Präklinik, Schockraum und Intensivstation

Within the treatment algorithm for accident victims there is an additional risk potential beyond those associated with the complex treatment procedures in primary medical care, and it is inherent in the interfaces between the different treatment sectors. Besides the substantial loss of time and information, such factors as technical incompatibilities between items of equipment, differing treatment concepts and responsibilities and difficulties in transfer and positioning can put the patient at risk. The entire process involves multiple interfaces both between preclinical and clinical medical care and within the various treatment sectors, e.g. when a preclinical patient is transferred from ground medical staff to the air rescue team. The goal of an efficient treatment algorithm should be the reduction of multiple interfaces in order to optimize the various procedures. Future concepts directed at optimizing trauma management should therefore make some contribution to interface reduction.     

Benign ovarian cysts in England and Wales and in the United States.

OBJECTIVE: To compare the rates of hospital admission for management of ovarian cysts in England and Wales and the United States between 1972 and 1974 and 1984 and 1986; and to determine whether these rates are related to rates of early diagnosis of ovarian cancer. DESIGN: Analysis of published and unpublished hospital discharge data based on national samples, the Hospital In-patient Enquiry (HIPE), a 10% hospital discharge sample for England and Wales, and the National Hospital Discharge Survey (NHDs), a 5% sample for the United States. MAIN OUTCOME MEASURES: Age-specific discharge rates for primary and secondary diagnoses of ovarian cyst or benign ovarian tumour. RESULTS: There was an age-adjusted increase in discharge rates of about 8% in both countries; discharge rates in the United States were approximately double those in England and Wales in both time periods. There was no difference in the rates of early diagnosis of ovarian cancer. CONCLUSIONS: Ovarian cysts are a common cause of hospital admission in both countries. The higher rates in the United States are not associated with earlier diagnosis of ovarian cancer.     

Breast cancer risk associated with ovulation-stimulating drugs

BACKGROUND: Despite the recognized role of hormones in the aetiology of breast cancer, there has been little evaluation of hormonal preparations used to treat infertility. METHODS: A retrospective cohort study of 12,193 women evaluated for infertility between 1965 and 1988 at five clinical sites identified 292 in situ and invasive breast cancers in follow-up through 1999. Standardized incidence ratios (SIRs) compared breast cancer risks with those of the general population. Analyses within the cohort estimated rate ratios (RRs) associated with medications after adjustment for other breast cancer predictors. RESULTS: Infertile patients had a significantly higher breast cancer risk than the general population [SIR = 1.29, 95% confidence interval (CI) 1.1-1.4]. Analyses within the cohort showed adjusted RRs of 1.02 for clomiphene citrate and 1.07 for gonadotrophins, and no substantial relationships to dosage or cycles of use. Slight and non-significant elevations in risk were seen for both drugs after > or = 20 years of follow-up (RRs = 1.39 for clomiphene and 1.54 for gonadotrophins). However, the risk associated with clomiphene for invasive breast cancers was statistically significant (RR = 1.60, 95% CI 1.0-2.5). CONCLUSIONS: Although there was no overall increase in breast cancer risk associated with use of ovulation-stimulating drugs, long-term effects should continue to be monitored.     

DNA analysis for donor screening of Dombrock blood group antigens

Due to the scarcity of reliable antibodies, RBC typing for Doa and Dob is notoriously difficult. Inaccurate typing can place patients at risk for hemolytic transfusion reactions. The molecular basis of the DOA/DOB polymorphism is associated with three nucleotide changes:378 C>T, 624 T>C,and 793 A>G of DO. While the 378 C>T and 624 T>C are silent mutations, the 793A>G polymorphism in codon 265 encodes asparagine for Doa and aspartic acid for Dob. We describe here the use of a PCR-RFLP assay as an alternative to traditional hemagglutination for typing donor blood for Dombrock. Primers were designed to amplify the region of DO containing the 793A>G polymorphism. DNA samples from blood donors were amplified and subjected to RFLP analysis. A total of 613 samples were tested for the Dombrock polymorphism (793 A>G) by PCRRFLP. PCR-RFLP can be used to screen for Do(a-) or Do(b-) donors. This approach overcomes the scarcity of the reagents required for testing by hemagglutination.     

Urinary calprotectin,NGAL, and KIM-1 in the differentiation of primarily inflammatory vs. non-inflammatory stable chronic kidney diseases

Introduction It has been demonstrated that urinary neutrophil gelatinase-associated lipocalin (NGAL) and calprotectin are helpful biomarkers in the differentiation of intrinsic and prerenal acute kidney injury.Objective The present cross-sectional study investigates, whether urinary biomarkers are able to differentiate primarily inflammatory from non-inflammatory entities in chronic kidney disease (CKD).Methods Urinary calprotectin, NGAL, and kidney injury molecule-1 (KIM-1) concentrations were assessed in a study population of 143 patients with stable CKD and 29 healthy controls. Stable renal function was defined as an eGFR fluctuation ≤5 ml/min/1.73 m² in the past 12 months. Pyuria, metastatic carcinoma, and renal transplantation were regarded as exclusion criteria. Diabetic nephropathy, hypertensive nephropathy, and polycystic kidney disease were categorized as ‘primarily non-inflammatory renal diseases’ (NIRD), whereas glomerulonephritis and vasculitis were regarded as ‘primarily inflammatory renal diseases’ (IRD).Results Urinary calprotectin and NGAL concentrations significantly differed between CKD and healthy controls (p < 0.05 each), whereas KIM-1 concentrations did not (p = 0.84). The three biomarkers did neither show significant differences in-between the individual entities, nor the two categories of IRD vs. NIRD (calprotectin 155.7 vs. 96.99 ng/ml; NGAL 14 896 vs. 11 977 pg/ml; KIM-1 1388 vs. 1009 pg/ml; p > 0.05 each). Albumin exceeds the diagnostic power of the investigated biomarkers by far.Conclusions The urinary biomarkers calprotectin, NGAL, and KIM-1 have no diagnostic value in the differentiation of primarily inflammatory vs. non-inflammatory etiologies of CKD.     

Risk factors for Epstein–Barr virus reactivation after renal transplantation: Results of a large,multi-centre study

Epstein–Barr virus (EBV) reactivation is a very common and potentially lethal complication of renal transplantation. However, its risk factors and effects on transplant outcome are not well known. Here, we have analysed a large, multi-centre cohort (N = 512) in which 18.4% of the patients experienced EBV reactivation during the first post-transplant year. The patients were characterized pre-transplant and two weeks post-transplant by a multi-level biomarker panel. EBV reactivation was episodic for most patients, only 12 patients showed prolonged viraemia for over four months. Pre-transplant EBV shedding and male sex were associated with significantly increased incidence of post-transplant EBV reactivation. Importantly, we also identified a significant association of post-transplant EBV with acute rejection and with decreased haemoglobin levels. No further severe complications associated with EBV, either episodic or chronic, could be detected. Our data suggest that despite relatively frequent EBV reactivation, it had no association with serious complications during the first post-transplantation year. EBV shedding prior to transplantation could be employed as biomarkers for personalized immunosuppressive therapy. In summary, our results support the employed immunosuppressive regimes as relatively safe with regard to EBV. However, long-term studies are paramount to support these conclusions.     

A comparison of the reactivity of monoclonal and polyclonal Rh reagents with red cells after prolonged storage

Previous studies with stored red cells collected into EDTA anticoagulant had shown that commercial polyclonal anti-C, -c, and -E reagents gave acceptable reactions for 60 days, hut polyclonal anti- e reagents reliably detected the e antigen only through 14 days. At that time it was noted that a monoclonal anti-e reacted 3+ to 4+ with red cells that no longer reacted, or reacted very weakly, with the polyclonal anti-e reagents. This observation led to a comparison study of the reactivity of monoclonal versus polyclonal R h reagents with stored red cells. Monoclonal and polyclonal anti-C, -c, and -E reagents showed comparable reaction strengths, and gave acceptable reactions over the entire testing period. Polyclonal anti-e reagents, which are known to he of lower titer, again did not give reliable reactions with stored cells after 14 days. However, three different monoclonal anti-e reagents were able to detect the presence of the e antigen on stored cells for many weeks, This study showed that the monoclonal anti-e reagents tested are superior to polyclonal anti-e reagents for typing specimens that have been stored for more than 14 days.     

Red cell antigen stability in K3EDTA

Commercial blood grouping reagents are not approved for testing EDTA anticoagulated blood specimens that are more than 48 hours old. Many studies on the stability of blood group antigens in other anticoagulants have been reported, but none are available for EDTA. This study was undertaken to assess whether current commercially available blood grouping reagents give acceptable reactions with red cell antigens when the cells are stored for mended periods in EDTA We defined acceptable reaction strength to be 2+ (score 8). As expected, the A, B, and D reactions were very stable with red cells stored for 60 days. All antigens except Lea exhibited 2+ (score 8) or greater reactions at day 14, and at day 2 1 only the Lea, Fyb, and e antigens were less than 2+. On day 60, twelve of twenty-one antigens tested still exhibited 2+ or greater reactions. This study shows that antigen reactivity for red cells collected and stored in EDTA is at least equal to that for clotted specimens These red cells can be used for reliable antigen typing for at least 14 days, and even longer for most antigens.     

CeReS-18, a novel cell surface sialoglycopeptide, induces cell cycle arrest and apoptosis in a calcium-sensitive manner

Very few growth inhibitors have been identified whichcan inhibit the proliferation of a broad spectrumof human breast cancer cell lines. CeReS-18, anovel cell surface sialoglycopeptide growth inhibitor, can reversiblyinhibit the proliferation of both estrogen receptor positive(MCF-7) and negative (BT-20) human breast cancer celllines. In addition, at concentrations above those requiredfor the reversible inhibition of cell proliferation, CeReS-18can also induce cell death in MCF-7 cells.Changes in nuclear and cytoplasmic morphology, characteristic ofapoptosis, were detected in MCF-7 cells treated witha cytotoxic concentration of CeReS-18, and internucleosomal DNAcleavage was also observed. The sensitivity of MCF-7and BT-20 cells to the biological properties ofCeReS-18 could be influenced by altering the calciumconcentration in the extracellular growth medium, such thatwhen the calcium concentration in the environment wasdecreased, an increased sensitivity to CeReS-18-induced growth inhibitionand cytotoxicity were observed. The addition of thecalcium chelating agent EGTA to MCF-7 cells, culturedin a normal calcium environment, could mimic theincreased sensitivity to the biological effects of CeReS-18observed under reduced calcium conditions.