Cholesterol-reducing medications-a new therapeutic option for multiple sclerosis? Statins as immunomodulators

Statins are inhibitors of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase, which is crucial for cholesterol biosynthesis, and are widely used as lipid-lowering agents. These drugs greatly reduce atherosclerosis and cardiovascular morbidity, which in the past was mainly attributed to their cholesterol-lowering properties. However, recent evidence suggests that statins are also potent immunomodulators. They exerted beneficial effects on animal models of experimental autoimmune encephalomyelitis and thus have therapeutic potential for multiple sclerosis. Their exact mechanism of action is still unclear. HMG-CoA-dependent effects and a direct effect on immune receptors are conceivable and are reviewed here.     

Quality of life assessment after surgery for diverticulitis - a follow-up study

BACKGROUND: Laparoscopic sigmoid resection is a well established procedure for surgical treatment of benign colorectal diseases. The aim of the present study was to assess the longterm quality of life of patients who underwent laparoscopic sigmoid resection for sigmoid diverticulitis. Differences in health related life quality to the open-conventional approach were evaluated in a matched pair analysis (age, gender, Hinchey-Stage, Type of Surgery) using a validated quality of life instrument. METHODS: A total of 45 matched pairs (laparoscopic/open) operated for diverticulitis at stage I-IIa (Hinchey classification) were included in this study. The quality of life was measured with the Short-Form-36-Health Survey (SF-36), a standardized questionnaire with 8 scales and 36 items. The follow-up period was at least 2 years (mean 62.2 months). RESULTS: Pair members (n = 45) operated via laparoscopic or open approach for Hinchey I-IIa diverticulitis were of the same sex (21 female/24 male pairs) and age at time of surgery (range: lap.: 53.5-66 years; open: 53.5-67 years). Mean follow-up periods for patients operated laparoscopically and with open procedure were 2 (range: 1-3) and 7 (range: 5-9) years, respectively. The SF-36 scale scores for both groups appeared high and only slightly below a validated norm population. This represents a high quality of life after open as well as laparoscopic surgery for sigmadiverticulitis. No significant differences were apparent between the 45 matched-pairs. Pairs 65 years old or older presented no significantly different score values compared to those younger than 65 years. CONCLUSIONS: The long-term follow-up data in this age and sex matched pair analysis showed favorable results after open as well as laparoscopic surgery for sigmadiverticulitis. No statistically significant differences were observed between the two surgical techniques. Self-reports by the patient concerning his or her health condition, recovery and quality of life following any surgical procedure are needed to assess valid outcome data of new surgical treatments including a critical evaluation of all its benefits and burdens.     

Disorganized reasoning in Holocaust survivors

In 2 related studies of nonclinical Israeli samples, the long-term sequelae of traumatic Holocaust experiences were investigated from an attachment perspective. In each study, Holocaust survivors were compared with participants who had not experienced the Holocaust, and their attachment style and state of mind with regard to past and present attachment experiences as well as their state of mind regarding unresolved loss were assessed. In both studies, the Holocaust groups were found to be significantly more inclined to show disoriented thought processes around trauma than were the groups without Holocaust background. From an attachment perspective, the authors showed that even after 50 years, traumatic traces of Holocaust experiences are present in the survivors.     

Preparation and achievement of American College of Surgeons level I trauma verification raises hospital performance and improves patient outcome

OBJECTIVE: The purpose of this study was to assess the impact on patient outcome and hospital performance of preparing for and achieving American College of Surgeons (ACS) Level I trauma verification. METHODS: The center was a previously designated state regional trauma center located adjacent to a major metropolitan area. Preparation for ACS verification began in early 1996 and was completed in early 1998. Final verification took place in April 1999. Data were analyzed before (1994) and after (1998) the process. There was a marked increase in administrative support with trauma named one of the hospital's six centers of excellence. Two full-time board-certified trauma/critical care surgeons were added to the current six trauma surgeons. Their major focus was trauma care. Trauma support staff was also increased with case managers, a trauma nurse practitioner, additional trauma registrars, and administrative support staff. Education and continuous quality improvement were markedly expanded starting in 1996. RESULTS: There were 1,098 trauma patients admitted in 1994, and 1,658 in 1998. Overall mortality decreased (1994, 7.38%; 1998, 5.37%; p < 0.05). There was a marked decrease in mortality for severely injured (Injury Severity Score > 30) patients (1994, 44% mortality [38 of 86]; 1998, 27% [22 of 80]; p < 0.04). Average length of stay also decreased (1994, 12.22 days; 1998, 9.87 days; p < 0.02). This yielded an estimated cost savings for 1998 of greater than $4,000 per patient (total saving estimate of $7.4 million). CONCLUSION: Trauma system improvement as related to achieving ACS Level I verification appeared to have a positive impact on survival and patient care. There were cost savings realized that helped alleviate the added expense of this system improvement. The process of achieving ACS Level I verification is worthwhile and can be cost effective.     

Langzeitbeatmung respirator-abhängiger Kinder mit schweren Atemregulationstörungen bei Myelomeningozele und Chiari-II-Malformation

Case report: We report on three female patients with myelomeningocele, Chiari II malformation and severe respiratory control disorder despite neurosurgery. After life-threatening events (two patients) and negative weaning (one patient) we decided a longterm home-care ventilation at the age of 5 months, 3.1 respectively 10.1 years of age. Patients were ventilated by a pressure-controlled ventilator via nasal mask (one patient) respectively by a volume-controlled ventilator via tracheostoma (two patients). Over a period of 2.7 respectively 5.2 years we could prevent two patients from life-threatening events. During a follow-up of 7.3 years our third patient suffered from a prolonged convulsion, which led to a severe neurologic deterioration. Two of the three patients showed a positive neurologic development and social integration. Discussion. Longterm ventilation can prolong life expectancy and optimize neurological development and social integration for patients with myelomeningocele and severe respiratory control disorders despite neurosurgery. According to the complex neurologic situation, and the patient's and their family's stress the elective decision for a longterm ventilation has to be judgded critically and individually.     

Vorgehen bei Oberarmschaftfrakturen mit primärem oder sekundärem Radialisschaden

We give an account of 28 patients with fractured humerus diaphysis, suffering from primary and seven patients suffering from secondary lesion of the radialis nerve, all treated by operation. In each case the radialis nerve was exposed and the fracture was treated by fixation with compression plates. In case of primary lesions of the radialis nerve, we found intraoperative damages by traction (six times), contusions (seven times), intraneural hämatomas (six times) and for one time perforation of the nerve by bones. The rest of this group (eight times) did not show any pathological finding. Those patients with secondary lesion of the radialis nerve showed damages by traction (three times) and in two cases the nerve was walled up by callus or connective tissue. Two times we could not find any pathological alteration of the nerve. 23 (six) out of 28 (seven) patients with primary (secondary) lesion of the radialis nerve could be followed up. On this occasion we stated complete neurological restitution 20 times (four times) and incomplete restitution three times (two times). The great number of pathological findings, which necessitate operative treatment, the short duration of remission and the high rate of restitution confirm us to leave the way of conservative treatment in cases of primary or secondary lesion of the radialis nerve and the indication of acute operation is given.