Direkte maschinelle Erfassung von Krankenblattdaten

In der vorliegenden Arbeit wird ein modernes Verfahren zur Erfassung des klinischen Aufnahmebefundes und der Anamnese dargestellt. Es ermöglicht die direkte maschinelle Verarbeitung klinischer Informationen durch eine elektronische Datenverarbeitungsanlage. Die Befunde sind speicherbar und stehen jederzeit zur weiteren Auswertung zur Verfügung. Im einzelnen wird der Aufbau dieses neuartigen Krankenblattes besprochen und die Prinzipien aufgestellt, denen ein derartiges Verfahren unterworfen ist, wenn es Anspruch auf Flexibilität erheben und in der Praxis anwendbar sein soll.

X-ray asterism and the structure of cracks from indentations in silicon

The asterism observed in white radiation X-ray diffraction images (topographs) of extended cracks in silicon is investigated and found to be associated with material that is close to breakout and surrounded by extensive cracking. It is a measure of the mechanical damage occurring when the fracture planes do not follow the low-index cleavage planes associated with the crystal structure. It is not related to a propensity for some cracked wafers to shatter during subsequent high-temperature processing. There is no correlation between crack morphology and alignment of an indenter with respect to the orientation of a silicon wafer, the cracks being generated from the apices of the indenter and having threefold symmetry for Berkovich indents and fourfold symmetry for Vickers indents. X-ray diffraction imaging (XRDI) of indents does not reveal this underlying symmetry and the images exhibit a very substantial degree of variation in their extent. This arises because the XRDI contrast is sensitive to the long-range strain field around the indent and breakout reduces the extent of this long-range strain field. Breakout is also detected in the loss of symmetry in the short-range strain field imaged by scanning micro-Raman spectroscopy. Weak fourfold symmetric features at the extremes of the images, and lying along 〈110〉 directions, are discussed in the context of slip generated below the room-temperature indents. Scanning electron microscopy imaging of the region around an indent during focused ion beam milling has permitted the three-dimensional reconstruction of the crack morphology. The surface-breaking Palmqvist cracks are found to be directly connected to the median subsurface cracks, and the presence of extensive lateral cracks is a prerequisite for material breakout at indenter loads above 200 mN. The overall crack shape agrees with that predicted from simulation.

Continuous polycrystalline silicon layers on glass grown from tin solutions

Polycrystalline silicon on glass for photovoltaic applications is grown at low temperatures in a two-step process.

Modification of the circadian pattern of ventricular tachyarrhythmias by beta-blocker therapy

BACKGROUND

Sudden cardiac death exhibits a circadian variation and predominantly occurs during morning hours, Beta-adrenergic antagonists have shown to blunt this morning peak. However, previous reports studying the effects of beta blockers on the circadian variation did not analyze the underlying cause of sudden cardiac death. It thus remains unclear whether ventricular tachyarrhythmias are influenced by beta-blocker therapy.

HYPOTHESIS

This study tested the hypothesis that beta-blocking agents blunt the morning peak of life-threatening ventricular tachyarrhythmias.

METHODS

In 87 patients who were treated and monitored with an implantable cardioverter defibrillator, the circadian distribution of ventricular tachyarrhythmias terminated by appropriate shocks was analyzed and compared in those receiving beta blockers versus those not receiving beta-blocker therapy.

RESULTS

Tachyarrhythmic episodes in the absence of beta-blocker therapy (n = 344) exhibited a circadian variation with a distinct morning peak (16, 38, 28, and 18% of episodes at 0-6, 6-12, 12-18, and 18-24 h, respectively, p < 0.001). In contrast, tachyarrhythmic episodes during beta-blocker therapy (n = 104) were equally distributed over time (22, 27, 24, and 27% of episodes at 0-6, 6-12, 12-18, and 18-24 h, respectively, p = 0.95). The circadian distribution of episodes was significantly different in patients with and those without beta blockade (p < 0.05).

CONCLUSION

Beta-adrenergic antagonists influence the circadian distribution of malignant ventricular tachyarrhythmias in patients with an implantable cardioverter defibrillator. The blunted morning peak of tachyarrhythmic events during beta blockade supports the hypothesis that a sympathetic surge is involved in the circadian pattern of malignant arrhythmias.

[Angiomyolipoma of the kidneys as a rare cause of retroperitoneal hemorrhage. Two case reports with tuberous sclerosis Bourneville-Pringle]

Tuberous sclerosis (Bourneville-Pringle-disease, TSC) is an autosomal dominant disorder characterized by seizures, mental retardation and hamartomatous tumours in multiple organs, including subependymal giant cell astrocytomas, cardiac rhabdomyomas and renal angiomyolipomas. Recent population-based studies suggest a prevalence of 1 case per 25,000 individuals. Renal angiomyolipomas, which may be found sporadically or associated with TSC, become evident as an acute retroperitoneal haemorrhage or by symptoms of a flank mass. Ultrasound and computed tomography provide clear evidence of lipomatous formation while, in rare instances, angiography can demonstrate the existence of multiple vascular tumour compartments. In view of two cases which were admitted with the clinical picture of an acute abdomen on the basis of retroperitoneal haemorrhage, the therapeutic strategies for TSC patients with renal angiomyolipomas are discussed, paying regard to the literature in this field.

Comparison of two pH meters used for skin surface pH measurement: the pH meter 'pH900' from Courage & Khazaka versus the pH meter '1140' from Mettler Toledo

BACKGROUND/AIMS

Measurement of skin surface pH is used in clinical research to evaluate hazardous shifts in pH following external exposures and to evaluate the state of diseased skin with acute or chronic changes. It is therefore important to measure skin surface pH as precisely as possible. The aim of this study was to compare two commercially available pH meters used for skin surface pH measurement, to reveal differences between them in measured skin pH on the forearm.

METHODS

The first pH meter (pH900) had a pointed electrode and a stabilisation period of 3 s. The second pH meter (pH meter 1140) had a circular electrode and no fixed stabilisation period. Twelve healthy subjects (6 male and 6 female Caucasians) entered the study. The pH measurements were performed once an hour from 8 a.m. to 3 p.m. on both forearms in five areas from the elbow to the "wristwatch" zone. In each area, three measurements were performed next to each other with both pH meters (15 measurements per arm per hour per pH meter).

RESULTS

The pH900 has a higher measuring level and a higher variation than the pH meter 1140.

CONCLUSION

A skin surface pH meter with a circular electrode and with no fixed stabilisation period is preferable. It is recommended that the pH meter be allowed to stabilise for at least 7 s before the result is read.

Females have lower skin surface pH than men. A study on the surface of gender, forearm site variation, right/left difference and time of the day on the skin surface pH

BACKGROUND/AIMS

It is of great interest to describe the many functions and properties of the skin in order to better understand reactions that result in different skin abnormalities, as a prerequisite in the development of skin products and topical medicines. Skin surface pH is considered a critical parameter of skin wellbeing and is typically studied on the forearm skin. Despite many previous investigations, this is an extensive field that still needs a great deal of research. The aim of our study was to investigate gender related differences, differences between right and left arms, anatomical variation and daytime variation in skin surface pH.

METHODS

Skin surface pH was measured on the flexor surface of the forearm on eleven healthy volunteers (6 men and 5 women). A Mettler Toledo pH meter (pH meter 1140) was used. The subjects were measured once every hour from 8 a.m. to 3 p.m. in five areas from the elbow to the wrist. In each of the five areas, three measurements were performed next to each other, and the mean of these was used in subsequent calculations.

RESULTS

A statistically significant difference in skin pH between men (mean pH=5.80) and women (mean pH=5.54) was found, with women being more acidic than men (P<0.01). No difference between right and left arm was found. In men, the area closest to the wrist had significantly lower pH values compared with the proximal sites. This was not the case in women. Skin surface pH decreased during normal working hours in both genders.

CONCLUSION

Spontaneous skin surface pH was found to be significantly lower in women, as compared to men--albeit, the difference was small and of unknown relevance. Nevertheless, comparative studies on skin surface pH should be balanced with respect to gender. There appeared to be no right/left difference and no systematic change during the working day. Also, measurements should not be conducted close to the wrist.

Genotyping of the polymorphic N-acetyltransferase (NAT2) and loss of heterozygosity in bladder cancer patients

Acetylation is one of the major routes in metabolism and detoxification of a large number of drugs, chemicals and carcinogens. Slow acetylators are said to be more susceptible to developing bladder cancer and because of investigations about tumor risk based on phenotyping procedures, it was our aim to study the distribution of allelic constellations of the N-acetyltransferase (NAT2) by genotyping patients with bladder cancer. We analysed NAT2 gene of blood and tumor DNA from 60 patients with primary bladder cancer and DNA of blood samples from 154 healthy individuals. Using ASO-PCR/RFLP techniques we identified 70% of patients with bladder cancer (n = 42) to be slow acetylators while genotyping of controls resulted in 61% with slow acetylators (n = 94). In addition, dividing bladder cancer patients in males and females the genotype NAT2*5B/NAT2*6A occured with much higher frequencies in males (OR = 4, 95%); CI = 1.8-8.9). Furthermore, investigating bladder cancer tissues we could detect loss of heterozygosity (LOH) in slow and rapid acetylator genotypes. In eleven out of 60 tumor samples (18.3%) we observed allelic loss at the NAT2 locus while in control DNA of blood from the same patients both alleles were still detectable.

Risk of ventricular arrhythmias in survivors of myocardial infarction

The most recent studies have made it clear that the prognosis of asymptomatic post-MI patients has significantly improved in the last two decades. Holter monitoring as well as a low LVEF still is an important method for the risk stratification in the thrombolytic era of patients with post-MI. Patients with normal noninvasive tests do have a good prognosis. The electrophysiological stimulation seems to be the clinically most valuable single method to predict arrhythmic events. However, as an invasive procedure it is not suitable as a screening test for a large cohort. The stepwise risk stratification technique using first noninvasive followed by invasive procedures seem to be most suitable and effective for identifying asymptomatic infarct survivors which incidence of arrhythmic events is as high as the recurrence rate of patients who had been resuscitated from ventricular fibrillation. Consequently, prophylactic implantation of a defibrillator in asymptomatic MI patients, whose positive predictive value is around 30% becomes more and more interesting.

Screening for molecules interacting with proteasomes in Thermoplasma acidophilum

Thermoplasma acidophilum cell extracts were fractionated by gel filtration. Proteasomes were eluted as two major peaks. The first one (molecular mass(r) about 2 MDa) contained proteasomes associated with DNA/protein complexes. Proteasomes eluted in the other peak were partially resolved into three subpeaks and based on their preferential hydrolysis of casein, Z-GGL-MCA, and suc-LLVY-MCA, were designated C, L and Y, respectively. Further purification of proteasomes from peak Y resulted in a homogenous enzyme preparation, whereas proteasomes purified from peak C contained a homomultimeric protein composed of 20 kDa subunits. Thus, association of proteasomes with this protein seems to be responsible for the observed increase in molecular mass and for inhibition of caseinolytic activity by Ca2+-ions.

[Cerebral ischemia during implantation of automatic defibrillators]

In order to study the influence of repetitive episodes of ventricular fibrillation (VF) during defibrillator implantation on the electrical activity of the brain, we performed an electroencephalographic (EEG) monitoring during implantation procedure in 18 patients. For defibrillation threshold testing 62 episodes of VF (1-6 episodes per patient) were induced. The mean duration of VF was 20 +/- 12 s; the mean duration of hypotension during an episode (defined as a mean arterial pressure of 50 mm Hg or less) was 33 +/- 16 s. EEG monitoring was performed using the International 10-20 System. The duration of cardiac arrest-related EEG alteration was assessed by an experienced neurologist and could be determined in 41 test-episodes; in 21 episodes analysis was not possible due to poor recordings. Ischemia-related EEG changes started 7.8 +/- 4.6 s after VF induction and lasted 64 +/- 49 s (range, 12-240). The duration of EEG alteration was significantly (p < .001) correlated with the duration of VF episodes (r = .71) and the associated hypotension (r = .82). With regard to patients the duration of ischemia related EEG changes also correlated significantly (p = .001) with the individual cumulative duration of VF (r = .85) and the associated hypotension (r = .88). In females EEG changes lasted longer than in males (p = .03); this finding, however, was only based on 2 women. Other clinical parameters, such as patient age, degree of congestive heart failure, left ventricular ejection fraction, stroke volume and cardiac index, the order of episodes within the testing sequence, and the time interval between episodes did not correlate with the duration of EEG alteration after VF induction. The duration of ischemia-related EEG alteration during VF episodes depends on the duration of cardiac arrest. In females EEG changes tended to last longer than in males, however, this finding has to be confirmed. An association with other clinical parameters has not been observed. Limitation of VF duration appears to be the most important factor to avoid prolonged cerebral ischemia.

Management and prophylaxis of life-threatening arrhythmias--recent achievements

Patients resuscitated from ventricular fibrillation or haemodynamically compromising ventricular tachycardias have an unfavourable clinical outcome. Moreover, there is no evidence that the prognosis can be improved by empirical use of antiarrhythmic therapy. Therapy guided by electrophysiological stimulation or long-term ECG identifies a subgroup of patients with a better outcome (in whom arrhythmias are suppressed) and a subgroup with a bad prognosis (in whom arrhythmias are not suppressed). However, this does not say that antiarrhythmic drugs actually improve the outcome. It may simply identify patients with an intrinsically good prognosis, regardless of whether they receive drug treatment. Because retrospective trials have reported that empiric administration of amiodarone provides long-term control in two-thirds or more of patients with refractory ventricular tachyarrhythmias, a direct comparison with other drugs guided by electrophysiological testing or long-term ECG was performed (CASCADE-study). Six-years survival was 41% under amiodarone versus 20% with other drugs. Even those conventionally treated patients, whose inducible arrhythmias were suppressed, had a trend toward a worse prognosis compared to those who were inducible and treated empirically with amiodarone. However, the high recurrence rate of arrhythmic events demonstrates the limitation of any antiarrhythmic drug, irrespective of the drug used and irrespective of whether it is given empirically or in a study.

Circadian variation of sustained ventricular tachyarrhythmias terminated by appropriate shocks in patients with an implantable cardioverter defibrillator

To determine the circadian variation of sustained ventricular tachyarrhythmias, 78 consecutive patients with an implanted cardioverter defibrillator were analyzed with regard to the occurrence of spontaneous shock episodes during a mean follow-up period of 18 +/- 12 months. In 39 patients 207 shock episodes that terminated potentially life-threatening ventricular tachyarrhythmias could be related to an exact time of onset. A circadian variation (p < 0.001) of these events was demonstrated, with a primary morning peak between 7 hours and 11 hours and a secondary, much smaller peak between 16 hours and 20 hours. This finding indicates the relevance of endogeneous or exogeneous triggers in the cause of malignant arrhythmias that potentially lead to sudden cardiac death. Subgroup analyses revealed an association of the circadian pattern to the New York Heart Association functional classification, indicating perhaps a different role of triggers in different patient populations.

Melatonin in edible plants identified by radioimmunoassay and by high performance liquid chromatography-mass spectrometry

Melatonin, the chief hormone of the pineal gland in vertebrates, is widely distributed in the animal kingdom. Among many functions, melatonin synchronizes circadian and circannual rhythms, stimulates immune function, may increase life span, inhibits growth of cancer cells in vitro and cancer progression and promotion in vivo, and was recently shown to be a potent hydroxyl radical scavenger and antioxidant. Hydroxyl radicals are highly toxic by-products of oxygen metabolism that damage cellular DNA and other macromolecules. Herein we report that melatonin, in varying concentrations, is also found in a variety of plants. Melatonin concentrations, measured in nine different plants by radioimmunoassay, ranged from 0 to 862 pg melatonin/mg protein. The presence of melatonin was verified by gas chromatography/mass spectrometry. Our findings suggest that the consumption of plant materials that contain high levels of melatonin could alter blood melatonin levels of the indole as well as provide protection of macromolecules against oxidative damage.

[Reproducibility of symptom-limited oxygen consumption and anaerobic threshold within the scope of spiroergometric studies in patients with heart failure]

A prerequisite for the clinical utility of cardiopulmonary exercise testing is high reproducibility of gas-exchange characteristics. Therefore, we studied reproducibility of peak oxygen uptake and anaerobic threshold during bicycle-exercise stress testing in 34 patients with congestive heart failure in NYHA classes II and III. Additionally, we analyzed interobserver variability with regard to anaerobic threshold measured with the V-slope method. Correlations of results between two exercise stress tests were high concerning peak oxygen uptake and anaerobic threshold (r = 0.871 and r = 0.917, respectively). For both measures, however, 90% percentile of the relative difference between tests was 25% and 22%, respectively. Correlation between two observers with regard to the anaerobic threshold was high (r = 0.985). We conclude that reproducible determination of peak oxygen uptake and anaerobic threshold is possible in heart-failure patients. In individual subjects, however, considerable variation of results may occur during serial exercise testing. Interobserver variability with regard to anaerobic threshold is low.

[Clinical aspects and prognosis of atrial fibrillation]

Atrial fibrillation is alleged to be one of the most frequently occurring arrhythmia. Many patients with atrial fibrillation are asymptomatic. Others, however, complain of palpitations and paroxysmal atrial tachycardias. And especially in patients with preexisting heart failure, atrial fibrillation can lead to a clear worsening of cardiac output. Not only rheumatic but nonrheumatic atrial fibrillation as well are associated with an increased risk of thromboembolic complications. Arterial hypertension, a history of thromboembolism as well as signs of heart failure are clinical parameters which additionally increase the risk of embolism. On the other hand, this increased risk does not hold true for younger patients with idiopathic atrial fibrillation and is also low in patients with only one additional risk factor. Thus, it would indeed be false to anticoagulate every patient with atrial fibrillation. In each case, a careful individual risk stratification including an extensive history and detailed clinical examination should be performed before deciding on antithrombotic therapy.

In vitro activation of the 20S proteasome

The effect of chemical compounds like sodium dodecyl sulfate (SDS), fatty acid esters of glycerol, carnitine and coenzyme A, phospholipids, histones, polylysines as well as homobifunctional chemical cross-linkers on the various proteolytic activities of mammalian proteasomes have been tested. Most of the reagents enhance these activities, and some, e.g. fatty acid CoA esters, histones and the chemical cross-linkers, exert dual effects, i.e. activation and inhibition at the same time, depending on the activity measured. With optimally activating concentrations of SDS, no structural changes in proteasomes can be detected by electron microscopy. Formation of micelles at supra-optimal detergent concentrations may be a reason for irreversible denaturation of the proteasome.

Human growth hormone releasing factor infusion effects on plasma growth hormone in affective disorder patients and normal controls

In a preliminary, prospective pilot study, five patients with major depressive disorder and eleven age and sex matched normal controls received intravenous human growth hormone releasing factor (hGRF) (1 microgram/kg in 5 cc of normal saline infused over five minutes) and placebo. Thirty minutes after insertion of the catheter, blood was sampled every 15 minutes for thirty minutes prior to and for 2 hours subsequent to intravenous infusion of hGRF or placebo. hGRF but not placebo caused significant elevations of plasma growth hormone levels in all subjects. Of interest, the depressed patients had a significantly attenuated rise in plasma growth hormone concentrations when compared with the normal controls. These results must be considered preliminary awaiting replication with a larger subject population.

Verbal learning differences in epileptic patients with left and right temporal lobe foci

A verbal learning test patterned after and using the same format as the Rey Auditory-Verbal Learning Test was administered to the following three groups: (1) patients with left temporal lobe epilepsy (L-TLE) as defined by EEG criteria (n = 11); (2) patients with right temporal lobe epilepsy (n = 10); and (3) normal controls (n = 11). Performance was highly similar for all three groups during the five immediate recall learning trials. The performance of the L-TLE group, averaged across three delayed recall trials (free recall, phonemic cued recall, semantic cued recall), was significantly poorer than that of the other two groups. The L-TLE group showed the worst performance on the phonemic cued recall trial, poor performance on the delayed free recall trial, and relatively intact performance on the semantic cued recall trial. Immediate and delayed free recall and phonemic and semantic cued recall for the distractor list did not discriminate groups. Word frequency, word presentation order, and concrete versus abstract words did not have different effects across groups.

Effects of intraventricular infusions of 6-hydroxydopamine (6-OHDA) on pituitary LH release and ovulation in the rabbit

Repeated infusions of 6-hydroxydopamine (6-OHDA) into the third ventricle of the rabbit brain in dosages shown to depress hypothalamic norepinephrine (NE) by more than 80% failed to block the copulation-induced ovulatory surge of LH release from the adenohypophysis in estrogen-primed, multiparous New Zealand White does. Only when infusion of the neurotoxin produced a basal hypothalamic lesion did it intercept the coital stimulus and prevent LH release. In 5 rabbits the initial infusion of 6-OHDA stimulated an LH surge presumably by activating NE release from noradrenergic nerve endings. The failure of chronic depletion of hypothalamic NE to prevent coitally-induced LH release suggests that the transmitter may normally play only a modulatory role in hypothalamopituitary activation in the reflex ovulator, as has also been proposed for its function in cyclic ovulation in the rat. The results suggest that alternative systems may be brought into play to subserve reproductive mechanisms when hypothalamic NE is chronically depleted.

Response to CO2 of intrapulmonary chemoreceptors in the emu

We studied discharge frequencies of 12 intrapulmonary chemoreceptors in the paleopulmonic lung of an emu (Dromiceius novaechollandiae) during unidirectional, artificial ventilation when step changes and static CO2 concentrations were given. Discharge frequency in afferent neurons from the receptors increased as intrapulmonary CO2 decreased. The response of the receptors to various static intrapulmonary CO2 concentrations was similar to that previously demonstrated for the duck and chicken. The median sensitivity of the emu receptors at one-half maximal discharge was 4.6 imp-(sec-0.01 F1CO2)-1. Discharge frequencies altered phasically in nine of 12 receptors when step changes in CO2 of 3.3% at 1.6 Hz were given in the unidirectional gas stream while four of 12 modulated their discharge when the CO2 changes were as rapid as 3.2 Hz. Hence, some receptors can respond to rapid fluctuations in CO2 in their microencironment. We conclude that intrapulmonary chemoreceptors in the paleopulmonic lung of the emu exhibit similar characteristics to those in birds that possess varying amounts of neopulmonic parabronchi, such as the duck and chicken.