Impact of the COVID-19 pandemic on people in need of care or support: protocol for a SARS-CoV-2 registry

INTRODUCTION

People in need of care or support are severely affected by the COVID-19 pandemic. We lack valid data of long-term assessments. We present a register study to detect the physical and psychosocial impact of the COVID-19 pandemic on people in need of care or support in Bavaria, Germany. To describe the persons' life conditions comprehensively, we assess the perspectives and needs of the respective care teams too. Results will serve as evidence-based source to manage the pandemic and long-term prevention strategies.

METHODS AND ANALYSIS

The 'Bavarian ambulatory COVID-19 Monitor' is a multicentre registry including a purposive sample of up to 1000 patient-participants across three study sites in Bavaria. The study group consists of 600 people in need of care with a positive SARS-CoV-2 PCR test. Control group 1 comprises 200 people in need of care with a negative SARS-CoV-2 PCR test, while control group 2 comprises 200 people with a positive SARS-CoV-2 PCR test but are not in need of care. We assess the clinical course of infection, psychosocial aspects and care needs using validated measures. Follow-up is every 6 months for up to 3 years. Additionally, we assess up to 400 people linked to these patient-participants (caregivers, general practitioners (GPs)) for their health and needs. Main analyses are stratified by level of care I-V (I=minor/V=most severe impairment of independence), inpatient/outpatient care setting, sex and age. We use descriptive and inferential statistics to analyse cross-sectional data and changes over time. In qualitative interviews with 60 stakeholders (people in need of care, caregivers, GPs, politicians), we explore interface problems of different functional logics, of everyday and professional perspectives.

ETHICS AND DISSEMINATION

The Institutional Review Board of the University Hospital LMU Munich (#20-860) and the study sites (Universities of Wurzburg and Erlangen) approved the protocol. We disseminate the results by peer-reviewed publications, international conferences, governmental reports, etc.

Socioeconomic and risk-related drivers of compliance with measures to prevent SARS-CoV-2 infection: evidence from the Munich-based KoCo19 study

OBJECTIVES

Although a growing share of the population in many countries has been vaccinated against the SARS-CoV-2 virus to different degrees, social distancing and hygienic non-pharmaceutical interventions still play a substantial role in containing the pandemic. The goal of this study was to investigate which factors are correlated with a higher compliance with these regulations in the context of a cohort study in the city of Munich, southern Germany, during the summer of 2020, i.e. after the first lockdown phase.

METHODS

Using self-reported compliance with six regulations and personal hygiene rules (washing hands, avoiding touching face, wearing a mask, keeping distance, avoiding social gatherings, avoiding public spaces) we extracted two compliance factor scores, namely compliance with personal hygiene measures and compliance with social distancing regulations. Using linear and logistic regressions, we estimated the correlation of several socio-demographic and risk perception variables with both compliance scores.

RESULTS

Risk aversion proved to be a consistent and significant driver of compliance across all compliance behaviors. Furthermore, being female, being retired and having a migration background were positively associated with compliance with personal hygiene regulations, whereas older age was related with a higher compliance with social distancing regulations. Generally, socioeconomic characteristics were not related with compliance, except for education, which was negatively related with compliance with personal hygiene measures.

CONCLUSIONS

Our results suggest that for a targeted approach to improve compliance with measures to prevent SARS-CoV-2 infection, special attention should be given to younger, male and risk-prone individuals.

Detecting Medication Risks among People in Need of Care: Performance of Six Instruments

INTRODUCTION

Numerous tools exist to detect potentially inappropriate medication (PIM) and potential prescribing omissions (PPO) in older people, but it remains unclear which tools may be most relevant in which setting.

OBJECTIVES

This cross sectional study compares six validated tools in terms of PIM and PPO detection.

METHODS

We examined the PIM/PPO prevalence for all tools combined and the sensitivity of each tool. The pairwise agreement between tools was determined using Cohen's Kappa.

RESULTS

We included 226 patients in need of care (median (IQR age 84 (80-89)). The overall PIM prevalence was 91.6 (95% CI, 87.2-94.9)% and the overall PPO prevalence was 63.7 (57.1-69.9%)%. The detected PIM prevalence ranged from 76.5%, for FORTA-C/D, to 6.6% for anticholinergic drugs (German-ACB). The PPO prevalences for START (63.7%) and FORTA-A (62.8%) were similar. The pairwise agreement between tools was poor to moderate. The sensitivity of PIM detection was highest for FORTA-C/D (55.1%), and increased to 79.2% when distinct items from STOPP were added.

CONCLUSION

Using a single screening tool may not have sufficient sensitivity to detect PIMs and PPOs. Further research is required to optimize the composition of PIM and PPO tools in different settings.

Long-term follow-up on HIV infected and non-infected women with cervical cancer from Tanzania: staging, access to cancer-directed therapies and associated survival in a real-life remote setting

Background

Worldwide 85% of cervical cancer (CC) related deaths occur in low- and middle-income countries. Sub-Saharan Africa is burdend by an overlapping high incidence of CC as well as HIV infection, a risk factor for HPV associated disease progression. Recent upscaling of CC screening activities increased the number of CC diagnoses in a previous unscreened population. The aim of the 2H study was to follow up on women with CC in the context of available health care services in Tanzania in relation to their HIV infection status.

Methods

This longitudinal observational cohort study included women with histological confirmed CC from Mbeya, Tanzania, between 2013–2019. All women were referred for CC staging and cancer-directed therapies (CDT), including surgery and/or radio-chemotherapy, or palliative care. Annual follow-up focused on successful linkage to CDT, interventions and survival. We assessed factors on compliance, used Kaplan–Meier-Survivor functions to evaluate survival time and poisson regression models to calculate incidence rate ratios on mortality (IRR) two years after diagnosis.

Results

Overall, 270 women with CC (123 HIV infected) were included. Staging information, available in 185 cases, showed 84.9% presented with advanced stage disease (FIGO ≥ IIB), no difference was seen in respect to HIV status. HIV-infected women were 12 years younger at the time of cancer diagnosis (median age 44.8 versus 56.4 years, p < 0.001). Median follow up period was 11.9 months (range 0.2–67.2). Survival information, available in 231 cases, demonstrated for women diagnosed in early-stage disease a median survival time of 38.3 months, in advanced-stage 16.0 months and late-stage disease 6.5 months after diagnosis. Of all women, 42% received CDT or palliative support. HIV co-infection and education were associated with higher health care compliance. CDT was significantly associated with lower 2-year mortality rates (IRR 0.62, p = 0.004). HIV coinfection did not impact mortality rates after diagnosis.

Conclusion

High numbers of advanced and late staged CC were diagnosed, compliance to CDT was low. A beneficial impact of CDT on CC mortality could be demonstrated for local health care services. This study indicates challenges for successful linkage and supports an effective scale up of cancer care and treatment facilities.

Acriflavine, a clinically approved drug, inhibits SARS-CoV-2 and other betacoronaviruses

The COVID-19 pandemic caused by SARS-CoV-2 has been socially and economically devastating. Despite an unprecedented research effort and available vaccines, effective therapeutics are still missing to limit severe disease and mortality. Using high-throughput screening, we identify acriflavine (ACF) as a potent papain-like protease (PL^pro) inhibitor. NMR titrations and a co-crystal structure confirm that acriflavine blocks the PL^pro catalytic pocket in an unexpected binding mode. We show that the drug inhibits viral replication at nanomolar concentration in cellular models, in vivo in mice and ex vivo in human airway epithelia, with broad range activity against SARS-CoV-2 and other betacoronaviruses. Considering that acriflavine is an inexpensive drug approved in some countries, it may be immediately tested in clinical trials and play an important role during the current pandemic and future outbreaks.

Depletion and activation of mucosal CD4 T cells in HIV infected women with HPV-associated lesions of the cervix uteri

BACKGROUND

The burden of HPV-associated premalignant and malignant cervical lesions remains high in HIV+ women even under ART treatment. In order to identify possible underlying pathophysiologic mechanisms, we studied activation and HIV co-receptor expression in cervical T-cell populations in relation to HIV, HPV and cervical lesion status.

METHODS

Cervical cytobrush (n = 468: 253 HIV- and 215 HIV+; 71% on ART) and blood (in a subset of 39 women) was collected from women in Mbeya, Tanzania. Clinical data on HIV and HPV infection, as well as ART status was collected. T cell populations were characterized using multiparametric flow cytometry-based on their expression of markers for cellular activation (HLA-DR), and memory (CD45RO), as well as HIV co-receptors (CCR5, α4β7).

RESULTS

Cervical and blood T cells differed significantly, with higher frequencies of T cells expressing CD45RO, as well as the HIV co-receptors CCR5 and α4β7 in the cervical mucosa. The skewed CD4/CD8 T cell ratio in blood of HIV+ women was mirrored in the cervical mucosa and HPV co-infection was linked to lower levels of mucosal CD4 T cells in HIV+ women (%median: 22 vs 32; p = 0.04). In addition, HIV and HPV infection, and especially HPV-associated cervical lesions were linked to significantly higher frequencies of HLA-DR+ CD4 and CD8 T cells (p-values < 0.05). Interestingly, HPV infection did not significantly alter frequencies of CCR5+ or α4β7+ CD4 T cells.

CONCLUSION

The increased proportion of activated cervical T cells associated with HPV and HIV infection, as well as HPV-associated lesions, together with the HIV-induced depletion of cervical CD4 T cells, may increase the risk for HPV infection, associated premalignant lesions and cancer in HIV+ women. Further, high levels of activated CD4 T cells associated with HPV and HPV-associated lesions could contribute to a higher susceptibility to HIV in HPV infected women.

OC 8561 RAPAED TB: AN INNOVATIVE CHILD TB DIAGNOSTIC VALIDATION STUDY

Background

Children account for an estimated 1 million new cases of TB every year, representing roughly 7% of the total disease burden. Every year, around 2 09 000 children die from TB, half of those cases are in Africa. The main issue continues to be timely and accurate diagnosis, as treatment outcomes – even in the case of drug resistance – are significantly better than in adults.

Clinical diagnosis in the absence of laboratory confirmation is hampered by non-specificity of symptoms. Diagnostics validation studies in children are difficult – in most studies, very few of the symptomatic children achieved microbiological disease confirmation, resulting in imprecise estimates for test sensitivity.

Design/methods

With the RaPaed TB study funded by EDCTP, we are preparing an improved diagnostic validation study design to improve on the traditional approach of a single-gate, double diagnostic study in the target population. The project will evaluate multiple new tests on the same patients, to determine algorithms of screening and confirmatory tests. Most novel tests in this study use non-sputum samples and are therefore more suitable for children.

Allocation of patients to standardised groups will follow the recommendations of the NIH-convened consensus panel on case definitions of paediatric TB diagnostic studies. Using an endpoint review committee will allow blinded review of those new-positive cases, plus matched controls, and determine their likelihood of disease based on clinical data including follow-up, and X-ray. This will improve the quality of evaluation of false positive vs. true positive results of new tests and therefore improve the assessment of specificity.

To improve on sensitivity assessment, the study includes partners with a high number of confirmed cases in past studies and plans to draw in cases of confirmed disease from other diagnostic facilities.

Conclusion

This improved methodology will lead to more meaningful and applicable results of diagnostic validation studies.

Kulturelle Unterschiede zwischen Mitglieds- und Beitrittsländern der EU / Cultural Differences between Present and Future Member Countries of the European Union

Kulturelle Unterschiede zwischen den Mitglieds- und Beitrittsländern werden die Integration der neuen Länder in die EU erschweren. Wir gehen in dem Artikel der Frage nach, inwieweit sich die Bürger in den Mitglieds- und Beitrittsländern der Europäischen Union im Hinblick auf ihre Einstellungen zur Familie und zu Geschlechterrollen unterscheiden. In einem ersten Schritt rekonstruieren wir das von der EU-Politik bevorzugte Leitbild einer politisch erwünschten Familie. Die EU favorisiert mit ihrer Politik die doppelte Erwerbstätigkeit von Mann und Frau, die gerechte Aufteilung von Hausarbeit und die zumindest partielle Sozialisation der Kinder in außerfamiliären Einrichtungen. Wir untersuchen dann mit Hilfe einer Sekundäranalyse von Umfragedaten aus west- und mittel/osteuropäischen Ländern, inwieweit dieses Familienmodell der EU von den Bürgern akzeptiert wird. Die empirischen Ergebnisse zeigen, dass sich die beiden Ländergruppen deutlich voneinander unterscheiden. Die Bürger der Mitgliedsländer der Europäischen Union unterstützen signifikant häufiger das EU-Leitbild als die Bürger der mittel/osteuropäischen Länder. Wir interpretieren diesen Unterschied vor allem als Folge der geringeren ökonomischen Modernisierung der Beitrittsländer und der Dominanz einer katholisch geprägten Kultur. Innerhalb der Gruppe der Mitgliedsländer der EU zeigen sich Unterschiede zwischen den protestantischen und katholischen Ländern. Die protestantischen Länder, die zudem meist einen Wohlfahrtsstaat entwickelt haben, der eine Berufstätigkeit der Frauen fördert, kommen dem Leitbild der EU am nächsten. Zum Abschluss des Artikels beziehen wir unsere Befunde auf die klassische kultursoziologische Frage nach dem Zusammenhang von Ökonomie und Kultur und diskutieren die Folgen unserer Ergebnisse für den Integrationsprozess der EU.

A DFT study of ruthenium pincer carboxylate complexes as potential catalysts for the direct carboxylation of arenes with CO2- meridional versus facial coordination

A recent DFT study of the ruthenium pincer benzoate complex [Ru(PNP)(PhCOO)2] I (PNP = 2,6-bis(diphenylphosphanyl)lutidine) in its meridional form has revealed mer-I to be a promising catalyst lead structure for the direct insertion of CO2 into the C-H bonds of arenes, such as benzene. After the successful synthesis of I, its solid state structure interestingly and unexpectedly showed the pincer ligand to adopt the facial rather than the meridional coordination mode. Recalculation of the catalytic cycle with fac-I including all relevant local minima and transition states revealed (a) fac-I to be significantly more stable (6.1 kcal mol(-1)) than mer-I, (b) that the energetic span (ES; i.e. the effective activation barrier) for the cycle with fac-I amounts to 38.8 kcal mol(-1), while the cycle with mer-I has an ES of 25.5 kcal mol(-1) only. These results are a hint that fac-I is catalytically inactive. Experimental testing of fac-I showed indeed no product formation, which is in full accordance with the computations. To reduce the spatial flexibility of the pincer ligand, its CH2 groups were replaced by O atoms. The resulting complex [Ru(PONOP)(PhCOO)2] II (PONOP = 2,6-bis(diphenylphosphinito)pyridine) was used for the calculation of the catalytic cycle in benzene as the solvent. Gratifyingly, the starting complex mer-II is more stable than fac-II by 1.9 kcal mol(-1) in benzene as the solvent. Consequently, mer-II should be available experimentally. As with fac-I, also fac-II generates a catalytic cycle with a high ES (37.1 kcal mol(-1)), while mer-II generates a cycle with a significantly lower ES (27.2 kcal mol(-1)) indicating mer-II to be a potentially active catalyst. A possible explanation of the much lower ES in the case of the meridionally coordinated species is found in the stronger interaction of the substrate with the metal center in the arene-σ-bond complex. As a result the issue that is created by the mer/fac isomerism can be resolved by creating spatially less flexible structures.

Different mutation patterns of Plasmodium falciparum among patients in Jimma University Hospital, Ethiopia

Background

The emergence of drug resistance is a major problem in malaria control. Combination of molecular genotyping and characterization of mutations or single nucleotide polymorphisms (SNPs) correlated with drug resistance can provide information for subsequent surveillance of existing and developing drug resistance patterns. The introduction of artemether/lumefantrine (AL) as first-line treatment, never used before in Ethiopia, allowed the collection of baseline data of molecular polymorphisms before a selection due to AL could occur.

Method

97 patients with uncomplicated falciparum malaria were recruited from April to June 2006 and treated with either AL, quinine (Q) or atovaquone/proguanil (AP) in Jimma University Hospital, Ethiopia. Mutations or SNPs associated with resistance to these drugs were analysed by RFLP (pfdhfr, pfmdr1) and sequencing of the target genes (pfcytb, pfserca ).

Results

SNPs previously reported to be associated with resistance to the study drugs were identified in recrudescent and treatment sensitive isolates. A total of seven recrudescences were obtained. The pfmdr1 N86Y mutation was found in 84.5% of isolates. The triple mutation 51I,59R,108N of the pfdhfr gene occured in high frequency (83.3%) but no pfcytb mutation was detected. Sequencing showed a variety of previously described and new mutations in the pfserca gene.

Conclusion

The prevalence of mutations was in accordance with the expected patterns considering recent drug regimens. The broad introduction of AL and the cessation of former drug regimens might probably change the current distribution of polymorphisms, possibly leading to decreased sensitivity to AL in future. Continuous surveillance of molecular patterns in this region is, therefore, recommended.

Options in the management of esophageal perforation: analysis over a 12-year period

Controversies exist about the management of esophageal perforation in order to eliminate the septic focus. The aim of this study was to assess the etiology, management, and outcome of esophageal perforation over a 12-year period, in order to characterize optimal treatment options in this severe disease. Between May 1996 and May 2008, 44 patients (30 men, 14 women; median age 67 years) with esophageal perforation were treated in our department. Etiology, diagnostic procedures, time interval between clinical presentation and treatment, therapeutic management, and outcome were analyzed retro- or prospectively for each patient. Iatrogenic injury was the most frequent cause of esophageal perforation (n= 28), followed by spontaneous (n= 9) and traumatic (n= 4) esophageal rupture (in three patients, the reasons were not determinable). Eight patients (18%) underwent conservative treatment with cessation of oral intake, antibiotics, and parenteral nutrition. Twelve (27%) patients received an endoscopic stent implantation. Surgical therapy was performed in 24 (55%) patients with suturing of the lesion in nine patients, esophagectomy with delayed reconstruction in 14 patients, and resection of the distal esophagus and gastrectomy in one patient. In case of iatrogenic perforation, conservative or interventional therapy was performed each in 50% of the patients; 89% of the patients with a Boerhaave syndrome underwent surgery. The hospital mortality rate was 6.8% (3 of 44 patients): one patient with an iatrogenic perforation after conservative treatment, and two patients after surgery (one with Boerhaave syndrome, one with iatrogenic rupture). No death occurred in the 25 patients with a diagnostic interval less than 24 hours, whereas the mortality rate in the group (n= 16 patients) with a diagnostic interval of more than 24 hours was 19% (P= 0.053). In three patients, the diagnostic interval was not determinable retrospectively. An individualized therapy depending on etiology, diagnostic delay, and septic status leads to a low mortality of esophageal perforation.

33-jährige Libanesin mit rezidivierenden Hämoptysen und zystischer Raumforderung in der Lunge

A 33 year old woman from Lebanon presented with recurrent hemoptysis, subfebrile temperature, dyspnoe in stress, fatigue, weight loss, and pruritus. Serological tests and results from chest X-ray and computer tomography revealed cystic echinococcosis with pulmonary involvement. After refusal of surgical therapy a medical treatment with albendazole was implemented. Two months after the start of the therapy only a small fibrotic residuum in the lung was seen. A spontaneous healing success seems unlikely because of the duration of the pulmonary cyst and the progressive symptoms before treatment.

Postulation of the mechanism of the selective synthesis of isotactic poly(methyl methacrylate) catalysed by [Zr[(Cp)(Ind)CMe2](Me)(thf)](BPh4): a Hartree-Fock, MP2 and density functional study

The bridged. C1-symmetric, single-component zirconocene [Zr((Cp)(Ind)CMe2](Me)(thf)](BPh4) (Ind = indenyl, Cp = cyclopentadienyl) polymerises methyl methacrylate (MMA) selectively to isotactic poly(methyl methacrylate) (PMMA) without further cocatalysts or activators. To elucidate the stereoselective steps of the polymerisation of MMA by using this catalyst we studied the propagation steps occurring with the derivative [Zr[(Cp)(Ind)CH2][-O-C(OMe)=C(Me)(Et)](MMA)]+ by ab initio calculations at the Hartree-Fock(HF) level of theory. After the initiation step, which consumes the first two MMA molecules, each new catalytic cycle begins with the stereoselective addition of a new MMA molecule at the indenyl side of the zirconocene fragment. At the same time the enolate ring undergoes a stereoselective in-plane ring shift to the side opposite to the indenyl ring. These findings are used to postulate a mechanism for the polymerisation that explains the stereoselective synthesis of isotactic PMMA.

Prevalence of infection with dengue virus among international travelers

BACKGROUND

Dengue has been recognized as a potential hazard to tourists. A prospective, controlled study in the outpatient clinic of a German infectious disease clinic was conducted to assess the prevalence of dengue virus infection among international travelers.

METHODS

Serum samples from 130 patients with signs or recent history clinically compatible with dengue (fever, headache, muscle and joint pain, or rash), 95 matched controls with diarrhea, and 26 patients who never visited a country endemic for dengue were investigated.

RESULTS

Nine (6.9%) of the 130 patients with compatible symptoms and 1 (1%) of the 95 controls with diarrhea developed rising antibody titers against dengue virus. Of these 10 patients with probable dengue infection, 6 had been to Thailand, 2 to Malaysia, and 1 each to Indonesia and Brazil.

CONCLUSIONS

Infection with dengue virus appears to be a realistic threat to travelers to Southeast Asia. Symptoms commonly associated with dengue, such as fever, myalgia, arthralgia, and vomiting, can be helpful for diagnosis when present, but the absence of typical symptoms does not exclude infection.

[The concept of early functional management of spontaneous Achilles tendon ruptures in patients with kidney transplants]

The special risk constellation of renal transplant patients suffering from rupture of the Achilles tendon promoted the development of a therapeutic concept with early functional treatment. The significant differences to the methods usually employed so far are: local anaesthesia, additional interlacing of the tendon suture, and early functional after-treatment. In a total of ten patients, 15 spontaneous ruptures of the Achilles tendon were treated according to this therapeutic principle. Follow-up after an average of 26 months yielded in all cases a good to very good functional result. This treatment method avoids risk factors that can lead to secondary complications and is thus very suitable for treating spontaneous ruptures of the Achilles tendon in the renal transplant patient.

[Developments in the therapy of advanced FIGO III ovarian cancer]

From 1982 to 1992 103 patients with ovarian cancer stage FIGO III have been treated. In 38% of the patients there was no residual tumour postoperatively, in 40.8% the residual tumour was smaller than 2 cm. In 51.5% bowel resections were necessary, a stoma was unavoidable in just one case. A lymphadenectomy (pelvic, paraaortic or combined) was done in 46.6% of the patients. Postoperatively, 54.4% of the patients received a platinum-based chemotherapy, in the other patients other kinds of chemotherapy were applied. A radiation of the whole abdomen was done only in 3.9%. A median survival time for more than 60 months could be achieved in tumour-free patients due to the increased radical operations in combination with the platinum based chemotherapy. The lymphadenectomy seems to prolong the survival time of the patients. The positive nodal status is definitely unfavourable for the prognosis. By this therapeutic approach, an increased survival time with a good life quality can be achieved.

Radical surgical procedure improves survival time in patients with recurrent ovarian cancer

BACKGROUND

There is plenty of evidence that survival time associated with advanced ovarian cancer is predominantly related to the amount of residual tumor after primary operation. However, there are only few and inconclusive reports concerning the effect of second debulking procedures on survival time after relapse.

METHODS

To evaluate the effect of radical second operation, 30 patients with clinically diagnosed relapses had second operations after a median recurrence-free interval of 16 months. Considerable efforts were made to resect all tumor tissue. Complete resection was achieved in 14 of 39 (47%) patients, and residual tumors smaller than 2 cm remained in 12 (40%) patients. In 19 (63%) patients, intestinal resections were necessary. Operation time, blood units needed, hospital stay, and complication rates were comparable to those associated with primary debulking procedures.

RESULTS

Survival time after second operation was closely correlated with the residual tumor remaining after second surgical procedure and also with the length of the recurrence-free interval. Patients with complete resections had significantly longer survival times than those with residual tumors of less than 2 cm (median, 29 months versus 9 months; P = 0.004). Patients with a recurrence-free interval of more than 12 months had a longer survival time than those with a shorter disease-free time (median, 29 months versus 8 months; P = 0.002). Postoperative treatment also was shown to influence survival time, whereas grade of the tumor (P = 0.74), age of the patient (P = 0.87), and initial FIGO stage (P = 0.58) had no influence on survival time after second operation. Multivariate analysis (Cox regression) revealed that residual tumor after second surgical procedure (relative risk, 4.7) was the most important independent variable predicting survival time after second surgical procedure. Recurrence-free interval (relative risk, 2.7) and postoperative (second-line) treatment (relative risk, 3.0) were equally potent variables. Residual tumor after primary operation, was almost significant (P = 0.06) in the univariate analysis, but was canceled in the multivariate setting by the recurrence-free interval. Again, FIGO stage, grade of the tumor, and patient age had no predictive value.

CONCLUSIONS

The authors conclude that radical surgical procedure can prolong survival times in patients with recurrent ovarian cancer. Patients who had a complete resection of cancer tissue in the primary operation or those who experienced a disease-free interval of more than 12 months after primary operation are most likely to benefit from second operation in recurrent ovarian cancer. Radical surgical procedure should be offered to these patients to enhance efficacy of second-line chemotherapy, which is of limited value in bulky recurrent disease.

[Spontaneous uni- and bilateral Achilles tendon rupture--a frequent complication after kidney transplantation]

In our clinic we observed uni- or bilateral ruptures of the Achilles tendon as a complication in 5% of all renal transplant patients. The majority of ruptures took place within the first two months following transplantation in a phase of increasing physical activity. Besides steroid treatment, elevated uric acid and hyperparathyroidism, advanced age at the time of transplantation as well as long duration of chronic hemodialysis must be considered as risk factors.

[Post-ischemia normal function of living related kidney transplants after preservation with HTK solution]

This study reports on the first clinical use of HTK preservation solution devised by Bretschneider in renal transplantation. Using this HTK solution, nine living related donor kidneys subjected to cold ischemia for up to 4 h were consecutively transplanted between 1987 and 1989. The postoperative function of the donor and recipient kidneys is analyzed. The endogenous creatinine clearance and the plasma creatinine level are used as function parameters. Within 24-48 h after transplantation a postischemic normal graft function occurred. With triple drug therapy the transplanted kidneys showed an increase in renal function identical with that in the donor's single remaining kidney. Within 7 postoperative days no perfusion damage and no HTK or CyA nephrotoxicity was observed.

[Surgery of acute pancreatitis. A problem of retroperitoneal sepsis?]

Of 99 patients with acute pancreatitis 31 had to be operated upon. Surgical intervention was indicated if, in the presence of pancreatic necrosis demonstrated by computed tomography, clinical evidence of sepsis developed. The operation was performed on average ten days after the onset of symptoms. Evidence of bacterial contamination of the pancreatic necrosis was obtained in 26 patients. The operation consisted of left pancreatic resection with formation of a left compartment. Four of the 31 operated patients died (12.9%).

[Treatment guidelines in intestinal burns]

Intestinal burns due to ingestion of acids or alkaline materials still put the physician in a difficult position because until now it is not possible to correlate the amount of ingested material to the extent of damage that can be expected. Furthermore, there are no objective criteria to determine the depth of the burn. Diagnosis is based on endoscopy. Mild, moderate and severe damage can be differentiated endoscopically. Mild and moderate burns are not operated upon primarily. Surgery is indicated with moderate burns whenever complications occur during intensive care treatment, and generally with severe corrosive burns. Operative management depends on intraoperative findings.

[Stomach cancer--the current situation from the surgical viewpoint]

From July 1st 1982 to December 31st 1986, 359 patients with a histologically confirmed gastric carcinoma were operated on. At the beginning of therapy, 44.3% were in the pathological anatomical stages I and II, 55.7% in stages III and IV (UICC 1987). 307 patients could be resected (resection rate 85.5%). The proportion of R0 resections (no residual tumor) was 61.9%, R1 resections (microscopically demonstrable tumor residues) 23.1% and R2 resections (macroscopical tumor residues) 15%. Overall, a curative resection could be carried out in 61.9% of the cases and a palliative resection in 38.1% of the cases. In 21.5%, a subtotal gastric resection, in 48.2% a total gastrectomy and in 30.3% an extended total gastrectomy was necessary in addition. The lethality was 3.0% for subtotal resection, 5.4% for the simple total gastrectomy and 9.6% for the extended total gastrectomy. The prognosis corresponds to the tumor stage at the beginning of therapy (three year actuarial survival: stage I 76%, stage II and III 26%, stage IV 7%).

[Esophageal carcinoma: transthoracic esophagectomy with regional lymphadenectomy and reconstruction with deferred priority]

In a retrospective analysis the risks were assessed of transthoracic oesophagectomy with mediastinectomy and regional lymphadenectomy followed 48-72 hours later by an abdomino-cervical operation with supra-pancreatic lymphadenectomy, retrosternal gastric interposition and cervical oesophageal stump anastomosis. Results in this group of 37 patients were compared with those in a group of 42 patients who had undergone a transmediastinal oesophagectomy (without thoracotomy) and immediate reconstruction. The 30-day death rate was 8.1% in the former (group I) and 7.1% in the latter (group II), total hospital death rate 10.8% and 11.9%, respectively. The complication rate was similar in the two groups, as was the recorded operative stress. The results indicate that the risk of an oncologically indicated oesophagectomy with regional lymphadenectomy is no greater than that of a palliative transmediastinal oesophagectomy.

Effects of preservation conditions and temperature on tissue acidification in canine kidneys

The influence of temperature (5, 15, 25, and 35 degrees C) on the degree of tissue acidification was examined using 74 canine kidneys with simple ischemia or after protection of the kidneys with Euro-Collins solution or with the HTK-solution of Bretschneider. At an incubation temperature of 5 degrees C, the intrarenal pH value in HTK-protected kidneys is continuously higher than 7.3 during 36 hr of ischemia. In Euro-Collins kidneys the pH value decreases to a pH of 6.4 during this time. In simple ischemic kidneys pH is 6.3 after 36 hr. At 15 degrees C the pH value falls to a lower level in Euro-Collins kidneys than in purely ischemic kidneys, but the pH in HTK-protected kidneys is higher than 6.9 for 24 hr. At 25 degrees C, and especially at 35 degrees C the intrarenal acidosis in Euro-Collins kidneys is much stronger than in unprotected kidneys, and the pH in HTK-protected kidneys does not decrease below 6.7. The lactate production in simple ischemic kidneys and in HTK-protected kidneys is nearly the same (80-100 mumol/gdw), although Euro-Collins kidneys have a steeper increase and reach higher lactate levels (330 mumol/gdw). The HTK solution guarantees satisfactory protection against damaging acidosis over the whole temperature range (5-35 degrees C), but the Euro-Collins solution leads to a stronger and more dangerous acidosis the higher the temperature.

[Choice of procedure in the surgical treatment of liver injuries]

We give an analysis of liver-rupture cases among our own patients and discuss the problems of diagnosis and surgical therapy. Total lethality is 29%; this is dependent on quick diagnostic procedure, the number and severity of accompanying traumas, and the type of liver rupture. The main diagnostic feature seems to be peritoneal lavage, Operative procedure depends on the type and severity of the liver rupture. We therefore propose a classification of the types of liver ruptures, together with their adequate surgical therapy. Some postoperative complications can also be avoided.

Prolongation of skin graft survival by sodium-copper-chlorophyllin. Inhibition of the first- and second-set phenomenon

Sodium-copper-chlorophyllin which has a strong anticomplementary and membrane-stabilizing effect also has, by these mechanisms, a strong immunosuppressive competence. In HAN-rotation-breeded Wistar rats there is a time- and dose-dependent prolongation of skin allograft survival by this drug. The first-set and the second-set phenomena are inhibited.

[Behavior of fibrinogen-split-product-E in fibrinuria following allogeneic kidney transplantation (author's transl)]

80 urine samples from 10 kidney grafted patients were immunologically analyzed for detection of fibrin degradation products by various techniques. Split product E, which was quantitatively determined by two-dimensional immunoelectrophoresis only contributes to a minor part to fibrinuria, but increases significantly during periods of severe acute rejection also during the first 2-3 weeks, when overall fibrinuria is not a useful indicator of impending rejection. Determination of split-product E therefore seems to be a valuable diagnostic procedure.