Whole blood interleukin 8 and plasma interleukin 8 levels in newborn infants with suspected bacterial infection

AIM

To evaluate a new micro-method technique for measurement of interleukin 8 in detergent-lysed whole blood (whole blood IL-8) applicable to capillary blood sampling as a test for bacterial infections in neonates.

METHODS

Whole blood IL-8 was measured at the first suspicion of infection along with IL-8 determined in plasma (plasma IL-8), C-reactive protein and blood cultures in 154 consecutive newborn infants with clinical signs of bacterial infection. Only 20 microl of whole blood were required for the new assay.

RESULTS

Blood culture-proven infections were diagnosed in six infants and clinical infection (defined as a combination of clinical and laboratory signs) in 20 infants. 1000 pg/ml was determined as the suitable threshold for whole blood IL-8 by ROC-curve analysis. At that threshold, whole blood IL-8 detected blood culture-proven infections with a sensitivity of 83% and a specificity of 67%. The areas under the ROC curves were similar for whole blood IL-8 and plasma IL-8.

CONCLUSIONS

Compared with plasma IL-8, whole blood IL-8 offers the advantages that measurements of whole blood IL-8 require a smaller blood sample volume and are not altered by haemolysis. The diagnostic accuracy of whole blood IL-8 remains to be studied in more detail in the future.

Risk indicators for falls in institutionalized frail elderly

The aim of this study was to identify individual predisposing risk indicators for falls in a sample of institutionalized frail elderly in southern Germany. The design was a prospective observational study with a 1-year follow-up (October 1998-September 1999). The study population included 472 long-term-care residents whose mean age was 84 years; 77% were female. Risk indicators for accidental falls were analyzed by using logistic regression. Residents were found to have an incidence density rate of falls of 2,558 per 1,000 resident-years. Multiple logistic regression analysis revealed short-term memory loss, transfer assistance, urinary incontinence, positive fall history, and use of trunk restraints as predictors of falls. In a further logistic regression analysis, depressive symptoms, transfer assistance, urinary incontinence, and positive fall history were associated with frequent falls. Using these risk indicators as a screening procedure to identify fallers would be easy to administer and could be accomplished by nursing staff. Study results encourage specifically addressing urinary incontinence, cognitive impairment, use of restraints, depression, and transfer difficulties as modifiable predisposing risk factors for falls. Fall history represents an important nonmodifiable marker to identify residents at high risk.

[Abilities and restrictions of nursing home residents. Evaluation with the Minimum Data Set of the Resident Assessment Instrument]

The main objective of the study was to examine the prevalence of problems and resources of an unselected cohort of nursing home residents. The sample includes residents (n=769) of an urban area in Southern Germany. The assessment definitions were used according to the Minimum Data Set of the Resident Assessment Instruments (Version 2.0).

RESULTS

The mean age was 84.2 years, 608 of the residents were female. Dementia (446) and stroke (185) were the most common main diagnosis. Syndrome prevalences are reported for depressive symptoms (323), mobility impairments (608), urinary incontinence (461), decubitus (54), use of restraints (54), disruptive behavior (185), psychopharmacy (377), severe visual impairment (123) and severe hearing impairment (123).

[Familial versus sporadic prostate cancer in the German population. Clinical and pathological characteristics in patients after radical prostatectomy]

Family history is one of the strongest epidemiological risk factors for the development of prostate cancer. The impact on the clinical presentation and prognosis, however, is controversial. In the present study, we analyzed 464 familial and 492 sporadic prostate cancer patients following radical prostatectomy. The average age at onset was 62.1 years in the familial group and 64.2 years in the sporadic controls (p<0.001). The screening attitude, DRE findings and the PSA values at diagnosis the pT- and pN-stages, and the tumor grade did not differ between both groups. With a median follow-up of 3.3 years, the 5- and 10-year progression-free survival rates were 76.2% and 56.5% in familial and 70.8% and 55.5% in sporadic patients, respectively (n.s.). A multiple logistic regression analysis revealed that family history did not have an influence on disease recurrence. In our population there was no association between a familial predisposition and clinical features or clinical course of the disease. Whether hereditary prostate cancer is distinct from sporadic forms cannot be determined before the underlying genetic alterations are identified.

Outdoor activities in childhood: a protective factor for cutaneous melanoma? Results of a case-control study in 271 matched pairs

BACKGROUND

A matched case-control study was performed in Munich, Germany, in 1996-97 to evaluate the risk of cutaneous melanoma due to ultraviolet (UV) exposure behaviour in Southern Bavaria, Germany.

OBJECTIVES

Patients with cutaneous melanoma and controls were investigated by two physicians using a standardized questionnaire to identify risk factors for the development of melanoma, such as professional and leisure sun exposure behaviour. In each person, a total body examination was performed to detect benign skin alterations, phenotypic characteristics and precursor lesions for skin cancer.

PATIENTS/METHODS

A total of 271 melanoma patients and 271 controls were individually matched for residence, age and gender. A multiple conditional logistic regression analysis was performed.

RESULTS

Of 56 factors, those risk factors with a strong effect on the development of melanoma were: the existence of melanoma in first degree relatives, solar lentigo, actinic keratosis, actinic cheilitis, skin phototype, immediate skin reaction to UV light at the start of the outdoor season, sunburn in childhood and sun exposure during holidays in sunny areas 20 years before melanoma was diagnosed; outdoor activities in childhood were found to be protective.

CONCLUSIONS

Sunburn in childhood and increased sun exposure during annual holidays in sunny areas should be avoided. In contrast, outdoor activities in childhood, including soccer and gardening, should be encouraged because they are associated with a lower risk of melanoma formation.

CSF filtration is an effective treatment of Guillain-Barré syndrome: a randomized clinical trial

OBJECTIVE

To compare CSF filtration (CSFF) and plasma exchange (PE) in the treatment of patients with Guillain-Barré syndrome (GBS).

METHODS

In a prospective controlled clinical trial, 37 patients with acute GBS were randomized to receive either CSFF or PE. Inclusion criteria were fulfillment of National Institute of Neurological and Communicative Disorders and Stroke criteria and disability to walk >5 m unassisted.

RESULTS

With similar baseline features in both groups (initial disability grades on the six-point grading scale of the GBS Study Group) the primary outcome variable (improvement within 28 days after randomization) was almost identical (test for equivalence p = 0.0014), the mean grade values being 0.82 in the CSFF group and 0.80 in the PE group. After 56 days, 56% (9 of 16 patients) of the CSFF group and 37% (7 of 19 patients) of the PE group had reached grade 2 (i.e., ability of unassisted walking >5 m). After 6 months, the probability to reach grade 2 was about 80% in both groups. In the CSFF group, transient pleocytosis occurred without apparent clinical complications. Clinically relevant complications were higher in the PE-treated group.

CONCLUSIONS

Although the number of patients was small, the authors found that the treatment of GBS with CSFF is at least as effective as with PE. CSFF might work by removing from the CSF inflammatory mediators, autoantibodies, or other factors.

Interleukin-8: a valuable tool to restrict antibiotic therapy in newborn infants

This study was conducted to evaluate the accuracy and kinetics of interleukin 8 (IL-8) as a test for early-onset bacterial infections (EOBI) in neonates and to examine whether IL-8 would allow "unnecessary" antibiotic therapy to be reduced. First, IL-8 was measured 378 times on admission, along with C-reactive protein (CRP), immature to total neutrophil ratio (IT ratio) and blood cultures, in full-term and preterm neonates with suspected EOBI. Combined culture-proven and clinical EOBI were detected on admission by the combination of IL-8 > or = 70 pg ml(-1) and/or CRP > 10 mg l(-1) with 92% sensitivity and 74% specificity. An increased IL-8 was found in 62% of the infected infants, while CRP was still normal. In a second study period, IL-8 was determined prospectively in 331 infants who presented clinical signs of EOBI or had a birth history of amniotic infection. Antibiotic therapy was restricted to those infants with suspected infection who also had an increased IL-8 and/or CRP (n = 158). Another 39 infants received antibiotics on the basis of clinical signs despite negative IL-8 and CRP. Of 150 non-infected infants in whom IT ratio, IL-8 and CRP were available, treatment would have been indicated for 93 infants based on IT ratio and/or CRP (n = 77) or clinical signs (n = 16), but was only initiated in 55 infants based on IL-8 and/or CRP (n = 28) or clinical signs (n = 27), an apparent reduction in "unnecessary" antibiotic therapy of 40%.

CONCLUSION

The combination of IL-8 and CRP is a reliable test for the diagnosis of EOBI and may be helpful in enabling antibiotic therapy to be reduced in newborn infants.

Efficacy of ultrasound B-scan compared with physical examination in follow-up of melanoma patients

BACKGROUND

The value of ultrasound B-scan for routine follow-up of melanoma patients still is not generally accepted. Therefore, the authors compared the efficacy of physical examination (PE) with ultrasound B-scan (UBS) for detection of regional tumor recurrence in melanoma patients. The aim of the current study was to evaluate whether early detection of metastases improves relapse-free and overall survival.

METHODS

For a period of 4 years, 829 consecutive melanoma patients were followed prospectively. Physical examination of 3011 patients and concomitant UBS of in-transit routes and regional lymph node basins were performed. Suspicious lesions were diagnosed by fine-needle aspiration cytology and pathology.

RESULTS

During the study period, 242 (90.6%) of 267 patients with melanoma recurrences were first recognized by PE or UBS within the routine follow-up program. The sensitivities of both methods differed significantly (P = 0.001). Metastases were detected by PE in only 61 of 242 recurrences (25.2%, 95% confidence interval [CI]: 19.9-31.2%), whereas UBS revealed 240 recurrences (99.2%, 95% CI: 97.3-99.6%). The specificity was 98.4% (95% CI: 97.8-98.8%) and 98.3% (95% CI: 97.7-98.7%), respectively. Survival of 103 patients who presented with a first nodal melanoma recurrence was followed and analyzed by multiple Cox regression. Overall survival was affected by the diameter of the largest metastasis (P = 0.001) and the number of metastatic lesions (P = 0.012).

CONCLUSION

The study found that ultrasound B-scan was highly effective in the early detection of regional melanoma metastases compared with physical examination. Earlier detection of such metastases seemed to result in improved overall survival.

Epiretinal membranes after extracapsular cataract surgery

PURPOSE

To determine whether uneventful extracapsular cataract extraction (ECCE) with posterior chamber intraocular lens (PC IOL) implantation induces epiretinal membranes (ERMs).

SETTING

Private practice, with statistical evaluation at a university department in Germany.

METHODS

This prospective study comprised 296 consecutive patients (332 eyes) who had uneventful ECCE with PC IOL implantation for senile cataract. Eyes were examined within 2 weeks preoperatively and 2 weeks and 6, 9, and 12 months postoperatively. The macula was examined with a 78.0 diopter Volk lens. The main outcome measure was the presence of ERM. The membranes were classified as present when cellophane macular reflex (CMR) or macular pucker (MP) was observed.

RESULTS

The median age of the patients was 78 years (range 50 to 97 years). At baseline, ERM was present in 49 of 332 eyes (14.8%), 40 (12.1%) with CMR and 9 (2.7%) with MP. Six months postoperatively, ERM was present in 84 of 332 eyes (25.3%), 72 (21.7%) with CMR and 12 (3.6%) with MP. The difference between the baseline and 6 month incidence was significant (P <.001). All new cases of ERM were of the CMR type. One year after surgery, ERM was present in 54 of 198 eyes (27.3%), 47 (23.7%) with CMR and 7 (3.5%) with MP. The ERMs rarely influenced visual acuity; however, 6 of 12 eyes (50.0%) with MP and 13 of 72 (18.1%) with CMR had metamorphopsia.

CONCLUSIONS

The prevalence of ERM increased by 71.4% during the first 6 months after uneventful ECCE with PC IOL implantation. Thereafter, the prevalence remained about the same. Newly formed ERMs were probably induced by the uneventful surgery. Although new-onset membranes usually do not preclude good visual acuity, they can cause metamorphopsia postoperatively.

Human anti-asparaginyl-tRNA synthetase autoantibodies (anti-KS) increase the affinity of the enzyme for its tRNA substrate

Autoantibodies directed against specific human aminoacyl-tRNA synthetases have been associated with a clinical picture including myositis, arthritis, interstitial lung disease and other features that has been referred to as the "anti-synthetase syndrome". Anti-asparaginyl-tRNA synthetase autoantibodies (anti-KS), the most recently described anti-synthetase autoantibodies, are directed against human cytosolic asparaginyl-tRNA synthetase and neutralize specifically its activity. Here we show that these antibodies recognize two epitopes on the human enzyme, an N-terminal epitope reactive in immunoblot experiments and a heat-labile epitope in the catalytic domain. In contrast to the well studied anti-Jo-1 autoantibodies anti-KS when bound to the synthetase increase the affinity of the synthetase for its tRNA substrate and prevent aminoacylation without interfering with the amino acid activation step.

Efficacy of selective neck dissection: a review of 503 cases of elective and therapeutic treatment of the neck in squamous cell carcinoma of the upper aerodigestive tract

OBJECTIVE

The purpose of this study was to evaluate the efficacy of selective neck dissection (SND) in elective and therapeutic treatment of the neck.

METHODS

A retrospective review was undertaken of 503 previously untreated patients undergoing 711 SNDs as a part of initial therapy for squamous cell carcinoma of the larynx, oral cavity, oropharynx, and hypopharynx from August 1986 to June 1997 at a single institution. Lymph nodes were pathologically negative in 249 and positive in 254 patients. Postoperative radiotherapy was given to 14.5% of the node-negative and 62.2% of the node-positive patients. The median follow-up interval was 41 months.

RESULTS

The 3-year regional recurrence rates estimated according to Kaplan-Meier were as follows: pN0, 4.7%; pN1, 4.9%; pN2, 12.1%. A comparison of recurrence rates with respect to the extent of neck disease and postoperative radiotherapy demonstrated a tendency to an improved regional control in irradiated patients with one metastasis and a distinctly improved regional control in patients with multiple metastases or metastases with extracapsular spread.

CONCLUSION

The results achieved with SND compare favorably with the results reported for modified radical neck dissection. The application of SND might be extended to more advanced neck disease.

Presurgical ultrasound-guided anchor-wire marking of soft tissue metastases in stage III melanoma patients

BACKGROUND

Due to increased sensitivity of diagnostic procedures, soft tissue metastases in melanoma patients are frequently detected very early. However, small sizes, deep location, or position close to vulnerable structures could render subsequent surgery quite difficult.

OBJECTIVE

To test the feasibility and effectiveness of presurgical ultrasound-guided anchor-wire marking of melanoma metastases.

METHODS

We selected melanoma patients with cytologically proven metastases in clinical stage III which were either unfavorably located or which have failed removal by previous surgery. Anchor-wire marking was performed ultrasound guided and free-hand style without the use of local anesthesia.

RESULTS

Twelve procedures in nine patients were well tolerated without any complications. In 11 cases the wire tip proved to be located within the tumor lesion; in one case the wire tip missed the target by less than 5 mm and thus was close enough to support appropriate surgery. Earlier, 3 of the 12 study lesions had undergone unsuccessful surgery. The median diameter of the removed metastases was 18.5 mm (range 7-30 mm).

CONCLUSION

Ultrasound-guided anchor-wire marking of unfavorably located melanoma metastases is feasible and might facilitate subsequent surgery.

Organ preservation by transoral laser microsurgery in piriform sinus carcinoma

OBJECTIVE

To determine the effectiveness of organ-preserving CO2 laser microsurgery for the treatment of piriform sinus carcinoma.

METHODS

A retrospective review of 129 previously untreated patients undergoing CO2 laser microsurgery for the treatment of squamous cell carcinomas of the piriform sinus from 1981 to December 1996 was undertaken. The intention was complete tumor removal by preserving functionally important structures of the larynx. Distribution of tumors (Union Internationale Contre le Cancer/American Joint Committee on Cancer, 1992) was 24 cases with pT1, 74 with pT2, 17 with pT3, and 14 with pT4 disease. Node status was positive in 68% of patients. Seventy-five percent of patients had stage III or IV disease. Forty-two percent of the patients were treated solely with surgery, and 58% had surgery and postoperative radiotherapy. The median follow-up interval was 44 months.

RESULTS

Eighty-seven percent of patients were controlled locally. Neck recurrences occurred in 14.0% of patients, metachronous distant metastases with locoregional control in 6.2%, and second primary tumors in 18.6%. Twenty percent of patients died of TNM-related deaths. The 5-year overall Kaplan-Meier survival rate was 71% for stages I and II and 47% for stages III and IV disease; the 5-year recurrence-free survival rates were 95% and 69%, respectively.

CONCLUSION

A comparatively low local recurrence rate, a high recurrence-free survival rate, and the avoidance of laryngectomy favor function-preserving surgery of piriform sinus carcinomas.

[Ultrasound-guided fine needle aspiration cytology (FNAC) of unclear lesions in melanoma patients]

AIM

Fine needle aspiration cytology (FNAC) is widely used in oncology to obtain the diagnosis of unclear tumours in cancer patients. However, because the method is established only in few melanoma centers, we performed this study to evaluate ultrasound guided FNAC in routine follow-up of melanoma patients.

METHOD

Unclear tumours recognised during routine follow-up of melanoma patients underwent ultrasound guided fine needle aspiration with cytological examination. The results were then compared to subsequent histopathology or future clinical outcome.

RESULTS

275 unclear tumours received ultrasound guided fine needle aspiration with cytological examination. Sensitivity showed to be 95.6% [95% CI: 91.5-98.1], specificity was 100% [95% CI: 96.2-100.0]. The positive predictive value was 100.0% [95% CI: 97.9-100.0], the negative predictive value 92.2% [95% CI: 85.1%-96.9%]. In 89 cases lesions turned out to be cytologically benign thus diagnosis avoiding surgery. In lesions with diameters up to 10 mm sensitivity and specificity were 91.4% and 100.0%, respectively.

CONCLUSION

Ultrasound guided FNAC proved to be a minimal invasive procedure in the diagnosis of unclear tumours in the follow-up of melanoma patients. It allows definite diagnosis and avoids unnecessary diagnostic surgery.

Prospective randomized trial of early versus late enteral iron supplementation in infants with a birth weight of less than 1301 grams

OBJECTIVES

To examine whether early enteral iron supplementation (EI) would improve serum ferritin as a measure of nutritional iron status at 2 months of age and would prevent definite iron deficiency (ID) in infants with a birth weight of <1301 g.

METHODS

Infants were randomly assigned to receive enteral iron supplementation of 2 to 6 mg/kg/day as soon as enteral feedings of >100 mL/kg/day were tolerated (EI) or at 61 days of life (late enteral iron supplementation [LI]). Nutritional iron status was assessed: 1) at birth, 2) at 61 days of life, 3) when the infants reached a weight of 1.6 times birth weight, and 4) before blood was transfused at a hematocrit of <.25. ID was defined by any one of the following criteria: ferritin, <12 microg/L; transferrin saturation, <17%; or increase of absolute reticulocyte counts by >50% one week after the onset of enteral iron supplementation. Restrictive red cell transfusion guidelines were followed and all transfusions were documented. Erythropoietin was not administered. The primary outcome variables were: 1) ferritin at 61 days and 2) the number of infants with ID.

RESULTS

Ferritin at 61 days was not different between the groups. Infants in the LI group were more often iron-deficient (26/65 vs 10/68) and received more blood transfusions after day 14 of life. No adverse effects of EI were noted.

CONCLUSIONS

EI is feasible and probably safe in infants with birth weight <1301 g. EI may reduce the incidence of ID and the number of late blood transfusions. ID may occur in very low birth weight infants despite early supplementation with iron and should be considered in the case of progressive anemia.preterm infant, iron supplementation, iron deficiency, blood transfusion.

Lymphatic filariasis in the Philippines

Lymphatic filariasis caused by Wuchereria bancrofti and Brugia malayi is endemic throughout most of the southern half of the Philippine archipelago. Economic and manpower shortages prior to 1996 made it difficult to acquire new prevalence data and vector control data concurrently from all provinces. Nevertheless, analysis of cumulative prevalence data on filariasis indicates the persistence of filariasis in each of the three major island groups - Luzon, Visayas and Mindanao - including 45 out of 77 provinces. Here, Michael Kron and colleagues summarize the prevalence data, and review host, parasite and vector characteristics relevant to the design and implementation of disease control initiatives in the Philippines planned for the year 2000.

A quotient of independent measurements as outcome. A statistical method to compare groups in biological experiments

The methodology in this paper was proposed to analyze biological data. The variable of interest, W, was a quotient of measurements; W: = X/(Y.Z). The peculiar problem was that X, Y, and Z could only be determined in three independent units of observation which were destroyed in the course of each measurement. A test statistic for the comparison of two treatments in W is proposed which is based on robust measures of location and dispersion in order to account for outliers in the data. Simulations showed that the test statistic proposed is approximately normally distributed, even for small sample sizes.

Ultrasound-guided fine-needle aspiration cytology in the early detection of melanoma metastases

BACKGROUND

The early detection and treatment of tumor recurrences in melanoma patients is dependent on reliable, sensitive, and specific techniques to verify suspected tumor metastases. As of now, fine-needle aspiration cytology (FNAC) has yet to establish itself in the routine follow-up of melanoma patients.

METHODS

FNAC procedures were performed in melanoma patients with palpable tumors or nonpalpable, ultrasonically suspicious lesions. Cytodiagnostic evaluation of fine-needle samples obtained from suspicious lesions was performed morphologically. Findings were validated either by histopathologic diagnosis or prolonged clinical follow-up.

RESULTS

The cytologic examination of 739 FNACs from 330 melanoma patients was conducted within 1 day of sampling. Complications were not observed. This study showed a sensitivity of 97.9% and a specificity of 100.0%. Moreover, in 158 FNACs derived from lesions with a diameter less than 1 cm a sensitivity of 94.6% was achieved. Diagnosis of metastatic melanoma with unknown primary tumor was established in 20 cases.

CONCLUSIONS

FNAC is very reliable for the early detection of melanoma metastases. FNAC is a swift method free of complications and is able to replace diagnostic surgery completely for nonmalignant lesions in a large number of patients. Moreover, FNAC is especially useful in combination with ultrasound in melanoma follow-up and can enable diagnosis of lesions smaller than 1 cm without impairment of sensitivity or specificity.

Measurement of antinuclear antibodies: assessment of different test systems

The performance of rat liver and HEp-2 in the detection of antinuclear antibodies (ANA) was studied by two independent sites and compared against an ANA enzyme immunoassay (EIA) screen and EIA systems for the measurement of antibodies to double-stranded DNA (dsDNA) and ENA. Sixty-two sera from patients with connective tissue disease (CTD) and 398 from controls suffering from other disorders were included. The level of agreement was, for HEp-2 and rat liver (within one site), 82.0% (ANA positive/ANA negative) and 51.0% (ANA pattern); and for HEp2- and HEp-2 (between sites), 71.8 and 86.5%. On sera with the ANA homogeneous pattern, the measurement of anti-ENA EIA added little to the detection rate with anti-dsDNA EIA alone. On ANA speckled sera, the EIA reactivity depended on the reaction of the mitotic cells: while sera with positive mitoses reacted similarly to ANA homogeneous sera, in those with negative mitoses the measurement of anti-ENA added about 10% to the detection rate achieved with anti-dsDNA alone. The measurement of anti-Scl-70 and anti-Jo-1 did not markedly improve the positive rate with classical ENA (anti-SSA, -SSB, -Sm, and -RNP) alone, raising doubts about the cost efficiency of including these measurements in unselected sera. The ANA EIA identified patients with CTD at a rate similar to that for rat liver and HEp-2. However, up to 98% of the sera found to be negative by ANA EIA but positive by use of rat liver and HEp-2 were from controls. Thus, the ANA EIA may possible be used as an alternative screen, particularly in laboratories with a high frequency of sera from patients not suffering from CTD.

[Prevalence of cholecystolithiasis in South Germany--an ultrasound study of 2,498 persons of a rural population]

Gallbladder stones represent one of the most common reason for morbidity in western industrial nations. There remains a paucity of exact information regarding the prevalence and risk factors for this disease entity in Germany. As part of a whole-community survey focusing on the prevalence of echinococcosis multilocularis conducted in a population in southwestern Germany (response rate: 66.6%), 2,560 subjects underwent an upper abdominal ultrasound examination at which the presence of gallbladder stones was ascertained. In each case, upper abdominal sonography was performed following completion of a standardized interview. In 62 subjects, the gallbladder could not be adequately visualized due to an insufficient fasting period; the remaining 2,498 subjects (1,326 females, age 38.9 +/- 19.9 years; 1,172 males, age 37.7 +/- 18.8 years) were included in the study collective. Gallbladder stones (sonographically visualized gallbladder stones or history of cholecystectomy for cholecystolithiasis) were found in 196 participants (7.8%; 139 females [10.5%] versus 57 males [4.9%]). Statistical treatment of the data using multiple logistical regression techniques revealed a significant influence of the variables age, gender, body mass index (BMI) and positive family history on the development of gallbladder stones. The prevalence of gallbladder stones in the present study population is lower than figures reported for a study in Brandenburg and at 7.8% is rather low in comparison with other European studies. One explanation may be the low average age of study participants, almost 50% of whom were less than 35 years. Besides age, subjects' gender, BMI and positive family history were identified as significant risk factors.

[Perioperative prevalence of epiretinal membranes in eyes with senile cataract]

BACKGROUND

Results from epidemiologic studies suggest that cataract extraction is a risk-factor for the formation of epiretinal membranes (EM).

PATIENTS AND METHODS

250 consecutive eyes which underwent uneventful phakoemulsification with implantation of a posterior chamber intraocular lens were examined within two weeks prior and an two weeks after surgery for the presence of epiretinal membranes. Cellophane macular reflex (CMR) was distinguished from macular pucker (MP).

RESULTS

We found an increase in the prevalence of epiretinal membranes from preoperatively 12/250 (4.8%) to post-operatively 33/250 (13.2%). The prevalence of CMR increased from 8/250 (3.2%) to 27/250 (10.8%). The prevalence of MP remained almost the same 4/250 (1.6%) prior and 6/250 (2.4%) after surgery.

CONCLUSIONS

Increased prevalence of epiretinal membranes following cataract extraction observed in epidemiological studies can be explained by easier detection of such membranes in pseudophakic eyes where the observer gets a clear view of the fundus. Therefore it is questionable whether uneventful extracapsular cataract extraction can induce the formation of epiretinal membranes.

Reduction of unnecessary antibiotic therapy in newborn infants using interleukin-8 and C-reactive protein as markers of bacterial infections

OBJECTIVE

To examine whether the determination of interleukin 8 (IL-8) and C-reactive protein (CRP) in neonates with suspected nosocomial bacterial infection (NBI) is feasible and cost-effective in reducing antibiotic therapy.

METHODS

Between April 1996 and May 1997, IL-8 was measured 260 times along with blood cultures, CRP, and immature-to-total-neutrophil (IT) ratio for suspected NBI in term and preterm neonates. All infants were retrospectively analyzed for NBI. Sensitivity, specificity, positive and negative predictive values, and 95% confidence intervals were calculated for IL-8, CRP, and IT ratio. Receiver-operating characteristic curves were analyzed to determine optimal thresholds. Between June 1997 and June 1998, IL-8 was measured 215 times in newborn infants with suspected NBI and the decision to start antibiotic therapy was based on increased IL-8 and/or CRP values. A cost-effectiveness analysis was performed and sensitivity, specificity, and receiver-operating characteristic curves were reevaluated.

RESULTS

At the first suspicion of NBI, the combination of IL-8 >/= 53 pg/mL and/or CRP >10 mg/L detected culture-proven NBI with 96% sensitivity. The combined culture-proven and clinical NBI were detected with 93% sensitivity and 80% specificity. The use of IL-8 reduced unnecessary antibiotic therapy for suspected NBI by 73% and was cost-effective when compared with initiating antibiotic therapy based on clinical signs alone or based on clinical signs and an increased IT ratio and/or CRP.

CONCLUSIONS

The combination of IL-8 and/or CRP is a reliable and early test for the diagnosis of NBI in newborn infants. Using the combination of IL-8 and/or CRP to restrict antibiotic therapy to truly infected infants reduces unnecessary antibiotic therapy and is cost-effective.

Comparing women's views on family and sexual problems in family and gynecological practices

This study compares the role of community gynecologists and family physicians, seen from the patients' perspective. A sample of 126 female patients in family practices and 212 patients in gynecological practices were surveyed about their preferences and expectations of whether their doctor should address personal, family and sexual problems. The effects of covariates (such as the type of doctor, patient age, family status, child desire) on patient expectations were simultaneously assessed by multiple logistic regression. Between 40% and 70% of the patients contacted confirmed the family-oriented approach, both in family practices and gynecological practices. Family practice patients more frequently stressed their doctor's knowledge of personal and family aspects (odds ratio [OR] = 1.7, 95% confidence interval [95% CI] = 1.1-2.7); whereas communication about sexual problems and a possible desire to have a child was more often considered as the gynecologist's domain (OR = 2.8 [95% CI = 1.8-4.4] and OR = 1.8 [95% CI = 1.1-2.8], respectively). Female patients older than 30 years were more often interested in communication on family related affairs (OR = 2.2, 95% CI = 1.4-3.4). These data illustrate that many patients would like both their community gynecologist and their family physician to take notice of their personal and family life conditions, including sexual problems and to initiate communication about these subjects.

Plasma viscosity and fibrinogen in relation to haemodynamic findings in chronic congestive heart failure

The aim of this study was to investigate an inflammatory response indicated by fibrinogen and plasma viscosity in relation to haemodynamic and clinical findings of patients with stable CHF due to coronary heart disease (CHD).

Comparison of procalcitonin with interleukin 8, C-reactive protein and differential white blood cell count for the early diagnosis of bacterial infections in newborn infants

OBJECTIVE

To evaluate procalcitonin (PCT) as a test for early diagnosis of bacterial infections (BI) in newborn infants and to compare the results of PCT with those of interleukin 8 (IL-8), C-reactive protein (CRP) and differential white blood cell count.

STUDY DESIGN

PCT was prospectively measured along with IL-8, CRP and differential white blood cell counts and blood cultures in 197 newborn infants at the first suspicion of bacterial infection. PCT, IL-8, CRP and differential white blood cell counts were analyzed for sensitivity, specificity and positive and negative predictive values after receiver operating characteristic curve analysis for best thresholds. The kinetics of PCT was determined in infants with and without BI.

RESULTS

Forty-six infants were diagnosed clinically as having BI, of whom 9 had BI with positive blood cultures. At a cutoff value of 0.50 microg/l, PCT detected combined culture-proved and clinical BI with a sensitivity of 57% (95% confidence interval, 41%, 71%) and a specificity of 66% (95% confidence interval, 57%, 74%). The combination of IL-8 > or =70 ng/l and/or CRP >10 mg/l achieved a sensitivity of 91% (95% confidence interval, 79%, 98%) and a specificity of 73% (95% confidence interval, 64%, 81%). PCT values of infected and not infected infants tended to rise for 24 h after initial evaluation and then decreased.

CONCLUSION

The combination of IL-8 and CRP is more reliable than PCT as a test for early diagnosis of BI in newborn infants.

Carbon dioxide laser microsurgery for early supraglottic carcinoma

Forty-eight untreated patients with early supraglottic carcinoma (12 patients stage I and 36 patients stage II) had primary carbon dioxide laser microsurgery between 1979 and 1994 with the intent of complete tumor removal with preservation of functionally important structures of the larynx. Ninety-six percent of the patients were treated exclusively by surgery; 4% had laser microsurgery and postoperative radiotherapy. With a median follow-up of 55 months, the 5-year local control rate with the first treatment was 100% for pT1 cases and 89% for pT2 cases. The ultimate local control rate with voice preservation, including patients successfully salvaged after a local recurrence, was 97% for pT2 carcinomas. Five (10%) patients died of tumor (TNM)-related deaths. The 3-year recurrence-free rate and 3-year overall survival rate (Kaplan-Meier) were 87% and 85%; the 5-year recurrence-free rate and 5-year overall survival rate were 83% and 76%, respectively. The results achieved with transoral laser microsurgery in early supraglottic carcinoma are comparable to those of open supraglottic laryngectomy with respect to local control and survival. The functional results are superior, since clinically relevant aspiration did not occur.

Clinical staging of oropharyngeal carcinoma: a critical evaluation of a new stage grouping proposal

BACKGROUND

An alternative to the International Union Against Cancer/American Joint Committee on Cancer (UICC/AJCC) stage grouping system was proposed for patients with oropharyngeal carcinoma by Hart et al. (1995) on behalf of the Dutch Head and Neck Oncology Cooperative Group. The system was created by regrouping the T, N, and M categories without redefining the categories themselves.

METHODS

Data related to epidemiology, treatment, and survival from 224 previously untreated patients with oropharyngeal carcinoma were analyzed. Staging was performed according to the 1992 UICC/AJCC criteria and according to the proposed stage grouping system. Kaplan-Meier estimates of overall survival were compared for both staging systems; and in a Cox proportional hazards regression analysis, the influence of the variables age, gender, subsite and side of tumor location, histopathologic grade, form of treatment, and stage distribution (according to 1992 UICC criteria and that proposed by Hart et al.) on overall survival was determined.

RESULTS

The proposed staging system showed a more balanced distribution of patients (16% in Stage I, 37% in Stage II, 14% in Stage III, and 33% in Stage IV compared with 5% in Stage I, 7% in Stage II, 21% in Stage III, and 67% in Stage IV according to UICC/AJCC 1992 staging). Furthermore, the proposed staging system showed better prognostic discrimination for overall survival (5-year survival rates according to the staging system of Hart et al. were 59% in Stage I, 31% in Stage II, 28% in Stage III, and 16% in Stage IV, vs. 61% in Stage I, 59% in Stage II, 32% in Stage III, and 24% in Stage IV according to UICC/AJCC 1992 staging).

CONCLUSIONS

The results are in concordance with the results published by the Dutch Head and Neck Oncology Cooperative Group. It is possible to improve the current staging system by regrouping the T, N, and M categories. [See editorial on pages 1611-2, this issue.]

[Importance of pre- and perinatal risk factors in respiratory distress syndrome of premature infants. A logical regression analysis of 1100 cases]

BACKGROUND

Respiratory distress syndrome (RDS) due to surfactant deficiency remains a cause of considerable mortality in the neonatal period.

METHODS

In a retrospective study we analysed the records of 1109 premature newborns with a birth weight below 1500 g that were treated on our unit. RDS was assumed if the infants needed mechanical ventilation with oxygen supplementation and the typical radiological signs were present on chest x-ray.

RESULTS

No changes in the incidence of RDS were found during the period of observation. Below 29 weeks gestational age 90% of infants suffered from RDS (55% severe RDS grade III or IV). The incidence was 75% (grade III or IV: 32%) for infants born at 29 and 30 weeks, 48% (grade III or IV: 15%) at 31 and 32 weeks and 33% (grade III or IV: 6%) for neonates born at 33 weeks of gestation. Using a logistic regression analysis model the following parameters were found to increase the risk for RDS significantly (p < 0.05): no prenatal steroid treatment, Cesarean section, male gender, APGAR at 5 min < 7, metabolic acidosis (base excess < or = -6 mval) and rectal temperature < 36 degrees C on admission. Following gestosis, insufficiency of the placenta and premature rupture of membranes a decrease in the incidence of RDS was observed.

CONCLUSION

We conclude that although some risk factors for RDS will be difficult to exclude (e.g. maternal disease, gender) the incidence and severity of RDS can be reduced by measures like maternal antenatal steroid treatment. Perinatal asphyxia (low APGAR values and/or acidosis) and hypothermia should be avoided, as these conditions increase the relative risk for developing RDS.

Bartonellosis in Ecuador: serosurvey and current status of cutaneous verrucous disease

Human bartonellosis is a classically biphasic disease caused by infection with the alpha-2 Proteobacteria Bartonella bacilliformis, which is phylogenetically related to the etiologic agents of cat scratch disease, bacillary angiomatosis, and trench fever. In Ecuador, typical bartonellosis has remained endemic for the past century in highland provinces near the Peruvian border. During the past six years, public health officials have noted an increasing number of atypical cases in which monophasic verrucous cutaneous disease is the only clinical manifestation. Epidemiologic, immunologic, histopathologic, and molecular biological studies have confirmed the presence of sporadic, atypical bartonellosis in residents of the lowland province of Manabi, where archeologic evidence exists of bartonellosis in pre-Colombian times. Between 1987 and 1995, 11 cases of cutaneous bartonellosis were investigated and serologic studies were done on 224 persons from five villages, two lowland and three highland. In the lowland village of Pajan in the province of Manabi, there was a 21% seropositivity proportion in contacts of index cases. These combined data suggest that bartonellosis is significantly under-reported due to the existence of mild clinical disease, possibly associated with less virulent bacterial strains, which are now disseminating or re-emerging in previously disease-free areas.

[Effectiveness of multi-factorial intervention for reducing falls with proximal femoral fractures in homes for the aged and nursing homes. Goals and study design of a population-based study]

The article presents the design of an open controlled, non-randomized population based intervention trial in institutionalized elderly that will be performed in Ulm/Germany starting in 1998. The multimodal intervention includes education, counseling, training, and hip protectors as well as information on potential environmental modifications in nursing homes. Two historical and one geographical control group will be formed. All institutionalized elderly will be assessed by means of the Minimum Data Set of the Resident Assessment Instrument. The intervention will last 12 months. The main objective is to test a model for cost-effective reduction of proximal femoral fractures in institutionalized elderly and to demonstrate its effectiveness.

The 75-kilodalton antigen of Bartonella bacilliformis is a structural homolog of the cell division protein FtsZ

A genomic library of Bartonella bacilliformis was constructed and screened with human anti-Bartonella serum from a patient with the chronic, verruga peruana phase of bartonellosis. An immunoreactive clone isolated from this library was found to code for a 591-amino-acid protein with a high degree of sequence similarity to the FtsZ family of proteins. The degree of amino acid identity between the B. bacilliformis protein (FtsZ[Bb]) and the other FtsZ proteins is especially pronounced over the N-terminal 321 amino acids (N-terminal domain) of the sequence, with values ranging from 45% identity for the homolog from Micrococcus luteus (FtsZ[Ml]) to 91% identity for the homolog from Rhizobium melliloti, (FtsZ[Rm1]). All of the functional domains required for FtsZ activity are conserved in FtsZ(Bb) and are located within the N-terminal domain of the protein. FtsZ(Bb) is approximately twice as large as most of the other FtsZ proteins previously reported, a property it shares with FtsZ(Rm1). Like the Rhizobium homolog, FtsZ(Bb) has a C-terminal region of approximately 256 amino acids that is absent in the other FtsZ proteins. Evidence is presented that implicates this region in the protein's antigenicity and suggests that, unlike most other FtsZ homologs, FtsZ(Bb) is at least partly exposed at the cell surface. PCR analysis revealed that an ftsZ gene similar in size to the B. bacilliformis gene is present in Bartonella henselae, a bacterium that is closely related to B. bacilliformis.

Energy transfer spectroscopy for measuring mitochondrial metabolism in living cells

Microscopic energy transfer spectroscopy was established using mixed solutions of reduced nicotinamide adenine dinucleotide (NADH) and the mitochondrial marker rhodamine 123 (R123). This method was applied to probe mitochondrial malfunction of cultivated endothelial cells from calf aorta incubated with various inhibitors of specific enzyme complexes of the respiratory chain. Autofluorescence of the coenzyme NADH as well as energy transfer efficacy from excited NADH molecules (energy donor) to R123 (energy acceptor) were measured by time-gated fluorescence spectroscopy. Because intermolecular distances in the nanometer range are required for radiationless energy transfer, this method is suitable to probe selectively mitochondrial NADH. Autofluorescence of endothelial cells usually exhibited a weak increase after specific inhibition of enzyme complexes of the respiratory chain. In contrast, pronounced and statistically significant changes of energy transfer efficacy were observed after inhibition of the same enzyme complexes. Detection of NADH and R123 in different nanosecond time gates following the exciting laser pulses enhances the selectivity and improves quantification of fluorescence measurements. Therefore, time-gated energy transfer spectroscopy is suggested to be an appropriate tool for probing mitochondrial malfunction.

Changes in drug prescribing under the Public Health Reform Law--a survey of general practitioners' attitudes in East and West Germany

The aim of the study was to examine general practitioners' attitudes towards drug prescribing in times of economic pressure, and to determine the relevance of different factors for changed prescribing behavior. A random sample of general practitioners in Eastern Germany and in Western Germany was surveyed, after the Public Health Reform Law, a budgetary initiative to reduce prescribing costs in Germany, had come into effect. Multiple logistic regression was performed to analyze the association between self-reported prescribing behavior and covariates (such as sex and age, level of certification, doctors' prescribing costs, criteria of prescribing, sources of drug information). Response rates had been 53.4% (n = 550) in Eastern Germany and 56.8% (n = 579) in Western Germany respectively. About two thirds of the doctors (East: 60.4%, West: 73%) believed that they had changed their prescribing behavior under the new law. They used generic drugs more often (East: 29.5%, West: 52.3%) and often used more generic drugs (East: 29.5%, West: 52.3%) and were less liberal in meeting patients' wishes (61.0% and 72.8%, respectively). Doctors whose total prescribing costs were above the average of their colleagues, more frequently reported change in prescribing behavior in response to the new law (OR: 3.11, 95% CI: 1.63, 5.91 for Eastern doctors and OR: 5.90, 95% CI: 2.49, 13.98 for Western doctors). This was also true for doctors who considered the price of a drug to be a very important criterion for drug selection (OR: 4.34, 95% CI: 2.69, 7.01 and OR: 3.23, 95% CI: 1.9, 5.49, respectively). "Price-oriented" and "cost-concerned" doctors were also more likely to handle patient prescription wishes less liberal and to prescribe generic rather than original brand name drugs more often. We conclude that budgetary initiatives, such as the German Public Health Reform Law, seem to influence general practitioners towards a more economic prescribing behavior. Doctors concerned about their prescribing costs or about drug costs may be more responsive to such administrative regulations.

Mib-1 evaluated proliferative activity in ovarian cancer with respect to prognostic significance

In the present study, tumor tissue of 251 patients with ovarian cancer was immunohistochemically analysed for proliferative activity using the monoclonal antibody mib-1 and the analyse system CAS 200. The rate of the growth fraction varied from 0% to 71% mib-1 positive tumor cells with a median of 17%. There was a strongly significant association between proliferative activity and the degree of histological differentiation (p = 0.0005), whereas there was no significant correlation with tumor stage and histological subtypes. Using the median as the cut-off point, patients with higher proliferating tumors (> or = 17%) had a statistically significant worse prognosis (p = 0.0431). Especially in the group of patients with grade 1 and grade 2 tumors, measurement of the proliferative activity is of help for prediction of the postoperative survival time of patients (p = 0.0336), suggesting that measurement of the growth fraction estimated by mib-1 reflects more closely the degree of tumor differentiation. However, multivariate analyses cannot confirm these results.

Selective neck dissection in the management of squamous cell carcinoma of the upper digestive tract

Selective neck dissection has been used clinically in elective treatment of carcinoma, although many surgeons continue to advocate modified radical or radical neck dissection for therapeutic management of the neck. In a retrospective study 167 previously untreated patients were reviewed following curative laser microsurgical resections of oral or pharyngeal primary tumors and a unior bilateral selective neck dissection. In all, 221 (54 bilateral) neck dissections were performed. In patients with oral primary disease lymph nodes of levels I-III were removed, while nodes in levels II and III were removed in patients with pharyngeal tumors. Level IV was dissected when several metastases were suspected during operation. The posterior triangle was not dissected. Lymph nodes were histopathologically negative in 73 patients and positive in 94 patients. Twenty-five of these latter cases had pN1 disease, 55 had pN2b disease and 10 had bilateral lymph node metastases. Twenty patients in the pN0 group and 63 patients in the pN+ group received postoperative radiotherapy (to 56.7 Gy to the primary site and 52.5 Gy to the neck). With a median follow-up interval of 34 months, recurrence in the dissected neck occurred in 3 of 73 patients (4.1%) with pN0 disease and 6 of 90 patients (6.6%) with pN+ necks. Four patients with pN+ necks had simultaneous recurrences at the primary site. The addition of adjuvant radiotherapy seemed to improve disease control in the neck and improve overall survival in patients with an unfavorable prognosis due to multiple metastases or metastases with extracapsular spread.

Drug prescribing in hospital as experienced by general practitioners: East versus West Germany

BACKGROUND AND OBJECTIVES

Drugs prescribed by the general practitioner (GP) are often changed during hospitalization. This study set out to test the hypothesis that the extent of drug change and the information provided by the hospital determines the GPs' assessment of hospital co-operation. The perception of drug change and hospital co-operation may also be influenced by the degree of institutional separation of primary and secondary care. Therefore we compared GPs' respective attitudes in 'East' and 'West' Germany.

METHOD

In 1993, a representative sample of 'eastern' and 'western' German doctors received a structured questionnaire; 554 doctors (63%) participated.

RESULTS

Fifty-seven per cent of the western and 39% of the eastern GPs believed that their medication was changed in hospital in more than 60% of their patients. Only a minority of eastern (10%) and western (15%) doctors described the information provided by the hospitals as more or less satisfactory. More western than eastern doctors (56% versus 32%) expressed dissatisfaction with hospital co-operation. Respondents in eastern Germany who felt sufficiently informed about hospital drug change were more likely to express satisfaction with the hospital doctors' co-operation. In the former area of West Germany the judgement of co-operation was significantly better if the extent of drug change and the frequency of generic drug replacement by original brand-name drugs were lower.

CONCLUSIONS

The study showed that hospital-initiated drug change is a matter of concern, especially for GPs who are working in an area with a tradition of strictly separated primary and secondary care.

Micrometastases in carcinoma of the upper aerodigestive tract: detection, risk of metastasizing, and prognostic value of depth of invasion

BACKGROUND

The purpose of this study was to investigate the incidence of micrometastases from squamous cell carcinomas of the upper aerodigestive tract in neck dissection specimens, and to determine whether features of the primary tumor might be of prognostic value for metastasizing.

METHODS

Seventy-six originally pNO staged neck dissection specimens from 60 patients were evaluated using serial sectioning in 10-micrometer intervals, H&E staining and immunostaining with an antibody to pan-cytokeratin. The influence of the variables pT-category, cytologic grade, and maximum depth of invasion of the primary tumor on the nodal status was analyzed in 128 patients.

RESULTS

The examination of 1020 lymph nodes from 76 neck dissection specimens revealed 8 micrometastases in 6 specimens (7.9%) from 6 patients with oral and pharyngeal primaries, resulting in upstaging. Six micrometastases were located in lymph nodes of 3-6 mm in diameter. Depth of invasion was the only significant risk factor for metastasizing selected in logistic regression.

CONCLUSION

The surgeon should be aware of a relatively high incidence of micrometastases from oral and pharyngeal carcinomas, which are neither detectable preoperatively nor histopathologically by a reasonable effort. The measurement of the maximum depth of invasion of the primary can delineate a group of patients who should be treated by elective neck dissection.

An immunodominant antigen of Brugia malayi is an asparaginyl-tRNA synthetase

Lymphatic filariasis is caused by infection with the filarial nematodes Brugia malayi, Brugia timori, Wuchereria bancrofti and Onchocerca volvulus which collectively infect about 200 million persons throughout the world. Protein sequence homology analysis of a major nematode antigen suggested that it was a class II aminoacyl-tRNA synthetase. The overproduction, purification and verification that the major B. malayi antigen is an asparaginyl-tRNA synthetase is described.

Randomized, controlled trial of amoxicillin prophylaxis for prevention of catheter-related infections in newborn infants with central venous silicone elastomer catheters

OBJECTIVE

To clarify the effectiveness of amoxicillin prophylaxis in the prevention of catheter-related infections.

METHOD

We performed a randomized, controlled, sequential, prospective trial in newborn infants undergoing percutaneous central venous catheterization.

RESULTS

Seventy-five infants (median birth weight, 1240 gm; median age at catheter insertion, 3 days) received prophylactic amoxicillin (100 mg/kg per day); 73 infants in the control group (median birth weight, 1170 gm; median age, 2 days) received no routine prophylactic antibiotic treatment. No infant receiving amoxicillin had septicemia, whereas two infants (2.7%) in the control group did; suspected septicemia (positive clinical and laboratory findings but negative blood culture results) was found in 3 infants in the amoxicillin group and in 6 of the control group (not significantly). Bacterial contamination of the catheter tip at removal was significantly reduced in the amoxicillin group (13.3% vs 28.8% in control subjects; p < 0.05). Negligible differences were found in duration of catheterization (median, 15 days in both groups), or the number of thrombotic (9.3% vs 2.7% in control subjects) and other catheter-related complications between the groups.

CONCLUSION

A low incidence of catheter-related infections can be achieved in neonates with central venous catheters without using prophylaxis with an antibiotic.

The effect of workplace based strengthening on low back injury rates: A case study in the strip mining industry

The purpose of this study was to demonstrate the effect of a once a week exercise program focused specially at lumbar extensor strengthening. This is a comparative study where workers volunteered to exercise were compared to workers who did not exercise. Low back claims for one year were noted to document efficacy of the training program. Change in strength was also noted. There was a 54% to 104% increase in strength during a 20 week program. The incidence of back injuries in the exercise group was 52 injuries per 200,000 employee hours versus the industry average of 1.09 back injuries per 200,000 employee hours. The average incidence of injury for the previous nine years at the company participating in the program was 2.94 injuries per 200,000 employee hours. The injury incidence in the workers not exercising was 2.55 injuries for 200,000 employee hours. The average workers' compensation liability dropped from $14, 430.00 per month to $380.00 per month for the study year. The significant increase in strength associated with the exercise program correlated with the greatly reduced incidence of back claims.

EGF-R and overexpression of the oncogene c-erbB-2 in ovarian cancer: immunohistochemical findings and prognostic value

PURPOSE

The purpose of this study was to investigate the prognostic value of EGF-R (c-erbB-1) compared to the overexpression of the c-erbB-2 oncogene product p185 in ovarian cancer.

PATIENTS AND METHODS

The study was conducted on 266 previously untreated ovarian cancer patients with FIGO stage I-IV disease. EGF-R and c-erbB-2 oncogene product p185 have been evaluated using immunohistochemistry. Survival times were analyzed according to the method described by Kaplan and Meier. For the simultaneous evaluation of the prognostic relevance of the analyzed factors, a Cox proportional hazards regression was performed.

RESULTS

EGF-R was detected in 13%, and c-erbB-2 oncogene product p185 in 18% of primary tumors. EGF-R showed no significant impact on the survival time, whereas c-erbB-2 oncogene product p185 positive patients had a significantly worse prognosis compared to p185 negative cases (p = 0.002). In the multivariate analysis, c-erbB-2 oncogene product p185, like tumor stage, histological grade and age, was found to be a significant prognostic factor.

CONCLUSION

These data confirm the prognostic importance of the c-erbB-2; oncogene product p185 in ovarian cancer at the time of primary surgery, while EGF-R does not seem to have prognostic relevance.

[Mortality of premature infants 1980-1990: analysis of data from the Göttingen perinatal center]

We analyzed retrospectively (1980-1990) the causes of death and by using a logistic regression model the perinatal and neonatal risk factors influencing the mortality in preterm infants < 34 weeks of gestation (n = 1132). When comparing the interval from 1980-1986 to 1987-1990 we observed a decreasing mortality in infants < or = 1000 g from 57% to 19% as well as in the preterm infants > 1000 g from 8.3% to 3.0% (p < 0.001). The causes of death changed considerably. During 1980-1986 fifty-two (8.2%) out of the 632 preterm infants and during 1987-1990 only seven (1.3%) out of the 600 preterm infants died in the course of a severe respiratory distress syndrome or intracranial hemorrhages. From 1980 to 1986 21% (n = 10) and from 1987 to 1990 77% (n = 10) of the neonatal deaths in preterm infants > 1000 g were attributed to lethal malformations. In those infants without lethal malformations (n = 1109) we performed a logistic regression analysis. 87 (7.8%) of these neonates died. The risk of dying was significantly higher in infants born before 1987, in male newborns and in infants suffered from a severe respiratory distress syndrome III-IV or septicemia (p < 0.0001). An increasing gestational age of one week resulted in a lowered risk of mortality (odds ratio 0.59, p < 0.0001). Adjusted for these basic variables the mortality risk was also significantly higher for birth weights < or = 1000 g, low Apgar scores, peripartal acidosis, hypothermia and intracranial hemorrhages. An intrauterine growth retardation < 10. percentile resulted in a lower mortality risk.

Elevated serum levels of a c-erbB-2 oncogene product in ovarian cancer patients and in pregnancy

Amplification of the proto-oncogene c-erbB-2 (HER-2/neu) has been shown to be a prognostic marker in ovarian cancer. In order to obtain further information on the biological role of the c-erbB-2 gene product p185 it is necessary to quantify expression levels. In this study we evaluated an enzyme-linked immunosorbent assay (ELISA) for the extracellular domain of p185 to determine whether a soluble oncoprotein fragment can be detected in the serum of ovarian cancer patients and in the serum of pregnant women. Sera from 199 women (57 previously untreated ovarian cancer patients, 62 pregnant women and 80 healthy controls) were assayed in a sandwich ELISA utilizing two mouse monoclonal antibodies. To study c-erbB-2 overexpression in ovarian cancer tissue samples we have used an immunohistochemical technique involving a monoclonal antibody specifically reactive with the external domain of the protein p185. The mean serum value for the normal controls was 1203 HNU/ml with a standard deviation (SD) of 279 HNU/ml and a range of 595-1947 HNU/ml. We chose a level of 1761 HNU/ml (2 SD above the mean) as a cut-off to distinguish individuals with elevated levels. The ovarian cancer patients' serum values ranged from 526 to 16,332 HNU/ml. Immunohistochemically detectable p185 was noted in 8 of 57 ovarian cancer patients. The oncoprotein fragment levels in the sera from these 8 patients ranged from 878 to 16,332 HNU/ml. Of 8 patients with p185 overexpression in their tumors, 4 had elevated serum levels. In the sera from the 49 cancer patients without overexpression the values were distributed in the range 526-2892 HNU/ml. There was no association between serum oncoprotein fragment levels and tumor stage, histological type or grading. Serum concentrations of the p185 fragment in pregnancy ranged from 612 to 3265 HNU/ml. The highest levels were found in the third trimester. The results of the present study raise the possibility that the soluble c-erbB-2 protein level in serum is an indicator for cell proliferation and therefore deserves further evaluation as a diagnostic tool in ovarian cancer patients and pregnancy.

Overexpression of the oncogene c-erb B2 in primary ovarian cancer: evaluation of the prognostic value in a Cox proportional hazards multiple regression

To date, there are no prognostic factors in ovarian cancer that adequately account for tumor biology and disease behavior. In recent years, some reports have described the prognostic significance of the amplification and overexpression of the oncogene c-erb B2 in various human cancers. Concerning ovarian cancer, this is still a matter of discussion. In the present study, tumor tissue of 275 patients treated for ovarian cancer at the Department of Obstetrics and Gynecology of the University of Göttingen between 1982 and 1992 was immunohistochemically analyzed for overexpression of c-erb B2-encoded transmembrane protein p185. In 19% (51 of 275 cases), p185 overexpression was detected. The percentage of p185-positive cases varied from 7 to 46% according to histological subtype. Correlation with tumor stage and the degree of histological differentiation was not observed. Patients with p185-positive tumors had a significantly worse prognosis (p = 0.001); median survival was 20 months compared with 33 months for p185-negative tumors. In the Cox proportional hazards regression, p185 overexpression was identified as an independent prognostically relevant factor. These results suggest that overexpression of oncogene c-erb B2 in ovarian cancer characterizes a group with unfavorable tumor biology and a significantly worse prognosis.

OHIO-1 beta-lactamase is part of the SHV-1 family

The OHIO-1 beta-lactamase gene was subcloned in a 1.16-kilobase TaqI fragment in the 2.4-kilobase chimeric plasmid pSK04. After directional subcloning into M13, the DNA sequence of this fragment was determined. The results showed an open reading frame of 858 base pairs (bp) encoding a protein of 286 amino acids. The structural gene showed 95, 87, and 60% DNA sequence identity with SHV-1, LEN-1, and TEM-1, respectively, and 93, 85, and 62% predicted amino acid sequence identity, respectively. The 87 bp upstream of the OHIO-1 structural gene had 96% identity with the upstream flanking sequence of SHV-1, including the -35 and -10 consensus sequences and the putative ribosomal binding site. A 223-bp DNA probe derived from a PstI-HaeII fragment in the C-terminal sequence of OHIO-1 had predicted 96, 88, and 61% sequence identity with SHV-1, LEN-1, and TEM-1, respectively. This probe hybridized to SHV-1 and poorly to LEN-1, but not to TEM-1 or a variety of other plasmid-mediated beta-lactamase genes, under stringent conditions. Screening of plasmid DNA derived from 40 ampicillin-resistant clinical isolates by Southern hybridization with the 223-bp probe uncovered no strains encoding OHIO-1. Isoelectric focusing of the same collection did identify two strains producing enzymes resembling SHV-1, however. We have also performed a kinetic comparison of OHIO-1, SHV-1, and TEM-1. OHIO-1 and SHV-1 were indistinguishable from each other but could be distinguished from TEM-1. These data clearly place OHIO-1 within the SHV-1 family of beta-lactamases.