶功能的异常,但其机制尚不清楚。本研究拟观察高静水压培养对人脐静脉内皮细胞（HUVECs）t-PA和PAI-1的影响以及卡托普利的干预效果,并探讨其可能的作用机制。方法：选用第4～6代HU-VECs,接种于24孔培养板中。依培养压力分为3组：大气压组（0mmHg）,中压组（90mmHg）,高压组（180mmHg）。在同一压力组,根据不同药物干预又分为两个亚组。即对照组（Ctrl）和卡托普利组（Cap,10^-5mol/L）。每组6份标本。采用ELISA法测定上清液t-PA和PAI-1的抗原浓度,并用细胞内总蛋白进行标化（单位：ng/μg proteins）。同时测定细胞内Ca^2＋浓度（nmol/L）。结果：与大气压组相比,中压和高压组t-PA浓度均显著降低,PAI-1浓度显著增高,t-PA/PAI-1比值显著降低,[Ca^2＋]i也显著增高。卡托普利对大气压组的t-PA、PAI-1和[Ca^2＋]i无显著影响,但在两个高压组,卡托普利显著升高t-PA浓度,显著降低PAI-1浓度,t-PA/PAI-1比值显著升高,[Ca^2＋]i显著地降低。结论：高静水压可损害内皮细胞的纤溶功能,而卡托普利的干预可降低高压所升高的[Ca^2＋]i,并改善高静水压对内皮细胞纤溶功能的影响。     

The immunohistology of follicle lysis in lymph node biopsies from homosexual men

Follicle lysis is a characteristic alteration of B cell follicles described recently in lymph node biopsies from homosexual men. It consists of disruption of germinal centers by aggregates of small mature lymphocytes variably associated with erythrocyte extravasation. We studied the immunohistology of follicle lysis identified in lymph node biopsies from 11 homosexual men. The results indicate that follicle lysis has two principal immunohistologic features: (1) intrafollicular aggregates of small lymphocytes predominantly of polytypic mantle B cell phenotype (T015+/Leu-8+/mu+/delta+/k+ or lambda+), and (2) disruption of the normal, unified follicular meshwork of R4/23+ dendritic reticulum cells by these B cell aggregates. These structural alterations may affect the functional integrity of the germinal center as it pertains to the abnormal B cell effector function and the increased prevalence of B cell lymphoma recently documented in the acquired immunodeficiency syndrome and related disorders. Because dendritic reticulum cells weakly express the Leu-3 (T4) antigen, which is known to be an essential component of the receptor for human T- lymphotropic virus type III/lymphadenopathy-associated virus (HTLV- III/LAV) retrovirus infection, it is possible that retroviral infection of dendritic reticulum cells may play a role in the pathogenesis of follicle lysis.     

Response properties of striate cortex neurons in cats raised with divergent or convergent strabismus

Recordings were made from striate cortex in five groups of cats that had been raised with strabismus produced by sectioning the extraocular muscles. These groups included animals reared with exotropia, unilateral or bilateral esotropia, and esotropia combined with lid suture of the unoperated eye. In addition, a group of esotropes was studied in which the unoperated eye was removed a few hours prior to recording. For comparison, five normal adult cats were also studied. In each of the above groups, cells were sampled in the representations of the central and peripheral visual fields in area 17 ipsilateral and contralateral to the deviated eye. We mapped the receptive field of each responsive cell, determined its ocularity, and tested it for selectivity. Confirming previous work, we found a marked loss of cortical binocularity in cats raised with strabismus. On average only 7% of the neurons that we recorded could be driven by both eyes. This percentage was relatively constant at all cortical locations that were studied and was not influenced by whether cats had been reared with exotropia, unilateral esotropia, or bilateral esotropia. The percentage of selective cells driven by the deviated eye in exotropes or esotropes did not appear to be different from normal at most cortical locations (but see 5, below). In addition, we did not observe any bias in the axial preference of selective cells in strabismic cats when compared with normal adult cats. In both exotropes and esotropes the deviated eye drove fewer cells when compared with the proportion that are driven by one eye in normal cats. In exotropes this deficit did not vary at different cortical representations of the visual field. In esotropes, however, this deficit was graded, being least in the representation of the peripheral visual field in area 17 contralateral to the deviated eye, intermediate in the representations of the central visual field in the contralateral and ipsilateral hemispheres, and greatest in the representation of the peripheral visual field in ipsilateral area 17. Furthermore, only when recording from the peripheral field representation in the ipsilateral hemisphere did we encounter significant numbers of cells driven by the deviated eye that lacked normal selectivity. Since it is possible that deprivation of the converged eye during development might account for the deficits noted above, we attempted to evaluate this factor using several independent lines of evidence. First, we could find no correlation between the angle of esotropia and the ability of the deviated eye to drive ipsilateral cortical cells representing the peripheral visual field.(ABSTRACT TRUNCATED AT 400 WORDS)     

Marrow transplantation with or without donor buffy coat cells for 65 transfused aplastic anemia patients

Sixty-five multiply transfused patients with severe aplastic anemia were given cyclophosphamide followed by grafts anemia were given cyclophosphamide followed by grafts from HLA-identical siblings. The effect of the administration of viable donor buffy coat cells following the marrow inoculum was evaluated with regard to graft rejection and survival. Results in 43 patients so treated are presented along with those in 22 concurrent patients given marrow alone. Most patients given buffy coat had positive in vitro tests of sensitization indicating a high risk for graft rejection, while all but one of the patients given marrow alone had negative tests. Thirty of the 43 (70%) patients given marrow and buffy coat are alive between 10 and 61 mo (median 36) after grafting; 4 died after graft rejection and 6 with acute or chronic graft-versus-host disease (GVHD). Eleven of the 22 (50%) patients given marrow alone are alive between 29 and 65 mo (median 52); 7 died after graft rejection and 3 with GVHD. The addition of buffy coat cell infusions to the marrow inoculum reduced the risk of rejection and increased survival in the currently reported transfused patients when compared to patients grafted before 1976. However, there was an increased risk of chronic GVHD. Recipients of marrow from female donors survived slightly better (73%) than recipients of male marrow (58%).