Assessment of eye damage in private accident insurance (author's transl)]

Following a fundamental sentence of the German Supreme Court eye damage affecting both eyes - actual or preexisting - has to be judged under the aspect of coordinating function. So the usual practice of isolated judgement of each eye can only be performed in unilateral damage associated with complete function of the other eye.     

Aortic root motion determined by ultrasound: relation to cardiac performance in man

The purpose of this study was to determine if aortic root systolic anteroposterior excursion measured ultrasonically is related to cardiac performance. Aortic motion was 9 +/- 1.5 mm (mean +/- SD) in 30 normal subjects (range 7-12 mm). Ten patients with coronary artery disease and congestive failure and 10 with congestive cardiomyopathy had significantly smaller values of 4 +/- 1.2 and 5 +/- 1.7 mm, respectively (P less than 0.001). In 28 subjects undergoing cardiac catheterization, aortic root motion correlated positively with stroke volume (r = 0.59), but did not correlate significantly with ejection fraction. By increasing heart rate in 14 subjects from 75 to 174 beats/min with atrial pacing, stroke volume decreased from 81 +/- 22 to 34 +/- 14 ml/beat and aortic excursion from 10 +/- 1.6 to 5 +/- 1.5 mm (P less than 0.001). This study has shown: 1) Aortic root motion less than or equal to 6 mm indicates left ventricular dysfunction; 2) stroke volume correlates positively with, but cannot be accurately predicted from, root motion.     

Influence of the duration of ischemia and reperfusion on infarct volume and microvascular damage in mice

OBJECTIVES: Focal cerebral ischemia is responsible for alterations of vascular permeability, and the loss of microvascular integrity is a primary source of subsequent hemorrhages. We evaluated the influence of different durations of ischemia and reperfusion on infarction size and microvascular damage after focal cerebral ischemia in the mouse.METHODS: C57BL/6 mice (n=39) were subjected to focal cerebral ischemia (I) and reperfusion (R). Consecutive brain sections were analysed for infarction volumes (Nissl-staining) and for collagen type IV (immunohistochemistry and western blot).RESULTS: Infarction size (percentage of the infarction volume versus ipsilateral hemisphere) increased with total time of ischemia and reperfusion: 19+/-2% (I3R0), 30+/-2% (I3R3), 36+/-4% (I3R12), 41+/-4% (I1R24), 45+/-6% (I2R24) and 58+/-2% (I3R24). The ischemic hemispheres showed a significant progressive reduction of collagen type IV positive vessels (ischemic versus non-ischemic contralateral area): 90+/-3% (I3R0), 88+/-1% (I3R3), 82+/-3% (I3R12), 85+/-3% (I1R24), 79+/-3% (I2R24), 72+/-2% (I3R24).CONCLUSIONS: Both prolonged ischemia and reperfusion lead to an increased infarction volume, as well as progressive microvascular damage.     

Reduction in mortality in severely injured patients following the introduction of the “treatment of patients with severe and multiple injuries” guideline of the German society of trauma surgery – a retrospective analysis of a level 1 trauma center (2010–2012)

Objective

The German society of trauma surgery published the “Treatment of Patients with Severe and Multiple injuries” guideline in 2011. This achieved the highest level of recommendation for guidelines published in Germany. This study investigated if there was an improvement in the survival rates of severed injured patients following the introduction of the guideline in clinical treatment.

Methods

All patients with an injury severity score ≥16 on primary admission to hospital between January 2010 and December 2012 (a total of 373 patients) were included in this study. The data for these patients were collected from the German Trauma Registry and from patients’ hospital records. Patients who were treated in 2010 were compared with patients who were treated in 2011 and 2012, following the introduction of the “treatment of patients with severe and multiple injuries” guideline in the authors’ clinic at the beginning of 2011.

Results

Significant differences were found in ISS, RTS, New ISS, and TRISS between 2010 and 2011/2012. No differences were found in the severity of injury when classified by different body regions. Major differences were found in the total volume replacement, the length of emergency surgery, the length of surgery performed within the first 24 h and the rate of whole-body computed tomography. The mortality rate dropped from 32.48% in 2010 to 18.75% in 2011/2012 (p = 0.003).

Conclusions

The introduction and use of a guideline-based medical care regime for severely injured patients might reduce the rate of mortality.     

Congestive heart failure with intact systolic function

A retrospective study was undertaken of the cases of patients admitted for congestive cardiac failure over a 4 year period, and investigated by radionuclide angiography to determine the prevalence of cardiac failure with normal left ventricular systolic function, to document the underlying mechanisms of this condition and to assess whether the clinical data could predict the presence or absence of left ventricular systolic dysfunction. After excluding patients with significant valvular disease, severe renal failure, or myocardial infarction in the previous 2 months, the study population comprised 152 patients divided into 2 groups: Group I (N = 112) with abnormal systolic function (radionuclide ejection fraction less than 45%) and Group II (N = 40) with normal systolic function (radionuclide ejection fraction greater than or equal to 45%). The clinical, echocardiographic and radionuclide angiographic data was analysed (global ejection fraction in both groups and peak filling rate in Group II). The patients in Group II (26% of the total study population) were older (66.5 +/- 12.4 vs 61.3 +/- 12.3 years, p less than or equal to 0.02), were more often female (35% vs 17.9%, p less than or equal to 0.02), had acute cardiac failure (75% vs 37%, p less than 0.00001), and were frequently hypertensive (65% vs 39%, p less than or equal to 0.005). Univariate analysis of clinical and radiological signs did not show any significant difference between the two groups except for increased jugular venous pressure and cardiomegaly which were more common in Group I (56% vs 25%, p less than 0.00001 and 93% vs 68%, p less than or equal to 0.00001, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)     

Rapid second-tier molecular genetic analysis for congenital adrenal hyperplasia attributable to steroid 21-hydroxylase deficiency

BACKGROUND: Neonatal screening for steroid 21-hydroxylase (CYP21) deficiency is performed to identify congenital adrenal hyperplasia (CAH). The immunologic assay for 17alpha-hydroxyprogesterone (17-OHP) has a high rate of false positives. We assessed the potential for increasing the specificity for CAH by use of a second step involving analysis of the CYP21 gene. METHODS: Between January 1999 and December 2003, a total of 810,000 newborns were screened. Of these, 7920 had to be retested because their 17-OHP values were above the cutoff of the assay. Sixty-one had positive 17-OHP values in their recall samples and were diagnosed as having CAH. We used a rapid assay for common mutations of the CYP21 gene to analyze these 61 samples. In a prospective study, 198 consecutive samples that had increased 17-OHP and 100 samples that had normal 17-OHP concentrations were genotyped. RESULTS: Fifty-nine of 61 cases diagnosed as having CAH were confirmed genetically as CYP21 deficiencies. One patient had a 3beta-hydroxysteroid dehydrogenase deficiency, and one patient carried no CYP21 mutations. The 198 increased 17-OHP results were designated as false positives after immunologic testing of recall samples. None of these samples exhibited the genetic pattern consistent with CYP21 deficiency. CONCLUSIONS: If samples with increased 17-OHP values were screened genetically, the number of retests would decrease by approximately 90%, but the overall sensitivity of CAH screening would remain the same. Adding a second-tier genetic step would require a modest increase in costs, but is counterbalanced by fewer recalls, less clinical follow-up, and a reduction in unnecessary worry for families.     

Simple technique for internal control of real-time amplification assays

BACKGROUND: In real-time PCR assays, the most accurate way to identify false-negative results, e.g., those caused by PCR inhibitors, is to add to samples an internal control that will be coamplified with the target (e.g., pathogen) DNA. Current internal control procedures, however, which usually involve the introduction of a DNA fragment, are complex, time-consuming, and expensive. METHODS: Single-stranded oligonucleotides, which contain little more than primer and probe binding sites, were used as internal controls in real-time PCR assays. Mismatches were included in the probe-binding region of the internal control oligonucleotide (ICO) to prevent probe-control hybridization during the fluorescence acquisition step of the PCR. Amplified ICOs were detected by melting point analysis. ICOs could be added directly to the sample material before DNA extraction. RESULTS: To demonstrate the feasibility of the new approach, we designed ICOs for the LightCycler hybridization probe assays for Mycobacterium tuberculosis complex, hepatitis B virus, herpes simplex virus, and varicella zoster virus. In each case, the controls did not interfere with detection of the pathogen, but were clearly detectable during a subsequent melting point analysis. CONCLUSIONS: A single-stranded oligonucleotide that mimics the target region of the pathogen but is clearly distinguishable from the target during melting point analysis can serve as a simple, cost-effective internal control for real-time amplification assays. Such control oligonucleotides are easy to design and inexpensive. A costly second probe system is not necessary. Moreover, the internally controlled assay uses only one fluorescence detection channel of the instrument, leaving the second channel free for multiplex applications.     

Validity of revised Doppler echocardiographic algorithms and composite clinical and angiographic data in diagnosis of diastolic dysfunction

BACKGROUND: Commonly used echocardiographic indices for grading diastolic function predicated on mitral inflow Doppler analysis have a poor diagnostic concordance and discriminatory value. Even when combined with other indices, significant overlap prevents a single group assignment for many subjects. We tested the relative validity of echocardiographic and clinical algorithms for grading diastolic function in patients undergoing cardiac catheterization. METHOD: Patients (n = 115), had echocardiograms immediately prior to measuring left ventricular (LV) diastolic (pre-A, mean, end-diastolic) pressures. Diastolic function was classified into the traditional four stages, and into three stages using a new classification that obviates the pseudonormal class. Summative clinical and angiographic data were used in a standardized fashion to classify each patient according to the probability for abnormal diastolic function. Measured LV diastolic pressure in each patient was compared with expected diastolic pressures based on the clinical and echocardiographic classifications. RESULT: The group means of the diastolic pressures were identical in patients stratified by four-stage or three-stage echocardiographic classifications, indicating that both classifications schemes are interchangeable. When severe diastolic dysfunction is diagnosed by the three-stage classification, 88% and 12%, respectively, were clinically classified as high and intermediate probability, and the mean LV pre-A pressures was >12 mmHg (P < 0.005). Conversely, the mean LV pre-A pressure in the clinical low probability or echocardiographic normal groups was <11 mmHg. CONCLUSION: Use of a standardized clinical algorithm to define the probability of diastolic function identifies patients with elevated LV filing pressure to the same extent as echocardiographic methods.