243. Die transduodenale Pankreaticoplastik in Verbindung mit Pankreojejunostomie: Früh- und Spätergebnisse

Zusammenfassung Exokrine und endokrine Funktionsminderung sind typische Merkmale der chronischen Pankreatitis. Seit 1982 wurden bei 76 Patienten mit calcifizierender Pankreatitis wegen extrapankreatischer Komplikationen oder Schmerz eine langstreckige Pankreojejunostomie und eine transduodenale Papilloplastik der Wirsungianusmündung durchgeführt. Die Frühletalität betrug 5,3%, die Spätletalität 7,9%. 59 Patienten wurden bei der Erstoperation beschwerdefrei, bei 7 Patienten wurde im Verlauf eine Nachoperation wegen Schmerz erforderlich (0% Letalität); 61 Patienten sind derzeit beschwerdefrei. 32 Patienten haben einen Diabetes mellitus, der bei 13 Patienten bisher mit Insulin behandelt wird. Verlaufskontrollen zeigen eine stabile endokrine Funktion an. Die Ergebnisse zeigen die Möglichkeit des Parenchymerhalts bei schwerer chronischer Pankreatitis durch diese Operation auf. Sie erlaubt eine bestmögliche funktionelle Reserve.     

Guidelines for employment policies in Europe and national action plans: opportunities for people with disabilities

The scourge of unemployment has been roundly identified throughout Europe as the most pressing social and economic problem on the current political agenda. At Luxembourg in November 1997, the European Jobs Summit brought Europe's leaders together in an historic occasion that mapped out employment guidelines for Europe. The Luxembourg Jobs Summit agreed a set of guidelines for the Member States employment policy under four pillars, employability, entrepreneurship, adaptability, and equal opportunities. One guideline referred to promoting integration of people with disabilities into working life. The Member States subsequently agreed to incorporate the Guidelines into national employment action plans. The question of this paper is, to what extent do employment guidelines and National Action Plans improve the opportunities of disabled persons? This paper seeks to establish a set of fundamental issues concerning employment and disability. Included in this analysis are recommendations in order to achieve a better presence of disabled people in National Action Plans in future.     

The role of white cells in the transmission of Yersinia enterocolitica in blood components

The mechanism for the transmission of Yersinia enterocolitica in blood components has been studied experimentally. One hypothesis is that, during a Yersinia infection in the blood donor, bacteria are phagocytosed by white cells (WBCs), but are not killed. After collection of blood from such a donor and component production, the bacteria are present in WBCs for some time, during which the unit appears sterile. Later, when the WBCs disintegrate, the bacteria are released and multiply in the unit. Aliquots of whole blood and buffy coat were inoculated with 100 colony-forming units (CFU) per mL of a Y. enterocolitica strain of type O:3 and left at room temperature for 5 hours. Some aliquots were then WBC-reduced by filtration, while others retained their WBC contents. All aliquots were kept at 4 degrees C for 6 weeks. Meat extract broth culture medium was used as a control. Growth in the range of 2000 CFU per mL was obtained in the broth control by 24 hours, whereas the whole blood and buffy coat units appeared sterile for the first days of storage. After 1 week, a trace of bacteria and, after 4 weeks, massive growth were found in the WBC-containing units but not in the WBC-reduced units. The likely explanation is that the bacteria had been phagocytosed by the WBCs and were thereby hidden and not available for bacterial culture during the first phase of storage. When the WBCs spontaneously disintegrated, bacteria were released and multiplied in the blood units.(ABSTRACT TRUNCATED AT 250 WORDS)     

Augmentation of spontaneous macrophage-mediated cytolysis by eosinophil peroxidase

Eosinophil peroxidase (EPO), a cationic protein purified from horse blood, adhered to four different types of tumor cells, markedly potentiating their lysis by preformed or enzymatically generated H(2)0(2) (up to 76-fold, as assayed in serum-containing tissue culture medium without supplemental halide). Similarly, compared with uncoated tumor cells, EPO-coated tumor cells were up to 32 times more sensitive to lysis when incubated with macrophages or granulocytes whose respiratory burst was triggered by PMA. However, EPO-coated tumor cells were also readily lysed by bacillus Calmette- Guerin-activated macrophages in the absence of exogenous triggering agents. This spontaneous cytolysis was rapid (50 percent at 2 h) and potent (50 percent lysis at macrophage/tumor cell ratios of 1.5 to 4.6), and was observed with both a peroxide-sensitive tumor (TLX9) and a peroxide-resistant tumor (NK lymphoma). Under the conditions used, neither EPO alone nor macrophages alone were spontaneously cytolytic. Neither EPO nor EPO-coated tumor cells triggered a detectable increment in H(2)0(2) release from macrophages. Nonetheless, spontaneous macrophage-mediated cytolysis of EPO- coated tumor cells was completely inhibitable by catalase (50 percent inhibition, 23 U/ml), although not by heated catalase, indicating a requirement for H(2)0(2). Cytolysis was also completely inhibitable by azide (50 percent inhibition, 2.6 X 10 -5 M), indicating a requirement for enzymatic activity of EPO. Thus, a cytophilic peroxidase from eosinophils and H(2)0(2) spontaneously released from activated macrophages interacted synergistically in a physiologic medium to destroy tumor cells.     

Investigation of the chemical structure and biological activity of oligosaccharides isolated from rough-type Xanthomonas campestris pv. campestris B100 lipopolysaccharide

The rough-type lipopolysaccharide (LPS) of the phytopathogenic bacterium Xanthomonas campestris pv. campestris B 100 was isolated utilizing the hot phenol-water method and successively de-acylated by treatment with hydrazine and hot potassium hydroxide. Four compounds were separated by preparative high-performance anion-exchange chromatography and studied by sugar analysis and by 1D and 2D homonuclear and heteronuclear (1)H-, (13)C- and (31)P-NMR spectroscopy as well as ESI FT-MS. The two main products were a heptasaccharide and a pentasaccharide of the structures alpha-D-Manp-(1-->3)-alpha-D-Man p-(1-->4)-beta-D-Glcp-(1-->4)-alpha-D-Manp-3P -(1-->5)-alpha-Kdo-(2-->6)-beta-D-GlcpN-4P-(1-->6)-alpha-D-Glc pN-1P (1) and beta-D-Glcp-(1-->4)-alpha-D-Man p-3P-(1-->5)-alpha-Kdo-(2-->6)-beta-D-GlcpN-4 P-(1-->6)-alpha-D-GlcpN-1P (2), respectively. The products in smaller amounts were a heptasaccharide and pentasaccharide possessing the above structures plus a phosphate group at C-4 of the Kdo residue (compounds 3 and 4). Both, heptasaccharide 1 and pentasaccharide 2 were able to induce an oxidative burst in cell cultures of the non-host plant tobacco.     

Initiation rites as a perceived stressor for Isixhosa males with schizophrenia

Although traditional initiation forms a pivotal part of Xhosa culture, it may be a stressful life event for the individual. In this study, 75 Xhosa males diagnosed with schizophrenia were interviewed to examine their perceptions of the role of initiation in the onset and course of their illness. In all, eight patients (10.7%) perceived the initiation rites as a stressful event that had triggered the onset of a psychotic episode, and six (8%) felt it precipitated a relapse. Our findings suggest that initiation rituals may be perceived as a stressful life event influencing the onset and course of schizophrenia. This underlines the importance of understanding the cultural background of patients.     

Whole-genome resequencing in pharmacogenomics: moving away from past disparities to globally representative applications

Africa suffers from a high burden of disease; nonetheless, it has been one of the most under-represented continents with regard to genomic research. It can be argued that this disproportionate research is related to the fact that the genome architecture of African individuals is poorly suited to SNP-based genome-wide association studies, given existing genotyping platforms. However, this argument is no longer plausible with the arrival of next-generation sequencing technologies, which allow for the analysis of entire genomes. Using pharmacogenes to critically examine the merit of next-generation sequencing technologies in pharmacogenomics, we found a substantial amount of novel/uncharacterized variation, which was predicted to alter protein function. This variation was predominantly observed in African individuals, emphasizing the benefit of next-generation sequencing technologies specifically for these individuals. We also observed an improvement in the reliability of sequencing technologies in a relatively short time. Therefore, as sequencing technologies develop and decrease in cost, the ability to reliably detect variation will improve and these technologies will begin to replace other less comprehensive genotyping assays.     

Providing monovalent oral polio vaccine type 1 to newborns: findings from a pilot birth-dose project in Moradabad district, India

Problem

Poliovirus transmission remained a public health challenge in western Uttar Pradesh, India in late 2005 and early 2006. In 2006, the India Expert Advisory Group for Polio Eradication concluded that, given the peak incidence of polio among children 6 to 12 months of age, a targeted birth dose of oral polio vaccine may be necessary to interrupt intense poliovirus transmission in high risk areas.

Approach

The Government of Uttar Pradesh, the National Polio Surveillance Project and the United Nations Children’s Fund (UNICEF) implemented a pilot birth-dose project aimed at identifying and vaccinating all newborns with a dose of oral polio vaccine within 72 hours of birth in an effort to evaluate operational feasibility and potential impact on population immunity.

Local setting

The project was piloted in Moradabad district: zone 7 in Moradabad City (urban setting), Kunderki block (rural setting) and in select birthing hospitals.

Relevant changes

Between July 2006 and February 2007, 9740 newborns were identified, of which 6369 (65%) were vaccinated by project personnel within 72 hours of birth. Project coverage (for total newborns vaccinated) ranged from 39% (in zone 7) to 76% (in Kunderki block) of the estimated number of newborns vaccinated during previous supplemental immunization activities.

Lessons learned

Birth-dose coverage among newborns was lower than expected. Expansion costs were estimated to be high, with marginal impact. The project, however, provided opportunities to strengthen newborn tracking systems which have increased the number of newborns and young infants vaccinated during supplemental immunization activities and enrolled in routine programmes.