Continuation of Geriatric Discharge Medication in Primary Care and its Association with Rehospitalizations - A Cohort Study

Transition of care in geriatric patients is a complex and high risk process, particularly the continuation of discharge medication in primary care. We aimed to determine how general practitioners' management of geriatric patients' discharge medication is associated with rehospitalizations. A prospective monocentric cohort study was done in an acute geriatric inpatient clinic with six-months follow-up. Acutely hospitalized patients ≥ 70 years old with functional impairment and frailty currently taking medications were followed up after hospital discharge and continuation (n=27) or change (n=44) of discharge medication by the General Practitioner was determined. Outcomes were rehospitalizations, days spent at home and time until recurrent rehospitalizations. 71 patients (mean age 82 years, 46 women [65%]) were followed up for six months after hospital discharge. In a negative binomial regression model, the rehospitalization rate after three months was 3.8 times higher in participants whose discharge medication was changed (p = 0.023). The effect did not persist over six months. Patients who were continued on their discharge medication were rehospitalized significantly later and/or less often during the six months observation period, statistically measured by a recurrent events survival model (HR 0.267, p = 0.003). In conclusion, continuation of discharge medication after an acute hospitalization in a specialized geriatric clinic could prevent early rehospitalizations.

Nanotechnology for catalysis and solar energy conversion

This roadmap on Nanotechnology for Catalysis and Solar Energy Conversion focuses on the application of nanotechnology in addressing the current challenges of energy conversion: 'high efficiency, stability, safety, and the potential for low-cost/scalable manufacturing' to quote from the contributed article by Nathan Lewis. This roadmap focuses on solar-to-fuel conversion, solar water splitting, solar photovoltaics and bio-catalysis. It includes dye-sensitized solar cells (DSSCs), perovskite solar cells, and organic photovoltaics. Smart engineering of colloidal quantum materials and nanostructured electrodes will improve solar-to-fuel conversion efficiency, as described in the articles by Waiskopf and Banin and Meyer. Semiconductor nanoparticles will also improve solar energy conversion efficiency, as discussed by Boschloo et al in their article on DSSCs. Perovskite solar cells have advanced rapidly in recent years, including new ideas on 2D and 3D hybrid halide perovskites, as described by Spanopoulos et al 'Next generation' solar cells using multiple exciton generation (MEG) from hot carriers, described in the article by Nozik and Beard, could lead to remarkable improvement in photovoltaic efficiency by using quantization effects in semiconductor nanostructures (quantum dots, wires or wells). These challenges will not be met without simultaneous improvement in nanoscale characterization methods. Terahertz spectroscopy, discussed in the article by Milot et al is one example of a method that is overcoming the difficulties associated with nanoscale materials characterization by avoiding electrical contacts to nanoparticles, allowing characterization during device operation, and enabling characterization of a single nanoparticle. Besides experimental advances, computational science is also meeting the challenges of nanomaterials synthesis. The article by Kohlstedt and Schatz discusses the computational frameworks being used to predict structure-property relationships in materials and devices, including machine learning methods, with an emphasis on organic photovoltaics. The contribution by Megarity and Armstrong presents the 'electrochemical leaf' for improvements in electrochemistry and beyond. In addition, biohybrid approaches can take advantage of efficient and specific enzyme catalysts. These articles present the nanoscience and technology at the forefront of renewable energy development that will have significant benefits to society.

Rydberg Excitons in the Presence of an Ultralow-Density Electron-Hole Plasma

We study the Rydberg exciton absorption of Cu_{2}O in the presence of free carriers injected by above-band-gap illumination. Already at plasma densities ρ_{EH} below one hundredth electron-hole pair per μm^{3}, exciton lines are bleached, starting from the highest observed principal quantum number, while their energies remain constant. Simultaneously, the band gap decreases by correlation effects with the plasma. An exciton line loses oscillator strength when the band gap approaches its energy, vanishing completely at the crossing point. Adapting a plasma-physics description, we describe the observations by an effective Bohr radius that increases with rising plasma density, reflecting the Coulomb interaction screening by the plasma.

Synthesis, chemical behavior, structure elucidation and iNOS inhibitory activity of 1-substituted 3-methylsulfanyl-5,6,7,8-tetrahydro-1H-[1,2,4]triazolo[1,2-a]pyridazines. Pharmazie 2017;72:371-382. [PMID: 29441933 DOI: 10.1691/ph.2017.6902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

Novel slim and shapely sp3-rich nitrogen containing heterocyclic ring systems are sought-after platforms for the expansion of molecular diversity in lead discovery. The present work describes the synthesis and characterization of a series of derivatives of hitherto unknown 3-methylsulfanyl-5,6,7,8-tetrahydro-1H-[1,2,4]triazolo[1,2-a]pyridazines 2. This approach was guided by a computational study, aiming at an optimization of previously reported [1,2,4]triazolo[1,2-a]pyridazine-1-thiones 1 known to inhibit the inducible nitric oxide synthase (iNOS). The title compounds are accessible by methylation of compounds 1 under mild conditions. The products were biologically evaluated by the same cell-based assay as applied for previous products of type 1 using RINm5F cells, which were stimulated to produce NO on the influence of proinflammatory cytokines IL-1β and IFN-γ. Compounds 2 did not display the anticipated improved iNOS inhibitory activity in the selected assay but contribute to SAR in the field. In addition, an unprecedented formation of side-products 3 via oxidation has been investigated. The novel scaffolds represent attractive starting points for the construction of diverse molecules which differ considerably from known compounds based on flat and lipophilic aromatic scaffolds.

Mild, visible light-mediated decarboxylation of aryl carboxylic acids to access aryl radicals

Herein we present the first example of aryl radical formation via the visible light-mediated decarboxylation of aryl carboxylic acids using photoredox catalysis.

Herein we present the first example of aryl radical formation via the visible light-mediated decarboxylation of aryl carboxylic acids using photoredox catalysis. This method constitutes a mild protocol for the decarboxylation of cheap and abundant aryl carboxylic acids and tolerates both electron-rich substrates and those lacking ortho-substitution. The in situ formation of an acyl hypobromite is proposed to prevent unproductive hydrogen atom abstraction and trapping of the intermediate aroyloxy radical, enabling mild decarboxylation.

Non-genomic activities of retinoic acid receptor alpha control actin cytoskeletal events in human platelets

Essentials Platelets employ proteins/signaling pathways traditionally thought reserved for nuclear niche. We determined retinoic-acid-receptor alpha (RARα) expression and function in human platelets. RARα/actin-related protein-2/3 complex (Arp2/3) interact via non-genomic signaling in platelets. RARα regulates Arp2/3-mediated actin cytoskeletal dynamics and platelet spreading.

SUMMARY

Background Platelets utilize proteins and pathways classically reserved for the nuclear niche. Methods We determined whether human platelets express retinoic-acid-receptor family members, traditionally thought of as nuclear transcription factors, and deciphered the function of RARα. Results We found that RARα is robustly expressed in human platelets and megakaryocytes and interacts directly with actin-related protein-2/3 complex (Arp2/3) subunit 5 (Arp2/3s5). Arp2/3s5 co-localized with RARα in situ and regulated platelet cytoskeletal processes. The RARα ligand all-trans retinoic acid (atRA) disrupted RARα-Arp2/3 interactions. When isolated human platelets were treated with atRA, rapid cytoskeletal events (e.g. platelet spreading) were inhibited. In addition, when platelets were cultured for 18 h in the presence of atRA, actin-dependent morphological changes (e.g. extended cell body formation) were similarly inhibited. Using in vitro actin branching assays, RARα and Arp2/3-regulated complex actin branch formation was demonstrated. Consistent with inhibition of cytoskeletal processes in platelets, atRA, when added to this branching assay, resulted in dysregulated actin branching. Conclusion Our findings identify a previously unknown mechanism by which RARα regulates Arp2/3-mediated actin cytoskeletal dynamics through a non-genomic signaling pathway. These findings have broad implications in both nucleated and anucleate cells, where actin cytoskeletal events regulate cell morphology, movement and division.

THAI experimental programme for containment safety assessment under severe accident conditions

The THAI (THAI = Thermal hydraulics, Hydrogen, Aerosols, Iodine) experimental programme aims to address open questions concerning the behavior of hydrogen, iodine and aerosols in the containment of water cooled reactors. Since its construction in 2000, THAI programme is being performed in the frame of various national projects (sponsored by German Federal Ministry for Economic Affairs and Energy, BMWi) and two international joint projects (under auspices of OECD/NEA). THAI experimental data have been widely used for the validation and further development of Lumped Parameter (LP) and Computational Fluid Dynamics (CFD) codes with 3D capabilities. Selected examples of code benchmark exercises performed based on the THAI data include; hydrogen distribution experiment (ISP-47 and OECD/NEA THAI code benchmark), hydrogen combustion behaviour (ISP-49), hydrogen mitigation by PARs (OECD/NEA THAI-2 code benchmark), iodine/surface interactions, iodine mass transfer, and iodine transport and multi-compartment behaviour (EU-SARNET and EU-SARNET2), thermal-hydraulic tests (German CFD-network). In the present paper, a brief overview on the THAI experiments and their role in the containment safety assessment is discussed.

[Use and potential risks of over-the-counter analgesics]

BACKGROUND AND AIM

We investigated the use of prescription and non-prescription (over-the-counter, OTC) analgesics and the associated risks in elderly patients with multiple morbidities.

METHODS

Pain medication use was evaluated from the baseline data (2008/2009) of the MultiCare cohort enrolling elderly patients with multiple morbidities who were treated by primary care physicians (trial registration: ISRCTN89818205). We considered opioids (N02A), other analgesics, and antipyretics (N02B) as well as nonsteroidal anti-inflammatory drugs (NSAIDs; M01A). OTC use, duplicate prescription, dosages, and interactions were examined for acetylsalicylic acid, diclofenac, (dex)ibuprofen, naproxen, and acetaminophen.

RESULTS

Of 3,189 patients with multiple morbidities aged 65-85 years, 1,170 patients reported to have taken at least one prescription or non-prescription analgesic within the last 3 months (36.7 %). Of these, 289 patients (24.7 % of 1,170) took at least one OTC analgesic. Duplicate prescription was observed in 86 cases; 15 of these cases took the analgesics regularly. In two cases, the maximum daily dose of diclofenac was exceeded due to duplicate prescription. In 235 cases, patients concurrently took a drug with a potentially clinically relevant interaction. In 43 cases (18.3 % of 235) an OTC analgesic, usually ibuprofen, was involved.

DISCUSSION

About one third of the elderly patients took analgesics regularly or as needed. Despite the relatively high use of OTC analgesics, the proportions of duplicate prescription, medication overdoses, and adverse interactions due to OTC products was low.

Synthesis and structure elucidation of 2,3,5,6,7,8-hexahydro-1 H-[1,2,4]triazolo[1,2-a]pyridazine-1-thione, 3,3-disubstituted and 2-substituted derivatives and evaluation of their inhibitory activity against inducible nitric oxide synthase

The 3-monosubstituted 2,3,5,6,7,8-hexahydro-1 H-[1,2,4]triazolo[1,2-a]pyridazine-1-thiones 3 (R1, R3 = H) were recently reported to possess inhibitory activity against inducible nitric oxide synthase in a cell based assay (Schulz et al. 2013). The 3,3-disubstituted 2,3,5,6,7,8-hexahydro-1H-[1,2,4]triazolo[1,2-a]pyridazine-1-thiones 3 and 4 (R2,R3 ≠ H) were synthesized by cyclocondensation of the hexahydropyridazine-1-carbothioamides 1 with ketones. In order to access the 3,3-unsubstituted 2,3,5,6,7,8-hexahydro-1H-[1,2,4]triazolo[1,2-a]pyridazine-1-thiones, the unsubstituted parent system of these compounds, several synthetic routes were studied. By these methods the desired heterocyclic system 2a as well as new a-anellated and N-substutited hexahydropyridazines were obtained. The biological evaluation of the title compounds confirmed the previously made finding that an aromatic moiety in position 3 of the substance is important for an inducible nitric oxide synthase (iNOS) inhibitory activity.

Improvement of the quality of life concerning the health of patients with peripheral arterial disease (PAD) after successful bypass surgery

BACKGROUND

To test whether quality of life depends on the psyche of patients after successful bypass surgery for peripheral arterial disease (PAD).

PATIENTS AND METHODS

A total of 74 consecutive patients aged 36-69 years (57.7 +/- 8.8 years) with symptomatic PAD in the stages Fontaine IIb-IV were enrolled in a prospective study after successful bypass surgery. Because of bypass failure and one death during the study period, 11 of these patients were excluded from evaluation. Prior to surgery, Doppler sonography and digital subtraction angiography were carried out in all patients. Before and after revascularization, the ankle / brachial index (ABI) was determined in all study objects and the pain free walking distance (PFWD) in those with PAD stage Fontaine IIb. Health-related quality of life was measured by using the "Medical Outcomes Study Group Short Form 36" (SF-36), and personality was determined by employing the Psycho-Diagnostic-Test (PDT).

RESULTS

After surgery, there was an increase in ABI from 0.32 +/- 0.13 to 0.79 +/- 0.19 (p < .01), in PFWD from 42.6 m +/- 38.6 m to 419.7 m +/- 152.3 m (p < .01), and in the SF-36 scales "Physical functioning", "Bodily pain", "General health perceptions", and "Role-functioning physical" (p < .05). ABI correlated positively with "Bodily pain" (p < .01), "General health perceptions" (p < .01) and "Mental health" (p < .05). Among SF-36 and PDT-scales, "Role-functioning physical" correlated negatively with "Moodiness" / "Neuroticism" (p < .05), and "Social functioning" correlated positively with "General activity" (p < .01).

CONCLUSIONS

Whether objective clinical improvement increases quality of life mainly depends on the psyche of patients: A high level of general activity favors an improved quality of life and neurotic characteristics are more likely to be a hindrance.

Novel strategy for diameter-selective separation and functionalization of single-wall carbon nanotubes

The problem of separating single-wall carbon nanotubes (CNTs) by diameter and/or chirality is one of the greatest impediments toward the widespread application of these promising materials in nanoelectronics. In this paper, we describe a novel physical-chemical method for diameter-selective CNT separation that is both simple and effective and that allows up-scaling to large volumes at modest cost. Separation is based on size-selective noncovalent matching of an appropriate anchor molecule to the wall of the CNT, enabling suspension of the CNTs in solvents in which they would otherwise not be soluble. We demonstrate size-selective separation in the 1-2 nm diameter range using easily synthesized oligo-acene adducts as a diameter-selective molecular anchor. CNT field effect transistors fabricated from diameter-selected CNTs show markedly improved electrical properties as compared to nonselected CNTs.

Pre-incisional epidural ropivacaine, sufentanil, clonidine, and (S)+-ketamine does not provide pre-emptive analgesia in patients undergoing major pancreatic surgery

BACKGROUND

The concept of pre-emptive analgesia remains controversial. This prospective, randomized, and double-blind study compared epidural administration of ropivacaine 2 mg ml(-1), sufentanil 0.5 microg ml(-1), clonidine 3 microg ml(-1), and S(+)-ketamine 0.25 mg ml(-1) (study solution) given before incision with the same combination started at the end of the operation.

METHODS

After testing the stability of the solution using high performance liquid chromatography (HPLC) and examining 12 patients for possible side-effects in comparison with the epidural infusion of ropivacaine 2 mg ml(-1) and sufentanil 0.5 microg ml(-1), 30 patients undergoing major pancreatic surgery were recruited into the study. Before induction of anaesthesia, an epidural catheter was inserted (TH6-8). Patients in Group 1 received a bolus of 8 ml followed by a continuous infusion (8 ml h(-1)) of the study solution before induction of anaesthesia. In Group 2, patients received the same volume of saline before operation, the study solution was started at the end of surgery. After operation, the infusion was maintained for at least 96 h using a patient-controlled epidural analgesia (PCEA) pump in both groups. Patients were evaluated up to the seventh postoperative day for pain and side-effects.

RESULTS

Visual analogue scale (VAS) values at rest were as follows: G1 vs G2: 24 h, 19 (sd 23) vs 6 (13); 48 h, 4 (10) vs 11 (21); and 72 h, 12 (22) vs 13 (21). VAS values during coughing and mobilization were also comparable. Total volume of epidural infusion was 904 (114) ml in G1 vs 892 (154) ml in G2. The incidence of side-effects (nausea, vomiting, and motor block) was low and not different between the groups.

CONCLUSIONS

Pre-incisional epidural analgesic infusion did not provide pre-emptive analgesia compared with administration started at the end of surgery, but both groups had low pain scores.

Doping and phonon renormalization in carbon nanotubes

We show that the Raman frequency associated with the vibrational mode at approximately 1,580 cm(-1) (the G mode) in both metallic and semiconducting carbon nanotubes shifts in response to changes in the charge density induced by an external gate field. These changes in the Raman spectra provide us with a powerful tool for probing local doping in carbon nanotubes in electronic device structures, or charge carrier densities induced by environmental interactions, on a length scale determined by the light diffraction limit. The G mode shifts to higher frequency and narrows in linewidth in metallic carbon nanotubes at large fields. This behaviour is analogous to that observed recently in graphene. In semiconducting carbon nanotubes, on the other hand, induced changes in the charge density only shift the phonon frequency, but do not affect its linewidth. These spectral changes are quantitatively explained by a model that involves the renormalization of the carbon nanotube phonon energy by the electron-phonon interaction as the carrier density in the carbon nanotube is changed.

Comparative study of different concentrations of prilocaine and ropivacaine for intraoperative axillary brachial plexus block

BACKGROUND AND OBJECTIVE

To compare the anaesthetic characteristics in terms of onset and offset times of the sensory and motor blocks of prilocaine 1% and ropivacaine 0.75% alone and in different combinations when used for brachial plexus anaesthesia in axillary perivascular blocks.

METHODS

After informed consent 96 ASA I-III patients undergoing forearm or hand surgery participated in this prospective, randomized, double-blind study. Patients received either prilocaine 1% 40 mL (G1), prilocaine 1% 30 mL and ropivacaine 0.75% 10 mL (G2), prilocaine 1% 20 mL and ropivacaine 0.75% 20 mL (G3) or ropivacaine 0.75% 40 mL (G4) for axillary perivascular brachial plexus anaesthesia. Onset and duration of sensory and motor blocks in the distribution of the musculocutaneous, radial, median and ulnar nerves were assessed.

RESULTS

The onset time of the sensory and motor blocks of the whole brachial plexus differed only between patients in G4 with ropivacaine 0.75% 40 mL demonstrating a later motor onset in comparison to all other groups and a later sensory onset in comparison to G1 and G2 (P < 0.01). The addition of ropivacaine resulted in longer offset times of the sensory and motor blocks. The median offset time of the motor block was 179.5 min in G1, 262 min in G2, 389.5 min in G3 and 745 min in G4 (P < 0.01). The median offset time of the sensory block was 163.5 min in G1, 277 min in G2, 383.5 min in G3 and 784 min in G4 (P < 0.01). There was no difference in onset and offset times between sensory and motor blocks within the groups.

CONCLUSIONS

For axillary perivascular brachial plexus block prilocaine 1% alone and in combination with ropivacaine 0.75% was similar in terms of onset of sensory and motor blocks but different in duration of sensory and motor blocks without a differential sensory and motor offset.

Entfernung eines Epiduralkatheters unter antithrombotischer Therapie

A rare though extremely harmful complication in neuraxial anaesthesia is an epidural hematoma which can be associated with deleterious consequences for the patient, e. g. persistent paraplegia. The risk of epidural haematomas after neuraxial blockade is dependent on abnormal anatomy of the spine, difficult and multiple punctures and coagulation disorders. Especially when patients undergo therapy with anticoagulants like low molecular heparin or platelet inhibitors (tyclopidine) or a combination of them, the indication for neuraxial blockade must strictly outweigh risk of spinal bleeding. In this context, the precautions and contraindications are the same for spinal puncture and catheter insertion as for catheter removal. We describe the case of a patient who underwent emergency coronary angioplasty in combination with coronary stent implantation due to acute postoperative myocardial infarction following knee replacement in continuous epidural anaesthesia. Under the symptoms of a beginning local infection at the puncture site the epidural catheter had to be removed in spite of ongoing antithrombotic therapy. A possible management of such cases is discussed with regard to risk minimization.

[Gas gangrene with ulcerative colitis under immunosuppressive therapy: report of a case]

We report on a 30-year-old male with ulcerative colitis who developed a spontaneous gas gangrene in the right limb, the gluteal muscles and the retroperitoneal region under immunosuppressive therapy. In spite of immediate aggressive surgical and antibiotic therapy the massive infection led to septicemia and ultimately death. Clostridium septicum was identified with multiple local manifestations in the skeletal muscles. Gas gangrene is extremely rare in patients with ulcerative colitis or Crohn's disease and immunosuppression. The therapeutic options are discussed and the relevant present literature is reviewed.

Pulmonary embolism caused by polymethylmethacrylate during percutaneous vertebroplasty in orthopaedic surgery

Vertebroplasty consists of percutaneous injection of acrylic cement--polymethylmethacrylate (PMMA)--into a partially collapsed vertebral body in order to obtain pain relief and augment mechanical stability of the vertebral body. Although vertebroplasty is an efficient treatment it is not free of complications. Our present case report describes a woman with pulmonary polymethylmethacrylate embolism during percutaneous vertebroplasty who presented with hypotension, arrhythmia and hypocapnia.

Kontinuierliche interscalenäre Plexusblockade bei einem dreijährigen Kind nach Armamputation - Ein Fallbericht

Amputations of extremities, especially in the childhood, impose high demands on the perioperative management. Apart from the intraoperative care of these children, the postoperative pain therapy has to do one's utmost in the avoidance of the development of phantom limb pain, which can, especially in the childhood, be associated with far reaching psychological consequences. We report the case of a 3-year old boy who had to undergo exarticualtion of his left arm due to an osteosarcoma of the humerus. The perioperative pain management was performed by a preoperatively placed interscalene catheter and infusion of 0.2 % ropivacaine. Within the first six days postoperatively complete pain relief could be ensured with this analgetic regimen.

Effects of isovolaemic haemodilution on oxygenation of liver and skeletal muscle

BACKGROUND AND OBJECTIVE

Hydroxyethyl starch is frequently used for volume substitution during surgical procedures and for isovolaemic haemodilution. Haemodilution has also been shown to improve tissue oxygen tension in skeletal muscle: However, effects of this volume substitute on tissue oxygen tension of the liver during haemodilution remains unknown.

METHODS

Fourteen foxhounds were anaesthetized with fentanyl/midazolam and mechanically ventilated with 30% oxygen. Following splenectomy animals were randomly assigned to a control group without haemodilution but fluid substitution with Ringer's lactate (Group C) or underwent isovolaemic haemodilution to a haematocrit of 25% with hydroxyethyl starch 70/0.5 (Group H). Haemodynamic parameters and oxygen transport during 100 min following isovolaemic haemodilution were measured. Liver oxygen tension was recorded using a flexible polarographic electrode tonometer, whereas in the muscle a polarographic needle probe was used.

RESULTS

Animal characteristics and baseline haematocrit were similar in both groups. At baseline the tissue oxygen tension of liver and skeletal muscle were not different between groups. Haemodilution with hydroxyethyl starch 70/0.5 provided augmentation of mean liver tissue oxygen tension (baseline: 46 +/- 13 mmHg; 20 min: 60.3 +/- 12 mmHg; 60 min: 60 +/- 16 mmHg; 100 min: 63 +/- 16 mmHg; P < 0.05 vs. baseline), while oxygen tensions in Group C remained unchanged (baseline: 48 +/- 16 mmHg; 20 min: 52 +/- 19 mmHg; 60 min: 49 +/- 12 mmHg; 100 min: 52 +/- 16 mmHg) and no differences could be detected between groups. Oxygen tension in skeletal muscle changed as follows: Group H - baseline: 24 +/- 32 mmHg; 20 min: 32 +/- 3 mmHg; 60 min: 33 +/- 7 mmHg; 100 min: 33 +/- 11 mmHg. Group C - baseline: 22 +/- 6 mmHg; 20 min: 21 +/- 3 mmHg; 60 min: 24 +/- 4 mmHg; 100 min: 18 +/- 4 mmHg (P < 0.05 vs. baseline, p < 0.05 vs. Group C).

CONCLUSION

In this animal model, isovolaemic haemodilution with hydroxyethyl starch 70/0.5 increased tissue oxygen tension in liver and skeletal muscle in comparison with baseline values. However, when compared between groups haemodilution only resulted in an increase of tissue oxygen tension in the muscle but not in the liver.

Korreliert die Patientenzufriedenheit mit dem Schmerzniveau bei der Anwendung von patientenkontrollierter Epiduralanalgesie?

INTRODUCTION

The evaluation of patients' satisfaction and outcome after surgery is of increasing importance. An optimized postoperative pain management may contribute substantially to this important goal.

METHODS

After approval of the local ethics committee and written informed consent, 150 adult patients receiving epidural catheters for postoperative pain management were evaluated over 1 week postoperatively with respect to their satisfaction with the pain therapy and incidence of side effects. All patients received a continuous epidural infusion with ropivacaine 0.2% plus sufentanil 0.5 microg/ml via a PCEA pump (basal rate 6-8 ml/h, bolus 2 ml, lockout time 5 min). For assessment of pain the VAS scale (0-100 mm) was used, and patients' satisfaction was evaluated using a numeric rating scale (1-6, 1=very good, 6=very dissatisfied).

RESULTS

Of the patients, 95 were operated in general surgery, 32 in orthopedics, and 23 in gynecology. Time of treatment with epidural catheters (71% thoracic, 29% lumbar catheters) was 5.1 +/- 2.9 days. Of the patients, 87.8% evaluated the postoperative pain service as very good or good, and 89% of the patients would choose the same pain therapy again. Side effects mainly consisted in bladder dysfunction (19%) and intermittent motor blockade (18%) especially with lumbar catheters. Correlation between patient satisfaction and the remembered maximum pain levels was low ( r=0.266).

CONCLUSION

Evaluation of patients' satisfaction with postoperative epidural pain therapy resulted in a high degree of satisfaction without correlation between patients' satisfaction and recalled maximum pain levels. These results, including side effects and special problems during pain therapy, provide motivation to further improve postoperative pain management.

Nichtinvasive Diagnostik von Hautfunktionen

Noninvasive investigation of skin functions is increasingly employed in dermatology and cosmetology. It enables one to study aspects of skin functions that cannot always be appreciated by sensory perception. Noninvasive methods permit objective and reproducible investigation of distinct biophysical parameters. In the age of evidence-based medicine this becomes more and more important. Biophysical data can be quantified, analyzed, and stored electronically. In an overview, selected noninvasive techniques of skin function testing are introduced and their relevance in dermatology, dermatopharmacology, and cosmetology is discussed.

Plasmakonzentrationen von Ropivacain und Bupivacain während postoperativer Patienten-kontrollierter thorakaler Epiduralanalgesie

BACKGROUND

The postoperative continuous epidural application of local anesthetics can cause side effects like motor blockade and systemic intoxication. The study was performed to evaluate the plasma levels of two local anesthetics and their analgesic and side effects in continuous postoperative epidural analgesia.

METHODS

In a prospective, randomized and double-blind study we have compared side effects of ropivacaine 0.375% (group R) vs. bupivacaine 0.125% in combination with sufentanil 0.5 microg ml(-1) (group B/S) via thoracic epidural catheters for a duration of 96 hours after major abdominal surgery in 30 gynaecological tumor patients. Analgesic effects, side effects and plasma levels of the respective local anesthetic were measured 24, 48, 72 and 96 h after start of epidural infusion.

RESULTS

No differences were seen in demographics, perioperative data and analgesic effects. The following cumulative doses of local anesthetics were applied (Group R vs. B/S (median/minimum-maximum ml)): 24 h: 151/121-225 vs. 141/83-171; 48 h: 311/237-424 vs. 299/184-497; 72 h: 454/366-566 vs. 440/256-598; 96 h: 572/399-859 vs. 568/284-711. Plasma levels of local anesthetics remained far below the toxic threshold of 0.6 micro g/ml (Group R vs. B/S (median/minimum-maximum micro g/ml): 24 h: 0.05/0.03-0.24 vs. 0.0/0.0-0.02; 48 h: 0.06/0.02-0.15 vs. 0.006/0.0-0.02; 72 h: 0.05/0.0-0.11 vs. 0.0/0.0-0.02; 96 h: 0.02/0.01-0.32 vs. 0.0/0.0-0.01). The incidence and intensity of motor block (Bromage scale) and other side effects did also not differ between groups.

CONCLUSION

The present study shows that thoracic epidural infusion with bupivacaine 0.125% and with a higher concentration of ropivacaine 0.375% during 96 h provides plasma levels of unbound local anesthetic far below the toxic threshold.

Mechanisms of apoptosis: UVA1-induced immediate and UVB-induced delayed apoptosis in human T cells in vitro

OBJECTIVE

The decreased number of lymphocytes combined with the induction of apoptosis and necrosis seems to be the key mechanism of many phototherapeutic agents. The purpose of our study was to determine the regulating pathway, time course and dose dependence of UVA1- vs. UVB-induced cell death in human T lymphocytes.

METHODS

In our study we applied an in vitro method using single-laser flow cytometry differentiating between intact (Annexin V-FITC-/PI-), apoptotic (Annexin V-FITC+/PI-) and necrotic T cells (Annexin V-FITC+/PI+) following UVA1 (340-400 nm) or UVB (280-320 nm) irradiation. Additionally, fluorescence microscopy of apoptotic cells was performed using acridine orange and ethidium bromide.

RESULTS

Compared to DNA-binding fluorescent microscopy, the flow cytometric method revealed similar, but more precise, results concerning apoptosis and necrosis. Our data indicate that UVB irradiation exerts its effects by the induction of delayed apoptosis within 24-48 h. In contrast, UVA1 irradiation acts via the dose-dependent induction of immediate apoptosis and necrosis within 6 h.

CONCLUSIONS

Our findings demonstrate that UVA1 irradiation may effect structural and functional modifications leading to immediate initiation of apoptosis followed by early membrane rupture, whereas UVB irradiation leads to DNA damage followed by delayed apoptosis, obviously without initial membrane alteration.

Hemoglobin-based oxygen carrier HBOC-201 provides higher and faster increase in oxygen tension in skeletal muscle of anemic dogs than do stored red blood cells

BACKGROUND

Increasing need for and potential shortage of blood products have intensified the search for alternative oxygen carriers. A solution to this problem could be use of the bovine hemoglobin-based oxygen carrier HBOC-201. While hemodynamic reactions to cell-free hemoglobin have been studied, little knowledge exists about tissue oxygenation properties of hemoglobin solutions, especially in comparison with red blood cells (RBCs).

STUDY DESIGN AND METHODS

Tissue oxygenation in skeletal muscle of 12 anesthetized dogs was examined after decrease of hemoglobin concentrations by means of hemodilution to hematocrit 10% and subsequent transfusion with either HBOC-201 or autologous banked RBCs. In addition to hemodynamic parameters, blood gas concentrations and oxygen content in arterial and muscular venous blood, tissue oxygen tension (tPO(2)) were measured in the gastrocnemius muscle with a polarographic needle probe.

RESULTS

Hemodilution increased muscular blood flow and oxygen extraction and decreased tPO(2). Transfusion decreased muscular oxygen extraction in the RBC group but not in the HBOC-201 group (P <.01). The 10th percentile of tPO(2) increased by 400% after the first dose of HBOC-201 (P <.001 vs posthemodilution) but only by 33% after equivalent RBC transfusion (P <.01 vs HBOC-201). Increases in the 50th (120%, P <.05) and 90th (31%) percentiles and all percentiles of tPO(2) after the second and third HBOC-201 dose were less pronounced but higher than in the RBC group.

CONCLUSION

Compared with RBC transfusion, infusion of low doses of HBOC-201 maintain enhanced oxygen extraction after extended hemodilution and provide faster and higher increase in muscular tissue PO(2).

[Glomus tumour of the stomach. A case report]

Glomus tumours are benign neoplasms that usually arise in the skin of the extremities but have infrequently been found to occur in other sites including the stomach. We report on a 71-year-old female with non-specific epigastric pain who was diagnosed as having a small, intramural gastric tumour in addition to a cholecystolithiasis. Intraoperatively, the tumour was investigated by frozen section, but the diagnosis remained inconclusive. The ultimate histological examination showed clusters of uniform epithelioid cells surrounding wide vascular spaces. This led to the diagnosis of a glomus tumour. In a review of the recent literature,we discuss the methods and limitations of preoperative diagnostic measures.