Angiographic distribution of lower extremity atherosclerosis in patients with and without diabetes.

AIMS: To determine differences in the anatomic site of atherosclerosis in the lower extremity between patients with and patients without diabetes. DESIGN: Cross-sectional study of patients who underwent angiography of both legs because of symptoms of intermittent claudication, rest and/or night pain, ulceration or gangrene. METHODS: The angiographies of 37 patients with diabetes and 37 patients without diabetes, matched for age, sex and smoking behaviour, were evaluated using the Bollinger scoring system. RESULTS: The mean (sd) Bollinger score in the upper leg (from the abdominal aorta to and including the superficial femoral artery) was higher (P = 0.01) for patients without diabetes (35.3 (22.8)) than for patients with diabetes (23.3 (16.1)). In the lower leg (from the popliteal artery to the posterior tibial artery) patients with diabetes tended to have a higher score than patients without diabetes: 47.4 (34.2) and 37.6 (32.9), respectively (P = 0.22). CONCLUSION: This angiographic study confirms the clinical notion that lower limb atherosclerosis in diabetes is more severe in distal segments of the lower extremity, while the proximal segments remain less attenuated compared with patients without diabetes.     

Intestinal hemodynamics during laparotomy: effects of thoracic epidural anesthesia and dopamine in humans

The effects of thoracic epidural anesthesia (TEA) and dopamine infusion (4 micrograms.kg-1.min-1) on superior mesenteric artery blood flow (SMABF), the mesenteric arteriovenous oxygen difference (AVDO2), and the mesenteric venous lactate concentration were studied in nine patients before abdominal aortic reconstruction. Thoracic epidural anesthesia reduced SMABF, as measured by electromagnetic flowmetry, to 77% +/- 8% (mean +/- SEM) of control (P less than 0.05), and mean arterial pressure to 46% +/- 4% of control (P less than 0.01). The mesenteric AVDO2 increased from 27 +/- 3 to 39 +/- 6 mL/L (P less than 0.05) and superior mesenteric venous lactate from 1.03 +/- 0.11 to 1.60 +/- 0.38 mmol/kg (P less than 0.05); systemic AVDO2 and lactate did not change. Dopamine had no significant effect on SMABF and mean arterial pressure before TEA. However, dopamine increased SMABF during TEA (from 77% +/- 8% to 137% +/- 21% of control; P less than 0.01), returned mesenteric AVDO2 to 27 +/- 3 mL/L (P less than 0.05), and elevated mean arterial pressure to 62% +/- 4% of control (P less than 0.05). It is concluded that the decrease in perfusion pressure during TEA reduces SMABF with resultant evidence of intestinal reductive metabolism. The intestinal blood flow during TEA was improved by dopamine.     

Selective digital subtraction arteriography in necrosis of the femoral head

Summary Selective digital subtraction arteriographic investigations of the arteries of the femoral head in 31 patients with traumatic and 34 patients with nontraumatic femoral head necrosis (FHN) were compared with investigations in a control group of 35 patients without hip disease. In the control group and in patients with nontraumatic FHN atypical arteriographic findings were found only in one third of cases. In traumatic FHN, however, vascular alterations could be detected in 97% of cases. This evidence suggests that damage to the femoral head vessels is a major etiological factor in traumatic, but not in nontraumatic, FHN. In late arterial phases of DSA a perinecrotic hypervascularization was the common feature in all nontraumatic necroses and could be observed in 71% of traumatic necroses. Its pathophysiological mechanism is discussed.     

Survival among children with medulloblastoma in Greece: gains from transition to chemotherapy and socio-economic differentials.

The objective of this study was to quantify improvements in survival due to chemotherapy among children with medulloblastoma treated during the last three decades at a university unit in Greece, compare these gains with figures derived from a specialized unit in the United States and explore the role of extrinsic factors affecting survival. The records of all children with medulloblastoma (n=50) treated at the University Childhood Oncology Unit in Athens, Greece during the period 1973-2003 were reviewed. The role on survival of socio-demographic factors was studied by modeling the data through Cox's proportional-hazards regression, controlling for the mode of treatment (chemotherapy, yes vs. no), whereas survival of children with medulloblastoma treated in Greece was compared with that of 76 children treated in a specialized center in the United States during a respective period. After adjustment for demographic factors, children with medulloblastoma who received adjuvant therapy in Greece had an approximately four times higher instantaneous rate of remaining alive than those who did not (P=0.05). The 5-year survival of children with medulloblastoma treated at specialized medical centers in Greece and the United States was 66 and 63%, respectively. Despite the comparable figure with that of an acceptable standard, however, there was a suggestion (P=0.07) that a rural place of residence in Greece is a poor prognostic indicator. Assuming inherently similar age of occurrence in urban and rural areas, children from rural areas in this study had a more advanced age at diagnosis than those residing in urban Greece (mean age: 7.9 vs. 6.6 years) with a 5-year survival of 57 and 73%, respectively. As expected, incorporation of adjuvant chemotherapy in the treatment of Greek children with medulloblastoma has yielded remarkable improvement in 5-year survival, comparable to that of technologically advanced countries. On the contrary, children residing in rural areas of the country seem to enjoy less favorable prognosis, possibly owing to delays in diagnosis or limited access to optimal treatment facilities.     

Adenosine, dipyridamole and isosorbide dinitrate are ineffective to prevent the sympathetic initiation of poststenotic myocardial ischemia

An activation of cardiac sympathetic nerves increases coronary vascular resistance distal to severe stenoses and induces ischemia of the dependent myocardium. The selective alpha 2-adrenoceptor antagonist rauwolscine and the calcium antagonist nifedipine prevent both poststenotic vasoconstriction and ischemia. To exclude the possibility that the beneficial action of nifedipine is based on unspecific coronary dilation rather than a functional antagonism against alpha 2-adrenoceptor mediated poststenotic vasoconstriction we now tested coronary dilatory drugs with a different underlying mechanism. The left ventrolateral cervical cardiac sympathetic nerve was stimulated in 12 anesthetized, vagotomized dogs. A severe stenosis of left circumflex coronary artery was defined by the absence of a postocclusive reactive hyperemia. Sympathetic stimulation increased end-diastolic poststenotic resistance from 0.45 +/- 0.10 to 0.83 +/- 0.18 mmHg X min X 100 g/ml and induced a net lactate production of the poststenotic myocardium. Adenosine (50 micrograms/kg X min i.c., n = 5), dipyridamole (0.2 mg/kg i.v., n = 3) and isosorbide-dinitrate (1 mg i.c., n = 4) did not prevent the increase in resistance and the net lactate production. Thus the effectiveness to prevent alpha 2-adrenergic poststenotic coronary constriction appears to be specific for alpha 2-antagonists and calcium antagonists.     

Die Motivation bei der Behandlung von Lippen-, Kiefer- und Gaumenspalt-Patienten — eine psychosoziale Studie

Zusammenfassung 36 Lippen-, Kiefer- und Gaumenspalt-Patienten und 24 Eltern wurden standardisierte und selbst ausgearbeitete Fragebögen zur Beantwortung vorgelegt. Die Antworten ergaben, daß die Einsicht in die Notwendigkeit der operativen Eingriffe an erster Stelle aus dem Patienten selbst erwächst. Verbessertes Aussehen, besonders im Bereich der Lippe, ist absolut vorrangig. Die Durchführung der funktionellen Behandlung wird überwiegend vom Einfluß der Eltern bestimmt. Die Sorge um Behandlungsrisiken, aber auch bedingungsloses Streben nach Behandlungserfolg zeichnen ein uneinheitliches Bild der Eltern. Besonders die kieferorthopädische Behandlung ist von den überdurchschnittlichen seelischen Konflikten der Patienten während der Pubertät belastet. Das Verhaltensmuster des Spaltträgers insgesamt ist von wiederholtem Frustrationserleben geprägt. Hieraus schöpft er kompensatorisch Energien — auch als Motivation zur Behandlung.

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Summary Standardized and specially formulated questionnaires were completed by 36 cleft lip and palate patients and 24 parents. The evaluation of the questionnaire showed that the understanding for the need for surgery comes primarily from the patients themselves. The improvement in appearance, in particular of the lips is of primary importance. The success of functional therapy depends largely on the influence of the parents. They show a variable reaction with regard to their concern about risks during treatment and their desire for success in treatment. The orthodontic treatment is particularly influenced by the above-average emotional conflicts of the patients during puberty. The behavioural pattern of the cleft lip patient is overshadowed by repeated experiences of frustration. As a result the patient develops compensatory energy which can be directed towards motivation during treatment.

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Résumé On a soumis à un même questionnaire 36 patients atteints d'une fente labio-palatine ainsi que 24 parents. Les réponses ont donné les résultats suivants: pour les patients eux-mêmes, la nécessité de l'opération venait en première place. L'amélioration de l'esthétique, surtout de la lèvre supérieure, est absolument primordiale et justifie l'opération. La motivation pour la poursuite du traitement fonctionnel est surtout prise en charge par les parents. Les parents se préoccupent différemment des risques du traitement ainsi que du résultat final. Chez les patients, particulièrement durant la phase pubertaire, le traitement orthodontique provoque des conflicts psychiques. Le comportement des patients avec fente labio-palatine révèle qu'ils souffrent de frustrations repétées. Mais les patients tirent une énergie compensatrice de cette situation et sont motivés pour le traitement.

     

Muß bei jedem Thoraxtrauma sofort oder später zur Kontrolle ein EKG angefertigt werden?

Ohne Zusammenfassung

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Muß bei jedem Thoraxtrauma sofort oder später zur Kontrolle ein EKG angefertigt werden?

     

Composition of blood preparations. Quantitative and qualitative properties

Some aspects of the composition of the main blood bank products are reported and discussed. Appearance of the desired clinical effect or undesired side-effect is a consequence of qualitative and quantitative characteristics of blood derivatives. Red cell products are of different purity (leukocyte contamination and plasma content) therefore clinical effects and side-effects, including long-term consequences, are also different. Actual volume of single-donor products are in a wide range, thus the effect of quantity should be taken also into consideration. Actual practical problems will be answered adequately only in the case, if the transfusiologist knows the exact fine details of the composition and quantitative aspects of blood products.