Prädiktiver Wert eines Ischämietests bei Männern und Frauen mit stabiler Angina pectoris im Klinikalltag

BACKGROUND AND OBJECTIVE

Symptoms of coronary artery disease (CAD) and the accuracy of non-invasive tests differ between men and women. This study sought to evaluate the difference between the predictive value of a stress test in clinical practice for the diagnosis of significant coronary heart disease (CHD: stenosis > 50%) between women and men with stable angina.

PATIENTS AND METHODS

143,848 consecutive patients undergoing diagnostic coronary angiography at 99 hospitals during 2002 were included in the prospective cardiac catheter registry of the Working Party of Senior Hospital Cardiologists (Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte [ALKK]). All patients with stress test and stable angina CCS class I-III (n=27387; 20.4%) were included, 10,911 (39.8%) of them female. 70.6% of women and 73.2% of men had a positive stress test.

RESULTS

In 46.1% of women and 71.5% of men with positive test and stable angina had relevant CHD (p<0,001). Diabetes increased the prevalence of CHD in patients with a positive test both in women (65.5%) and men (80.5%), with CCS class III angina to 63.3% and 85.8%, respectively.

CONCLUSIONS

In clinical practice a positive stress test in women with stable angina is associated significantly less often with clinically relevant CHD than in men. The low positive predictive value of 46.1% underlines the need for additional clinical features like diabetes or cardiac symptoms (CCS class) before invasive diagnosis is performed.

[Interdisciplinary management of severe midfacial trauma]

The anatomy of the craniofacial skeleton is complex, the bones being closely associated with important neurological structures and sensory organs. The face itself is intimately associated with hereditary features and emotional feelings, and, as a consequence, midfacial trauma may lead to important aesthetic, functional and personal problems. Patients suffering from severe midfacial injuries reveal significant concomitant lesions of other body regions in a high percentage of cases. Thus, midfacial trauma patients require an elaborate interdisciplinary regimen of diagnostics and therapy. This paper provides on overview of the interdisciplinary management of midfacial trauma patients. The overlapping multispecialty fields are analyzed with emphasis on the viewpoint of the practicing ENT-surgeon. Assuming that basic principles of trauma care are known, interdisciplinary strategies and specific responsibilities for problem solving are provided. The ENT-surgeon is guided and called upon to play an active and cooperative part in the midfacial traumatology team.

Outcomes with the selective use of enteric exocrine drainage in pancreas transplantation

BACKGROUND

Bladder drainage of the exocrine secretions of pancreas transplants has been the standard of practice as it affords the ability to monitor for rejection and is thought to be associated with decreased morbidity. Recently, there has been renewed interest in avoiding the urinary tract complications and metabolic derangements that accompany bladder drainage by draining pancreatic exocrine secretions into the jejunum (enteric drainage). We sought to determine whether enteric drainage of pancreas transplants is safe and offers advantages without compromise in graft function or longevity.

METHODS

We retrospectively reviewed all pancreas transplants performed at the University of Washington between 2000 and 2003. Selection of the exocrine drainage method was based on the length of cold ischemia time and whether the pancreas was transplanted alone or in combination with a kidney. Pearson's chi-square and Fisher's Exact tests were used for statistical comparisons in complications or rejections between the groups.

RESULTS

Thirty-four pancreas transplants were performed with exocrine drainage into the bladder used in 17 and enteric drainage in 17. The complication rate was 53% in the bladder-drained group and 41% (P=.49) in the enteric-drained group. The incidence of pancreas rejection was 24% in the bladder-drained versus 29% in the enteric-drained patients (P=.50). One graft failed, which was in the bladder cohort.

CONCLUSIONS

We found comparable rejection and complication rates between groups. We conclude that enteric drainage is safe when used selectively, and entails no increased risks compared with bladder drainage.

WITHDRAWN: Actions of a fungal keratinase and reducing agents on the nail plate

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Measurement of the exclusive 3He(e,e'p) reaction below the quasielastic peak

New, high-precision measurements of the 3He(e,e(')p) reaction using the A1 Collaboration spectrometers at the Mainz microtron MAMI are presented. These were performed in antiparallel kinematics at energy transfers below the quasielastic peak, and at a central momentum transfer of 685 MeV/c. Cross sections and distorted momentum distributions were extracted and compared to theoretical predictions and existing data. The longitudinal and transverse behavior of the cross section was also studied. Sizable differences in the cross-section behavior from theoretical predictions based on the plane wave impulse approximation were observed in both the two- and three-body breakup channels. Full Faddeev-type calculations account for some of the observed excess cross-section, but significant differences remain.

Molecular probes: what is the range of their interaction with the environment?

We performed pressure-tuning hole-burning experiments on a modified cytochrome c protein in a glycerol/buffer glass. The shift and the broadening of the holes were investigated for various frequencies within the inhomogeneous band. On the basis of a simple model, we were able to estimate the interaction range between chromophore and protein. It is approximately 4.5 A. The parameters that enter the model are the compressibility, the static mean-square displacement, the inhomogeneous width, and the average spectral shift per pressure. From this result and from our experiments on pressure-induced denaturing, we conclude that water molecules have to be brought very close to the chromophore during the denaturation process.

[Epidural analgesia during childbirth]

Epidural analgesia is the most effective means of pain relief during labor and is considered to be the "gold standard". For sufficient epidural analgesia, a wide range of nerve-block has to cover the segments Th10 to S4. This article includes the pathophysiological background as well as aspects of risk information and informed consent. Practical issues such as the insertion of the epidural catheter, choice of medication and application modes are described. The influence of epidural analgesia on labor, instrumental delivery and rate of caesarean section is discussed.

[Blood management in surgery--an analysis]

The surgeon has a tremendous influence on the usage of blood and blood products. He determines the indication and operative strategy. So the co-operation of anesthetist, intensivist, transfusion specialist, and surgeon is essential to achieve improvement in blood saving. Guidelines of blood saving methods can support the aim of an effective blood management. We analyzed the today's situation of blood saving in surgery and discuss the matter by a questionnaire sent to all surgical institutions of Nordrhein-Westfalen. The data observed cover the results of the Sanguis study from 1994 and the resume that the indication of blood transfusion mostly is not driven by clinical and scientific facts alone. Till today no evidence based data exist on indications for transfusion of blood and blood products. This is required for the next years in order to create changes in the current system of blood saving. The key points to stay within the low range of the number of transfusions are to develop a specific peri-, intra-, and postoperative strategy according to patient, disease, and expected procedure. The surgical aspects are discussed.