Kindliche Ureterabgangsstenose in einem Zuweisungszentrum

Background

Ureteropelvic junction obstruction is the most frequent malformation of the upper urinary tract and treatment with conservative or operative management remains controversial. In this study we present the retrospective analysis of 129 children with ureteropelvic junction obstruction who underwent conservative or operative management.

Material and methods

A total of 129 children with ureteropelvic junction obstruction, who were treated in the department of pediatric nephrology at the University of Essen from 1998–2005, were included into the analysis. Clinical charts were reviewed for the parameters urinary tract infections (total number, severity, bacteriology), antibiotics, ultrasound, Tc-99 diuresis renography, and management (conservative or operative). Statistical analysis was performed using the SPSS software (Version 11.0)

Results

A total of 89 urinary tract infections was observed in 52 children. The mean width of renal pelvis was 3.04±1.33 cm in the operative group and 1.98±1.2 cm in the conservative group (p=0.001, ANOVA test). Tc-99 diuresis renography was performed in 70 children of which 46 children received primarily conservative management and 24 children were operated. In the conservative group 6 children underwent pyeloplasty later on due to aggravation of renal function. In 59 out of 129 cases diuresis nephrography was not performed due to only mild ectasia.

Conclusions

This study demonstrates that conservative management is safe in children with ureteropelvic junction obstruction with no or only little constricted renal function, if a close-meshed surveillance protocol is followed and parental compliance is given.     

Isolation of murine thymic epithelium and an improved method for its propagation in vitro

A reliable and reproducible method for the isolation and propagation of thymic epithelial cells is described. Thymic epithelial cells from enzymatically dissociated thymus stroma are first enriched by separation on a discontinuous Percoll density gradient. The cell fractions enriched for epithelial cells are then cultured with irradiated fibroblasts in Ham's F-12 nutrient medium. Colonies of cells in these cultures contain keratin and exhibit morphologic characteristics of epithelial cells. When subcultured, the epithelial cells no longer require irradiated fibroblasts as filler cells. Some of the epithelial cells in vitro retain expression of class II (Ia) major histocompatibility antigens. The generation of defined cultures of thymic epithelial cells promises to be useful in defining their role in T cell differentiation.     

The effect of anxiety and personality on the pharmacokinetics of oral midazolam

We investigated the relationship between the pharmacokinetic variables of oral midazolam and patients' state/trait anxiety and personality. Twenty-six patients received the standard 15-mg oral dose for anxiolysis on the evening before otorhinolaryngological surgery. Blood samples were taken over a 9-h period after the administration, and the samples were analyzed for concentrations of midazolam and its two main metabolites by using a gas chromatography-mass spectrometry procedure. The pharmacokinetic variables maximum concentration, time to reach the maximum concentration, the elimination half-life, and the area under the curve were calculated from these data. When the patients were divided into groups with respect to their anxiety and personality scores, no significant differences in the pharmacokinetic variables of midazolam could be found. Only small, insignificant changes in the maximum concentrations were found with respect to nervousness and emotionality. We conclude that personality traits and anxiety levels had no effect on the pharmacokinetic variables of midazolam. IMPLICATIONS: We conclude that personality traits and anxiety levels had no effect on the pharmacokinetic variables of midazolam. Therefore, it is not necessary to obtain anxiety or personality scores to find the proper midazolam dose for the individual patient.     

Indikationsstellung und operationstechnisches Vorgehen bei chronischen Verschlüssen des Truncus brachiocephalicus und der A. subclavia im Abschnitt I

Zusammenfassung Die Operationsindikation ist im klinischen Stadium II und beim subclavian steal-Syndrom gegeben. Bei Obliteration des Truncus brachiocephalicus ist die direkte Desobliteration von einer medianen Sternotomie aus das Operationsverfahren der Wahl. Die Operationsletalität liegt bei 6%. Der Verschluß der linken proximalen A. subclavia kann entweder von einer anterolateralen Thoracotomie aus direkt desobliteriert werden oder durch eine extrathorakale Umleitung überbrückt werden. Dem extrathorakalen Bypass-Verfahren wird z.Z. wegen der geringen Operationsletalität (0.8% gegenüber 7% beim transthorakalen Vorgehen) der Vorzug gegeben. Rechtsseitige Subclaviaverschlüsse werden supraclaviculär desobliteriert.

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Indication and operative technique in chronic occlusions of the innominate artery and proximal subclavian artery

Summary Surgery is indicated in clinical stage 11 and cases of subclavian steal syndrome. Endarterectomy by mid-sternotomy is the operation of choice for obliteration of the innominate artery. The lethality rate is 6%. Occlusion of the left proximal subclavian artery can be treated by transthoracic endarterectomy or extrathoracic bypass procedure. The bypass procedure is preferred because of low operative lethality rate (0.8% versus 7% in transthoracic procedure). Occlusions of the right proximal subclavian artery are treated by supraclavicular endarterectomy.

Auszugsweise als Vortrag gehalten auf der 96. Tagung der Deutschen Gesellschaft für Chirurgie     

Cross-cultural validity of the Yale-Brown Obsessive Compulsive Scale

Some psychometric properties of an adaptation of the Yale–Brown Obsessive Compulsive Scale for use in the Netherlands (Y-BOCS-NL) were examined in 65 psychiatric inpatients. The factorial invariance of two-dimensional systems were determined, namely Severity and Disturbance versus Obsessions and Compulsions, with the latter performing substantially better than the former in different respects. All further analyses were therefore focused on the Obsessions and Compulsions prototype. Inter-rater agreement was established in four inpatients by 39 raters at different institutions and found to be excellent. Internal consistency was also excellent. Concurrent and divergent validity were examined and established by correlating the Y-BOCS-NL with the Padua Inventory, the Burns Perfectionism Scale and state and/or trait measures of, among others, hostility, anxiety, depression, irrational fears and assertiveness. The Obsessions and Compulsions dimensions were lowly intercorrelated and showed evidence of clearly different patterns of correlations with external measures (divergent validity).     

Genetic risk factors for erectile dysfunction and genetic determinants of drug response--on the way to improve drug safety?

Association studies give hint for the fact that the risk to develop cardiovascular disorders such as hypertension or coronary heart disease is influenced by the genotype in single nucleotide polymorphisms (SNPs). Considering the close relationship in the pathophysiology of these diseases and erectile dysfunction (ED), the analysis of the association of genotypes in SNPs and ED stands to reason. In an analysis of ED patients and their genotypes in the GNB3 C825T, the ACE I/D and the NOS3 G894T polymorphisms, there was no evidence for influence of the genotypes on the susceptibility to develop ED. At the same time, a significant variation in drug response to sildenafil dependent on the genotypes in the GNB3 C825T and ACE I/D polymorphisms was demonstrated. In the group of GNB3 825C allele carriers, only 50% of patients showed a positive response, while > 90% of the patients genotype TT responded adequately. In parallel, only 50% of ACE D allele carriers showed a positive response to sildenafil in contrast to men genotype II in the ACE I/D polymorphism, who had a response rate of 75%. Considering cardiovascular side effects under sildenafil treatment, it would be interesting to determine if genetic factors have an impact on the side effect profile of this drug.     

Ovarielle Protektion und Erhalt der Fertilität im Rahmen der Therapie gynäkologischer Malignome bei Kinderwunsch

Zusammenfassung Neue reproduktionsmedizinische Techniken und ein steigendes Bewusstsein in der Bevölkerung für die Möglichkeit der Erfüllung eines Kinderwunsches nach einer Krebserkrankung haben zu einer zunehmenden Verbreitung fertilitätserhaltender Maßnahmen im Rahmen zytotoxischer Therapien geführt. Bei gynäkologischen Malignomen ist das Mammakarzinom von größter Relevanz, da ca. 2500 Frauen bis zu einem Alter von 35 Jahren/Jahr erkranken. Für den Fertilitätserhalt kommen IVF/ICSI-Behandlungen, die In-vitro-Maturation, die Oozytenkryokonservierung, die Kryokonservierung von Ovarialgewebe und die Gabe von GnRH-Analoga in Betracht. Allerdings ist die Wahrscheinlichkeit, dass die Patientin letztlich von diesen Therapien im Sinne der Geburt eines Kindes profitieren kann, begrenzt. Deswegen sollten diese Therapien nur nach einer sorgfältigen Risiko-Nutzen-Abwägung und nach einer ausführlichen interdisziplinären Beratung der Patientin angewendet werden.