Near fatal infection of a patient with a left ventricular assist device due to unrecognized fetal death.

We report on an unusual case of a young female patient who received an implantable LVAD after unsuccessful emergency coronary bypass surgery following acute myocardial infarction. After LVAD placement, it became evident that the patient had been pregnant. She had to undergo gynaecological surgery during mechanical support to remove the deceased fetus.     

An occupational perspective on the concept of participation in the International Classification of Functioning, Disability and Health--some critical remarks.

The International Classification of Functioning, Disability and Health (ICF; World Health Organization, 2001) provides an international and interprofessional scientific basis for understanding and studying health. The concept of participation plays an important role in the classification and has become a central construct in health care, rehabilitation, and in occupational therapy. The aim of this paper is to provide a critical analysis of the concept of participation in the ICF. As background, the origins and current presentation of the ICF are presented. The use and function of the ICF and the contemporary discussions regarding the classification are reviewed. An occupational perspective on participation in the ICF reveals major shortcomings regarding the subjective experience of meaning and autonomy. Furthermore, the ICF has limitations in capturing different kinds of participation in a single life situation. Following these analyses we discuss the advantages and shortcomings of using the ICF, and how an occupational perspective can contribute to an ongoing discussion about the development of the ICF.     

Differences in CMV-Specific T-Cell Levels and Long-Term Susceptibility to CMV Infection after Kidney, Heart and Lung Transplantation

Patients after kidney, heart and lung transplantation differ in their immunosuppressive drug regimens and in susceptibility to infectious complications with cytomegalovirus (CMV). In this study, CMV-specific T-cell responses were characterized in long-term transplant recipients and associated with the frequency of infectious complications. CMV-reactive CD4 T cells from 50 healthy controls, 68 renal, 14 heart and 24 lung transplant recipients were flow cytometrically quantified by the induction of cytokines after specific stimulation. Moreover, the immunosuppressive effect of calcineurin inhibitors on specific T-cell reactivity was quantified in vitro and compared with responses in vivo. Median CMV-specific T-cell frequencies in long-term renal (1.48%; range 0.06-17.26%) and heart transplant recipients (0.90%; 0.13-12.49%) did not differ from controls (1.82%; 0.26-21.00%). In contrast, CMV-specific T-cell levels were significantly lower in lung transplant recipients (0.50%; <0.05-4.98%) and showed a significant correlation with the frequency of infectious episodes (r =-0.57, p = 0.005). The differences within the groups were associated with increasing dosages of immunosuppressive drugs, as exemplified for calcineurin inhibitors that dose dependently reduced specific T-cell reactivity in vitro. In conclusion, monitoring CMV-specific CD4 T cells may serve as a measure for long-term disease susceptibility and may contribute to an improved management of CMV complications after lung transplantation.     

Results of pulmonary resection for lung cancer in Norway, patients older than 70 years.

OBJECTIVE: Surgical resection for lung cancer is the mainstay of curative treatment, but studies regarding postoperative results and long term outcome in the elderly have differed. The purpose of the present study was to assess the early and long-term results of surgical resection in patients more than 70 years of age. METHODS: In Norway all clinical and pathologic departments submit reports on cancer patients to the Cancer Registry of Norway. This investigation included all patients more than 70 years of age resected for lung cancer in the time period 1993-2000. For results of long-time follow-up only patients operated on between 1993 and 1998 were included. RESULTS: A total of 763 patients (541 men) were identified aged 71-87 years. Postoperative mortality rate was 9%, highest after bilobectomy and pneumonectomy. The most commonly reported causes of postoperative death were pneumonia and cardiac complications. The majority of patients had tumor categorized as clinical stage (cStage) Ia and Ib. More than 100 in each of these groups proved to have more advanced disease postoperatively (pStage). The 5-year relative survival rate was significantly better in patients with disease in pStage I compared to higher stages. Women had a significantly better 5-year survival rate compared to men, 62.8 and 35.7%, respectively. CONCLUSIONS: Lung cancer surgery appears to be a relatively safe procedure even in the elderly. There is a high postoperative mortality after bilobectomy and pneumonectomy. However, when old people survive the postoperative period the long term prognosis seems favorable.     

Myotonie und Cataracta myotonica

Ohne Zusammenfassung     

Über die Bedingungen des Eintrittes der Totenstarre beim gereizten Muskel

Zusammenfassung Es wird gezeigt, daß das Nichteintreten der Totenstarre in einer Gasatmosphäre bei bis zur Erschöpfung gereizten Froschmuskeln in hohem Maße abhängig ist von genügender Sauerstoffzufuhr zu allen Teilen.Beim dünnen M. sartorius genügt der Sauerstoff der Luft. Beim M. gastrocnemius ist es auch durch Sauerstoffüberdruck nicht möglich, den Eintritt der Starre nach Reizung zu verhindern. Erst durch gleichzeitiges Eintauchenlassen in Flüssigkeit wird dieser Zweck erfüllt.Bei Aufbewahrung inFlüssigkeit genügt für den M. sartorius im allgemeinen die Unterbringung in selbst O₂-armer (ausgekochter) Ringerlösung zur Verhütung von Starre nach erschöpfender Reizung. Nachträgliches Durchleiten von Wasserstoff oder Stickstoff ruft Contractur hervor. Bei M. gastrocnemius genügt einfaches Unterbringen in Lösung nicht, erst bei Sauerstoffdurchleitung oder bei gleichzeitigem Sauerstoffüberdruck läßt sich Starre vermeiden.Durchleiten eines indifferenten Gasesvor Beginn der Reizung führt zu einer sehr raschen Erschöpfbarkeit des Muskels ohne Starre.Auch beimWarmblütermuskel gelingt es in vielen Fällen trotz erschöpfender Reizung den Starreeintritt zu verhindern, jedoch nur bei dünnen, ungeschädigten Muskeln, unter Sauerstoffüberdruck und in einem flüssigen Medium.Die Untersuchungen bestätigen durchaus die Auffassung, daß die Totenstarre eine Folge der Anhäufung von Milchsäure ist. Die Wegschaffung der letzteren durch Diffusion und Oxydation verhindert den Starreeintritt.Zum Schlusse möchte ich Herrrn ProfessorWinterstein auch an dieser Stelle meinen herzlichsten Dank aussprechen für die dauernde Unterstützung und Förderung bei vorliegender Arbeit.     

Beiträge zur Frage der O2-Überdrucktherapie beim krebskranken Menschen

Ohne ZusammenfassungMit 12 Textabbildungen.     

Effect of early and late antibiotic treatment in experimental acute pancreatitis in rats

Background The clinical course in acute necrotizing pancreatitis is mainly determined by bacterial infection of pancreatic and peripancreatic necrosis. The effect of two antibiotic regimens for early and late treatment was investigated in the taurocholate model of necrotizing pancreatitis in the rat. Materials and methods Seventy male Wistar rats were divided into five pancreatitis groups (12 animals each) and a sham-operated group (10 animals). Pancreatitis was induced by intraductal infusion of 3% taurocholate under sterile conditions. Animals received two different antibiotic regimes (20 mg/kg imipenem or 20 mg/kg ciprofloxacin plus 20 mg/kg metronidazole) early at 2, 12, 20, and 28 h after induction of pancreatitis or late at 16 and 24 h after induction of pancreatitis or no antibiotics (control). Animals were examined after 30 h for pancreatic and extrapancreatic infection. Results Early and late antibiotic treatment with both regimes could significantly reduce pancreatic infection from 58 to 8–25%. However, extrapancreatic infection was only reduced by early antibiotic therapy. While quinolones also reduced bacterial counts in small and large bowel, imipenem did not. Conclusions In our animal model of necrotizing pancreatitis, early and late treatment with ciprofloxacin/metronidazole and imipenem reduce bacterial infection of the pancreas. Extrapancreatic infection, however, is reduced significantly only by early antibiotic treatment. The effectivity of early antibiotic treatment in the clinical setting should be subject to further investigation with improved study design and sufficient patient numbers.     

Zur Pathogenese der Mikromelie

Ohne Zusammenfassung     

Beiträge zur Fehldiagnose Hysterie

Ohne Zusammenfassung