Todeszeitschätzungen durch die mathematische Beschreibung der rektalen Leichenabkühlung unter verschiedenen Abkühlungsbedingungen

Zusammenfassung Von den als Bezug gewählten Standardbedingungen einer Leichenlagerung (unbekleidet — ruhende Luft) abweichende Abkühlungsbedingungen (permanente Luftbewegung — Bekleidung — Bedeckung — feuchte Bekleidung) können durch Korrekturfaktoren des Körpergewichts in der Todeszeitberechnung aus Daten der rektalen Leichenabkühlung angemessen berücksichtigt werden. Die Körpergewichts-Korrekturfaktoren umfassen am vorliegenden Material einen Bereich zwischen 0,7 für vollständig durchfeuchtete Bekleidung+permanente Luftbewegung und 2,4 für bettähnliche Bedeckung.Leicht zu handhabende Temperatur-Todeszeit-Bezugsnomogramme ersetzen die Berechnungen ohne Verlust an Präzision. Die 95%- bzw. 99%-Toleranzgrenzen einer Schätzung des wahrscheinlichen bzw. sehr wahrscheinlichen Todeszeitbereichs wurden ermittelt.Herrn Prof. Dr. O. Prokop zum 60. Geburtstag gewidmet     

Cystoid macular edema in anterior chamber lens implantation following posterior capsule rupture

By comparing the incidence of cystoid macular edema (CME) in three groups of patients having different surgical procedures, we attempted to assess the role of vitreous loss as a risk factor for CME development. In the first group (n = 470), the surgical procedure was extracapsular cataract extraction followed by implantation of posterior chamber lens (EC-CE + PC-IOL). The second group (n = 42) had extracapsular cataract extraction which was complicated by posterior capsule rupture, and therefore anterior vitrectomy followed by implantation of anterior chamber lens had to be performed (ECCE + anterior vitrectomy + AC-IOL). In the third group (n = 22) the surgery was intracapsular cataract extraction followed by anterior chamber lens implantation (ICCE + AC-IOL). The third group was included in this follow up study to assess the role of AC-IOL as a possible causative factor for development of CME in uncomplicated cases of ICCE and AC-IOL. The difference of incidences of CME in the second and third group would therefore depend mostly on the vitreous loss. The incidence of CME diagnosed by fluorescein angiography in the first, second and third group was 1.5% (7/470), 35.7% (15/42) and 9.0% (2/22), respectively. All patients who developed CME were treated with combination of corticosteroid-antibiotic drops, dexamethasone retrobulbarly (40 mg/day) and peroral indomethacine (25 mg/day/6 weeks). This therapeutic regime resulted in only moderate improvement of visual acuity.Abbreviations AC-IOL anterior chamber intraocular lens - CME cystoid macular edema - ECCE extracapsular cataract extraction - ICCE intracapsular cataract extraction - IOL intraocular lens - PC-IOL posterior chamber intraocular lens     

The ratio between carcinoma antigen-125 levels in the seminal plasma and serum may be a marker for fertilization in intracytoplasmic sperm injection

Objective: To assess the relationship between tumor marker carcinoma antigen-125 levels in seminal plasma and serum and fertilization rates in an IVF program, using intracytoplasmic sperm injection (ICSI).

Design: A prospective study.

Setting: IVF Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.

Patient(s): Twenty-five infertile patients with severe oligo-terato-asthenospermia syndrome and 25 fertile male donors.

Intervention(s): None.

Main Outcome Measure(s): Serum and seminal plasma carcinoma antigen-125 concentrations and fertilization rate per cycle.

Result(s): In the infertile group, the seminal plasma carcinoma antigen-125 levels ranged from 22.0 to 1,284.0 U/mL (mean level ± SD, 229.9 ± 274.2 U/mL). In the normospermic fertile male donors, the seminal plasma carcinoma antigen-125 concentrations ranged from 12.2 to 336.7 U/mL (mean level ± SD, 110.1 ± 91.6 U/mL). This difference was statistically significant. The mean ± SD ratio between the seminal plasma/serum carcinoma antigen−125 levels differed significantly between the infertile group (47.9 ± 61.3) and the fertile male donors (5.7 ± 3.5). In the infertile group, the ratio between the seminal plasma/serum carcinoma antigen-125 levels was found to be negatively correlated with the oocyte fertilization rate.

Conclusion(s): The ratio between carcinoma antigen−125 levels in the seminal plasma and serum may be an indirect marker for male infertility and fertilization rate in IVF treatment using ICSI.     

PVR B 级的裂孔性视网膜脱离术后复发与玻璃体病变关系临床分析

目的回顾分析近10年PVR B级的裂孔性视网膜脱离术后复发与玻璃体病变的关系.方法对429例(435只眼)PVR B级的裂孔性视网膜脱离施行巩膜扣带术治疗,其中41只眼术后复发(9.43%),分析术后复发与玻璃体病变的关系.结果术前玻璃体正常组与浓缩组的复发率(3.19%与12.33%)之间差异有显著性(P＜0.05);正常组与条索牵引组间的复发率(3.19%与14.29%)之间差异有极显著性(P＜0.01);正常组与总体组的复发率(3.19%与9.43%)之间差异有显著性(P＜0.05);术前无玻璃体后脱离组与玻璃体后脱离组间的复发率(5.56%与12.90%)之间差异有显著性(P＜0.05).视网膜脱离术前各种玻璃体的情况在视网膜脱离复发时均有不同程度地加重.结论PVR B级的裂孔性视网膜脱离术前玻璃体病变和玻璃体后脱离对术后复发影响明显.重视玻璃体-视网膜界面动态变化,可进一步提高手术治愈率.     

Therapy for a Healthy Sibling of a Child Diagnosed with Cancer: A Case Study

This article presents a case study for skills-directed intervention aiming to help healthy siblings of children with cancer control their emotions and gain self-control skills. Case study application of the intervention was with a boy aged 9 years and 8 months who had the verbal, cognitive, and motivational ability to learn and apply the skills. Intervention included the “Feeling Wheel” to enhance emotional identification, expression, understanding, acceptance, and control. Intervention also focused on teaching him to observe his automatic thoughts, change them to mediated ones, engage in internal dialogue, and seek/adopt alternative behaviors to gain self-control. In postintervention feedback, he reported less anxiety than previously, less inclination toward negative thinking, and more empowerment to deal with day-to-day difficulties he encountered.     

A novel host-protein assay outperforms routine parameters for distinguishing between bacterial and viral lower respiratory tract infections

Bacterial and viral lower respiratory tract infections (LRTIs) are often clinically indistinguishable, leading to antibiotic overuse. We compared the diagnostic accuracy of a new assay that combines 3 host-biomarkers (TRAIL, IP-10, CRP) with parameters in routine use to distinguish bacterial from viral LRTIs. Study cohort included 184 potentially eligible pediatric and adult patients. Reference standard diagnosis was based on adjudication by an expert panel following comprehensive clinical and laboratory investigation (including respiratory PCRs). Experts were blinded to assay results and assay performers were blinded to reference standard outcomes. Evaluated cohort included 88 bacterial and 36 viral patients (23 did not fulfill inclusion criteria; 37 had indeterminate reference standard outcome). Assay distinguished bacterial from viral LRTI patients with sensitivity of 0.93 ± 0.06 and specificity of 0.91 ± 0.09, outperforming routine parameters, including WBC, CRP and chest x-ray signs. These findings support the assay's potential to help clinicians avoid missing bacterial LRTIs or overusing antibiotics.