Identification and Quantitation of Reaction Products from Quinic Acid, Quinic Acid Lactone, and Chlorogenic Acid with Strecker Aldehydes in Roasted Coffee

To gain comprehensive insight into the interactions of key coffee odorants, like the Strecker aldehydes, acetaldehyde, propanal, methylpropanal, 2- and 3-methylbutanal, and methional, and the nonvolatile fraction of coffee, an untargeted metabolomics approach was applied. Ultra performance liquid chromatography (UPLC)-time of flight (TOF)-mass spectrometry (ESI^-) profiling followed by statistical data analysis revealed a marker substance for a coffee beverage spiked with acetaldehyde with an accurate mass of 217.0703 [M - H]^-. This compound could be identified as a reaction product of quinic acid (QA) and acetaldehyde linked by acetalization at the cis-diol function of QA. Consequently, the acetalization of aldehydes, QA, 5-O-caffeoyl quinic acid (CQA), and quinic acid γ-lactone (QAL) was investigated by means of model reactions, followed by synthesis, isolation, and structure elucidation via UPLC-TOF-MS and 1D and 2D NMR techniques. UHPLC-MS/MS_MRM screening and the quantification of aldehyde adducts in coffee beverages revealed the presence of QA/acetaldehyde, -/propanal, -/methylpropanal, and -/methional reaction products and CQA/acetaldehyde, -/propanal, -/methylpropanal, -/2- and 3-methylbutanal, and -/methional and QAL/acetaldehyde adducts for the first time, in concentrations of 12-270 μg/L for QA/aldehydes, 5-225 μg/L for CQA/aldehydes, and 62-173 μg/L for QAL/acetaldehyde. The sensory characterization of the identified compounds showed bitter taste recognition thresholds of 48-297 μmol/L for CQA adducts and 658 μmol/L for QAL/acetaldehyde, while the QA adducts showed no bitter taste (<2000 μmol/L).

Less intense conditioning with fludarabine, cyclophosphamide, idarubicin and etoposide (FCIE) followed by allogeneic unselected peripheral blood stem cell transplantation in elderly patients with leukemia

The objective of this study was to assess toxicity and feasibility of achieving engraftment of allogeneic blood progenitor cells following nonmyeloablative conditioning according to the FCIE protocol (fludarabine 25 mg/m(2)/day, days -7 to -3; cyclophosphamide 200 mg/m(2)/day, days -7 to -3; idarubicin 12 mg/m(2)/day, days -7 to -5; etoposide 250 mg/m(2)/day, days -4 to -3) in elderly patients with leukemia. Eleven patients were included in the study: six patients with acute myeloid leukemia (AML) in complete remission (CR); three patients with refractory or relapsed AML; one patient with chronic myeloid leukemia; one patient with acute lymphoblastic leukemia. The median age of the patients was 62 years. All patients received blood progenitor cells from an HLA-identical sibling with 8.8 x 10(6) CD34(+) cells/kg (median; range 4.7 to 26.2 x 10(6)/kg) and 5.5 x 10(8) CD3(+)cells/kg (median; range 4.5 to 7.9 x 10(8)/kg). Graft-versus-host disease (GVHD) prophylaxis consisted of cyclosporine and three courses of methotrexate. The median duration of white blood cell counts <1 x 10(9)/l was 17 days and of platelet counts <50 x 10(9)/l 20 days. In two patients acute GVHD grade I occurred. Nine of 10 patients analyzed developed mixed chimerism. Of seven patients transplanted in CR, three remained in CR 19 to 31 months after transplantation. Three patients with refractory leukemia did not achieve CR, while the patient with relapsed AML achieved a 3rd CR. After a median follow-up time of 22 months, chronic GVHD was mild and limited. The data from this pilot study in elderly patients with leukemia show that the combination of primarily immunosuppressive (FC) and antileukemic (IE) drugs for nonmyeloablative conditioning has moderate nonhematological toxicity and allows engraftment of allogeneic blood progenitor cells.

Criteria of functional operability in patients with bronchial carcinoma: preoperative assessment of risk and prediction of postoperative function

In this prospective study of 433 patients undergoing surgery for bronchial carcinoma 3 main factors influencing the operative risk were identified: (1) extent of resection, (2) pulmonary function and (3) age. The 30-day mortality rate was 8.3% in the whole group which comprised a high percentage of patients over 70 years of age (27%) and with a disturbed pulmonary function (45%). The value of various functional criteria proposed in the extensive literature is assessed and compared with the results of the study in which the use of FEV1 and quantitative regional analysis by perfusion scanning and 'regions of interest' proved to be highly efficient, allowing, in addition, the prediction of postoperative lung function even in sleeve resections. A new formula for estimation of the additional loss of function in the early postoperative phase after lobectomies is proposed along with a flow sheet for routine preoperative evaluation of pulmonary function.

Postpneumonectomy empyema: drainage by spontaneous oesophagopleural fistula

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Reoperation for bronchial carcinoma

After a primary operation for bronchial carcinoma, 17 patients underwent reoperation for local recurrence or intrathoracic metastasis (nine squamous cell, five alveolar cell, and three adenocarcinomas). The average interval between the first and second operation was 23 months (range: six to 48 months). Twelve patients had a pneumonectomy after an initial ipsilateral lobectomy. Five patients underwent contralateral wedge excision after initial lobectomy or wedge excision. Three patients died within 30 days of the reoperation. Eight of the remaining 14 patients died subsequently, the time of survival averaging 18 months (range: three to 54 months). Six patients are still alive, two having survived their reoperation for more than five years. Reoperation for recurrent bronchial carcinoma is rarely performed, but it should be considered in all cases where patients survive operation for lung cancer if the primary operation was thought to be radical.

[Standardised antibiotic therapy in major lung surgery (author's transl)]

Sputum and bronchial biopsies and smears were obtained from 221 patients who had undergone partial pneumonectomy without preceding antibiotic therapy. The results of 343 sputum examinations and of 126 bacteriological examinations of biopsies and smears were evaluated. Pathogenic bacteria were demonstrated in about 50% of the sputa and in about 25% of the biopsies and swabs. Anaerobic micro-organisms were extremely rare. Treatment was with tetracycline. Before antibiotic therapy Haemophilus influenzae, staphylococci and E. coli predominated, afterwards there were practically only staphylococci and Esch. coli. The incidence of primary resistance to the usual antibiotics was high, especially in respect of gram-negative organisms. The difference in incidence between primary and secondary resistance was one of degree. The least effective agents were ampicillin and amoxicillin, the most active were the aminoglycosides. Erycin proved satisfactory in infections with grampositive organisms while the cephalosporins were active against both gram-positive and gram-negative bacteria. The development of resistance and the clinical picture suggest that "eradication" of the infection during the postoperative stage is not advisable as it causes the selection of more or less drug-resistant organisms. A more satisfactory approach is gradually to reduce the infection until the immediate postoperative stage is over. Macroscopic and microscopic examination of the sputum is important, as the choice of the appropriate antibiotic is determined by the result of gram-staining.

[Chest trauma--a challenge to the general surgeon and chest surgeon for co-operation (author's transl)]

During 1968-1977 86 persons with chest trauma were treated at the Chest Clinic Heckeshorn. Until 1973 only a few cases of, mostly slight, chest injuries were admitted and treatment was mainly concerned with pneumothorax and haemothorax induced by fracture of ribs. Since 1974, however, cases of chest trauma have markedly increased in both number and seriousness of the injury. During the past years 50 patients with chest injuries were treated. They included 6 cases of stab wounds, 4 cases of bullet wounds and one case each of damage to the trachea and bronchial rupture respectively. Thoracotomy was performed in 11 of the 50 patients, in 3 cases to stabilize the chest wall. Willingness to cooperate on the part of the general surgeon has made it possible for the surgically trained lung specialist to participate in chest traumatology.

[Results of continuous suction drainage in the treatment of pleural empyema (author's transl)]

201 adults with non-specific pleural empyema (58 women, 143 men) had suction drainage. Most of the patients were aged 61-70 years. In the 47 patients who had not had antibiotic therapy before admission the main causal micro-organisms were staphylococci, pneumococci and streptococci; in the 149, who had had antibiotic therapy outside, micro-organisms such as Pseudomonas, Esch. coli and Proteus predominated. Suction drainage had to be kept up for a remarkably long time: for 4-8 weeks in 36% of the cases and for more than 8 weeks in 8%. 31 patients died, but only 17 of them as a direct result of the pleural empyema. They had all been "high risk" cases on account of age (average 67.7 years), type of bacteria (59%), serious primary or complicating disease (59%), duration of the pleural empyema (76%). Suction drainage succeeded in 140 patients in clearing the infection; but marked adhesions were demonstrable in 27% of the patients when they were discharged from hospital.

Bronchial carcinoma and long-term survival. Retrospective study of 433 patients who underwent resection

The long-term follow-up of patients with bronchial carcinoma treated by surgery is presented. Of 471 patients who underwent thoracotomy, the tumour could not be resected in 38 (8%). Sixty-three (13.4%) died within the first four weeks; 125 (28.9%) survived more than five years. A high percentage developed either late metastases, late recurrences, or a second primary lung carcinoma. The results of surgical resection for bronchial carcinoma cannot be considered satisfactory, although resection remains the best treatment even in those patients with an apparently unfavourable prognosis. In spite of reservations regarding retrospective studies, conclusions can be drawn regarding diagnosis, therapy, and prognosis. Questions concerning histological type, size, and site of tumour, and tumour stage can be answered only after an adequate postoperative interval. Five years after operation the patient who has apparently been successfully treated may die from a second primary carcinoma.

[Pulmonary varices (author's transl)]

In world literature up to now 41 cases of pulmonary varices have been described. Two own cases showed particulars in so far as one patient had an internal fistula between a varix in the base of the upper lobe of the lung and another varix in the apex of the lower lobe. Besides a varix the second patient had an AV-fistula in the right middle lobe. Already pre-operatively either case was diagnosed as vascular anomaly by angiography. By injecting the contrast medium into the vessels of the resection specimen a clear representation of the varices could be obtained.