[Congenital disorders of the lungs and airways--survey of cases at the Paediatric Hospital Erlangen in the period 2000 to 2011]

BACKGROUND

Congenital malformations of the lungs are rare, but might limit the quality of life of the patient. With the increased possibilities of diagnostic and therapeutic procedures during the last decades, these diseases can be recognised and successfully treated earlier than before. The aim of this article is to give an overview about the congenital malformations of the lungs in children who have been treated at the Kinderklinik Erlangen during the years 2000 and 2011. Clinical symptoms of the disease and associated malformations, diagnostic and therapeutic procedures were discussed.

METHODS

The analysis was done retrospectively (January 1st 2000-April 15th 2011) on the basis of the patients records. Patients who had been treated only at the outpatient clinic were not considered. All patients' data were listed according to the ICD code.

RESULTS

121 children were treated because of a congenital malformation of the lungs in the years between 2000 and 2011 in Erlangen. 68.6 % (n = 83) were males and 31.45 % (n = 38) were females. Nearly all of the malformations of the lungs were associated with other abnormalities. Most of the children also suffered from at least one cardiac defect. 28 of the 121 children had more than one malformation of the lungs. The diagnostic and therapeutic interventions correlated with the published recommendations.

CONCLUSIONS

The analysis of the patients' data used in this study indicate the importance of the early diagnosis and treatment. The cooperation of different medical disciplines is mandatory for a good outcome of those children.

Net costs of dementia by disease stage

OBJECTIVE

To estimate net costs of dementia by degree of severity from a societal perspective, including a detailed assessment of costs of formal and informal nursing care.

METHOD

In a cross-sectional study, costs of illness were analysed in 176 dementia patients and 173 matched non-demented control subjects. Healthcare resource use and costs were assessed retrospectively by means of a questionnaire. Dementia patients were classified into three disease stages, and linear regression models were applied to estimate net costs of dementia by degree of severity.

RESULTS

Annual net costs of dementia by stage were approximately €15 000 (mild), €32 000 (moderate) and €42 000 (severe), corresponding to US-$21 450, 45 760 and 60 060 respectively. Across disease stages, nursing care accounted for approximately three-quarters of total costs, of which half resulted from informal care. In sensitivity analyses using different valuation methods for nursing care, total costs decreased or increased by more than 20%.

CONCLUSION

Net costs more than double across stages of dementia. Informal care accounts for a considerable share of nursing care costs, and the approach to valuation of informal care has a large impact on cost-of-illness estimates.

Liver transplantation for hepatocellular carcinoma--is there a risk of recurrence caused by intraoperative blood salvage autotransfusion?

BACKGROUND/AIMS

The use of intraoperative blood salvage autotransfusion (IBSA) during surgical approaches may contribute to tumour cell dissemination. Therefore, IBSA should be avoided in cases of malignancy. However, the risks of IBSA might be acceptable in liver transplantation (LT) for selected small hepatocellular carcinoma (HCC).

METHODS

In total, 136 recipients of LT with histologically proven HCC in the explanted liver were included in this analysis. With regard to tumour recurrence, 40 patients receiving IBSA despite HCC (IBSA group) were compared to 96 patients without IBSA (non-IBSA group).

RESULTS

Milan criteria as assessed in the explanted liver were fulfilled in 24 of 40 IBSA patients and 58 of 96 non-IBSA patients (p = 0.85). Five of 40 patients in the IBSA group and 18 of 96 patients in the non-IBSA group experienced tumour recurrence (p = 0.29). In spite the theoretical risk of tumour cell dissemination, the recurrence rate was not increased in the IBSA group.

CONCLUSION

Our results indicate that IBSA does not modify the risk of HCC recurrence. Therefore, in highly selected HCC patients undergoing LT, the use of IBSA appears to be justified.

SDF1β expression in renal cell carcinoma correlates with grading and infiltration by CD8+ T-cells

For several tumor entities, a significant correlation between the chemokine stromal cell-derived factor 1 (SDF1) and its receptor C-X-C chemokine receptor type 4 (CXCR4), metastasis and tumor proliferation, as well as prognosis, has been described. In this study, a series of 105 renal cell carcinoma patients were analyzed in terms of expression of SDF1α and SDF1β and infiltration by CD4+ and CD8+ T-cells and the data correlated with TNM category, grading and survival. While the splice variant SDF1α had no impact on tumor grading, T-cell invasion or overall survival, expression of SDF1β showed a significant correlation with tumor grading and also suggested a correlation with metastasis, as well as CD8+ T-cell invasion. These results indicate a potential T-cell-mediated antitumor response induced by SDF1β up-regulation. Therefore targeting the SDF1β-CXCR4 signaling pathway may be a promising means for new therapeutic strategies in advanced tumor stages.

Biocomposite hydrogels with carboxymethylated, nanofibrillated cellulose powder for replacement of the nucleus pulposus

Biocomposite hydrogels with carboxymethylated, nanofibrillated cellulose (c-NFC) powder were prepared by UV polymerization of N-vinyl-2-pyrrolidone with Tween 20 trimethacrylate as a cross-linking agent for replacement of the native, human nucleus pulposus (NP) in intervertebral disks. The swelling ratios and the moduli of elasticity in compression of neat and biocomposite hydrogels were evaluated in dependence of c-NFC concentration (ranging from 0 to 1.6% v/v) and degree of substitution (DS, ranging from 0 to 0.23). The viscoelastic properties in shear and the material relaxation behavior in compression were measured for neat and biocomposite hydrogels containing 0.4% v/v of fibrils (DS ranging from 0 to 0.23), and their morphologies were characterized by cryo-scanning electron microscopy (cryo-SEM). The obtained results show that the biocomposite hydrogels can successfully mimic the mechanical and swelling behavior of the NP. In addition, the presence of the c-NFC shows lower strain values after cyclic compression tests and consequently creates improved material relaxation properties compared with neat hydrogels. Among the tested samples, the biocomposite hydrogel containing 0.4% v/v of c-NFC with a DS of 0.17 shows the closest behavior to native NP. Further investigation should focus on evaluation and improvement of the long-term relaxation behavior.

Do general practitioners recognize mild cognitive impairment in their patients?

OBJECTIVES

The need for recognition of mild cognitive impairment (MCI) in primary care is increasingly discussed because MCI is a risk factor for dementia. General Practitioners (GPs) could play an important role in the detection of MCI since they have regular and long-term contact with the majority of the elderly population. Thus the objective of this study is to find out how well GPs recognize persons with MCI in their practice population.

DESIGN

Cross-sectional study.

SETTING

Primary care chart registry sample.

PARTICIPANTS

3,242 non-demented GP patients aged 75-89 years.

MEASUREMENTS

GPs assessed the cognitive status of their patients on the Global Deterioration Scale (GDS). Thereafter, trained interviewers collected psychometric data by interviewing the patients at home. The interview data constitute the basis for the definition of MCI cases (gold standard).

RESULTS

The sensitivity of GPs to detect MCI was very low (11-12%) whereas their specificity amounts to 93-94%. Patients with MCI with a middle or high level of education more often got a false negative assignment than patients with a low educational level. The risk of a false positive assignment rose with the patients' degree of comorbidity. GPs were better at detecting MCI when memory or two and more MCI-domains were impaired.

CONCLUSION

The results show that GPs recognise MCI in a very limited number of cases when based on clinical impression only. A further development of the MCI concept and its operationalisation is necessary. Emphasis should be placed on validated, reliable and standardised tests for routine use in primary care encompassing other than only cognitive domains and on case finding approaches rather than on screening. Then a better attention and qualification of GPs with regard to the recognition of MCI might be achievable.

[Detection of hepatic micrometastases in the context of adjuvant chemotherapy and surgery for hepatic metastases]

Colorectal cancer is one of the three most frequent malignancies in humans. Survival is mainly determined by local recurrence, lymphatic and hematogenous dissemination. Primary liver resection for metastases is possible in ~20-25% of patients with hepatic metastases and results in a 50% recurrence rate within 23 months. The five-year survival without treatment in patients with UICC stage IV is only 5%, the mean survival 6-9 months. As a result of promising developments in chemotherapy and targeted therapies in the last decade, the mean survival rate has significantly improved to over more than two years. Furthermore, the use of polychemotherapy in combination with anti-angiogenic and anti-proliferative biologicals has resulted in a significant increase of secondary resectability of liver metastases. Despite of a R0-resection (i.e. resection with clear margins) of liver metastases, only 30% of patients remain free of recurrence in the long-term. Prognostic scores are used for optimal patient selection, e.g. the Fong-Score. Resection is often limited by a high number of recurrences: intrahepatic micrometastases and disseminated tumor cells (DTC) are suspected as the cause of their development. In this connection the load of disseminated tumor cells correlates significantly with the survival and recurrence rate after resection. These micrometastases are targets in current adjuvant treatment studies (e.g. MT 201) by using anti-EpCam antibodies. The detection of DTC can supplement the previously used scores and represents the indication for an adjuvant antibody-based treatment (e.g. anti-EpCam) in the context of clinical trials.

[Lamotrigine and the skin]

We report a patient with personality disorder and depression who developed a reversible macular rash 10 days after starting lamotrigine (LTG). We discuss the safety profile of LTG, risk factors for adverse reactions of the skin, the management of risk reduction of LTG - induced skin reactions and the possibility of a controlled reexpostion of patients with benign LTG - associated rash.

Isolated aneurysm of the internal jugular vein

True venous aneurysms are rare. We report the case of a 70-year-old male with the extremely uncommon finding of an aneurysm of the internal jugular vein. Due to their rarity, no general guidelines for the treatment of these aneurysms have been established. Upon surgical exclusion of the aneurysm, a progressive swelling of the right side of the face was noted in this patient leading to the decision to interpose a thin-walled ePTFE prosthesis for want of a suitable vein graft. Upon follow-up three years later, the patient is completely asymptomatic and the prosthesis is patent in Doppler sonography.

Ultrastructural appearance of embedded and polished wood cell walls as revealed by Atomic Force Microscopy

Atomic Force Microscopy (AFM) was used to investigate the ultrastructural appearance of transverse wood cell wall surfaces in embedded and polished Norway spruce wood blocks. The prepared surfaces showed only little height differences, suitable for high resolution AFM phase contrast imaging. Our results revealed randomly arranged wood cell wall components in the thick secondary 2 (S2) layers of the tracheid cell walls. It is concluded that the observed distribution pattern of the cellulose fibril/matrix structure is close to the original cell wall structure. In this context, the plasticity of wood cell wall components to re-arrange and adjust to different conditions resulting in diverse structural pattern is discussed.