Endarterektomie mit Ultraschall

Zusammenfassung Die Wirksamkeit des Ultraschalles zur Endarterektomie wurde bei der offenen Aussch?lung von Leichenaorten überprüft. Ultraschall hat gegenüber konventionellen Aussch?lmethoden wesentliche Vorteile. Die Aussch?lwirkung des Ultraschalles beruht nicht auf einem Vibrationseffekt, sondern auf der Kavitation, die Ultraschall in der Aussch?lebene hervorruft.     

Die Bedeutung der Süchtigkeit für die Indikationsstellung zu schmerzchirurgischen Eingriffen

Zusammenfassung Die Medikamentensucht ist eine schwere Erkrankung, die sowohl den postoperativen Verlauf als auch das Ergebnis schmerzchirurgischer Eingriffe beeinflussen kann. Eine Nachuntersuchung von 136 Chordotomien, darunter waren auch 30 süchtige Patienten, ergab, da? beide Gruppen wohl die im wesentlichen gleiche Aussicht haben, durch den Eingriff schmerzfrei zu werden, jedoch ist die Zahl der Mi?erfolge in der Gruppe der süchtigen Patienten au?erordentlich hoch. Die Süchtigkeit ist unseres Erachtens keine absolute Kontraindikation zu einer Chordotomie, mu? jedoch als ein erh?htes Operationsrisiko berücksichtigt werden. Vor der beabsichtigten Operation sollte bekannt sein, da? der Patient süchtig ist und die „stabilisierende Dosis” des Suchtgiftes sollte ermittelt werden, die in der Lage ist, das Auftreten des Abstinenz-Syndroms zu verhindern. Vegetative St?rungen, Stoffwechselst?rungen, St?rungen im Flüssigkeitshaushalt sowie eine Unterern?hrung, die bei Suchtkranken, auftreten k?nnen, müssen pr?operativ entsprechend behandelt werden. Im Hinblick auf die Suchtgef?hrdung bei Patienten, die an starken chronischen Schmerzen leiden, sollte man sich frühzeitig zu einer Chordotomie entschlie?en.

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Summary Drug addiction is a grave disease which may influence the postoperative course as well as the result of cordotomies. An examination of 136 cordotomies, including 30 patients with drug addiction, showed that both groups had essentially the same chance to be relieved from their pains, that however, the number of failures was especially high in the group of drug addicts. The preexistence of drug addiction is not necessarily a contraindication for cordotomy, it should however be considered as a greater risk for an operation. Before a cordotomy it should be known that the patient is a drug addict, furthermore it is necessary to find out the „stabilizing dose” of the drug which may prevent an abstinence-syndrom. The manifold disturbances (vegetative, fluid-balance, malnourishment and metabolism) which may occur with drug addicts, have to be treated accordingly before the planned operation. In view of the fact that patients suffering from severe chronical pain, may likely become drug-addicted, one should decide to make a cordotomy at an early sage.

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Nach einem Vortrag am Neurochirurgischen Diskussionstag, 26. Oktober 1968, Salzburg.     

A comparison of the therapeutic efficacy and tolerability of etoricoxib and diclofenac in patients with osteoarthritis

OBJECTIVE: To evaluate and compare the efficacy and tolerability of etoricoxib and diclofenac in patients with osteoarthritis of the knee or hip. METHODS: In this 6-week double-blind, active comparator controlled, parallel-group study eligible osteoarthritis patients were randomised to receive either etoricoxib 60 mg once daily (n = 256) or diclofenac 50 mg three times daily (n = 260). The primary study endpoint was the Western Ontario McMaster osteoarthritis index (WOMAC) pain subscale. Other endpoints included were the WOMAC stiffness and physical function subscales, and the Patient's Global Assessment of Response to Therapy (PGART) questionnaire. Early efficacy was evaluated using WOMAC first question (pain walking on a flat surface) and PGART 4 h after the morning dose of each drug on days 1 and 2. Rescue medication (paracetamol) used was also recorded. The study was designed to show comparable efficacy between etoricoxib 60 mg once daily and diclofenac 50 mg three times daily with respect to the primary endpoint and was conducted outside the United States at 67 centres in 29 countries. RESULTS: Etoricoxib (60 mg once daily) was comparable in efficacy to diclofenac (150 mg daily) on all the above parameters. The one exception was in the assessment of early efficacy where etoricoxib demonstrated significantly greater benefit within 4 h of taking the first dose on the first day of therapy (p = 0.007) as evaluated by the percentage of patients with good or excellent (PGART) responses. The treatment effects of both drugs were similar by the time day 2 was reached and were sustained throughout the 6 weeks of therapy. Both treatments were generally well tolerated. CONCLUSIONS: Etoricoxib is clinically effective in the therapy of osteoarthritis providing a magnitude of effect comparable to that of the maximum recommended daily dose of diclofenac. The onset of clinical benefit with etoricoxib on day one is more rapid than that of diclofenac. Both drugs were generally well tolerated.     

Criminality and aggression among psychotic in-patients: frequency and clinical correlates

OBJECTIVE: Violence is common among patients with psychoses. The aim of the study was to examine relations between diagnoses, crimes, demographic variables and aggressive behaviour during admission to hospital. METHOD: During 14 months 257 patients were consecutively referred to a unit with high staff/patient ratio. They were assessed for clinical symptoms at admittance and discharge. Also legal status, coercive measures, criminality and sentences were examined. RESULTS: Of the 257 patients, 38% were found in the police register and 33% had been prosecuted. Those patients committed 2525 crimes, including 292 acts of violence. Problems during admittance were related more to positive symptoms at admittance than to earlier criminality. CONCLUSION: Criminality rate is high among patients with functional psychoses. Many patients, especially women, had never been evaluated by a forensic psychiatrist. The psychiatric services have to consider the importance of preventing psychotic relapses and thereby also preventing violence and criminality.     

Changes of gastric mucosal architecture during long-term omeprazole therapy: results of a randomized clinical trial

Background The impact of long‐term acid suppression on the gastric mucosa remains controversial. Aim To report further observations on an established cohort of patients with gastro‐oesophageal reflux disease, after 7 years of follow‐up. Methods Of the original cohort randomized to either antireflux surgery or omeprazole, 117 and 98 patients remained in the medical and surgical arms, respectively. Gastric biopsies were taken at baseline and throughout the study. Results Fifty‐three antireflux surgery and 39 omeprazole‐treated patients had Helicobacter pylori infection at randomization. Eighty‐three omeprazole‐treated and 60 antireflux surgery patients remained H. pylori negative over the 7 years, and no change was observed in mucosal morphology except for a change in endocrine cell population (linear and diffuse hyperplasia, P = 0.03). During the 7‐year study many patients, who were initially H. pylori infected, had the infection eradicated leaving only 13 omeprazole and 12 antireflux surgery patients still infected. In these patients, omeprazole induced a deterioration of the mucosal inflammation scores (P = 0.01) with a numerical increase of glandular atrophy. Conclusions Long‐term omeprazole therapy does not alter the exocrine oxyntic mucosal morphology in H. pylori‐negative patients, but mucosal endocrine cells appear to be under proliferative stimulation; in H. pylori‐positive patients there are changes in mucosal inflammation and atrophy.     

Intrinsic labeling of chicken products with a stable isotope of selenium (76Se)

Chicken tissues were intrinsically labeled with a stable isotope of selenium (76Se) and were evaluated for use in a human feeding study. Laying hens were fed a low Se (0.06 ppm) basal diet for 39 days and then fed the basal diet supplemented with 0.3 ppm enriched 76Se (as selenite) for 35 days. Incorporation of 76Se into samples was determined by use of a double isotope dilution technique and a combined gas chromatography/mass spectrometry analysis. The 76Se content of the basal diet was increased by a factor of 9.7 with the addition of the enriched stable isotope. This maximal level of enrichment was approached in egg yolk (9.5-fold) and liver (9.0-fold). Enrichment was lower in egg white (7.2-fold) and breast meat (5.0-fold). Level of enrichment in a given tissue reflected both the turnover rate of the tissue and its natural selenium content. Selenium-depleted laying hens continuously fed 76Se at the 0.3 ppm level produced egg yolks and livers that were enriched sufficiently with the stable isotope for use in a human metabolic study.