Inkomplette Resektionen bei Bronchialcarcinom: Morbidität und Prognose

Zusammenfassung. Nach Lungenresektion und ipsilateraler Lymphknotendissektion wegen Bronchialcarcinoms verblieb in 88 von 2464 F?llen (3,6 %) mikroskopisch Residualtumor (R1) am zentralen Bronchusresektionsrand. Sieben Patienten entwickelten eine Insuffizienz der Bronchusnaht, 2 weitere eine Nachblutung bzw. eine Herzluxation (Morbidit?t 8,0 %). Die Hospitalletalit?t betrug 16,6 %. Todesursachen waren Bronchusnahtinsuffizienz (n = 7), Arrosionsblutung (n = 4), respiratorische Insuffizienz (n = 1) und Pleuraempyem (n = 1). Eine postoperative Bestrahlung wurde bei 43 Patienten durchgeführt. Die mediane überlebenszeit aller Patienten nach R1-Resektion war 16 Monate gegenüber 37 Monaten nach R0-Resektion (p < 0,001). Die überlebenszeit war unabh?ngig von Tumorstadium und -histologie, Lokalisation des Residualtumors in der Bronchuswand und einer Nachbestrahlung. Inkomplette Resektionen sind durch intraoperativen Schnellschnitt zu verifizieren. Sofern funktionell vertretbar, sollte in den Stadien I und II eine Nachresektion (R0) angestrebt werden; auch in den Stadien III a und III b ist bei R0-Resektion ein statistisch signifikanter überlebensvorteil gegenüber R1-Resektion zu verzeichnen, jedoch weniger deutlich als in niedrigeren Stadien.      

Toxicological investigations in the semiconductor industry: I. Studies on the acute oral toxicity of a complex mixture of waste products from the aluminium plasma etching process.

In dry etching processes--one of the sources of potential exposure to toxic wastes in the semiconductor industry--complex mixtures of inorganic and organic compounds arise from reactions between feed stock gases (BCl3/Cl2), top layers (aluminium photoresist), and the carrier gas (N2). Two different fractions of the complex mixture--one an ethanolic solution (ES) and the other an insoluble liquid residue (LR)--were examined for acute oral toxicity in rats. Analytical data showed that the ethanol soluble fraction contained mainly inorganic compounds, whereas the residue contained various halogenated hydrocarbons. Neither death nor behavioral changes occurred after oral administration and observation up to 23 days. ES caused a lower mean arterial blood pressure in both sexes, increased P-R-intervals in male rats, and caused some mild biochemical and hematological alterations and changes in relative organ weights compared to the control groups. Exposure to LR influenced food and water intake, and caused a significant decrease in body weights, signs of polyurie, as well as changes in various relative organ weights and biochemical and hematological parameters. The blood pressure of the male animals fell and the heart rates of both sexes decreased.     

Surgical closure of persistent ductus arteriosus in small premature infants in an incubator

In premature neonates a patent ductus arteriosus causes often other complications thus the immediate closure of the patent ductus arteriosus should be preferred or recommended. Performing the surgical closure of the ductus within the incubator can avoid complications during transportation from the premature neonates intensive care unit to the operating room. 25 very small premature neonates or those with another burden in addition were operated upon in the incubator on the premature infants intensive care unit of our hospital during the period from January 1987 to April 1989. No complications occurred during the operation, especially not caused by the strange circumstances for the operating team. Wound infections because of possible bacterial contamination of the incubator or the room were not observed during the postoperative period.     

Evaluation of the epidermal refractive index measured by optical coherence tomography

BACKGROUND/AIMS: It has recently been proposed that the refractive index (RI) measured by means of optical coherence tomography (OCT) may be a valid measure for hydration of skin. In this pilot study, using OCT in vivo, we aimed to investigate the interday variability of RI measurements and acute changes of RI following the application of a moisturizer. METHODS: Twenty healthy Caucasian volunteers were investigated on their forearms using a commercially available OCT system (SkinDex 300, ISIS optronics GmbH, Mannheim, Germany) fitted with an integrated algorithm for the evaluation of the RI. The interday repeatability of the OCT method was determined performing symmetrical measurements on both forearms on day 1, 5, 9, and 13. In order to investigate the acute effect of a moisturizer on RI, OCT assessments were performed before and 10 min after the application of an aqueous lotion with a lipophilic phase. As a control, the contralateral site was investigated in the same way, except for the use of distilled water instead of the lotion. RESULTS: Assessments of interday variability revealed insignificant (P>0.05) variances between the four measurement times as expressed in very small repeatability coefficients (right arm: 0.039; left arm 0.053) and small coefficients of variance (right arm: 1.02%; left arm: 1.38%). With regard to the RIs measured over time, we could not observe significant (P>0.05) differences between the two symmetrical anatomic sites (mean+/-SD of RI: 1.3893+/-0.0142 (right arm); 1.3875+/-0.0192 (left arm)). The acute effect of the moisturizer was indicated by a significant decrease of the RI 5 min after the application of the lotion (1.399+/-0.01 vs. 1.387+/-0.02; difference between means: 0.012; P=0.033; 95% confidence interval: 0.001-0.0023). However the control site treated with distilled water did not show significant differences between the two measurement times (1.387+/-0.013 vs. 1.391+/-0.023; difference between means: -0.004; P=0.57; 95% confidence interval: -0.019-0.011). CONCLUSIONS: In this pilot study, we have demonstrated that RI evaluation via OCT is a promising technique that may be used for the assessment of skin hydration in vivo. However, the direct comparison of OCT with standard methods, ideally such as nuclear magnetic resonance spectroscopy, is necessary.     

EXAMINATION OF DEVELOPMENTAL NEUROTOXICITY BY THE USE OF TISSUE CULTURE MODEL SYSTEMS

1. The rotation-mediated three-dimensional reaggregate culture system is uniquely suited for studies on developmental neurotoxicity. In this system, it is possible to reconstruct central neuronal pathways and follow their development. 2. Exposure to drugs of abuse including methamphetamine and methylenedioxyamphetamine or the appetite suppressant, fenfluramine, reduces monoamines in the cultures in a dose-dependent manner and interrupts normal monoaminergic development. 3. While the monoaminergic neurones may attain normal rates of development following drug removal, the affected neurones are not capable of overcoming the drug-induced insults and a deficiency in monoamines persists throughout development. 4. In addition, the production of immortalized monoclonal hybrid cells obtained by fusion of fetal mesencephalic neurones with a neuroblastoma has yielded cell lines expressing a dopaminergic phenotype. 5. Such cells have been useful in establishing the relationship of neurotoxicity to cell lineage and can serve as models for the study of the cellular and molecular mechanisms of neurotoxicity.     

Recommendations for participation in leisure-time physical activity and competitive sports of patients with arrhythmias and potentially arrhythmogenic conditions. Part II: ventricular arrhythmias, channelopathies and implantable defibrillators.

This consensus paper on behalf of the Study Group on Sports Cardiology of the European Society of Cardiology follows a previous one on guidelines for sports participation in competitive and recreational athletes with supraventricular arrhythmias and pacemakers. The question of imminent life-threatening arrhythmias is especially relevant when some form of ventricular rhythm disorder is documented, or when the patient is diagnosed to have inherited a pro-arrhythmogenic disorder. Frequent ventricular premature beats or nonsustained ventricular tachycardia may be a hallmark of underlying pathology and increased risk. Their finding should prompt a thorough cardiac evaluation, including both imaging modalities and electrophysiological techniques. This should allow distinguishing idiopathic rhythm disorders from underlying disease that carries a more ominous prognosis. Recommendations on sports participation in inherited arrhythmogenic conditions and asymptomatic gene carriers are also discussed: congenital and acquired long QT syndrome, short QT syndrome, Brugada syndrome, catecholaminergic polymorphic ventricular tachycardia, arrhythmogenic right ventricular cardiomyopathy and other familial electrical disease of unknown origin. If an implantable cardioverter defibrillator is indicated, it is no substitute for the guidelines relating to the underlying pathology. Moreover, some particular recommendations for patients/athletes with an implantable cardioverter defibrillator are to be observed.     

Bilateral spontaneous femoral neck fracture in chronic alcoholism and liver cirrhosis

One case of a double-time, bilateral spontaneous fracture of the femoral neck as a result of a hepatogenic osteopathy is reported. The other reasons for spontaneous fractures are shortly mentioned, the osteopathy in chronic liver disease is examined more closely.     

Identification of a parathyroid hormone in the fish Fugu rubripes.

A PTH gene has been isolated from the fish Fugu rubripes. The encoded protein of 80 amino acid has the lowest homology with any of the PTH family members. Fugu PTH(1-34) had 5-fold lower potency than human PTH(1-34) in a mammalian cell system. INTRODUCTION: Parathyroid hormone (PTH) is the major hypercalcemic hormone in higher vertebrates. Fish lack parathyroid glands, but there have numerous attempts to identify and isolate PTH from fish. MATERIALS AND METHODS: Polymerase chain reaction (PCR) was performed with primers based on preliminary data from the Joint Genome Institute database. PCR amplification was performed on genomic DNA isolated from Fugu rubripes. PCR products were purified and DNA was sequenced. All sequence was confirmed from more than one independently amplified PCR product. Multiple sequence alignments were carried out, and the percentage of identities and similarities were calculated. An unrooted phylogenetic tree, using all the known PTH and PTH-related protein (PTHrP) amino acid sequences, was determined. Synthetic peptides were tested in a biological assay that measured cyclic adenosine 3',5'-monophosphate formation in UMR106.1 cells. Rabbit polyclonal antisera specific for N-terminal human PTHrP and one rabbit polyclonal antiserum specific for N terminus hPTH were used to test the cross-reactivity with fPTH(1-34) in immunoblots.     

Update on transplant pharmacology: sirolimus.

Rapamune (Sirolimus), the latest immunosuppressant agent for solid organ transplants, is prescribed for induction therapy, refractory rejection, steroid withdrawal, and combination therapy. As the use of this agent increases among various transplant populations, it is essential for critical care nurses to be cognizant of the indications, pharmacodynamics, current research findings, side effects, and implications. This knowledge will ultimately improve patient education and outcomes in this ever-growing field of nursing.     

Ambulante Thromboseprophylaxe

While thrombosis prevention is routine in traumatology and orthopaedics departments, there is some controversy over whether it should be applied in outpatients. New clinical studies have shown that a trauma or an operation is followed by a period during which the risk of thrombosis is extremely high. So far no standardized models are available for determining the necessity for temporary prophylactic treatment to avoid thrombosis, and publications on the incidence of deep leg vein thrombosis during ambulatory treatment have presented widely deviating views. More recent studies show a difference between expositional risks and dispositional risks. In this article, evidential data, recent literature and the latest communications issued by specialist societies are used as a basis for presentation of the indications for such ambulatory treatment and guidelines on its maximum duration.