Thromboembolieprophylaxe bei hüftgelenknahen Oberschenkelfrakturen-Ergebnisse einer prospektiven randomisierten Studie zwischen Heparin-DHE und,ASS-DHE

The effectiveness of prophylaxis of thromboembolism either by acetyl-salicylic-acid (ASA) 0.5g+dihydroergotamin (DHE) 2.5 mg three times a day or by Heparin 5000 IU+0.5 mg DHE (HDHE) three times a day was compared in 404 patients, elder than 55 years, with fractures close by the hip joint. Effectiveness was proved daily clinical controls, perfusion scintigraphy on the day after admission, the fourth postoperative day and the day before discharge and by autopsy of the died patients. Clinical manifest thrombosis were seen on the operated legs in the HDHE-group in 7.6% of the patients in ASA-DHE-group in 15.6%, on the not operated leg under prophylaxis by HDHE in 3.8%, by ASA-DHE in 4.1% of the patients. Increased postoperative bleeding could be found under HDHE in 16.1% of the patients, under ASA-DHE in 9.3% of the patients, wound haematoma in 9.5% under HDHE and in 5.7% of the patients of the ASA-DHE-group. Superficial wound infections occurred under HDHE in 8.1%, under ASA-DHE in 5.7% of the patients, deep infections under HDHE in 0.5% and under ASA-DHE in 1.6% of the patients. Gastrointestinal bleeding under HDHE in 0.5% of the cases and under ASA-DHE in 3.1% of the cases Prophylaxis had to be discharged in 7.6% of the patients of the HDHE-group and of 19.7% of the ASA-DHE-group. Pathologic perfusion scars sould be found in 54.0% of the patients of the HDHE-group and in 54.9% of the ASA-DHE-group. Pulmonal perfusion became worse despite of prophylaxis by HDHE in 15.6% of the cases and despite prophylaxis with ASA-DHE in 17.6%. Pulmonal perfusion became better under HDHE in 11.9% and under ASA-DHE in 12.4% of the cases. The mortality was 9.7%. Fatal thromboembolism occurred under HDHE in three patients (1.4%) and under ASA-DHE in three patients too 6.25% of the patients without any significant difference between the two groups of prophylaxis. Fatal gastrointestinal     

The role of autopsy in the control of mortality in Austria

Maintenance of an acceptable autopsy rate is important for continuous quality control of the mortality statistics of a population, as well as for continuous quality control of clinical diagnosis in general. A high autopsy rate is of particularly great value for maintaining the quality of data on mortality from neoplastic diseases and, by feed-back, for ensuring the quality and accuracy of clinical diagnosis of malignant neoplastic diseases.     

Sarcoidosis of the nervous system. Clinical and diagnostic synopsis based on two cases

This paper reports two cases of neurosarcoidosis . Initially the clinical picture involved only the nervous system. Later on manifestations pertaining to other systems were detected by interdisciplinary investigations. The resulting diagnostic problems, the value of additional investigations and the therapeutic management are discussed on the basis of the two presented cases.     

Preoperative expectations and postoperative quality of life in liver transplant survivors

OBJECTIVE: To assess normalization in the lives of liver transplant patients and the impact of preoperative expectations on postoperative quality of life (QOL). DESIGN: A semistructured interview, 2 QOL questionnaires, and chart reviews of medical histories. SETTING: Internal medicine department at Innsbruck university hospital, Austria. PARTICIPANTS: Fifty-five patients (32 men, 23 women) with liver transplants. INTERVENTIONS: The Sickness Impact Profile (SIP) and Functional Assessment of Cancer Therapy-General. RESULTS: Patients' preoperative expectations of a normal life style posttransplantation were predominantly optimistic (60%), but postoperatively only 40% thought that their expectations had been realized. The patients' SIP values showed significant impairments in nearly every area of life when compared with the values of a healthy control group. Only "complications during the hospitalized phase" had a statistically significant impact among the sociodemographic and clinical parameters on postoperative QOL. The lowest QOL scores were found among patients whose expectations of a return to normal life style had not been realized. CONCLUSION: Unmet life-style expectations after liver transplantation may lead to increased stress, which affects QOL long term. This finding is of clinical relevance; therapeutic measures, particularly professional pretransplant counseling, are indicated.     

Status of oral contraceptives as a risk factor in cerebrovascular diseases

A critical review of the relevant literature revealed that the incidence of subarachnoid haemorrhage is increased in women taking oral contraceptives and the mortality rate is higher. The data concerning correlation between the use of oral contraceptives and other cerebrovascular disorders are less conclusive. Taking oral contraceptives seems to result in a higher risk of stroke, but there is no definite correlation to the incidence of strokes with a fatal outcome. However, in the case of the coexistence of more than one risk factor, including cigarette smoking, the risk of cerebrovascular disease is considerably increased for women using oral contraceptives. Age also seems to be a significant factor. Women older than 44 should avoid oral contraceptives in general; women between 35 and 44 should use oral contraceptives only if additional risk factors are absent, i.e. if they are non-smokers. Indeed, in the presence of this or other risk factors younger women should also avoid taking oral contraceptives.     

The high autopsy rate in Vienna

In 1983 34% of all persons who died in the Republic of Austria were autopsied. We examined the frequency of postmortem examinations in the capital city, Vienna, between 1983 and 1987 in view of this high overall autopsy rate. The annual autopsy rate in all 9 pathology institutes and the department of legal medicine of the University of Vienna was on average 51 to 53%. There was a slight statistically verifiable decline in 1987. The reason for this high necropsy rate is that Austrian law permits the autopsies without the consent of next of kin if it appears indicated for medical, scientific or educational reasons; further more the fact, that the chairman of the department is at the same time the coroner for the hospital. A high autopsy rate is necessary to maintain a high standard of diagnostic accuracy even in modern medicine. The diagnoses were inaccurate or incomplete in 15% of all cases. The high autopsy rate is the basis for extremely accurate mortality and morbidity statistics and provides the basis for long range public health planning. Medical students develop an insight in disease patterns, which cannot be gained in any other way. The pathology departments of Vienna introduce a new city-wide computer-supported diagnostic file system, which will provide a baseline for comparative scientific studies.     

Successful management of claustrophobia and depression during allogeneic SCT

As psychological problems are frequent in SCT patients we report on a patient with chronic myeloid leukemia, claustrophobia and depression. The successful allogeneic stem cell transplant of this patient in a reverse isolation setting required intensive interdisciplinary hematological, psychological and psychiatric collaboration. Psychopharmacologically the patient was treated with lorazepam 1 mg at 10 a.m. and 8 p.m. and after crisis on day +6, and 2.5 mg twice daily i.v. until one day before discharge (total 20 doses). Psychological counseling followed a cognitive-behavioural approach including progressive muscle relaxation and cognitive techniques focusing on the actual coping processes.     

NF-κB contributes to MMP1 expression in breast cancer spheroids causing paracrine PAR1 activation and disintegrations in the lymph endothelial barrier in vitro

RELA, RELB, CREL, NFKB1 and NFKB2, and the upstream regulators NEMO and NIK were knocked-down in lymph endothelial cells (LECs) and in MDA-MB231 breast cancer spheroids to study the contribution of NF-κB in vascular barrier breaching. Suppression of RELA, NFKB1 and NEMO inhibited “circular chemo-repellent induced defects” (CCIDs), which form when cancer cells cross the lymphatic vasculature, by ~20–30%. Suppression of RELB, NFKB2 and NIK inhibited CCIDs by only ~10–15%. In MDA-MB231 cells RELA and NFKB1 constituted MMP1 expression, which caused the activation of PAR1 in adjacent LECs. The knock-down of MMP1 in MDA-MB231 spheroids and pharmacological inhibition of PAR1 in LECs inhibited CCID formation by ~30%. Intracellular Ca²⁺ release in LECs, which was induced by recombinant MMP1, was suppressed by the PAR1 inhibitor {"type":"entrez-protein","attrs":{"text":"SCH79797","term_id":"1052762130","term_text":"SCH79797"}}SCH79797, thereby confirming a functional intercellular axis: RELA/NFKB1 – MMP1 (MDA-MB231) – PAR1 (LEC). Recombinant MMP1 induced PAR1-dependent phosphorylation of MLC2 and FAK in LECs, which is indicative for their activity and for directional cell migration such as observed during CCID formation. The combined knock-down of the NF-κB pathways in LECs and MDA-MB231 spheroids inhibited CCIDs significantly stronger than knock-down in either cell type alone. Also the knock-down of ICAM-1 in LECs (a NF-κB endpoint with relevance for CCID formation) and knock-down of MMP1 in MDA-MB231 augmented CCID inhibition. This evidences that in both cell types NF-κB significantly and independently contributes to tumour-mediated breaching of the lymphatic barrier. Hence, inflamed tumour tissue and/or vasculature pose an additional threat to cancer progression.