Presence of creatine phosphokinase brain band in the serum of chronic renal disease patients.

The almost universal presence of the isoenzyme creatine phosphokinase brain band (CPK-BB) in the sera of patients with chronic renal insufficiency and serum creatinine above 4.5 mg/dl is noted. It is absent in patients with severe acute renal failure and in transplanted patients with normal renal function. The source of the enzyme may be nerve tissue and may represent neuronal cell damage in uremics over a period of time.     

Colon perforation following percutaneous nephrostomy and renal calculus removal

Two patients had colonic perforation as a result of percutaneous nephrostomy placement followed by track dilatation and renal calculus removal. We present the technical aspects of nephrostomy placement and stone removal, as well as the clinical diagnosis and management of these cases. Both patients recovered well with conservative therapy and required no surgical intervention. This report reviews the anatomic considerations for percutaneous nephrostomy in patients undergoing renal stone removal.     

Influence of prosodic information on the processing of split particles: ERP evidence from spoken German

Spoken language comprehension involves the use of different sources of linguistic information such as prosodic, syntactic, lexical, and semantic information. The question, however, of 'when' and 'how' these sources of information are exploited by the language processing system still remains unanswered. In the present study, we used event-related brain potentials (ERPs) to investigate the interaction between prosodic, syntactic, and lexical information during the processing of spoken German sentences. The sentence structure was manipulated by positioning a split particle at the end of the sentences after the occurrence of inflected verb whose lexical entry does not contain a split particle (e.g., *Sie alarmierte den Detektiv an [*She alerted at the detective]) [According to linguistic convention, incorrect sentences are marked by an asterisk.]. The prosodic contour of the verb stems was manipulated such that it marked either the presence of a split particle at a later position in the sentence or not. Participants performed an off-line probe-detection task. ERP data indicate that prosodic information of German-inflected verb stems is consulted on-line by the language processing system ('parser') in order to 'predict' the presence of a split particle at a later position in the sentence. An N400 effect was observed for the processing of split particles following verb stems which do not take a particle. However, this effect was only observed when the prosody of the verb stem did signal the presence of a split particle. We argue that the N400 component reflects the high costs associated with the lexical search that the language processing system has to perform when confronted with nonexisting words such as these resulting from the combination of the split particle and the verb stem in the present study. Furthermore, as a general reflection of prosodic processes, a Closure Positive Shift (CPS) was found at intonational phrase boundaries. In sum, the present findings provide strong evidence that prosodic information is a good 'predictor' of upcoming information during the auditory processing of German sentences.     

Survival after ruptured abdominal aortic aneurysm: effect of patient, surgeon, and hospital factors

OBJECTIVE: The purpose of this study was to determine the effects of patient, surgeon, and hospital factors on survival after repair of ruptured abdominal aortic aneurysm (AAA) and to compare them with risk factors for survival after elective AAA repair. It was hypothesized that patients operated on by high-volume surgeons with subspecialty training would have better outcomes, which might argue for regionalization of AAA surgery. METHODS: In this population-based retrospective cohort study, surgeon billing and administrative data were used to identify all patients who had undergone AAA repair between April 1, 1992, and March 31, 2001, in Ontario, Canada. Demographic information was collected for each patient, as well as numerous variables related to the surgeons and hospitals. RESULTS: There were 2601 patients with ruptured AAA repair, with an average 30-day mortality rate of 40.8%. Significant independent predictors of lower survival were older age, female gender, lower patient income quintile, performance of surgery at night or on weekends, repair in larger cities, surgeons with lower annual volume of ruptured AAA operations, and surgeons without vascular or cardiothoracic fellowship training. There were 13,701 patients with elective AAA repair, with an average 30-day mortality rate of 4.5%. Significant independent predictors of lower survival were similar, except gender was not significant, but the Charlson Comorbidity Index was. When the hazard ratios associated with predictive factors were compared, surgeon factors appeared to be more important in ruptured AAA repair, and patient factors appeared more important in elective AAA repair. CONCLUSION: For elective AAA repair, and even more so for ruptured AAA repair, high-volume surgeons with subspecialty training conferred a significant survival benefit for patients. Although this would seem to argue in favor of regionalization, decisions should await a more complete understanding of the relationship between transfer time, delay in treatment, and outcome.     

Age, risk-benefit trade-offs, and the projected effects of evidence-based therapies

BACKGROUND: Physicians underutilize evidence-based therapies in the elderly, perhaps because of concerns about the generalizability of clinical trial results in elderly patients given that the relative efficacy of therapies may vary with age. We compared the estimated effects of age and efficacy of treatment on survival among patients with acute coronary syndromes. METHODS: Baseline risk, defined as mortality in the year after hospitalization for acute coronary syndromes, was determined for different age strata among 81,584 patients who had been discharged between April 1, 1997, and March 31, 2000, in Ontario, Canada. We calculated the relative efficacy (relative risk reduction) needed to achieve a clinically meaningful absolute survival benefit, using a number needed to treat of 50 patients for the different age strata. We also evaluated risk-benefit trade-offs in the elderly versus the young by modeling different levels of the relative efficacy and rates of fatal complication by age. RESULTS: Baseline risk (1-year all-cause mortality) was 12-fold lower in the youngest patients (age <50 years) than in oldest patients (age > or = 75 years). Given this gradient, a therapy would have to have a relative efficacy of 88% (i.e., a relative risk of 0.12) in the youngest age group, and 7% (a relative risk of 0.93) in the oldest age group, to generate a number needed to treat 50 patients. For a therapy whose relative efficacy was 25%, the fatal complication rate would have to be sevenfold greater in the oldest compared with the youngest age group to outweigh the survival benefits associated with treatment. CONCLUSION: For acute coronary syndromes, baseline mortality is so much higher for elderly patients that neither sharp reductions in the relative efficacy of therapies nor increases in the rates of serious complications are likely to negate the benefits of therapy. More attention should be paid to overall trial results and less to age-specific subgroup data, unless the latter provide very clear evidence for substantial reductions in absolute efficacy or net harm.     

Rezidivierende Synkopen bei Linksschenkelblock mit normaler PQ-Zeit

Zusammenfassung Wir berichten den Fall einer 53-j?hrigen Patientin, die sich wegen rezidivierender Synkopen zur station?ren Aufnahme vorstellte. Im Oberfl?chen-EKG fand sich ein Sinusrhythmus mit normaler PQ-Zeit und komplettem Linksschenkelblock. Echokardiographisch wurde eine auf ca. 45% reduzierte Pumpfunktion ermittelt. Unter dem Verdacht einer entzündlichen Herzmuskelkrankung wurde eine Herzkatheteruntersuchung mit Endomyokardbiopsie durchgeführt, deren histologische und immunhis-tologische Untersuchung keinen Anhalt für eine Myokarditis oder Speichererkrankung ergab. Die elektrophysiologische Untersuchung zeigte ein stark verl?ngertes HV-Intervall von 101 ms (normal 35–55 ms). Daraufhin wurde ein Zweikammerschrittmachersystem (DDD) implantiert. Eine Untersuchung nach 3 Monaten zeigte die bereits eingetretene Schrittmacherabh?ngigkeit der Patientin bei komplettem AV-Block ohne ausreichenden Ersatzrhythmus.