Ductus thoracicus lymph in mice. 1. A technique for cervical approach

A method is described for the collection of lymph from the thoracic duct in anaesthetized mice by a silastic catheter inserted into the duct proximal to the jugulo-subclavian junction. The operative procedure takes about 5 min, and there is less operative trauma to the animals than by the previously used abdominal approach. Lymph flow amounts to 0.396 ml/h and cell content to 38.6 X 10(6)/ml.     

Mechanisms of non-opsonized zymosan-induced and luminol-enhanced chemiluminescence in whole blood and isolated phagocytes

A luminol-dependent non-opsonized zymosan-induced chemiluminescence method for phagocytes in small quantities of whole blood (40 microliters; final dilution: 1:14) is described. It was characterized with reference to cellular and humoral components, and also applied to isolated neutrophils, eosinophils and monocytes. Normal values for whole blood chemiluminescence and for neutrophils, eosinophils and monocytes are presented. From the chemiluminescence characteristic of distinct phagocytes and their frequency distribution pattern in whole blood, it is concluded that whole blood chemiluminescence has its source predominantly in neutrophils. The question as to the origin of chemiluminescence in phagocytes of whole blood and isolated neutrophils is investigated. The results support the importance of the myeloperoxidase-H2O2-halide system, but also go beyond this. The release of arachidonic acid by phospholipase A2 and of diacylglycerol and inositol trisphosphate by phospholipase C, the metabolism of arachidonic acid by the cyclooxygenase and lipoxygenase pathway, the activation of membrane NADPH oxidase by diacylglycerol and the calcium mobilisation by inositol trisphosphate are necessary for the chemiluminescence reaction. Inhibition of either mechanism suppresses the chemiluminescence response. The interaction of non-opsonized zymosan with plasma opsonins, phagocyte Fc- and complement receptors, respectively, for the initiation of chemiluminescence, was investigated. Non-opsonized zymosan initiates a chemiluminescence response in blood phagocytes in the absence of opsonin from the interaction of the zymosan polysaccharide component glucan with the complement receptor type 3. In the presence of plasma this receptor type also mediates the major chemiluminescence response brought about by the zymosan-coated cleavage products of complement fraction three, iC3b and to a minor degree C3b, while immunoglobulin G-coated zymosan interaction with the Fc-receptor is in this case of minor importance.     

Schmerztherapeutische Angebote an Kliniken in Deutschland

Zusammenfassung Organisierte Schmerztherapie richtet sich mit (teil)stationären und ambulanten Angeboten an Patienten mit chronischen Schmerzen. Die Erhebung zu schmerztherapeutischen Einrichtungen an Kliniken in Deutschland ergab bei 579 Kliniken mindestens ein schmerztherapeutisches Angebot—meist ambulante Schmerztherapie. In den letzten Jahren wurden—regional unterschiedlich—viele stationäre und teilstationäre Angebote zusätzlich geschaffen.Die Differenz zwischen den tatsächlich—z. T. unter anderem Titel in anderen Bereichen—vorgehaltenen und den ausgewiesenen Betten führt dazu, dass die Schmerztherapie durch die nicht transparente Klassifikation in den DRG, Diagnosen (ICD-10) und Prozeduren (OPS) nur unzureichend abgebildet wird, zumal meist kein Abteilungscode dafür vorliegt.Laut Klinikangaben wird das Angebot überschätzt, da zwar viele Patienten mit Schmerzen behandelt, doch nicht im engeren Sinne schmerztherapeutisch betreut werden.Eine Übersicht über die schmerztherapeutischen Angebote ist Voraussetzung für die sinnvolle Nutzung, den Beleg der Notwendigkeit und für den Ausbau der Schmerztherapie bundesweit.Die Untersuchung wurde von der Kommission für Qualitätssicherung der DGSS geplant und beauftragt und von der DGSS finanziert.     

Health-related quality of life in patients with chronic pain

AIMS: An empirical comparison of the performance characteristics of 3 generic health-related quality of life (HRQL) measures in pain patients. METHODS: The Nottingham Health Profile (NHP), the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36), and the German Life Satisfaction Scale (FLZ-M) by Henrich et al. were simultaneously employed in a multicenter survey measuring the impact of pain on quality of life. The HRQL- instruments were incorporated into the German Pain Questionnaire (pain variables, CES-D, Pain Disability Index). RESULTS: Characteristics of 3294 pain patients of 13 pain facilities are detailed in tables 1-3. Six of the 8 SF-36- and 4 of the 6 NHP-scales show satisfactory item-total correlations, bottom- and ceiling-effects, and internal consistency. FLZ-M reliabilities are satisfactory. The item weighting procedure of the FLZ-M proves to be unnecessary. Principle component analyses result in 7 factors for the SF-36 and the NHP. Six of the SF-36-factors are fairly homogeneous. The heterogeneity of the NHP- factors is marked. Correlations of the HRQL scales with depression (CES-D), anxiety (STAI) and physical functioning (FFbH-R-18) are high in all related contents. All instruments discriminate well between headache and back pain patients, between several pain grades (v. Korff) and the 3 Mainz pain chronicity stages. CONCLUSIONS: The SF-36 has satisfactory to good psychometric properties in pain patients, the NHP item selection has to be improved. The FLZ-M weighting can be eliminated. The shortcomings of the SF-36 can be overcome by adding short scales on role functioning and pain (modular approach).     

Efficacy and safety of a polyester leukocyte removal filter for whole blood and red cell concentrate filtration

Patients receiving multiple whole blood transfusions often experience adverse clinical symptoms caused by leukocytes. In the present study, the efficacy and safety of a polyester filter for leukocytes (Sepacell R-500) was evaluated. Donor units of whole blood and red cell concentrate stored for varying lengths of time were filtered. Emphasis was placed on humoral parameters indicative of release and/or activation reactions of granulocytes (neutral proteinase elastase, lysozyme, aggregation, chemiluminescence) and erythrocytes (lactate dehydrogenase, plasma haemoglobin). Nonspecific adsorption effects were investigated by plasma protein determinations (albumin, alpha 2-macroglobulin). A complete blood cell count as well as values of haemoglobin and haematocrit were determined. Sepacell R-500 proved to be a highly efficient filter to the leukocyte depletion of blood. Our results of erythrocyte and granulocyte related humoral parameters provided no significant evidence of filtration mediated activation or releasing reactions of clinical consequence.     

Separation and chemiluminescence properties of human, canine and rat polymorphonuclear cells

Human as well as canine and rat polymorphonuclear cells (PMN) were separated from whole blood by centrifugation. Two-step discontinuous Percoll gradients with distinct densities were used. The purity of the preparations was 99.2%, 98.4% and 97.9%, respectively and the corresponding recoveries were 80.1; 66.3% and 69%. The chemiluminescence properties of the isolated PMN and of phagocytes in small quantities of whole blood were compared in luminol-enhanced assays after stimulation with various agents: non-opsonized zymosan (3.5 g/l), phorbol myristate acetate (PMA, 2.8 X 10(-6) M), calcium ionophore A 23187 (10(-5) M) and N-formyl-methionyl-leucyl-phenylalanine (FMLP, 3.5 X 10(-6) M). The isolated cells of the three species responded to all of the various stimuli. Species-related sensitivity followed the order: human greater than canine greater than rat. Responses to the various agents in the human cells was ranked: PMA greater than or equal to A 23187 greater than zymosan greater than FMLP; for the dog: A 23187 greater than PMA greater than zymosan greater than FMLP; and for the rat: zymosan greater than or equal to PMA greater than FMLP greater than or equal to A 23187. Time courses and peak maximum responses were different following stimulation in the absence or presence of autologous plasma. Distinct soluble stimuli resulted in maximum responses below the baseline in the whole blood assays with canine (FMLP) and rat (FMLP, A 23187) phagocytes.