Cerebral and extracerebral release of protein S100B in cardiac surgical patients

Although several clinical studies have shown that increased serum concentrations of protein S100B predict ischaemic brain damage after cardiac surgery, S100B may also be released from the heart or other injured tissue. We therefore investigated the correlation between serum S100B levels and those of the specific cardiac marker troponin I in order to assess the cerebral vs. extracerebral origin of S100B. In 64 cardiac surgical patients, serial blood samples were drawn for the measurement of S100B and troponin I before surgery and for seven days after surgery. Neurological function was assessed before with the National Institutes of Health Stroke Scale and the Folstein Mini Mental Test. The data show that a sustained increase in serum S100B levels is associated with neurological dysfunction, as witnessed by a positive correlation between S100B values and the results of the neuropsychological tests. In contrast, the early postoperative increased levels of protein S100B derive from cardiac tissue, as shown by the positive correlation between S100B and cardiac troponin I levels.

[Therapy with nonsteroidal anti-inflammatory drugs]

Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most frequently prescribed drugs worldwide. Their analgetic and antiphlogistic effect results from an efficient inhibition of prostaglandin synthesis. The risk of side effects is remarkable. This concerns namely side effects in the gastrointestinal tract and the kidneys. The common NSAIDs inhibit both isoforms of the cyclooxygenase (COX). The analgetic and antiphlogistic effect results from the inhibition of COX-2, whereas the inhibition of COX-1 is responsible for the majority of side effects. If NSAID therapy is necessary, patients at risk should receive an effective prophylaxis, or be treated with COX-2-selective substances. The analgetic effects of COX-2 inhibitors are comparable to common NSAIDs, with a significant reduction of the gastrointestinal risks, except in cases of additional risk factors, e.g., low-dose ASS therapy, etc. In cases of renal impairment both substances should be used with caution, and subtle monitoring is necessary.

Oxidative stress in cultured cerebral endothelial cells induces chromosomal aberrations, micronuclei, and apoptosis

There is evidence accumulating that brain microvasculature is involved critically in oxidative stress-mediated brain damage. Cultured cerebral microvascular endothelial cells were used to demonstrate the cytotoxic and genotoxic effects elicited by hypoxia/reoxygenation and DMNQ treatment in vitro. In addition, the effect of glucose deprivation during oxidative insult was assessed. The parameters determined were: 1) chromosomal aberrations; 2) induction of micronuclei; and 3) apoptosis. Our results indicate that both the exposure of the cerebral endothelial cells to 24 hr of hypoxia followed by 4 hr of reoxygenation, and treatment with the redox cycling quinone DMNQ, increased markedly the occurrence of chromosomal aberrations and micronuclei. It was found that expression of p53 was induced by oxidative stress, particularly when glucose had been omitted from the culture medium. Aglycemic culture conditions in general exacerbated the cytotoxic effects of oxidative insults, as evidenced by the increase in apoptotic cells and the decrease in the mitotic index. Interestingly, neither an elevation of cell lysis nor an increase in necrosis has been observed during our experiments. In summary, our data indicate that oxidative stress exerts considerable genotoxic and cytotoxic effects on cerebral endothelial cells, which might contribute to the progression of tissue damage in the central nervous system.

[Importance of rectal extirpation for the therapy concept of low rectal cancers]

INTRODUCTION

The main objective of surgery of rectal carcinomas is to avoid a permanent colostomy by sphincter-sparing surgical procedures. A variety of different abdominoperineal resection rates is described in the literature.

MATERIAL/METHOD

The study was performed in 2000 within the framework of a multicentric study including 282 hospitals. The purpose of the study was to document the quality of diagnosis and therapy for colorectal carcinomas.A total of 9477 patients were included in this study: 3402 suffering from a rectal carcinoma and 6075 suffering from a colon carcinoma.

RESULTS

A total of 866 abdominoperineal resections was performed. This corresponds to an abdominoperineal resection rate of 27.4%. In 30.4% of all men and in 23.0% of all women an abdominoperineal resection was performed. Of all tumor patients who underwent abdominoperineal resection, 8.3% had a pT4 carcinoma and 57.5% a pT3 carcinoma. Adapted to the localization of the tumor in the rectum, i.e., the distance of the aboral tumor margin to the anal verge, the following abdominoperineal resection rates were found: <4 cm from the anal verge 84.6%, 4-7.9 cm 43.9%, 8-11.9 cm 5.8%, and 12-16 cm 0.5%.Intraoperative complications occurred in 11.8%, specific postoperative complications in 33.1%, and general postoperative complications in 27.4% of the patients. The postoperative lethality was 2.8%. The mean postoperative hospital stay was 21.7 days. Logistic regression identified the body mass index, gender, the distance of the carcinoma from the anal verge, and the T category as independent factors influencing the abdominoperineal resection rate.

DISCUSSION

Despite an overall decrease in use, abdominoperineal resection will continue to play an important role for the surgical treatment of low rectal cancers in routine clinical practice in Germany. It will remain an individual decision for each patient whether the tumor and the patient allow sphincter preservation or whether abdominoperineal resection seems to be necessary. According to the results of the present study,a general definition of an abdominoperineal resection rate in an unselected group of patients should be viewed critically.

Osteosarcoma over the age of forty

The European Musculo Skeletal Oncology Society (EMSOS) has carried out a retrospective review of patients over the age of 40 years with osteosarcoma. 481 patients from 12 centres or multicentric groups were included. 42 patients had osteosarcoma arising in Paget's disease, median survival was 9 months. Patients with axial or metastatic tumours also did badly whilst 41 patients with radiation-induced osteosarcoma had a prognosis paralleling conventional osteosarcoma matched for patient age and site of the tumour. 238 patients had high grade non-metastatic osteosarcoma and had a survival of 46% at 5 years. Older patients had less chemotherapy and fared worse. Osteosarcoma in the elderly is a curable condition and warrants intensive treatment with chemotherapy and surgical resection.

Bacteria and fungi in aerosols generated by two different types of wastewater treatment plants

Raw wastewater is a potential carrier of pathogenic microorganisms and may pose a health risk when pathogenic microorganisms become aerosolized during aeration. Two different types of wastewater treatment plants were investigated, and the amounts of cultivable bacteria and fungi were measured in the emitted aerosols. Average concentrations of 17,000 CFU m(-3) of mesophilic, 2,100 CFU m(-3) of TSA-SB bacteria (bacteria associated with certain waterborne virulence factors), 1700 CFU m(-3) of mesophilic and 45 CFU m(-3) of thermotolerant fungi, were found in the aerosol emitted by the aeration tank of the activated sludge plant. In the aerosol of the fixed-film reactor 3000 CFU m(-3) mesophilic and 730CFUm(-3) TSA-SB bacteria, and 180 CFUm(-3) mesophilic and 14 CFU m(-3) thermotolerant fungi were measured. The specific emissions per population equivalent between the two types of treatment plants differed by two orders of magnitude. The microbial flux based on the open water surface area of the two treatment plants was similar. The aerosolization ratios of cultivable bacteria (expressed as CFU m(-3) aerosol/m(-3) wastewater) ranged between 8.4 x 10(-11) and 4.9 x 10(-9). The aerosolization ratio of fungi was one to three orders of magnitude higher and a significant difference between the two types of treatment plants could be observed.

Transoesophageal echocardiography shows high risk of gas embolism during laparoscopic hepatic resection under carbon dioxide pneumoperitoneum

BACKGROUND

The ultrasonically activated scalpel (UAS) enables safe and effective laparoscopic tissue dissection, making hepatic resection feasible. This study compared blood loss and risk of gas embolism using the UAS during open hepatic resection and laparoscopic hepatic resection.

METHODS

Female pigs were divided into two groups for laparoscopic (n = 7) and open (n = 5) left hepatic lobectomy. The UAS was used for both tissue cutting and coagulation. Laparoscopic liver resection was performed under carbon dioxide pneumoperitoneum (intraperitoneal pressure 12 mmHg). During surgery animals were monitored haemodynamically by an arterial line and Swan-Ganz catheter. Two-dimensional transoesophageal echocardiography (2D-TEE) was used to detect gas emboli with special attention to the right atrium and ventricle. Gas emboli were graded according to size, and correlated with haemodynamic and blood gas data.

RESULTS

During open and laparoscopic hepatic resection the UAS resulted in minimal blood loss and effective tissue dissection. No air embolism was seen during open surgery. With laparoscopic hepatic resection 2D-TEE revealed gas embolism in all animals. Gas embolism was accompanied by cardiac arrhythmia in four of seven animals. No direct correlation was observed between embolism episodes and blood gas variables. There were no deaths after episodes of embolization. A significant decrease in arterial partial pressure of oxygen was seen at the end of the laparoscopic procedure in all animals.

CONCLUSION

The UAS causes minimal blood loss during both open and laparoscopic hepatic resection. Laparoscopic liver dissection under carbon dioxide pneumoperitoneum carries a high risk of gas embolism.

Co-registration of EEG and MRI data using matching of spline interpolated and MRI-segmented reconstructions of the scalp surface

Accurate co-registration of MRI and EEG data is indispensable for the correct interpretation of EEG maps or source localizations in relation to brain anatomy derived from MRI. In this study, a method for the co-registration of EEG and MRI data is presented. The method consists of an iterative matching of EEG-electrode based reconstructions of the scalp surface to scalp-segmented MRIs. EEG-electrode based surface reconstruction is achieved via spline interpolation of individually digitized 3D-electrode coordinates. In contrast to other approaches, neither fiducial determination nor any additional provisions (such as bite bars, other co-registration devices or head shape digitization) are required, and co-registration errors associated with inaccurate fiducial determination are avoided. The accuracy of the method was estimated by calculating the root-mean-square (RMS) deviation of spline interpolated and MRI-segmented surface reconstructions in 20 subjects. In addition, the distance between co-registered and genuine electrode coordinates was assessed via a simulation study, in which surface reconstruction was based on virtual electrodes determined on the scalp surface of a high-resolution MRI data set. The mean RMS deviation of surface reconstructions was 2.43 mm, and the maximal distance between any two matched surface points was 5.06 mm. The simulated co-registration revealed a mean deviation of genuine and co-registered electrode coordinates of 0.61 mm. It is concluded that surface matching using spline interpolated reconstructions of scalp surfaces is a precise and highly practicable method to co-register EEG and MRI data.

Pulse contour analysis versus thermodilution in cardiac surgery patients

BACKGROUND

Previous studies have demonstrated that there is a lack of agreement between intermittent cold bolus thermodilution (ICO) and a semicontinuous method with dilution of heat (CCO) in cardiac surgical patients following hypothermic extracorporeal circulation (HCPB). Therefore, the aim of the present study was to compare both ICO and CCO with continuous pulse contour analysis (PCCO): a method based on a fundamentally different principle of determining cardiac output (CO).

METHODS

A prospective criterion standard study of 25 cardiac surgery patients undergoing HCPB. Cardiac output was determined using the three methods (ICO, CCO, and PCCO) before and after HCPB up to 12 h after arrival on the ICU. Bias and precision were evaluated.

RESULTS

A total of 380 triple determinations of CO could be analyzed. During the entire study period bias PCCO-ICO was -0.14 l*/min (precision 1.16 l*/min) and bias CCO-ICO was -0.40 l*/min (precision 1.25 l*/min). Up to 45 min after bypass PCCO agreed with ICO (bias -0.21 l*/min, precision 1.37 l*/min), while bias CCO-ICO was -1.30 l*/min (precision 1.45 l*/min).

CONCLUSION

The agreement between PCCO and ICO in contrast to CCO in the first 45 min after HCPB indicates that CCO underestimates CO during this period.

Organization and chromosomal localization of the human and mouse genes coding for LanC-like protein 1 (LANCL1)

We have determined the organization and chromosome location of the human LANCL1 and mouse Lancl1 genes encoding LANCL1, the lanthionine synthetase component C (LanC)-like protein 1. LANCL1 is related to the bacterial LanC family which is involved in the biosynthesis of antimicrobial peptides. The human and mouse genes span 45 kb and 38 kb, respectively, each comprising ten exons. Within the potential promoter regions, several consensus sequences for ubiquitous and tissue-specific transcription factors are present, reflecting the expression data. The nucleotide sequence of the previously unknown mouse full-length transcript is also reported here. Fluorescence in situ hybridization analyses assigned the LANCL1 gene to human chromosome 2q34 and the Lancl1 gene to mouse chromosome 1, region C2-C5, in accordance with the known homology.

Relationship between release of nitric oxide and CO2 and their dependence on oxidation reduction potential in wastewater treatment

Nitric oxide (NO) is an intermediate of denitrification process and can be produced by denitrifiers, nitrifiers and other bacteria. In our experiments we measured the dynamic flow of NO depending on oxidation reduction potential (ORP). Different ORP-ranges were related to various carbon loading stages in the wastewater treatment pilot plant. Nitrification and denitrification were achieved by a sequence of aeration and non-aeration periods. Our measurements show that different carbon loading conditions (low feed, balanced and overloaded conditions) did not change the range of the mixing ratio of NO emissions when the aeration conditions like air-flow and temperature were kept constant. Minimum and maximum NO mixing ratios were 34.7 and 91.8 ppbv; 52.3 and 91.3 ppbv; 57.6 and 109 ppbv for low feed, balanced and overloaded conditions, respectively. The curve of the NO graph relied on nitrification/denitrification dynamics. The dependence of NO release on different ORP and CO2-release during the various conditions are shown. Longer aeration times resulted in an increased release of gaseous NO. The net-release of NO g(-1) nitrogen removed was between 0.014% and 0.028%. The NO fluxes to the air were observed between 8.3 and 14.9 mg m(-2) d(-1) NO. The major release occurred during high aeration periods whereas the concentration of dissolved [NOaq] in the wastewater was less than 0.05% of the gaseous release due to very low solubility of the NO.

Evidence for premotor cortex activity during dynamic visuospatial imagery from single-trial functional magnetic resonance imaging and event-related slow cortical potentials

A strong correspondence has been repeatedly observed between actually performed and mentally imagined object rotation. This suggests an overlap in the brain regions involved in these processes. Functional neuroimaging studies have consistently revealed parietal and occipital cortex activity during dynamic visuospatial imagery. However, results concerning the involvement of higher-order cortical motor areas have been less consistent. We investigated if and when premotor structures are active during processing of a three-dimensional cube comparison task that requires dynamic visuospatial imagery. In order to achieve a good temporal and spatial resolution, single-trial functional magnetic resonance imaging (fMRI) and scalp-recorded event-related slow cortical potentials (SCPs) were recorded from the same subjects in two separate measurement sessions. In order to reduce inter-subject variability in brain activity due to individual differences, only male subjects (n = 13) with high task-specific ability were investigated. Functional MRI revealed consistent bilateral activity in the occipital (Brodmann area BA18/19) and parietal cortex (BA7), in lateral and medial premotor areas (BA6), the dorsolateral prefrontal cortex (BA9), and the anterior insular cortex. The time-course of SCPs indicated that task-related activity in these areas commenced approximately 550-650 ms after stimulus presentation and persisted until task completion. These results provide strong and consistent evidence that the human premotor cortex is involved in dynamic visuospatial imagery.

[Fatal outcome of a multisystemic sarcoidosis in a 54-year-old patient]

BACKGROUND

Sarcoidosis is a systemic granulomatous disease of unknown etiology in which the immune system is overstimulated. The intrathoracic lymph glands and the lungs are the most common site of involvement but all other organs and systems can be affected. Although the prognosis is mainly favourable there is a small group of patients who are resistant to therapy and will eventually succumb to their disease. There is no causative treatment but corticosteroids are the most effective therapeutic agents for sarcoidosis. If there is resistance to corticosteroids an immunsuppressive combination treatment is available. The immunsuppressive drugs (Azathioprin, Methotrexat, Ciclosporin, Pentoxifyllin, Thaliodomid) and the clinical effectiveness of the combination treatment are still under investigation.

CASE REPORT

We describe a 54-year-old patient admitted to our hospital because of abnormal liver function tests. The cause was a sarcoidosis of the liver but we found also an involvement of the lung. The chest x-ray did not show any pathological findings, the lung function tests - VC and FEV1 - were normal but the diffusion capacity (DLCO) was reduced to 60 %. The course of the disease was characterized by a progressive deterioration of the lung function and of the general condition (loss of weight, fatigue, decrease in vitality). In the further course colon, spleen, bone marrow and kidneys were involved and hypercalcemia, pancytopenia and hyperspleenism occur. The treatment consisted in the application of corticosteroids. We started with 30 mg prednison daily and reduced it over a period of nine weeks to 7.5 mg. In the periods of deterioration we increased the doses up to 40 mg daily and achieved a temporary improvement of the general condition and the function tests. But eventually the fatal outcome could not be prevented not even after the removal of the massive enlarged spleen. The patient died four years after the diagnosis was established. The cause of death was an advanced hepatic encephalopathy as a result of extensive granulomatous involvement of the liver by a multisystemic sarcoidosis.

CONCLUSION

We conclude that a steroid resistant multisystemic sarcoidosis should be treated early in the course with a combination of two immunsuppressive agents. We recommend Azathioprin in addition to corticosteroids. We refer to the corresponding literature.

Effect of fibrin glue occlusion of the hepatobiliary tract on thioacetamide-induced liver failure

BACKGROUND

Expression and activation of hepatocyte growth factor (HGF) is stimulated by a complex system of interacting proteins, with thrombin playing an initial role in this process. The impact of temporary occlusion of the hepatobiliary tract with fibrin glue (major component thrombin) on the HGF system in acute and chronic liver damage in a rat model was investigated.

METHODS

Chronic liver damage was induced in 40 rats by daily intraperitoneal application of thioacetamide (100 mg/kg) for 14 days. After 7 days half of them received an injection of 0.2 mL fibrin glue into the hepatobiliary system. Daily intraperitoneal administration of thioacetamide continued for 7 consecutive days. The rats were then sacrificed for blood and tissue analysis. Acute liver failure was induced in 12 rats by intraperitoneal administration of a lethal dose of thioacetamide (500 mg/kg per day for 3 days) after an injection with 0.2 mL fibrin glue into their hepatobiliary tract. Survival rates and histological outcome were investigated and compared with control animals.

RESULTS

Fibrin glue occluded rats showed significantly lower liver enzyme activities and serum levels of bilirubin, creatinine and urea nitrogen. Immunohistochemistry revealed a significant increase in c-met-, HGFalpha- and especially HGFbeta-positive cells. Rats subjected to a lethal dose of thioacetamide survived when fibrin glue was applied 24 hours prior to the toxic challenge. These animals showed normal liver structure and no clinical abnormalities.

CONCLUSION

Fibrin glue occlusion of the hepatobiliary tract induces therapeutic and prophylactic effects on chronic and acute liver failure by stimulating the HGF system. Therefore, fibrin glue occlusion might be useful in treating toxic liver failure.