Gewerbliche Tätigkeit eines Laborarztes – Beschäftigung eines eigenverantwortlich tätigen freien Mitarbeiters –

Abstrakt  Bedient sich ein Arzt nicht nur vorübergehend der Mithilfe eines Berufskollegen, so erzielt er Einkünfte aus Gewerbebetrieb, wenn er nicht eigenverantwortlich dessen T?tigkeiten überwacht und wenn der Berufskollege auch nicht als Mitunternehmer t?tig ist.     

Apoptosis and radiosensitization of hodgkin cells by proteasome inhibition

PURPOSE: Malignant cells from Hodgkin's disease have been reported to be defective in regulation of NF-kappaB activity. Ionizing radiation is known to activate NF-kappaB, and it has been suggested that this pathway may protect cells from apoptosis following exposure to radiation and other therapeutic agents. Defective NF-kappaB regulation in Hodgkin cells could therefore dictate the response of this disease to therapy, as well as be responsible for maintaining the malignant phenotype. The purpose of this study was to explore whether NF-kappaB activity could be modulated in Hodgkin cells and whether it determines the response of these cells to treatment with ionizing radiation and/or dexamethasone. METHODS AND MATERIALS: Activation of NF-kappaB in cells is accomplished in large part by degradation of its inhibitor IkappaB through the 26s proteasome. HD-My-Z Hodgkin cells were treated with the proteasome inhibitor MG-132 or transduced with a dominant negative super-repressor IkappaBalpha. Clonogenic survival, apoptosis, proteasome activity, and NF-kappaB binding activity were monitored in response to ionizing radiation and/or dexamethasone treatment. RESULTS: HD-My-Z Hodgkin cells had modest NF-kappaB levels but, unlike other cell types, did not decrease their level of constitutively active NF-kappaB in response to proteasome inhibition with MG-132. In contrast, transduction with a non-phosphorable IkappaBalpha construct abolished expression. MG-132 did, however, induce apoptosis in HD-My-Z cells and sensitized them to ionizing radiation. Dexamethasone treatment had no effect on NF-kappaB activity or clonogenic survival of Hodgkin cells, but protected them from irradiation. CONCLUSION: We conclude that inhibition of 26s proteasome activity can induce apoptosis in HD-My-Z Hodgkin cells and radiosensitize them, in spite of the fact that their constitutively active NF-kappaB levels are unaltered. The proteasome may be a promising new therapeutic target for intervention in this disease. In contrast, the use of glucocorticoids in conjunction with radiation treatment for this tumor may require re-evaluation.     

Psychiatrische Notfälle aus der Sicht von Notärzten

OBJECTIVE: In the German emergency medical system (EMS) psychiatric emergency situations (PES) are now responsible for up to 15% of all calls for the emergency physician (EP). A survey which was first conducted in 1996 to reveal knowledge about PES, reported a significant need for training. Seven years later it is interesting to investigate whether different conditions in the EMS may have changed assessments and attitudes. METHODS: The questionnaire of 1996 was modified to enable a comparison of PES and other frequent emergency situations with respect to the estimated number and the subjective stress. Open and multiple-choice questions or visual analogue scales were used to obtain the following data: demographic data, frequency of and stress by PES and other medical emergencies, own knowledge, and interest about training programs. RESULTS: Of the EPs 274 responded (male/female: 74/26%, mean age: 38 years, mean experience as an EP 6 years, anaesthesiologists 69%). The frequency of PES was estimated at 5% and 44% of EPs thought that there had been an increase in recent years. Personal knowledge was judged to be good by only 24%. The interest in training programs even increased slightly compared to the first survey; of particular interest was training in drug abuse disorders. Subsequent to internal, neurological and surgical emergencies, PES are considered to rank fourth in frequency, however the strain imposed by PES is significantly higher than for these other emergency situations. DISCUSSION: The results indicate an increase of relevance of PES in the German EMS, however, assessments made by the EP only changed marginally over the time period. The subjective awareness of the frequency of PES underestimates the reality in emergency medicine. The importance of training programs remains high to improve knowledge and to reduce feelings of incapability.     

Outcome of long-term intensive therapy of surgery patients

OBJECTIVE: The treatment of severely ill patients remains a medical and human challenge. The aim of the study was to determine the survival rate of patients with prolonged intensive care unit (ICU) treatment. Additionally, the somatic, psychological, and social sequelae of the survivors should be determined. METHODS: Data of all patients who stayed for at least 30 consecutive days on a surgical ICU were evaluated with respect to age, sex, diagnosis on admission, APACHE II-Score, ISS, pre-existing diseases, therapeutic procedures, complications, organ dysfunctions, and mortality. The survivors passed a follow-up examination after 35 +/- 14 months. This included somatic, psychological, and social parameters. RESULTS: Data of 101 patients were analysed (m/f: 78/23, mean age: 49.9 +/- 18.2 years, mean stay on ICU: 57 +/- 37 days, trauma patients: 46%). 31 subjects died on the ICU. Until the follow-up, another 24 patients deceased. Thus, the total mortality rose to 55%. Age, diagnosis on admission and severity of organ failure influenced the ICU mortality. Concerning the mortality after discharge, age, pre-existing morbidity and diagnosis on admission affected the outcome. 41 of the remaining 46 patients (89%) underwent the follow-up. Nearly half of them showed no or minor signs of impairment in any of the investigated areas. One third had severe handicaps. Trauma patients had the lowest mortality rates but showed worse results in rehabilitation. CONCLUSIONS: The mortality after prolonged ICU-treatment is substantially higher compared to average ICU patients. However, having survived the acute phase of the illness, successful rehabilitation in somatic, psychic as well as social terms could be performed to a considerable extent. This outcome is comparable to the one of other ICU populations. The results encourage to a consequent use of all medical options.