Assessment of tricuspid regurgitation by pulsed Doppler ultrasonography of the hepatic veins

Pulsed Doppler echocardiography was tested to assess the degree of tricuspid regurgitation (TR), classified by right ventriculography, in 47 patients. Forty-eight subjects without TR served as controls (39 with sinus rhythm and 9 with atrial fibrillation). Two Doppler methods were used: the distance of systolic turbulence within right atrium from the tricuspid plane and the quantitative analysis of the flow-velocity traces from the hepatic veins (HVs). Right atrial systolic turbulence was found in 41 of 47 patients with TR and in none of the control subjects, and moderately correlated with the angiographic grading (r = 0.57). In control subjects, TR flow-velocity traces from the HVs showed 2 anterograde flow waves, systolic and diastolic. The ratio of anterograde systolic/anterograde diastolic velocity was more than 0.6 in 38 subjects with sinus rhythm and in 8 with atrial fibrillation. Twenty-two control subjects had a positive wave (designated as "v") coincident with the end of T wave. In 30 patients with TR, a retrograde holosystolic wave was present. Of the remaining patients, 12 had a ratio of anterograde systolic/anterograde diastolic velocity less than 0.6. Fifteen had an end-systolic "v-like" wave, which occurred earlier than the v wave in control subjects (p less than 0.001). In patients with TR, maximal velocities of the anterograde diastolic and retrograde systolic flow correlated with angiographic grading (r = 0.74 and 0.73, respectively). An anterograde diastolic flow velocity more than 26 cm/s and a retrograde systolic flow velocity more than 16 cm/s excluded mild TR. Analysis of Doppler recordings of the HVs is valuable to semiquantitatively assess TR, complementing the right atrial Doppler findings.     

Forschung und Lehre in der Geriatrie an deutschen Universitäten und Hochschulen

Zusammenfassung Um die Situation geriatrischer Forschung und Lehre an deutschen Hochschulen und Universit?ten zu erfassen, wurde ein Fragebogen an die medizinischen Fakult?ten verschickt. Von 37 angeschriebenen Fakult?ten antworteten 34 (Rücklaufquote 91,9%). Es gibt gegenw?rtig fünf Universit?ten mit einem geriatrischen Lehrstuhl oder entsprechender korporationsrechtlicher Gleichstellung (14,7%), eine C-3-Professur innerhalb der Inneren Medizin und zwei C-3-Professuren für Gerontopsychiatrie. An 15 Universit?ten wird Forschung mit geriatrischem Schwerpunkt betrieben. Nur 12 Universit?ten bieten Lehre mit geriatrischem Inhalt w?hrend des Medizinstudiums an. W?hrend alle Universit?ten mit geriatrischen Lehrstühlen und geriatrischen/gerontopsychiatrischen Abteilungen geriatrische Forschung und Lehre durchführen, betreiben bei den übrigen Universit?ten nur sieben geriatrische Forschung (26,9%) und vier geriatrische Lehre (15,4%). Es besteht eine starke Korrelation zwischen der universit?ren Anbindung des Faches Geriatrie in Form von Lehrstühlen oder Abteilungen und Forschung und Lehre mit geriatrischem Schwerpunkt. Um die gegenw?rtige Situation der Geriatrie in Ausbildung und Wissenschaft zu verbessern, ist daher die Schaffung weiterer Lehrstühle und Abteilungen an deutschen Universit?ten und Hochschulen zu fordern. Eingegangen: 5. Juni 1998, Akzeptiert: 6. Juli 1998     

Peripheral neuropathy following a single exposure to arsenic. Clincal course in four patients with electrophysiological and histological studies.

Four patients are described who developed a peripheral neuropathy 10 days to 3 weeks after ingestion of a single dose of arsenic. All improved slowly, but after 6 to 8 years 3 of them still had abnormal neurological symptoms and signs. Electrophysiological studies showed reduction of motor conduction velocity and marked abnormalities of sensory nerve action potentials. The findings suggest that conduction is abnormal in at least some surviving nerve fibres. Sural nerve biopsies from 2 patients showed axonal degeneration, which was at an early stage in some fibres, even 10 weeks after intoxication.     

IP-10 contributes to the inhibition of mycobacterial growth in an ex vivo whole blood assay

Interferon-γ inducible protein 10 (IP-10), is a potent chemoattractant that promotes migration of monocytes and activated T-cells to inflammation foci. IP-10 is elevated in serum of patients with chronic hepatitis C virus (HCV) and tuberculosis (TB) infections, although it remains to be determined the contribution of IP-10 in restricting Mycobacterium tuberculosis (Mtb) replication. Here, we investigated the impact of IP-10 on mycobacteria replication using the ex vivo model of human whole-blood (WB) assay. In particular, we compared the levels of IP-10 upon infection with different Mtb clinical strains and species of non-tuberculous mycobacteria (NTM) and evaluated how IP-10 may contain bacterial replication. Interestingly, we observed that the inhibition of the host enzyme dipeptidyl peptidase IV (DPP-IV), which inactivates IP-10 through cleavage of two amino acids at the chemokine N-terminus, restricted mycobacterial persistence in WB, supporting the critical role of full length IP-10 in mediating an anti-Mtb response. Addition of recombinant IP-10 expressed in eukaryotic cells enhanced the anti-mycobacterial activity in WB, although no differences were observed when IP-10 containing different proportions of cleaved and non-cleaved forms of the chemokine were added. Moreover, recombinant IP-10 did not exert a direct anti-mycobacterial effect. Our results underscore the clinical relevance of IP-10 in mycobacteria pathogenesis and support the potential outcomes that may derive by targeting the IP-10/CXCR3 pathway as host directed therapies for the treatment of Mtb or NTM infections.     

2-Jahresbilanz eines Kooperationsmodells zwischen einer Chirurgischen Universitätsklinik und einem Spital der Grundversorgung

Zusammenfassung. Einführung: Mit dem Ziel Wartelisten zu verkürzen und volkswirtschaftlich relevant Kosten zu reduzieren wurde am 1.1.1998 eine partnerschaftliche Kooperation zwischen dem Universit?tsspital Bern (Insel) und dem Bezirksspital Grossh?chstetten (BSG) gestartet. Die der visceralchirurgischen Klinik im Inselspital zugewiesenen Patienten der einfacheren und mittleren Allgemeinchirurgie (kurzstation?res Krankengut) wurden in der Insel selektioniert, abgekl?rt und dann für die Operation ins BSG überwiesen. Die im BSG durchgeführten Eingriffe wurden vom im BSG stationierten visceralchirurgischen Team der Insel vorgenommen. Die Behandlung erfolgte nach einem standardisierten Konzept mit dem Ziel gleiche Qualit?t wie am Inselspital zu bieten bei aber deutlich niedrigerem Kostenanfall. Resultate: W?hrend der 2 j?hrigen Laufzeit konnten im BSG 574 Insel-Patienten operiert und nachbehandelt werden. Die Morbidit?t betrug 3,5 % (Reoperationsrate 1,0 %) bei einer Mortalit?t von 0,15 %. Die mittlere Hospitalisationszeit betrug 6,3 Tage. Die Qualit?tssicherungsstudie (Haus?rzte und Patienten) ergab eine hohe Zufriedenheit um 95 % bei beiden Gruppen. Aufgrund dieser Zusammenarbeit konnten in beiden Spit?lern das betriebliche Ergebnis verbessert werden und auch die Krankenkassen konnten von niedrigeren Fallpauschalen profitieren. Schlussfolgerungen: Das hier pr?sentierte Partnerschaftsmodell zwischen einem Universit?tsspital und einem Spital der Grundversorgung stellt eine Novit?t dar und hat Modellcharakter. Bei 95 % Zufriedenheit auf Patienten- und Arztseite konnten sowohl die Wartezeiten für einen operativen Eingriff wie auch die Kosten der durchgeführten Eingriffe bedeutend reduziert werden.      

Pregnancy After Liver Transplant: Neonatal Outcomes and Long-Term Maternal Follow-up

BackgroundToday, women who have undergone liver transplantation enjoy better health, so they encounter more frequently the possibility of living pregnancy. Many questions about the safety of pregnancy are pending. This study analyzes pregnancy outcomes in women with a liver transplant managed at Policlinico Universitario “A.Gemelli.”ResultsWe identified 17 childbirths in 13 women who had undergone a liver transplant. Causes of transplant include congenital or acquired disorders. The mean age at transplant was 22 ± 9 years, mean maternal age at delivery was 33 ± 5 years, and transplant-to-pregnancy interval was 12 ± 6 years. The mean gestational week was 36.1 ± 3.5. All women had normal liver function after pregnancy. Immunosuppressive therapy before and during pregnancy included tacrolimus (n = 8), cyclosporine (n = 5) and mycophenolate mofetil (n = 1). No maternal death was registered. Maternal complications included increase of aspartate transaminase and alanine transaminase, graft deterioration requiring liver retransplantation, increase of bile acids (n = 1), itch (n = 1), and anemia (n = 1). Twelve women had a high adherence to an immunosuppressive regimen during pregnancy. A woman with poor compliance continued therapy with mycophenolic acid during pregnancy, showing preterm birth (25th week) with fetal respiratory failure. Another woman continued therapy with tacrolimus during breastfeeding without adverse effects.ConclusionLiver transplant does not influence women’s fertility; during pregnancy, we report low rates of minor graft complications and no major issues. There are no adverse effects on babies. An evaluation by a multidisciplinary team is recommended. Compliance to an immunosuppressive regimen is fundamental to ensure the stability of graft function and to prevent graft deterioration in pregnancy. Moreover, it is suggested to avoid teratogenic drugs, such as mycophenolic acid.