Immunhistochemical analysis for expression of calpain 1, calpain 2 and calpastatin in ovarian cancer

Calpains, also called calcium activated neutral proteases (CANP), are expressed ubiquitously. They are intracellular, non-lysosomal cytoplasmic cysteine endopeptidases. Calcium is required for their activation. Their endogenous specific inhibitor is calpastatin, which is expressed ubiquitously and coexists within cells besides calpain. When calcium is present, calpastatin and calpain attach to each other inhibiting the protease. The calpain system plays an important role in many processes including apoptosis, necrosis, ischemia formation and exocytosis. So far, many reports exist on studies about the influence of calpains in different tumors (skin, breast, renal cell and prostate cancers). The role of calpains in pathogenesis or further tumor progression has always been proved in related studies, but their exact function could not be demonstrated. So far, no studies on calpains being involved in the pathogenesis of ovarian cancer have been published. In our study we focused on the expression of the enzymes calpain 1, calpain 2 and their inhibitor calpastatin in normal and malign ovarian tissue. Therefore, we performed immunohistochemical stainings of paraffin slices and evaluated staining intensity (SI), percentage of positive cells (PP) and immunoreactive score (IRS). We evaluated the correlation between enzyme expression in malign and benign ovarian tissues. In malignant ovarian tissue, we found decreased expression, staining intensity and immunoreactive score of calpastatin. With higher grading of the ovarian carcinoma, staining intensity and immunoreactive score of calpain 1 decreased. Staining intensity of calpain 2 in ovarian carcinoma decreased with increasing lymph node status. We clearly demonstrated differences between enzyme expressions in malign and benign tissue. This study could not find any specific function of calpains. Only few studies in the literature have been found that deal with calpain evaluation of ovarian cancer. Additional studies including more patients are required to elucidate the functional role and impact of calpain in tumors in detail.

Reference values of NT-proBNP serum concentrations in the umbilical cord blood and in healthy neonates and children

BACKGROUND

N-terminal brain natriuretic peptide (NT-proBNP) is a neurohormonal substance secreted mainly by the cardiac myocytes of the left ventricle and to a less degree of the left atrium. The releasing mechanism is induced by an increased wall stress on the base of volume or pressure load of the ventricle. The physiologic actions of BNP are prohibition of the sympathetic activity, vasodilatation, natriuresis, diureses and inhibition of the renin-angiotensin system. Because of its high sensitivity and specifity in relation to the left ventricular incompetence, BNP as well as NTproBNP are well accepted markers of ventricular dysfunction. It was the aim of the study to establish reference values of NT-proBNP serum concentrations throughout childhood, in particular in the newborn age group.

METHODS

In a cross sectional study, serum NT-proBNP concentrations were measured by an ElectroChemiLuminescenceImmunoAssay ("ECLIA" Roche) in the umbilical cord blood of 62 healthy full-term neonates and in 222 healthy probands from birth up to the age of 18 years.

RESULTS

The concentration of NT-proBNP in the cord blood samples ranged from 281 to 2595 pg/ml (mean: 818 pg/ml). There was a significant increase in the first days of life followed by a rapid decrease during the first year and a further gradual decrease throughout infancy; beyond the 10(th) year of age normal adult values were approached.

CONCLUSIONS

The knowledge of the normal range of plasma NT-proBNP levels in healthy subjects during childhood serves as a non-invasive marker for differentiation of pathologic conditions such as acute myocarditis, hypertrophic or dilated cardiomyopathy, tachyarrhythmias and pulmonary hypertension.

Body Mass Index, Proteinstoffwechselprofile und Ergebnisse bei Patientinnen unter IVF-/ICSI-Behandlung

OBJECTIVE

Higher risks of infertility have been found in overweight women. The purpose of the present study was to explore whether protein metabolism profiles related to body mass index (BMI) and to find out whether these parameters should affect IVF/ICSI outcome.

PATIENTS AND METHODS

52 patients were enrolled in this study. All patients underwent an ovarian stimulation either with recombinant follicle stimulating hormone (Gonal-F) or human menopausal gonadotropin (Menogon) after pituitary down-regulation with Goserelin (Zoladex) or Triptorelin (Decapeptyl Gyn). Five blood samples were taken: before treatment, at the beginning of ovarian stimulation, on the day of HCG injection for the ovulation induction, on the day of follicle aspiration and 14 days after embryo transfer. The blood samples were analysed with regard to the serum concentrations of total protein, albumin, total bilirubin and urea. According to the BMI values the patients were divided into two groups: BMI < 25 kg/m (2) (GI, n = 28) and BMI > 25 kg/m (2) (GII, n = 24). The results of IVF/ICSI outcome were compared in both groups.

RESULTS

In both groups, the serum concentrations of total protein, albumin, total bilirubin and urea decreased during ovarian stimulation. In GII, albumin concentration decreased significantly on the day of follicle aspiration (46.0 +/- 2.3 g/l versus 43.5 +/- 2.5 g/l, p < 0.001) and 14 days after embryo transfer (46.8 +/- 2.5 g/l versus 44.7 +/- 2.3 g/l, p < 0.002), whereas the concentration of total bilirubin was not significantly decreased on the day of HCG injection (0.57 +/- 0.29 mg/dl versus 0.49 +/- 0.26 mg/dl, p = 0.11). Furthermore, pregnancy rate in women with BMI < 25 kg/m (2) was 46.4 % and in women with BMI > 25 kg/m (2) 33.1 % (p = 0.34).

CONCLUSIONS

Serum concentrations of albumin and total bilirubin are influenced by BMI. Excess weight defined as BMI > 25 kg/m (2) has a negative impact on IVF outcome leading to decreased chances of pregnancy.

Factors affecting the interface of cervical spine facet screws placed in the technique by Roy-Camille et al

The objective of the study was to investigate the influence of bone cement, length of burr hole and bone density on pullout force and insertional screw torque of cervical spine facet screws. Both facets of 24 human cervical vertebrae were scanned for bone mineral density (BMD) and assigned to two groups for measuring of insertional screw torque and pullout strength. Maximal insertional screw torque was measured and removal of the screws was performed in displacement control (0.25 mm/s) without bone cement (PMMA), with 0.1 ml of PMMA and with the burr hole completely filled with PMMA. Screw torque was 59.1 N cm (+/-25.7 N cm), pullout force was 382.8 N (+/-140.5 N) without PMMA. Injection of 0.1 ml PMMA did not change significantly both screw torque (p=0.73) and pullout (p=0.129). Filling of the burr holes with PMMA increased significantly both screw torque (p<0.0001) and pullout force (p=0.028) when compared with injection of 0.1 ml of PMMA. A positive, moderate correlation was seen between BMD and screw torque before (r=0.501; p=0.097) and after filling with PMMA (r=0.514; p=0.088), BMD and pullout force before (r=0.441; p=0.152) and after complete filling with PMMA (r=0.673; p=0.047). The PMMA does increase both screw torque (p<0.0001) and pullout force (p=0.028) of facet screws significantly if the burr hole is filled with PMMA completely when compared with injection of 0.1 ml PMMA. Bone mineral density of the cervical facets moderately correlates with peak insertional torque and pullout force. This is true for a facet without PMMA and for a facet filled with PMMA. The length of the burr hole seems to be less important.

Variation of endplate thickness in the cervical spine

The purpose of the study was to investigate possible variation of thickness of the cervical spine endplate with respect to endplate orientation (superior or inferior endplate) and level distribution (C4-C7). Six human cervical spine segments C4-C7 were used to create six specimen of C4, C5, C6, and C7, respectively. The bony endplates of each vertebra were cleaned carefully from disc tissue without damaging the endplates. Six endplates with severe degenerative changes were excluded from the study. The posterior elements were removed, and a midaxial cut using a bone saw was performed through each vertebral body, thus producing a superior and inferior half. Each half-vertebra was then glued onto a piece of wood with the endplate oriented upwards and horizontally. For each specimen, four computed tomography scans were taken and thickness of the endplate was measured at five points on each scan perpendicular to the midaxial cut. Factorial analysis of variance (ANOVA) and Scheffe-test were used to detect significant differences. All peripheral regions were significantly thicker than the central point of the endplate if all measuring points were considered for statistical analysis, regardless of scan, endplate orientation or level (Scheffe-test, P<0.001). In both superior and inferior endplates, peripheral areas were thicker than the central region (Scheffe-test, P<0.001). For all levels, the endplate within the peripheral regions was thicker than within the central region and the difference reached significance for the superior and inferior endplate of C4, C5, and C6 and the inferior endplate of C7 (Scheffe-test, P<0.05). The peripheral regions of the cervical spine endplate are usually thicker than its central region, regardless of endplate orientation and level (C4, C5, C6, C7) distribution.

[Reliability and validity of the Wender-Utah-Rating-Scale short form. Retrospective assessment of symptoms for attention deficit/hyperactivity disorder]

The diagnosis of adult attention deficit/hyperactivity disorder (ADHD) requires the retrospective assessment of ADHD symptoms in childhood. The Wender Utah Rating Scale (WURS) is helpful in detecting ADHD-associated symptomatology in childhood. A German short version (WURS-k) of this instrument has been made available recently. In the present study, we investigated the validity of the WURS-k. In a population of 63 adult ADHD patients (according to ICD-10 and DSM-IV criteria) and 1,303 male controls, ROC analysis indicated a sensitivity of 85% and specificity of 76% at a cutoff of 30 points. In ADHD patients, seven individual factors explained 70.3% of the variance. The highest diagnostic precision was demonstrated using the WURS-k total score. The seven extracted factors of the WURS-k did not differ in diagnostic value. Significant correlations were found between impulsivity according to Eysenck's Impulsivity Questionnaire (EIQ) and excitability, aggression, emotional lability, and satisfaction on the Freiburg Personality Inventory (FPI-R) in ADHD patients. Concerning a 30-50% persistence of ADHD symptomatology in adults, these correlations underline the diagnostic validity of the WURS-k. The scale manifested excellent internal consistency (alpha=0.91) and a split-half correlation of r(12)=0.85.

Reference values of fetal ductus venosus, inferior vena cava and hepatic vein blood flow velocities and waveform indices during the second and third trimester of pregnancy

OBJECTIVE

Our objective was to establish reference values for ductus venosus, inferior vena cava and hepatic vein flow velocities during ventricular systole (S-wave) and diastole (D-wave), the lowest forward velocity during atrial contraction (a-wave), the intensity-weighted mean flow velocity (Vmean) and different calculated indices.

METHODS

Venous flow velocity waveforms were obtained from 329 singleton pregnancies at 20-42 weeks of gestation by pulsed-wave color Doppler. Reference values were constructed by means of a quadratic regression model after logarithmic transformation of original data.

RESULTS

With advancing gestational age the peak velocity index for the vein (PVIV) and pulsatility index for the vein (PIV) decreased whereas blood flow velocities increased. Blood flow velocities were highest in the ductus venosus and lowest in the right hepatic vein. Values for PVIV and PIV were highest in the hepatic vein and lowest in the ductus venosus. During atrial contraction there was a blood flow towards the fetal heart in the ductus venosus, whereas in the inferior vena cava and in the hepatic vein blood flow was either in the opposite from the fetal heart (reverse flow), or there was absent flow (zero flow) or flow was towards the fetal heart (positive flow).

CONCLUSIONS

The reference ranges and calculated velocities established in this study may be utilized in studies dealing with the role of ductus venosus and inferior vena cava blood flow in fetuses with chromosomal abnormalities or congenital heart disease as well as hypoxic conditions. We speculate, that the reduction in PVIV and PIV with advancing gestational age may reflect a decrease in cardiac afterload as a result of maturation of diastolic ventricular function.

Reference values of ductus venosus blood flow velocities and waveform indices from 10 to 20 weeks of gestation

OBJECTIVE

Our objective was to establish reference values for ductus venosus flow velocities during ventricular systole (S wave) and diastole (D wave), the lowest forward velocity during atrial contraction (A wave) and different calculated indices [(S-A)/D), (S-A)/Vmean, (S-A)/S, S/A, S/D)].

METHODS

Ductus venosus flow velocity waveforms were obtained from 329 singleton pregnancies at 10-20 weeks of gestation by pulsed-wave color Doppler. Reference values were constructed by means of a quadratic regression model after logarithmic transformation of original data.

RESULTS

A significant increase in blood flow velocity during atrial contraction [A-wave, (3.5 cm/s to 9.9 cm/s and 12.9 cm/s to 66.3 cm/s respectively, 5-95% centile)], during ventricular systole [S-wave, (19.2 cm/s to 30.1 cm/s and 45.1 cm/s to 84.9 cm/s respectively, 5-95% centile)] and during early ventricular diastole [D-wave, (15.7 cm/s to 26.1 cm/s and 37.9 cm/s to 77.9 cm/s respectively, 5-95% centile)]. The venous indices values decreased with increasing gestational age. In 3 of 329 fetuses (0.91%) a reversed flow during atrial contraction was seen.

CONCLUSION

Assessment of ductus venosus blood flow velocities during first and second trimester is feasible by means of color Doppler flow. The reference ranges and calculated velocities established in this study may be utilized in studies dealing with the role of ductus venosus blood flow in chromosomal abnormal fetuses, fetuses with congenital heart disease or fetal myocardial insufficiency of hypoxic origin.

Lateralization in autononic dysfunction in ischemic stroke involving the insular cortex

Autonomic nervous system dysfunction is a common complication of ischemic stroke. Clinical and experimental data indicate hemispheric lateralization in the control of autonomic activity. The insular cortex has also been shown to play a crucial role in the central autonomic network. The aim of this study was to assess cardio-autonomic dysfunction in patients with ischemic insular versus non-insular cortex infarction, and to demonstrate a possible lateralization in autonomic activity mediated by the insular cortex. Sympathetic function was prospectively assessed by determining plasma norepinephrine and epinephrine in 15 patients with left-hemisphere (LH; four insular infarction), and 14 with right-hemisphere (RH) middle cerebral artery (MCA) stroke (five insular infarction). Systolic and diastolic blood pressure and heart rate were recorded during the first 5 days after stroke. Sympathetic activity was significantly higher in insular than in non-insular infarction (p < 0.05) with concomitantly elevated cardiovascular parameters in insular stroke patients. The pathological activation of the sympathetic nervous system was most excessive in RH-stroke involving the insular cortex (p < 0.05). Our data indicate a hemispheric lateralization in autonomic activity which is mediated by the right-sided insular cortex. Patients with RH stroke involving the insular cortex are most susceptible to develop cardio-autonomic dysfunction.

Effekte der ovariellen Stimulation auf die Serumkonzentrationen von Lipiden und Ketonkörper bei Patientinnen unter IVF-/ICSI-Behandlung

OBJECTIVE

The ovarian stimulation increase the estradiol concentration in comparison to the one observed in the menstrual cycle. The aim of the study was to determine the influence of ovarian stimulation on serum concentrations of lipids and ketone bodies in patients undergoing IVF/ICSI treatment.

PATIENTS AND METHODS

50 patients were included in this study. All patients underwent an ovarian stimulation either with recombinant follicle stimulating Hormone (Gonal-F, n = 28) or human menopausal gonadotropin (Menogon, n = 22) after pituitary down-regulation with Goserelin or Triptorelin. Five blood samples were taken: before treatment, at the beginning of ovarian stimulation, on the day of HCG injection for the ovulation induction, on the day of follicle aspiration and 14 days after embryo transfer. Afterwards, the samples were analysed with regard to the concentrations of triglyceride, total-cholesterol, HDL-/LDL-cholesterol, acetoacetate, beta-hydroxybutyrate and alpha-ketoglutarate.

RESULTS

During the ovarian stimulation, total-cholesterol andA'LDL-cholesterol decreased significantly (p(Chol) < or = 0.001; p(LDL) < or = 0.001), whereas the concentration of HDL-cholesterol increased significantly (p(HDL) < or = 0.001). Furthermore, a significant increase of beta-hydroxybutyrate and alpha-ketoglutarate has been detected (p(HBS) = 0.039; p (KG) = 0.023).

CONCLUSIONS

The observed changes in serum concentrations of lipids and ketone bodies began with the application of gonadotrophins for stimulation and persisted until the end of the treatment. Therefore, the increase of estradiol, stimulated by gonadotrophins, seems to be responsible for the changes in the serum concentrations of lipids and ketone bodies. All women undergoing ovarian stimulation should be monitored for long-term thrombogenic and atherogenic risks.

[Association between ovarian stimulation regime and protein metabolism of patients undergoing IVF/ICSI therapy]

The aim of this study was to determine the relationship between the ovarian stimulation protocol (with HMG or FSH) after down-regulation with GnRH anologa and protein (total protein and albumin) as well as bilirubin and urea in serum. Furthermore, it was intended to find out the effect of these parameters on IVF/ICSI outcome. 50 patients were included in this study. All patients underwent controlled ovarian hyperstimulation for assisted reproduction therapy either with FSH (Gonal-F) or HMG (Menogon). Ovulation induction was induced by human chorionic gonadotrophine (HCG, Predalon) 10 000 IU i. m. The protein concentration (total protein, albumin) as well as bilirubin and urea concentrations were determined before down-regulation with GnRHa, at the beginning of ovarian stimulation with FSH or HMG, on the day of ovulation induction with HCG, during oocyte retrieval and fourteen days after embryo transfer. The age, body mass index and etiology of infertility showed no significant difference between patients stimulated with HMG or FSH. Total protein and albumin concentration decreased significantly (p=0.001) from 77.45 +/- 5.90 g/L and 47.02 +/- 3.41 g/L to 74.60 +/- 4.6 g/L and 45.04 +/- 2.39 g/L, respectively at the time of oocyte retrieval. Whereas, no significant change with bilirubin and urea concentration was observed. However, the mean concentration of total protein, albumin, bilirubin of patients who become pregnant was higher of those who did not. In conclusion, this study shows that total protein and albumin concentration in plasma decreased during the follicular phase significantly with the application of exogenous gonadotrophins and steroid hormones in comparison to the value before down-regulation. The mean value of total protein, albumin, bilirubin of patients who become pregnant was higher (but not significant) of those who did not. However, the high individual variation in the present results shows that these parameters are not useful as a predictor of IVF/ICSI outcome.

Location-dependent patterns in cardio-autonomic dysfunction in ischaemic stroke

BACKGROUND AND STUDY PURPOSE

Autonomic nervous system dysfunction is a common complication of acute cerebrovascular disorders. The aim of this study was to investigate a possible location-dependent difference in cardio-autonomic function in patients with ischaemic stroke.

PATIENTS AND METHODS

Sympathetic function was prospectively assessed by determining plasma norepinephrine and epinephrine in 19 patients with left-hemisphere (LH), 14 with right-hemisphere (RH) and 6 with brainstem/cerebellar (BS) stroke. Blood pressure, heart rate, cardiac output and transcranial flow velocity in the middle cerebral artery were recorded during the first 5 days after stroke.

RESULTS

Stroke caused an initial increase in sympathetic function in all 3 groups with a spontaneous decrease in norepinephrine in LH (p < 0.01) and BS stroke (p < 0.05) only. Norepinephrine was significantly higher in RH than in BS stroke (p < 0.05). The alterations in autonomic function were paralleled by a sustained elevation in cardiovascular parameters mainly in RH stroke.

CONCLUSIONS

Plasma catecholamines are feasible in monitoring location-dependent autonomic dysfunction in ischaemic stroke. Hemispheric lateralization in autonomic control should be taken into account in the management of stroke because of an increased susceptibility to cardio-autonomic dysfunction in patients with RH stroke.

Fibroblast growth factor (FGF), intracellular adhesion molecule (sICAM-1) level in serum and follicular fluid of infertile women with polycystic ovarian syndrome, endometriosis and tubal damage, and their effect on ICSI outcome

PROBLEM

The objective of this study was to determine the concentration of fibroblast growth factor (FGF) and soluble intracellular adhesions molecule (sICAM-1) in serum and follicular fluid (FF) of polycystic ovary (PCO), endometriosis and tubal factor infertility and male factor infertility patients, and to investigate the relationship between these parameters and the outcome of intracytoplasmic sperm injection (ICSI).

METHOD OF STUDY

The concentration of FGF and sICAM-1 in serum and FF were determined in patients undergoing controlled ovarian hyperstimulation (COH) for ICSI therapy for various etiology of infertility and the results of cytokines concentration and ICSI outcome were compared between the groups. Twenty patients with PCO (G.I), 17 with endometriosis (G.II), 19 with tubal damage (G.III) and 19 with male factor infertility (G.IV) were enrolled in this study. Quantitative determination of levels of FGF and sICAM-1 was performed using enzyme-linked immunosorbent assays (ELISAs).

RESULTS

The FGF level in serum of PCO patients (G.I) were 4.8 +/- 2.3 and in FF were 104.0 +/- 39.0 pg/mL. The corresponding values in the endometriosis patients group (G.II) were 5.9 +/- 3.1 and 125.4 +/- 74.9 pg/mL. The concentration of FGF in tubal factor infertility group (G.III) in serum was significantly higher (P = 0.009) than those observed in the PCO group (G.I) 7.4 +/- 4.5 pg/mL, whereas the concentration in FF was at the same level like the other groups investigated, 128.7 +/- 75.9 pg/mL. Besides, the sICAM-1 (pg/ml) concentration in FF showed a significant difference between the groups investigated (G.I, 175.3 +/- 52.8; G.II 194.4 +/- 32.2; G.III 233.1 +/- 54.3; and G.IV 215.1 +/- 54.4 ng/mL; P = 0.003). The sICAM-1 levels in serum were not significantly different between the groups (217.0 +/- 42.9; 216.3 +/- 73.6; 254.8 +/- 79.6; 237.56 +/- 78.4 ng/ml; P = 0.267). The fertilization rate was significantly higher in G.III (66.0 +/- 23.89%) in comparison to G.II (38.8 +/- 33.9%; P = 0.014) or G.IV (38.7 +/- 22.7%; P = 0.012). The pregnancy rates were similar in all groups (30, 35.3 and 35.0, 38.6%, respectively).

CONCLUSION

Both, FGF and sICAM-1 are present in serum and FF of patients undergoing controlled ovarian hyperstimulation for ICSI therapy. The FGF concentration in serum differs significantly between the groups investigated, whereas, no significant difference could be observed in the FF concentration of FGF. On the other hand, the sICAM in serum showed no significant difference between the groups, whereas, sICAM in FF demonstrated a significant difference between the patient groups investigated. On the whole, the ICSI outcome was not related to serum or FF concentrations of FGF or sICAM-1. Therefore, the mean concentration of FGF and sICAM-1 in serum and in FF could not be used to predict the fertilization rate in an ICSI program.

Comparison between cytokine concentration in follicular fluid of poor and high responder patients and their influence of ICSI-outcome

OBJECTIVE

The aim of this study was to compare the cytokine concentration in follicular fluid (FF) of low and high responder intracytoplasmic sperm injection (ICSI) patients and to find out the impact of these cytokines in FF on ICSI outcome.

DESIGN

The levels of insulin-like growth factor (IGF)-I, IL-6, IL-8, epidermal growth factor (EGF), platelet-derived growth factor (PDGF), granulocyte-macrophage-colony stimulating factor (GM-CSF) were measured from low and high responder ICSI patients, the results were compared between the two groups and their influence on ICSI outcome was analysed.

MATERIAL AND METHODS

A total of 49 low (G.I) and 34 high (G.II) responder patients were enrolled in this study. FF was collected at the time of oocyte retrieval and measured either by enzyme-linked immunosorbent assay (IL-6, IL8, EGF, PDGF, GM-CSF) or radio immuno assay (IGF-I).

RESULTS

The concentration of IL-6 (pg/mL), IL-8 (pg/mL), IGF-I (ng/mL), PDGF (pg/mL), EGF (pg/mL), GM-CSF (pg/mL) in G.I was 6.0 +/- 4.3, 288.1 +/- 139.2, 0.416 +/- 0.089, 249.8 +/- 150.1, 9.12 +/- 5.5 and 1.45 +/- 2.10 and the corresponding value in G.II was 7.4 +/- 4.8, 208.6 +/- 64.0, 0.431 +/- 0.094, 387.6 +/- 36.0, 8.9 +/- 5.4 and 1.8 +/- 3.3, respectively. Only the PDGF concentration showed a significant (P = 0.007) difference between the two groups. Besides, negative correlations were found between PDGF and fertilization rate (r = -0.287; P = 0.046) of G.I. The mean number of retrieved (6.4 +/- 2.3 versus. 15.7 +/- 5.4) and fertilized (3.6 +/- 1.6 versus 7.0 +/- 4.5) oocytes differ significantly (P = 0.001) between the two groups. The fertilization rate was significantly higher in G.I than in G.II (60.9 +/- 25.1 versus 43.4 +/- 20.7%).

CONCLUSION

There was no significant difference between IGF-I, IL-6, IL-8, EGF and GM-CSF concentrations of low and high responder patients. Besides, PDGF was significantly (P = 0.007) higher in high responder compared with low responder patients. Moreover, in poor responder patients, a negative correlation was found between PDGF and fertilization rate. However, the cytokine levels in FF of the patients undergoing controlled ovarian hyperstimulation for ICSI could not be used as a marker of oocyte fertilization and implantation potential.

[A population-based survey of critical care]

OBJECTIVES

Results of a population-based survey of critical care in a German state are presented. The indication for critical care was derived using the APACHE-II score,which measures the physiologic state of patients, and the TISS-28 score as a measure for expenditure of critical care.

METHODS

During 3 months all adult patients of intensive care units in Saarland, a German state with 1.08 million residents,were included. All kinds of hospitals were involved. Completeness and validity of data are proved.

RESULTS

The TISS score was registered daily on 13,391 adult patients with 54,503 days, the APACHE score during admission and discharge of intensive care units only. The correlation between the scoring-systems and indication, kind of care (critical care vs. intermediate care), kind of hospital, and ICD-10 diagnoses is analysed in this paper.

CONCLUSIONS

In this study the population-based critical care in a state is analysed the first time. It completes previously published studies,which were performed at the level of hospitals and departments.

Gamma-hydroxybutyrate versus chlorprothixene/phenobarbital sedation in children undergoing MRI studies

BACKGROUND

Few clinical studies have assessed gamma-hydroxybutyrate and chlorprothixene/phenobarbital sedation in children. This prospective trial compared the two regimes in children, in particular concerning differences in recovery time.

METHODS

28 pediatric oncology patients undergoing elective MRI studies at a university hospital were randomly assigned to either receive gamma-hydroxybutyrate or chlorprothixene/phenobarbital sedation. Time to induce deep sedation (Ramsay score of 5) and recovery time, the incidence of failure of sedation, the frequency of side effects, the need for therapeutic interventions, and the number of patients receiving additional midazolam were recorded. Analysis of hemodynamic parameters was performed at five defined time points.

RESULTS

All 28 MRI studies were successfully completed. Recovery time was significantly shorter with gamma-hydroxybutyrate (p < 0.01). There were more side effects with chlorprothixene/phenobarbital, in particular tachycardia and hyperexcitation. Vomiting was the side effect most often seen in gamma-hydroxybutyrate sedation. Therapeutic interventions were not required in any patient. Additional midazolam was necessary to maintain satisfactory sedation in six children receiving gamma-hydroxybutyrate and four receiving chlorprothixene/phenobarbital.

CONCLUSIONS

Due to its significantly shorter recovery time, gamma-hydroxybutyrate is a reasonable sedative drug for children undergoing non-invasive diagnostic procedures, and is superior to chlorprothixene/phenobarbital. In pediatric oncology patients gamma-hydroxybutyrate appears to be associated more often with vomiting. The long recovery time and its great variability make chlorprothixene/phenobarbital a less valuable alternative.

[Biodegradable meniscus fixations: a comparative biomechanical study]

PURPOSE

Numerous new all inside meniscus repair techniques using biodegradable fixation devices have become available in the last years. Few studies have dealt with the biomechanical properties of these implants so far. The aim of this study was to analyze meniscus repairs under cyclic loading conditions for different fixation devices (Meniscus Arrow, Clearfix Meniscal Screw, Meniscal Dart, BioStinger) and to compare them to standard suture techniques.

MATERIAL AND METHODS

Eighty meniscus repairs on 27 medial porcine menisci were performed. For biomechanical testing loosening, number of failures, failure modes and failure loads were evaluated under cyclic and maximum loading conditions. Testing was performed on a materials testing machine.

RESULTS

During cyclic loading 10 out of 40 (25%) fixation devices failed. A gap appeared between the 2 parts of the meniscus within the first loading cycles. The failure strengths obtained with the 4 meniscus fixation devices did not differ significantly (Meniscus Arrow: 44 N; Clearfix Meniscal Screw: 35 N; Meniscal Dart: 33 N; BioStinger: 54 N). Besides for the BioStinger, the values of the sutures were significantly higher. The use of a stronger suture material (PDS 0) increased the failure load significantly. During maximum loading the fixation devices failed by both pull-out of the head or the tip of the device, except for the BioStinger showing only pull-out of the head. All sutures failed by breakage, except for the PDS 0 horizontal sutures in which 50% of complete tissue failures could be noted.

CONCLUSION

This study shows that meniscal fixation devices may fail under repetitive loading conditions. A gap appeared between the meniscal margins within the first loading cycles irrespective of the suture type and fixation device used. Both gapping and failure modes of the fixation devices may be design-specific. The maximum failure loads differed significantly between the bioabsorbable devices and the sutures. Stronger suture materials increased the failure loads significantly. To allow a complete evaluation of new meniscus fixation devices not only biomechanical, but also biological and clinical parameters need to be analyzed in forthcoming studies.

Effect of an Er:YAG laser on periodontally involved root surfaces: an in vivo and in vitro SEM comparison

BACKGROUND AND OBJECTIVE

The recently introduced Er:YAG laser seems to be a promising alternative in periodontal treatment due to its thermo-mechanical ablation mechanism. The present study attempted to compare the effects of an Er:YAG laser on periodontally involved root surfaces at different power settings in vivo and in vitro using scanning electron microscopic (SEM) observations.

STUDY DESIGN/MATERIALS AND METHODS

Forty single rooted teeth (160 surfaces), with advanced periodontal destruction that were scheduled for extraction, were divided into two groups of 80 each which were treated in vivo (group A) and immediately after extraction in vitro (group B) using one of the following energy settings: 120, 140, 160, and 180 mJ at 10 Hz (71, 83, 94, and 106 J/cm(2)/pulse). The morphological changes on the treated root surfaces were evaluated using scanning electron microscopic (SEM) observations to assess the laser induced ultrastructural changes. The severity of the changes was evaluated according to an arbitrary scale in 7 degrees [1-7]. Untreated peripheral areas served as control.

RESULTS

All surfaces treated in vitro (group B) showed visible crater-like defects with notch-edged borders. The depth of the surface damages varied with the power applied and was localized into cementum at energy settings of 120-160 mJ but also reached dentine at 180 mJ. Compared to that, all in vivo (group A) treated surfaces showed a homogeneous and smooth root surface morphology. The surface alterations were not related to the used energy setting.

CONCLUSIONS

The results of the present study showed that the clinical use of an Er:YAG laser resulted in a smooth root surface morphology, even at higher energy settings. The results also seem to indicate that calculus removal can be selectively done in vivo.

Reliability of gas exchange measurements from two different spiroergometry systems

Reliability of two different spiroergometric systems was investigated by comparing gas exchange measurements from two consecutive identical bicycle ergometer ramp exercise tests which were conducted after an initial habituation trial. Twenty-three healthy subjects (age: 25+/-5 years; weight: 71+/-10 kg; peak oxygen uptake: 55+/-9 ml x min(-1) x kg(-1)) took part in the study. One apparatus was a portable mixing chamber system (MetaMax I, Cortex, Leipzig, Germany), the other one a stationary spiroergometric device measuring in the breath-by-breath mode (MetaLyzer 3B, Cortex). There were no relevant systematic changes in gas exchange measurements and heart rate from test 1 to test 2. Intra-class reliability coefficients were 0.984 (oxygen uptake = VO2), 0.977 (carbon dioxide output = VCO2), and 0.973 (minute ventilation = VE) for the MetaMax I, and 0.969 (VO2), 0.964 (VCO2), and 0.953 (VE) for the MetaLyzer 3B. Bland-Altman plots revealed a slightly smaller variability of MetaLyzer 3B measurements compared to those of MetaMax I. It is concluded that the spiroergometric devices MetaMax I and MetaLyzer 3B represent reliable instruments for exercise testing in sports medical routine and research. This is important to decide if longitudinal changes in gas exchange measurements represent clinically meaningful differences in performance or merely inconsistencies of the measuring tool.

Blood loss in anterior cruciate ligament (ACL) reconstruction with and without intercondylar notchplasty: does it affect the clinical outcome?

Blood loss is associated with any surgical procedure and should be reduced wherever possible. It was our impression that notchplasty adds to the amount of postoperative bleeding after anterior cruciate ligament (ACL) reconstruction. With posterior placement of the tibial tunnel, notchplasty is optional in many cases. This study aimed to quantify blood loss with and without notchplasty after arthroscopically assisted ACL reconstruction using bone-patellar tendon-bone autografts. We performed a prospective clinical study of 58 patients, who had undergone arthroscopically assisted autogenous patellar tendon ACL reconstruction. In group I, a notchplasty was necessary according to the local anatomical criteria (intraoperative impingement test). In group II, ACL replacement could be performed without notchplasty. Single and total day drainage volume, serum and suction drain hemoglobin (Hb) and hematocrit (Hct) levels were monitored. One year after surgery, the patients were reviewed to assess the outcome according to the IKDC and Lysholm scores and the KT-1000 arthrometer. The total drainage volume was 448 ml (range 150-550 ml) in group I and 299 ml (range 50-420 ml) in group II (p < 0.001). The serum hematocrit (Hct) decrease was 9.7% in group I and 7.4% in group II (p < 0.001). At 12 months after surgery, the IKDC and Lysholm score evaluations and the KT-1000 arthrometer measurements revealed no clinical differences between the notchplasty and non-notchplasty groups. Despite a 30% increase in blood loss, notchplasty has been shown to be a useful procedure to prevent graft impingement without negative side-effects.

Association between freezing agent and acrosome damage of human spermatozoa from subnormal and normal semen

This experimental study compares the effects of human sperm preservation medium (HSPM) with TEST-yolk buffer (TYB) as cryoprotectants of human spermatozoa with respect to the integrity of the acrosome after the freeze-thawing procedure. Fifty-six semen samples were included in this study; 18 were subnormal (G1) and 38 were normal (G2) based on World Health Organization criteria, except for morphology, which was evaluated according to strict criteria. Each semen sample was divided into two parts: the first part was prepared for cryopreservation by the addition of HSPM (1:1) and the second by addition of TYB (1:1). Freezing was performed in liquid nitrogen vapour. Smears were made before freezing and after the thawing process for evaluation of acrosome integrity using fluorescent-lectin labelling. The mean percentage of spermatozoa with intact acrosomes in the subnormal group was 77.0 +/- 7.2% before freezing and decreased significantly (P < 0.001) after thawing: to 63.7 +/- 8.2% with the use of HSPM and 66.8 +/- 8.7% with the use of TYB. The corresponding values in the normal semen samples were 83.4 +/- 9.2%, 76.0 +/- 8.8% and 77.9 +/- 9.2%, respectively. It is obvious that the decrease in the mean percentage of spermatozoa with intact acrosome was significantly higher when using HSPM in comparison with TYB, not only for G1 (-14.9 +/- 1.9% versus -11.8 +/- 1.4%) but also for G2 samples (-13.8 +/- 1.5% versus -11.9 +/- 1.3%). In conclusion, TYB should be recommended for freeze-thawing of human spermatozoa as the first-choice cryoprotectant, for normal as well as subnormal semen samples, in order to protect the sperm acrosome from the deleterious effects of the freeze-thawing procedure.

Predictive value of chromatin decondensation in vitro on fertilization rate after intracytoplasmic sperm injection (ICSI)

This study was undertaken to identify the relationship between sperm chromatin decondensation after incubation with sodium dodecyl sulphate (SDS) and ethylene diamine tetra acetic acid (EDTA), or heparin at various points of time. Likewise, this study will determine chromatin stability within definite time intervals, chromatin decondensation after intracytoplasmic sperm injection (ICSI), and whether chromatin decondensation in vitro could be used as a predictive test for fertilization capability after ICSI. Sixty-five infertile couples undergoing ICSI therapy were included in this prospective study. Male factor infertility was the main indication for inclusion. One millilitre from each semen sample after washing was mixed with SDS-EDTA (group 1) or SDS/heparin (group 2) and incubated for 120 min. Many smears were made within 10 min of mixing the spermatozoa with detergent and the reducing agents and at the following points of time 30, 60 and 120 min and after 24 h. Chromatin decondensation was evaluated after staining with acridine orange (AO). The mean percentage of uncondensed chromatin of spermatozoa in the semen sample in the first group before addition of SDS/EDTA was 26.1 +/- 19.0 and 22.3 +/- 18.9% in the second one. After incubation of spermatozoa for 30, 60 and 120 min and 24 h, the chromatin decondensation increased in the first group to 64.0 +/- 28.6, 83.0 +/- 21.1, 87.9 +/- 14.6, 92.1 +/- 16.2 and 98.0 +/- 6.75%, respectively. The corresponding values in the second group were 69.5 +/- 29.9, 78.6 +/- 22.4, 86.9 +/- 17.1, 95.13 +/- 6.5 and 98.3 +/- 5.6%. On the other hand, no correlations were found between the chromatin decondensation or chromatin decondensation rate in vitro and the fertilization rates in all investigated groups. In conclusion, neither the chromatin decondensation ability in vitro nor the rate of chromatin decondensation between various points of time after using SDS/EDTA, SDS/heparin could predict the chromatin decondensation of spermatozoa (fertilization capability) after ICSI.

Vasoreactivity of arterial grafts in the patient with diabetes mellitus: investigations on internal thoracic artery and radial artery conduits

OBJECTIVE

Arterial revascularization with either internal thoracic artery (ITA) or radial artery (RA) appears to be particularly attractive in diabetic patients. Previous investigations have shown that endothelial dysfunction and artherosclerosis are seen more often in these patients. The aim of this study was to compare the vasoreactive properties of ITA and RA grafts in diabetic and non-diabetic patients.

METHODS

Arterial rings were harvested from 57 patients who underwent complete arterial revascularization. The patients were divided into a non-diabetic group (I: n = 30) and patients with diabetes mellitus (II: n = 27). Arterial rings of the ITA (I: n = 30; II: n = 27) and RA (I: n = 28; II: n = 19) were mounted on a strain gauge in oxygenated, normothermic Krebs's--Henseleit solution at optimal resting tension. With KCL (80 mM) serving as the control, assessment of force of contraction (norepinephrine), endothelium-dependent relaxation (acetylcholine) and smooth muscle-dependent relaxation (glyceroltrinitrate) were obtained.

RESULTS

After KCL, the RA showed a trend to lower maximum contraction forces in diabetics (I: 76 +/- 25 mN; II: 69 +/- 29 mN), which was pronounced in patients with diabetes of more than 10 years duration (55 +/- 23 mN; P = 0.1). Maximum contraction force of the ITA was similar in both groups (I: 41 +/- 20 mN; II: 34 +/- 19 mN) and not influenced by the duration of diabetes. The two groups showed no significant differences of the relative vasoconstriction after norepinephrine in RA (I: 53 +/- 18%; II: 61 +/- 19%) and ITA rings (I: 70 +/- 23%; II: 69 +/- 25%). Also, endothelium-dependent relaxation with acetylcholine in RA (I: 53 +/- 14%; II: 57 +/- 16%) and ITA rings (I: 42 +/- 17%; II: 44 +/- 20%), and smooth muscle relaxation with glyceroltrinitrate of RA (I: 72 +/- 8%; II: 73 +/- 12%) and ITA rings (I: 64 +/- 12%; II: 58 +/- 20%) was comparable in both groups. No influence of duration of the diabetic disease was noted.

CONCLUSIONS

Although RA rings of patients with a long duration of diabetes have decreased maximum contraction forces, their relative vasoconstriction after norepinephrine, endothelium-dependent relaxation and smooth muscle relaxation was similar to non-diabetic patients. We thus conclude that the RA is an adequate arterial conduit in the patient with diabetes mellitus.

Evaluation of cryoinjury of spermatozoa after slow (programmed biological freezer) or rapid (liquid nitrogen vapour) freeze-thawing techniques

PURPOSE

This study was initiated to determine the negative effect (cryodamage) on human spermatozoa after freeze-thawing and to find out whether freezing of spermatozoa with a computerized biological freezer is more advantageous than freezing above static liquid nitrogen vapour with regard to spermatozoa vitality, chromatin normality, morphology, and membrane integrity.

METHODS

Forty-four semen samples were obtained from patients attending andrology laboratory, and each sample was divided into two aliquots. One aliquot was frozen using static liquid nitrogen vapour (G.II) and the second with a computerized biological freezer (G.III). Acridine orange was used for assessment of chromatin cryoinjury, whereas the morphology was evaluated according to WHO criteria. Hypoosmotic swelling test was used to identify membrane integrity and eosin-nigrosin staining was used to determine the vitality of spermatozoa.

RESULTS

The mean percentage of normally condensed chromatin in the native semen sample (G.I) decreased significantly (p < .001) after freeze-thawing by using either liquid nitrogen vapour (G.II), or a biological freezer (G.III), which was significantly higher (p < .001) after freezing with liquid nitrogen vapour than after freezing with the biological programmed freezer. Morphologically normal spermatozoa decreased significantly (p < .001) in both freezing methods in comparison to the native semen samples. In addition, membrane integrity of spermatozoa (HOS-test positive) was significantly lower (p < .001) after the freeze-thawing procedure in G.II and G.III compared to G.I. In both these parameters the deterioration was similar among the two freezing procedures. Finally the mean percentage of live spermatozoa decreased significantly (p < .001) in both freezing techniques in relation to the mean value in the neat semen samples.

CONCLUSIONS

Freeze-thawing procedure has a detrimental effect on chromatin, morphology, membrane integrity, and vitality of human spermatozoa not only by freezing above static liquid nitrogen vapour but even by using a computerized biological freezer. However, the chromatin deterioration rates are significantly higher by freezing above static liquid nitrogen vapour in comparison to freezing with a programmed biological freezer. Therefore, we recommend the use of this technique for freezing semen especially when ICSI technique is considered as the main therapeutic procedure.

Pulmonary thromboendarterectomy--risk factors for early survival and hemodynamic improvement

OBJECTIVE

Pulmonary thromboendarterectomy (PTE) for chronic thromboembolic pulmonary hypertension is a challenging procedure with a considerable mortality. The aim of this investigation was to identify risk factors influencing mortality and operative results.

METHODS

Between October 1995 and August 2000, 69 patients (age 54 years; 34 women; mean New York Heart Association (NYHA) stage 3.4) underwent PTE. The preoperative pulmonary vascular resistance (PVR) was 988+/-554 dynes x s x cm(-5), mean pulmonary artery pressure 50+/-12 mmHg, right atrial pressure (RAP) 11.5+/-4 mmHg. Hospital mortality was 10.1% (n=7/69). Mean postoperative PVR on the 2nd day was 324+/-188 dynes x s x cm(-5). Pulmonary angiography was reviewed for number of involved segments (mean 9.3+/-2) and bronchial arteries diameter (BAD; mean 4.6+/-1.6 mm). A univariate and multivariate analysis was performed to determine preoperative risk factors for hospital death and inadequate hemodynamic improvement.

RESULTS

By univariate analysis, mortality was influenced by age (P=0.04), right atrial pressure (P=0.009), NYHA (P=0.02) and the number of angiographically involved segments (P=0.02). Sex, left ventricular function, presence of coronary artery disease and bronchial artery diameter did not show correlation with mortality. Inadequate hemodynamic improvement in a dichotomized analysis (PVR > or =500 dynes x s x cm(-5), n=11, and PVR < 500 dynes x s x cm(-5), n=58), assessed by univariate analysis, was significantly influenced by age (P=0.02), preoperative PVR (P=0.01), NYHA (P=0.002), RAP (P=0.02) and female sex (P=0.02). Multivariate analysis identified age (P=0.1), RAP (P=0.002) and female sex (P=0.007) as risk factors for inferior hemodynamic improvement.

CONCLUSIONS

Preoperative parameters can be utilized to assess postoperative mortality and hemodynamic improvement after pulmonary thromboendarterectomy. Patient age and clinical deterioration of pulmonary hypertension are considerable preoperative factors influencing hospital mortality. Inadequate postoperative hemodynamic improvement is affected by severity of disease and female sex.

Comparison between computerized slow-stage and static liquid nitrogen vapour freezing methods with respect to the deleterious effect on chromatin and morphology of spermatozoa from fertile and subfertile men

The purpose of this study was to determine the negative effects (cryodamage) on human spermatozoa after freeze-thawing and to determine whether freeze-thawing of spermatozoa with a programmed slow freezer is better than freezing with liquid nitrogen vapour (rapid freezing) with regard to alterations in sperm chromatin and morphology in semen from fertile (donor) and subfertile, IVF/ICSI, patients. Ninety-five semen samples were obtained either from patients attending our IVF unit for treatment (n=34) or from donors (n=25) with proven fertility and normal sperm quality according to WHO guidelines. Each semen sample was divided into two parts after liquefaction and addition of the cryoprotectant. The first part was frozen using a programmed biological freezer and the second part was frozen by means of liquid nitrogen vapour. Smears were made before the freezing and after the thawing procedure to assess morphology (strict criteria) and chromatin condensation (Acridine Orange test). The mean percentage of chromatin condensed spermatozoa in the samples from donors (control group) was 92.4 +/- 8.4% before freezing and this decreased significantly (p < 0.0001) to 88.7 +/- 11.2% after freeze-thawing with the computerized slow-stage freezer and to 87.2 +/- 12.3% after using static liquid nitrogen vapour (p < 0.001). The corresponding values for semen obtained from patients was 78.9 +/- 10.3% before freezing which decreased to 70.7 +/- 10.8 and 68.5 +/- 14.8%, respectively (p < 0.001). On the other hand, the mean percentage of normal sperm morphology in the control group decreased from 26.3 +/- 7.5% before freezing to 22.1 +/- 6.4% (p < 0.0001) after thawing with the computerized slow-stage freezer and to 22.2 +/- 6.6% (p < 0.0001) after the use of static liquid nitrogen vapour. In the patient group, the mean percentage of normal morphology decreased from 11.7 +/- 6.1% after freezing with the biological freezer to 9.3 +/- 5.6% and to 8.0 +/- 4.9% after freezing with static liquid nitrogen vapour. This study demonstrates that chromatin packaging and morphology of human spermatozoa decrease significantly after the freeze-thawing procedure, not only after the use of static liquid nitrogen vapour but also after the use of a computerized slow-stage freezer. However, the chromatin of semen samples with normal semen parameters (donor sperm) withstand the freeze-thaw injury better than those with low quality semen samples. Therefore, the computerized slow stage freezer could be recommended for freezing of human spermatozoa, especially for subnormal semen samples, for example, ICSI and ICSI/TESE candidates and from patients with testicular tumours or Hodgkin's disease, in order to avoid further damage to the sperm chromatin structure.

Periodontal treatment with an Er: YAG laser compared to scaling and root planing. A controlled clinical study

BACKGROUND

The aim of the present study was to compare the effectiveness of an Er:YAG laser to that of scaling and root planing for non-surgical periodontal treatment.

METHODS

Twenty patients with moderate to advanced periodontal destruction were treated under local anesthesia and the quadrants were randomly allocated in a split-mouth design to either Er:YAG laser using an energy level of 160 mJ/pulse and 10 Hz or scaling and root planing (SRP) using hand instruments. Clinical assessments of plaque index (PI), gingival index (GI), bleeding on probing (BOP), probing depth (PD), gingival recession (GR), and clinical attachment level (CAL) were made prior to and at 3 and 6 months after treatment. Subgingival plaque samples were taken at each appointment and analyzed using darkfield microscopy for the presence of cocci, non-motile rods, motile rods, and spirochetes. Differences in clinical parameters and prevalence of bacterial species were analyzed using the paired t-test.

RESULTS

The PI remained nearly unchanged while a significant reduction of the GI occurred in both groups after 6 months (P < or =0.001, P< or =0.001, respectively). The mean value of BOP decreased in the laser group from 56% at baseline to 13% after 6 months (P < or =0.001) and in the SRP group from 52% at baseline to 23% after 6 months (P < or =0.001). The mean value of the PD decreased in the laser group from 4.9+/-0.7 mm at baseline to 2.9+/-0.6 mm after 6 months (P< or =0.001) and in the SRP group from 5.0+/-0.6 mm at baseline to 3.4+/-0.7 mm after 6 months (P < or =0.001). The mean value of the CAL decreased in the laser group from 6.3+/-1.1 mm at baseline to 4.4+/-1.0 mm after 6 months (P < or =0.001) and in the SRP group from 6.5+/-1.0 mm at baseline to 5.5+/-1.0 after 6 months (P < or =0.001). The reduction of the BOP score and the CAL improvement was significantly higher in the laser group than in the SRP group (P < or =0.05, P < or =0.001, respectively). Both groups showed a significant increase of cocci and non-motile rods and a decrease in the amount of motile rods and spirochetes.

CONCLUSIONS

An Er:YAG laser may represent a suitable alternative for non-surgical periodontal treatment.

Association between interleukin concentration in follicular fluid and intracytoplasmic sperm injection (ICSI) outcome

PROBLEM

The aim of this study was to determine the presence and concentration of interleukin IL-6, IL-8, and granulocyte-macrophage-colony-stimulating factor (GM-CSF) in pre-ovulatory ovarian follicular fluid (FF) of patients undergoing controlled ovarian hyperstimulation for intracytoplasmic sperm injection (ICSI) therapy on one hand, and to find out whether these cytotokine concentrations could be used as a predictive parameter for ICSI outcome.

DESIGN

The levels of IL-6, IL-8, and GM-CSF were measured from women that underwent ICSI therapy and the results were compared between the patients who became pregnant after IC

Predictive value of sperm chromatin condensation (aniline blue staining) in the assessment of male fertility

A case control study was carried out to determine the value of sperm chromatin condensation in the assessment of male fertility. A total of 165 semen samples from 90 patients (cases) and 75 healthy donors (control) were examined for chromatin condensation (aniline blue staining), as well as conventional sperm parameters, notably sperm morphology, sperm count, and progressive motility. Whereas only 55 +/- 12.0% of the samples from the infertile patients were unstained by aniline blue (chromatin condensed), 78 +/- 19.0% of the samples in the control group did not take up the stain (chromatin condensed). A significant difference (p < .001) was observed between the two groups. Similarly, the difference between the mean percentage of morphologically normal spermatozoa for the infertile patients (12.1 +/- 1.2%) and the control (23.9 +/- 1.9%) was very significant (p < .001). In addition, only 50 out of the 90 patients (55.5%) had a normal sperm count, whereas all the 75 (100%) were normal in the control group. By comparing between the two groups a significant difference (p < .001) was also observed. Furthermore, a significant difference (p < .001) was also found between the cases and the control with regard to the percentage of spermatozoa illustrating linear progressive motility (40 +/- 9.7% vs. 70 +/- 12.3%). However, no correlation was found between sperm chromatin condensation and morphology, count, and motility. This study suggests that chromatin condensation constitutes a valuable parameter in the assessment of male fertility, completely independent of conventional sperm parameters. Consequently, the inclusion of chromatin condensation to routine laboratory investigations of semen prior to assisted reproduction is strongly recommended.

Reliability and interobserver variability in radiological patellar height ratios

This study evaluated the reliability and interobserver variability of five patellar height ratios as measured by two examiners on standard radiographs: Insall-Salvati (IS), modified Insall-Salvati (MIS), Blackburne-Peel (BP), Caton-Deschamps (CD), and Labelle-Laurin (LL). Plain lateral radiographs with a knee flexion angle of 20 degrees for IS, MIS, BP, and CD ratios and 90 degrees for the LL method of 22 knees of 21 patients with varying pathological knee conditions were analyzed. Statistical results revealed a low interobserver variability with high correlation coefficients (0.86 for IS, 0.82 for MIS, 0.86 for BP, 0.92 for CD, and 0.81 for LL; P > 0.3) and low mean interobserver errors. However, regarding the reliability of the radiographic results of the different methods for patella alta, baja, or norma we found varying results in 68% of the patients. In two patients the patellar height was classified as alta, norma, or baja depending on the ratio used. Regarding the definitions of patellar height used by the authors of these methods, we found the lowest number of normal patellae with the IS ratio and no patella alta for the CD ratio. The LL method revealed the highest number of patella alta. The BP ratio showed intermediate results for both patella alta and baja, being the most moderate method. This study showed that there was a good interobserver reliability for the evaluation of patellar height according to the common radiological ratios. However, the high frequency of differing results between the different radiographic ratios showed that patellar height classification as "alta," "norma," or "baja" depends heavily on the chosen index. The differing results were due mainly to the normative patellar height data and to anatomical differences. Based on these findings we recommend a ratio using the articular surface of the patella in relation to the joint line. We recommend the BP method because it revealed the lowest interobserver variability and discriminated best among the groups alta, norma, and baja.

Complete arterial coronary artery bypass grafting versus conventional revascularization--early results

BACKGROUND

Complete arterial coronary artery bypass grafting (CABG) offers the potential to improve long-term results. However, an increased perioperative risk has been controversially discussed. New operative techniques (skeletonization of the ITA/ T-grafts/utilization of the radial artery (RA)) may decrease perioperative risk. We compared the outcome after conventional with that after complete arterial CABG.

MATERIAL AND METHODS

Three consecutive groups of patients were analyzed. In group I (n = 50), CABG was performed using left ITA and vein grafts. The other two groups received complete arterial CABG with either both ITA's (group II; n = 52) or left ITA and RA (group III; n = 52).

RESULTS

A mean of 3.9+/-0.8 (I) versus 4.2+/-0.8 (II) and 3.9+/-0.9 (III) anastomoses were performed per patient (ns). Mean operating time was significantly prolonged in group II (II: 252+/-54; p<0.0001; vs. I: 191+/-36; III: 203+/-33). Mean ischemic time was significantly prolonged in group II and III (II:65+/-20; p<0.0001; III: 68+/-16; p<0.0001; vs. I: 51+/-15). Mean bypass time (I: 83+/-23; II: 95+/-41; III: 91+/-21), the rate of postoperative complications and in-hospital mortality (I: n = 0; II: n = 2; III: n = 0; ns) showed no significant differences.

CONCLUSIONS

Complete arterial CABG using modern surgical techniques is as safe as the conventional surgical approach using left ITA and vein graft.

[Driving ability after reversal of phenylephrine 10% induced mydriasis by dapiprazole 0.5%; a prospective study on 65 eyes]

BACKGROUND

Particularly outpatients want to reach the ability for driving a car as soon as possible after pupillary dilatation. Dapiprazole is an alpha-1 adrenergic inhibitor that antagonizes the mydriatic effect of phenylephrine in a direct competitive way. The aim of this study was to determine restoration of traffic related functions after dapiprazole application in accordance with the guidelines of the German Society of Ophthalmology (DOG).

SUBJECTS

65 eyes of 33 subjects were tested (17 females, 16 males). All had driving licenses without restrictions. Before mydriasis and after reversal with dapiprazole traffic-related functions were evaluated (photopic visual acuity, mesopic vision, sensitivity to glare, colour vision, accommodation, visual field).

RESULTS

No relevant changes of the parameter responsible for the ability to drive a motor vehicle could be shown after reaching premydriatic pupil diameters.

CONCLUSIONS

There is evidence that reaching normal pupil diameters after reversal of mydriasis by dapiprazole is a valid sign of restoration of traffic related functions.

Quantitative analysis of proinflammatory cytokines (IL-1beta, IL-6, TNF-alpha) in human skin wounds

Proinflammatory cytokines play an important role in the mediation of inflammation and trauma. They could be useful for the determination of vitality and wound age. In the present study, 144 human skin wounds due to sharp force were investigated. The material was collected during operations (N=96) and postmortem examinations (N=48). The wound age varied from several seconds or minutes to 9 days. Control skin was available in each individual. The tissue specimens were homogenized and extracted in a solution of PBS and protease inhibitors. Interleukin-1beta (IL-1beta), interleukin-6 (IL-6) and tumour necrosis factor alpha (TNF-alpha) were measured by quantitative ELISA analysis. Statistical evaluation was performed by the t-test using the quotients of levels (wound sample/control skin). In surgical specimens the cytokine levels revealed a clear tendency to increase with wound age. IL-1beta in early skin wounds (</=30 min) and TNF-alpha after a wound age of 1-2 h demonstrated statistically significant changes in comparison with control skin (P<0.05). In autopsy samples with severe traumatization excessive elevation of cytokine levels was observed: IL-1beta, IL-6 and TNF-alpha showed significant increases (P<0.001-0.05) in stab and incised wounds with very short survival times of less than 5 min, but not in possibly supravital injuries. Elevated IL-6 levels persisted in older wounds (>24 h, P<0.05). The quantitative analysis of proinflammatory cytokines in wound extracts can contribute to the determination of vitality and wound age, in particular in the very early post-traumatic interval (classic stab wounds).

The influence of a 0.2% chlorhexidine mouthrinse on plaque regrowth in orthodontic patients. A randomized prospective study. Part II: Bacteriological parameters

In a prospective plaque regrowth study focusing on oral hygiene during fixed appliance therapy 12 adolescent patients (mean age 14.1 +/- 1.5 years) were evaluated twice over 2-day test periods. In the randomized, double-blind study the influences of a 0.2% chlorhexidine mouthrinse (Corsodyl, CHX) and a commercially available dentifrice supplementing fluoride (Odol-med-3) were compared intra- and interindividually in a crossover design with regard to the bacteriological parameters. The bacteriological parameters of vital fluorescence, bacteriological counts (BC), colony forming units (CFU), plating efficiency (PE) and mutans streptococci (MS) were related to the clinically assessed indices of plaque and gingivitis. All parameters analyzed demonstrated significant differences between the control and the test (chlorhexidine) group. Where-as the values of BC, CFU, and PE progressively increased in the control group from T0 to T2, these parameters distinctly decreased in the chlorhexidine group. All values of vital flora (VF) scored around 75% in the control group compared to values of 30% in the test group. BC, CFU und PE correlated significantly. The score of mutans streptococci persisted or increased in the controls whereas mutans streptococci approached 0 in the chlorhexidine group. Until the 5th day of washout a clear-cut carry over of the chlorhexidine rinse on mutans streptococci as well as on the gingival index was evident. Since dead microorganisms remain on the tooth surface and in order to maintain oral health, chlorhexidine application might advisedly be supplemented by mechanical plaque control.

Sperm morphology and chromatin condensation before and after semen processing

Semen analysis constitutes the most important investigation of male infertility. However, the true anomalies present in defective sperm cells have been only partially characterized. The integrity of the sperm chromatin may play the most important role, particularly in ICSI, where most of the natural selection mechanisms are bypassed. This study was carried out to characterize sperm morphology (strict criteria), to evaluate chromatin condensation and sperm count in native semen as well as after semen preparation by the swim-up technique, and to eventually evaluate any correlation between these parameters. Semen from 90 men was analyzed for the above parameters in both the fresh and processed semen. Whereas the sperm count decreased after sperm preparation by the swim-up technique in comparison to the value in the fresh semen (p < .001), there was an increase in the percentage of morphologically normal (p < .001) and chromatin-condensed sperm (p = .99). However, there was no correlation between sperm morphology, chromatin condensation, and sperm count either in the fresh or in the processed semen samples. These results suggest that sperm morphology, sperm count, and chromatin condensation are independent parameters that should be evaluated separately in the assessment of male fertility in an assisted reproduction program.

[Pathogenetic and clinical aspects of low estradiol level in the man]

To elucidate a possible role of low estradiol (E2) levels in blood serum of men, normal values were determined in 91 healthy men (age 20-75 years), classified as high or low complaint-index due to a psychological questionnaire. Statistical analysis gave no correlation of estradiol levels to age or complaint index in normal men whereas testosterone (T) could be significantly correlated to complaint-index (p < 0.01) and free testosterone (fT) could be significantly correlated to age (p < 0.001) and complaint-index (p < 0.01). T and E2 were determined in 1370 clinical patients with various urological diseases, T, fT and E2 in 1261 ambulant patients. In 72/1370 (5.2%) and 76/1261 (6%) patients, low E2-levels (< 10 pg/ml) were found in blood serum. In 56/76 (74%) patients with low E2-levels, T or fT was simultaneously low. Isolated low E2-levels were found in 20/1261 (1.6%) patients. In clinical patients, no special urological disease correlated to low E2-levels. Due to these results, low E2 levels in men are in most cases the result of low testosteron levels. The adequate hormonal treatment in men is therefore the replacement of testosteron. Substitution of E2 in men is at that time an experimental therapy, that is limited on selected cases.

Mitral-valve repair without annuloplasty rings: results after repair of anterior leaflet versus posterior-leaflet defects using polytetrafluoroethylene sutures for chordal replacement

OBJECTIVE

Defects of the anterior mitral leaflet (AML), including ruptured chordae, are often regarded as difficult or even impossible to repair. Chordal replacement may also be an option in extensive disease of the posterior mitral leaflet (PML). It has not yet been clearly defined whether the repair of either mitral leaflet using chordal-replacement techniques is as safe as the standard repair of the mitral valve (MV) including quadrangular resection and ring reduction alone.

METHODS

Between October 1995 and June 1999, 160 patients underwent MV repair for mitral regurgitation (MR) in our institution. Chordal replacement with polytetrafluoroethylene (PTFE) sutures for elongated or ruptured chordae was performed in 72 (45%) patients. These patients were divided into two groups according to the location of the MV lesions: 48 patients with prolapse of the anterior or both leaflets (AML group) received an average of 2.2+/-1. 1 PTFE sutures for repair; in 24 patients with isolated PML defects (PML group), we used an average of 1.5+/-0.8 PTFE sutures. No prosthetic annuloplasty rings were used. Dilatation of the posterior mitral ring was corrected by PTFE suture annuloplasty. The remaining 88 patients underwent a standard mitral repair without chordal replacement. There were no statistically significant (NS) differences between the two groups (AML/PML) regarding age (59/62 years, P=0.49), left ventricular (LV) ejection fraction (64/66%, P=0. 6) and preoperative NYHA class (2.9/2.9, P=0.36). Postoperatively, all patients were followed by serial transthoracic echocardiography at 1 week and after 3, 6, 12 and 24 months by the same investigator.

RESULTS

In-hospital mortality was 4.2% (2/48) in the AML group and 0% (0/24) in the PML group (P=0.55). Three of the AML patients (6. 3%) and one PML patient (4.2%) underwent reoperation for recurrent MR (P=1.0). The 1- and 2-year freedom from MV reoperation was 95. 1+/-3.4 and 92.6+/-4.2% in the AML group versus 95.0+/-4.9 and 95. 0+/-4.9% (P=0.67). The 1- and 2-year freedom from residual or recurrent MR grade 2 or higher was 97.6+/-2.4 and 94.9+/-3.5% (AML) versus 95.8+/-4.0 and 95.8+/-4.0% (PML) (P=0.97).

CONCLUSIONS

We were unable to find statistically significant differences concerning mortality, freedom from recurrent MR and MV reoperation between the AML and PML groups. Extensive prolapse or chordal pathology of the anterior and PML can be corrected by chordal replacement. Using these techniques, stable repair can be achieved in more than 90% of patients at mid-term follow-up. Long-term observations are necessary to confirm the durability of this type of MV repair.

Relationship between ovarian stimulation regimen and cytokine concentration in follicular fluid and their effect on fertilization and pregnancy outcome of patients undergoing ICSI program

PROBLEM

The aims of this study were to evaluate the presence of insulin-like growth factor (IGF)-I, platelet-derived growth factor (PDGF), and epidermal growth factor (EGF) in pre-ovulatory follicular fluid (FF) in patients undergoing ovarian hyperstimulation for intra-cytoplasmic sperm injection (ICSI) treatment, to determine the differences between the concentrations of these cytokines in relation to ovarian stimulation regimens, and to find the relationship between these parameters and estradiol 17-beta, progesterone, and luteinizing hormone (LH) concentration in serum, as well as ICSI outcome.

METHOD

IGF-I and PDGF were measured in the FF of 85 patients. The IGF-I levels were measured by radioimmunoassay, whereas the concentrations of PDGF and EGF were measured by enzyme-linked immunosorbent assay technique, using commercially available kits.

RESULTS

IGF-I (0.42 +/- 0.09 ng/mL), PDGF (307.3 +/- 274.5 pg/mL), and EDF (8.88 +/- 6.4 pg/mL) were present in pre-ovulatory FF in patients undergoing ovarian hyperstimulation for ICSI treatment. The mean concentration of IGF-I in the follicle-stimulating hormone (FSH) group was significantly higher (P = 0.036) than that found in the human menopausal gonadotrophin (hMG)/FSH group, whereas no significant difference in the mean concentrations of PDGF (P = 0.58) and EGF was shown between all investigated groups.

CONCLUSION

Controlled ovarian stimulation regimens affect only IGF-I levels in FF and the cytokine concentrations of all investigated groups, in turn, showed no correlation either with steroid hormones in serum or ICSI outcome.

Adult patients' view of orthodontic treatment outcome compared to professional assessments

One important aspect in evaluating the outcome and quality of orthodontic treatment is the patient's own assessment. The objective of this study was to evaluate the course and outcome of orthodontic treatment in adults from the patient's vs the operator's point of view. In a previous study, the orthodontic treatment of 88 adults was evaluated using the IOTN and PAR Index before and after treatment. Fifty-nine patients answered treatment questionnaires on 1. the reason for seeking treatment, 2. dentofacial aesthetics, 3. treatment outcome, 4. course of treatment, 5. attitude, 6. social well-being. Depending on the original treatment goal, the patient population was divided into an Ideal Group and a Compromise Group. In 75% of the patients, dissatisfaction with dental aesthetics was the prime motive for seeking treatment; correlations with PAR parameters (overjet and maxillary anterior teeth) were weak. In general, a high degree of patient satisfaction with orthodontic treatment was registered. As regards satisfaction with post-treatment dental aesthetics there were no significant differences between the groups. Comparison of professional assessment with the subjective rating by patients revealed discrepancies in that the patients' rating of outcome tended to be more positive. The differentiation between ideal and compromise treatment goals proved useful. In the Compromise Group, a high level of patient satisfaction was attained with a shorter treatment duration and lower appliance involvement. 92% considered their major pre-treatment need to have been met, and 95% would have had the treatment performed again.

[Arthroscopy for diagnosis and therapy of early osteoarthritis of the hip]

Failure to conservative treatment in patients with less advanced radiographic signs of osteoarthritis of the hip (Danielsson grade 2-5) confronts with the decision of further treatment. Since radiographic imaging has not been proved very useful in demonstrating intraarticular structures and results of hip arthroscopies have been promising, arthroscopies have been performed in 17 hips from November 1997 to September 1998. Arthroscopic findings were exceeding preoperative imaging. In addition to cartilage degeneration, concomitant loose bodies, impinging osteophytes, degeneration of the labrum and synovial disease were found. Removal of loose bodies and osteophytes, partial resection of labral tears and partial synovectomy were performed. 1 month after arthroscopy (n = 15), mean Harris-Hip-Score was increased by 13 points und pain reduced by 39 % on average. 6 months after arthroscopy (n = 9), mean Harris-Hip-Score was increased by 14 points and pain reduced by 32 % on average. In addition to its therapeutic benefit, arthroscopy offers direct visualisation of the hip providing important information for the decision of further treatment.

Amelioration of lung reperfusion injury by L- and E- selectin blockade

OBJECTIVE

Reperfusion injury is the main reason for early graft failure after lung transplantation. Inhibition of the adherence of polymorphonuclear leukocytes to activated endothelium by blocking L- and E-selectins (antibody EL-246) could potentially inhibit reperfusion injury.

METHODS

Reperfusion injury was induced in a left lung autotransplant model in sheep. After hilar stripping the left lung was flushed with Euro-Collins solution and preserved for 2 h in situ at 15 degrees C. After reperfusion right main bronchus and pulmonary artery were occluded leaving the animal dependent on the reperfused lung (control, n = 6). Pulmonary function was assessed by alveolo-arterial oxygen difference (AaDO2) and pulmonary vascular resistance (PVR), the chemiluminescence of isolated neutrophils, as well as the release of beta-N-acetyl-glucosaminidase (beta-NAG) served as indicator of neutrophilic activation. Extravascular lung water was an indicator for pulmonary edema formation. EL-246 group animals (n = 6) were treated additionally with 1 mg/kg BW of EL-246 given prior and during reperfusion.

RESULTS

After 3 h of reperfusion five control animals developed alveolar edema compared to one animal in the EL-246 group (P = 0.08). AaDO2 (mm Hg) was significantly higher in the control compared to the EL-246 group (510 +/- 148 vs. 214 +/- 86). PVR (dyn x s x cm(-5)) was significantly increased in the control compared to the EL-246 group (656 +/- 240 vs. 317 +/- 87). Neutrophilic activation was significantly lower in the EL-246 group. Extravascular lung water was significantly lower compared to control (6.88 +/- 1.0 vs. 13.4 +/- 2.8 g/g blood-free lung weight).

CONCLUSIONS

Treatment with EL-246 results in improved pulmonary function and less in vivo PMN activation in this experimental model. Further studies are necessary to evaluate the possible role of selectin blockade in amelioration of reperfusion injury in human lung transplantation.

Effect of freeze-thawing procedure on chromatin stability, morphological alteration and membrane integrity of human spermatozoa in fertile and subfertile men

Cryopreservation is known to impair sperm motility and decrease the fertilization rate by detrimental effects on acrosomal structure and acrosin activity. However, the consequences of cryopreservation on the integrity of the sperm nucleus, chromatin stability and centrosome are less clear. The present study was designed to determine the effect of the freeze-thawing procedure on chromatin condensation (aniline blue staining) and the morphology (strict criteria) and membrane integrity of human spermatozoa. The structural and functional characteristics of the sperm plasma membrane were measured by the eosin-test and hypo-osmotic swelling test which were done separately. Sperm cryopreservation was performed on semen samples from two groups of men classified as fertile (n = 20) and subfertile (n = 72), based on their reproductive history and semen analysis according to WHO guidelines. The mean percentage of condensed chromatin, morphologically normal spermatozoa and membrane integrity in all semen samples investigated (n = 92) decreased significantly (p = 0.0001) after freeze-thawing, in comparison to the value observed prior to freezing. By comparing the semen samples between fertile and subfertile patients, significantly (p = 0.0009) greater damage was demonstrated in the subfertile than in the fertile group. Furthermore, no significant difference was observed between the two groups with regard to the morphological alteration and structural as well as functional damage of the sperm membrane. In conclusion, the freeze-thawing procedure significantly affects chromatin structure and sperm morphology, especially in the head and the tail regions, and this may explain the lower fertilization rate and IVF/ICSI outcome when frozen-thawed spermatozoa are used. In addition, this study demonstrates that chromatin condensation is a sensitive parameter for the evaluation of cryodamage of semen samples from fertile and subfertile patients, though subfertile patients with very poor semen characteristics have yet to be studied. It is therefore recommended that chromatin condensation be used as an additional parameter for the assessment of sperm quality after freeze-thawing.