Polymorphonuclear leucocyte motility in patients with severe burns

Chemotaxis, chemokinesis and cellular orientation were measured for unstimulated and 10(-7) n-formyl methionyl leucyl phenylalanine (F-met-leu-phe) stimulated polymorphonuclear leucocytes (PMNS) of nine patients with recent 10-80 per cent burns using a computer-assisted image analysis technique. The technique records PMN movement, as viewed with a phase-contrast microscope on videotapes, and then uses computer programs to calculate the speed and direction of up to 50 PMNS over a 5-min period. Orientation was determined visually. Cellular adherence was also measured by attachment methods. PMNS from burn patients were slower (av. speed 16.8 microns/min), responded less well to F-met-leu-phe (av. speed 20.9 microns/min, av. McCutcheon index 0.32), were less often oriented towards the chemoattractant (av. 39 per cent) and were more adherent (av. 50 per cent) than control cells (av. speed 21.8 microns/min; av. speed F-met-leu-phe 32.2 microns/min; McCutcheon index 0.61; oriented 59 per cent adherent; 16 per cent). Thus PMNS from burn patients orient less well, are significantly slower and have less directionality in response to a chemoattractant, and are more adherent suggesting activation.     

239. Spätergebnisse chirurgischer Therapie bei der chronischen Pankreatitis

Zusammenfassung Von 1979 bis 1986 wurden an der Chirurgischen Klinik der Charité 190 Patienten wegen einer chronischen Pankreatitis operiert. Bei 52 Patienten mit einer cephalen Duodenopankreatektomie wurde in einer 6jährigen Verlaufsstudie die endokrine Pankreasrestfunktion verfolgt. Die eingesetzten Parameter (GTT, Serum-Insulin, C-Peptid, Sonographie, CT und Leberbiopsie) ergaben einen signifikanten Anstieg der diabetischen Stoffwechsellage, eine gesteigerte Verdauungsinsuffizienz und eine deutlich zunehmende Leberverfettung. Durch die Occlusion wird keine endokrine Schutzfunktion erkennbar.     

Storage telemetry of radionuclide tracers by implantable thermoluminescent dosimeters

A storage telemetrical method using thermoluminescent (TL) dosimeters for long-term measurements of incorporated radioactive substances in unrestrained rats has been developed. The system has been used in combination with radiotelemetrical registration of the circadian temperature rhythm. By sequential replacement of double TL dosimeters (60 mg, CaSO4:Dy) through an implanted silicon tube, the concentration of different radionuclides can be determined over long periods. The persistence of the circadian temperature rhythm indicates that the animals were unaffected by the experimental conditions. The relative uncertainty of the dosimeter system and the temperature transmitter is approximately +/- 2% (SD) at 5 mR exposures and +/- 0.05 degrees C, respectively. The weight of the system in total is 5.7 g. Disappearance studies (36-48 h) have been performed with the beta-emitters, 32P nad 42K, in subcutaneous tissues and tumor tissue. This TL method permits the repetition of an experiment on the same rat several times, and thereby avoids errors due to biological variations between animals.     

Fluvastatin reduces endothelin secretion of cultured human umbilical vein endothelial cells

Objective: Fluvastatin is an agent of a new lipid lowering drug class, the 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors, which seems to elicit direct effects on the vasculature. Methods: The effect of fluvastatin on endothelin secretion in endothelial cell cultures from human umbilical veins was investigated. Results: Fluvastatin significantly reduced endothelin secretion by 13% at a concentration of 10⁻⁸ M, by 41% at 10⁻⁷ M and by 62% at 10⁻⁶ M. Conclusion: Since endothelin is a potent vasoconstrictor which may be associated with the aetiology of cardiovascular diseases, the reduction of its synthesis by fluvastatin may contribute to the beneficial effects of this substance on the cardiovascular system. Received: 12 April 1999 / Accepted in revised form: 23 August 1999     

Multivariate Analysis of Risk Factors for Postoperative Complications in Benign Goiter Surgery: Prospective Multicenter Study in Germany

Risk factors for postoperative complications of benign goiter surgery have not been investigated systematically. To this end, a prospective multicenter study (January 1 through December 31, 1998) was conducted involving 7266 patients with surgery for benign goiter from 45 East German hospitals. High-volume providers (>150 operations per year) performed 69% (5042/7266), intermediate-volume providers 27% (50–150), and low-volume providers 4% (258/7266) of operations. Among the hospital groups, the pattern of thyroid disease did not vary significantly, but there was a trend that small-volume providers tended to perform more operations for uninodular goiter and high-volume providers treated more patients with Graves' disease and recurrent goiter. Extent of resection (p < 0.0001) and remnant size (multinodular goiter and recurrent goiter, p < 0.001), differed significantly, with total thyroidectomy being performed more often in hospitals with more than 150 operations compared to hospitals with an operative volume of less than 150 procedures per year. Despite the larger extent of resection and smaller remnant size, rates of recurrent laryngeal nerve (RLN) palsy or hypoparathyroidism were not increased. When the logistic regression analyses were fitted to evaluate the impact of risk factors on transient and permanent RLN palsy and hypoparathyroidism, larger extent of resection [relative risk (RR) 1.5–2.1] and recurrent goiter (RR 1.8–3.4) consistently evolved as independent risk factors. With hypoparathyroidism, additional significant factors included patient gender (RR 2.1–2.4), hospital operative volume (RR 0.8–1.5), and Graves' disease (RR 2.8). Unlike parathyroid gland identification during hypoparathyroidism, RLN identification (RR 1.6) significantly (p= 0.01) reduced permanent RLN palsy rates. The multivariate analyses clearly confirmed the pivotal role of routine RLN identification, independent of the extent of the thyroid resection. These findings might help hospitals with lower operative volumes to identify patients at increased risk whom they might consider for specialist care.     

Results of 188 gastric banding operations

The gastric banding is an effective operation for treatment of the morbid obesity. We report about 188 patients, we treated from April 1997 to December 1999. This review takes a stand on the indication for operation, the operative technique, the lost of weight and the complications. The benefit of this operation is the minimal invasive technique.     

"Acute cholecystitis"--laparoscopic cholecystectomy is often possible. Results of a multicenter study by the East German Study Group for Performance Assessment and Quality Assurance in Surgery

With the introduction of laparoscopic cholecystectomy (LCE) the method became very fast successful in clinical practice. To describe the actual situation we initiated in 1994/95 a clinical multicenter study with the name CESAQ. 29 hospitals participated in the study. 4,675 cholecystectomies were performed, a total number of 2,960 patients were operated upon with the laparoscopic and 1,468 with the conventional technique. Furthermore, conversion to open cholecystectomy was necessary in 247 cases. One part of the study focused on the results achieved for patients with acute cholecystitis. 9.4% of the laparoscopic but 37.3% of the conventional cholecystectomies were performed due to acute cholecystitis. We differentiated a simple (adhesions to gallbladder, hydrops) and complicated form (empyema, gangrenous gallbladder) of acute cholecystitis. Treating acute cases the incidence of intraoperative (simple 8.3%, complicated 12.1%) and specific postoperative complications (simple 9.2%, complicated 6.9%) was higher compared to elective procedures (intraoperative 4.6%, specific postoperative 3.7%). This is well known from the experience of open surgery. Nevertheless there were lower general complication rates (simple 5.5%, complicated 5.2%) and no mortality in acute cholecystitis when LCE was performed. Considering an early conversion to open cholecystectomy in cases of severe acute cholecystitis the indication for LCE can be made generously. Great surgical experience in LCE is a requirement for the laparoscopic management of acute cholecystitis.     

BDNF serum concentrations in healthy volunteers are associated with depression-related personality traits.

The issue of neurotrophins is recognized as a new lead in the quest for a deeper understanding of mood disorders. This hypothesis has emerged from experimental evidence suggesting that antidepressant drugs might work by a neuroprotective effect through the stimulation of the neurotrophin expression in distinct regions of the CNS. Endogenous levels of BDNF protein were measured in the serum samples of 118 healthy unrelated volunteers (64 male, 54 female, age: 42.1+/-13.0 years), and the NEO-FFI has been performed in all subjects. BDNF serum values amounted to 16.3+/-7.3 ng/ml. BDNF concentration correlated significantly with age (r=0.182, p=0.048), but showed no gender differences (male 16.1+/-7.2, female 16.5+/-7.4 ng/ml). A negative correlation between the BDNF serum concentration and the depression-related factor neuroticism (r=-0.212, p=0.022) has been found. Low BDNF levels in healthy humans with depressive personality traits might constitute a risk marker, reflecting a personality profilethat is linked to vulnerability to mood disorders. These results provide further support for the hypothesis that BDNF may be central to the development of depressive mood states.