Buchbesprechungen

Ohne Zusammenfassung     

Untersuchungen über das Verhalten der Glutamat-Oxalat-Transaminase,Glutamat-Pyruvat-Transaminase,Lactat-Dehydrogenase und Aldolase im menschlichen Spermaliquor

Zusammenfassung Die Aktivität der Fermente Glutamat-Oxalat-Transaminase, Glutamat-Pyruvat-Transaminase, Lactat-Dehydrogenase und Aldolase waren im von Spermien-getrennten Ejaculat mit normalem Fructosegehalt nicht abhängig von der Zahl, der Motilität und der Morphologie der Spermien. Die durchschnittlichen Werte betrugen für Glutamat-Oxalat-Transaminase 153±20 W.E., für die Glutamat-Pyruvat-Transaminase 16±4 W.E., die Aldolase 4,4±0,8 m.E. und die Lactat-Dehydrogenase 2034±165 W.E. Lediglich bei Funktionsstörungen der akzessorischen Geschlechtsdrüsen waren Abweichungen von der Norm feststellbar. Die Bestimmungen dieser Enzyme im Ejaculat ergaben für die andrologische Diagnostik keine weitere Aussage als die Auswertung des Fructosegehalts.

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Summary The activity of Glutamate-Oxalate-Transaminase, Glutamate-Pyruvate-Transaminase, Lactate-Dehydrogenase and Aldolase from a sperms free ejaculation after centrifugation with a normal Fructose content has no connection to the number, motility and morphology of the sperms. The mean values for Glutamate-Oxalate-Transaminase were 153±20 W.E., for Glutamate-Pyruvate-Transaminase 16±4 W.E., for Aldolase 4.4±0.8 m.E. and for Lactate-Dehydrogenase 2034±165 W.E. Only in cases of accessory sexual glands malfunction, deviations from normal values were noticed. The estimations of these Enzymes showed no further results against the evaluation of Fructose content.

     

Vorschlag für einen Iochkartengerechten Erhebungsbogen für Fertilitätsuntersuchungen

Ohne Zusammenfassung     

Arterio-venous gradients of free energy change for assessment of systemic and splanchnic perfusion in cardiac surgery patients

OBJECTIVE: Adequacy of organ perfusion depends on sufficient oxygen supply in relation to the metabolic needs. The aim of this study was to evaluate the relationship between gradients of free energy change, and the more commonly used parameter for the evaluation of the adequacy of organ perfusion, such as oxygen-extraction in patients undergoing valve replacement surgery using normothermic cardiopulmonary bypass (CPB). METHODS: In 43 cardiac patients, arterial, mixed venous, and hepato-venous blood samples were taken synchronously after induction of anaesthesia (preCPB), during CPB, and 2 and 7 h after admission to the intensive care unit (ICU+2, ICU+7). Blood gas analysis, cardiac output, and hepato-splanchnic blood flow were measured. Free energy change gradients between mixed venous and arterial (-deltadeltaG(v - a)) and hepato-venous and arterial (-deltadeltaG(hv - a)) compartments were calculated. MEASUREMENTS AND RESULTS: Cardiac index (CI) increased from 1.9 (0.7) to 2.8 (1.3) L/min/m (median, inter-quartile range) (p = 0.001), and hepato-splanchnic blood flow index (HBFI) from 0.6 (0.22) to 0.8 (0.53) L/min/m (p = 0.001). Despite increasing flow, systemic oxygen extraction increased after CPB from 24 (10)% to 35 (10)% at ICU+2 (p = 0.002), and splanchnic oxygen extraction increased during CPB from 37 (19)% to 52 (14)% (p = 0.001), and remained high thereafter. After CPB, high splanchnic and systemic gradients of free energy change gradients were associated with high splanchnic and systemic oxygen extraction, respectively (p = 0.001, 0.033, respectively). CONCLUSION: Gradients of free energy change may be helpful in characterising adequacy of perfusion in cardiac surgery patients independently from measurements or calculations of data from oxygen transport.     

The pharmacokinetics and analgesic efficacy of larger dose rectal acetaminophen (40 mg/kg) in adults: a double-blinded, randomized study

Analgesic acetaminophen plasma concentrations are not known. We investigated in a randomized, double-blinded study the pharmacokinetics and analgesic efficacy of small- (AS; 20 mg. kg(-1)) and larger- (AL; 40 mg/kg) dose rectal acetaminophen and compared it with the combination (C) of rectal diclofenac (100 mg) and acetaminophen (20 mg/kg) in 65 women undergoing hysterectomy. Suppositories were administered after the induction of a standardized general anesthesia. Pain (measured by using a 10-cm visual analog scale) and morphine consumption (patient-controlled analgesia) were repeatedly assessed for 24 h. Acetaminophen plasma concentrations were measured by using a fluorescence polarization immunoassay. Antipyretic plasma concentrations (10-20 mg/L) after 40 mg/kg acetaminophen were not associated with improved analgesia or decreased opioid requirements; 20 mg/kg acetaminophen produced subtherapeutic plasma levels (<10 mg/L). Maximal plasma concentrations of 17.2 and 10.4 mg/L (P < 0.01, analysis of variance) were achieved after 4.2 and 3.6 h for the AL and AS groups, respectively. The only difference in clinical outcome was lower visual analog scale scores after acetaminophen/diclofenac (C 2.0 versus AS 3.2 and AL 3.4) 4 h after the induction (P < 0.05, analysis of variance). Acetaminophen pharmacokinetics in adults were similar to those observed in children. Analgesic plasma concentrations are likely to be higher than antipyretic plasma levels, which were only attained after twice the recommended rectal dose was administered. Analgesic plasma concentrations have yet to be determined but may be higher than those associated with antipyresis. IMPLICATIONS: Acetaminophen pharmacokinetics were comparable in adults and children. Plasma concentrations known to reduce fever did not produce better pain relief and were only achieved after twice the conventional dose was administered. Analgesic plasma concentrations have yet to be determined but may be higher than those associated with antipyresis.     

The functional integrity of platelets in volume-reduced platelet concentrates

Premature and low-birth-weight infants usually require small-volume platelet transfusions to treat thrombocytopenia. Also, infants undergoing open-heart surgery with extracorporeal circulation and with compromised cardiac function are at risk for excessive intravascular volume. The small-volume platelet substitution can be achieved by dispensing an aliquot from the unit of a standard single-donor platelet concentrate (PC). Alternatively, there is an indication for volume reduction of PCs to maximize the number of platelets transfused in the smallest possible volume. We determined the spontaneous and induced activation of platelets before and after volume reduction in 20 consecutive single-donor-apheresis PCs. After a mean storage time of 2 days, the PCs were plasma-depleted by centrifugation. Spontaneous, adenosine diphosphate (ADP)-induced, and collagen-induced activation were determined by flow cytometry. Furthermore, ADP- and collagen-induced aggregation were measured. A total of 33.8% of platelets in standard PCs were activated spontaneously. Volume reduction of PCs led to a mild but significant increase of spontaneous activation of platelets (43.2%). Additionally, volume reduction resulted in an impaired ADP-induced aggregability of platelets, whereas collagen induction was unaffected. Transfusion of volume-reduced PCs is an effective alternative to use of standard PCs in patients at frequent risk for excessive intravascular volume, because equal volumes increase the platelet count twice as effectively.     

Die Bedeutung des Nelson-Tests im Rahmen der modernen Lues-Serologie

Zusammenfassung In der vorliegenden Arbeit wurde die Problematik der unspezifischpositiven (klassischen) Luesseroreaktionen besprochen, deren Zahl trotz zahlreicher Antigenverbesserungen zugenommen hat. Das Auftreten dieser unspezifisch-positiven Reaktionen hängt, abgesehen von dem Einfluß einiger weniger Krankheiten, nicht so sehr von einer bestimmten Erkrankung, als vielmehr von einer besonderen indivivuellen Reaktionslage des Patienten ab.Die klassischen Luesseroreaktionen waren für eine Lues nur in einem hohen Maße charakteristisch, aber nicht spezifisch. Die bisher bekannten Methoden (Anamnese, Durchuntersuchung, Wiederholung und quantitative Titrierung der klassischen Seroreaktionen, Verifizierungstest,Neurath-Test usw.) zum Ausschluß von unspezifisch-positiven Seroreaktionen waren unzureichend.Durch die Einführung desNelson-Tests ist eine spezifische Methode zur Diagnostik der Lues gegeben, durch die spezifische, immobilisierende, von den Reaginen verschiedene Antikörper nachgewiesen werden können.Durch die außerordentliche Kompliziertheit und Kostspieligkeit erfährt dieser Test eine gewisse Einschränkung, so daß die üblichen (klassischen) Seroreaktionen bei Vorhandensein klinischer Symptome ihre alte Bedeutung beibehalten.Durch eigene Untersuchungen konnte die hohe Spezifität desNelson-Tests bestätigt werden.Ein weiterer, vonNelson beschriebener spezifischer Test zur Diagnose der Lues, das Haft- und Schwundphänomen, wurde besprochen.Der Deutschen Forschungsgemeinschaft ist für die Unterstützung dieser Arbeit zu danken.Unter Mitarbeit des Laboranten P.Heussler.