Tailored positioning and number of hand rub dispensers: the fundamentals for optimized hand hygiene compliance

BACKGROUND

Availability of alcohol-based hand rub (ABHR) dispensers at positions adapted to the work flow of healthcare workers (HCWs) is decisive in order to carry out indication-based hand rubbing. Although requirements and guidelines regarding the positioning of ABHR dispensers are in place, scientific evidence is often lacking.

METHODS

In order to analyse the impact of the location and number of ABHR dispensers on hand hygiene performance, additional dispensers were systematically placed in patient rooms in a surgical 38-bed ward at Marburg University Hospital, Germany to complement the existing dispenser locations. ABHR use was monitored continuously before and after complementation using the NosoEx hand hygiene monitoring system. The ward had 53 dispensers before the intervention and 82 dispensers after the intervention.

RESULTS

The addition of dispensers increased ABHR consumption across the entire ward. Before the intervention, mean consumption was 20.6 mL/patient-day, whereas mean consumption after the intervention was 25.3 mL/patient-day. Depending on the combination of dispenser locations, consumption increased through targeted supplementation in patient rooms. The presence of two or three dispensers per patient room resulted in significantly greater ABHR consumption compared with one dispenser per patient room. The preferred location combinations were entrance-front bed-back bed and entrance-foot end.

CONCLUSION

ABHR consumption can be increased significantly by optimizing the position and number of dispensers. The outstanding factors are visibility and integrability of dispenser use into the work flow; in particular, a dispenser should be positioned in the entrance area. Recommendations should be optimized with regard to the required number and location of dispensers in patient rooms.

Increased Serum Levels of soluble ST2 as a Predictor of Disease Progression in Systemic Sclerosis

OBJECTIVE

Interleukin-33 (IL-33) has been investigated as a mediator in the pathogenesis of fibrosis in lung, liver, and heart. There is accumulating evidence for the involvement of the IL-33/IL-33 receptor ST2L signalling pathway in systemic sclerosis (SSc). Little is known about the role of serum sST2 in SSc, which is the subject of the present investigation.

METHOD

Serum levels of sST2 were measured in 49 patients with SSc, recruited prospectively between November 2017 and March 2019. Patients were divided into those with progressive and those with stable disease. Receiver operating characteristics (ROC) curve analysis was applied to study sST2 as a marker for identifying patients with progressive disease. We used multivariate logistic regression analysis to evaluate the predictive value of sST2 for progressive disease after adjustment for potential confounding factors.

RESULTS

Serum sST2 levels in patients with progressive disease were significantly elevated compared with patients with stable disease (mean ± sem: 50.4 ± 4.7 ng/mL vs 29.2 ± 2.97 ng/mL, p < 0.001). ROC curve analysis identified an sST2 cut-off value of 37.8 ng/mL as optimal for discriminating patients with progressive disease from those with stable disease (sensitivity 80.0%, specificity 79.3%, area under the curve 0.80). After controlling for potential confounding factors (age, gender, C-reactive protein, pro-brain natriuretic peptide, and sum of internal medicine comorbidities), sST2 remained predictive of progressive disease (odds ratio 1.070, 95% confidence interval 1.017-1.126, p < 0.009).

CONCLUSION

In the present study, sST2 serum levels were predictive of disease progression in patients with SSc.

Long-term risk of sudden cardiac death in hypertrophic cardiomyopathy: a cardiac magnetic resonance outcome study

AIMS

Sudden cardiac death (SCD) is an appalling complication of hypertrophic cardiomyopathy (HCM). There is an ongoing discussion about the optimal SCD risk stratification strategy since established SCD risk models have suboptimal discriminative power. The aim of this study was to evaluate the prognostic value of late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) for SCD risk stratification compared to the European Society of Cardiology (ESC) SCD risk score and traditional risk factors in an >10-year follow-up.

METHODS AND RESULTS

Two hundred and twenty consecutive patients with HCM and LGE-CMR were enrolled. Follow-up data were available in 203 patients (median age 58 years, 61% male) after a median follow-up period of 10.4 years. LGE was present in 70% of patients with a median LGE amount of 1.6%, the median ESC 5-year SCD risk score was 1.84. In the overall cohort, SCD rates were 2.3% at 5 years, 4.8% at 10 years, and 15.7% at 15 years, independent from established risk models. An LGE amount of >5% left ventricular (LV) mass portends the highest risk for SCD with SCD prevalences of 5.5% at 5 years, 13.0% at 10 years, and 33.3% at 15 years. Conversely, patients with no or ≤5% LGE of LV mass have favourable prognosis.

CONCLUSIONS

LGE-CMR in HCM patients allows effective 10-year SCD risk stratification beyond established risk factors. LGE amount might be added to established risk models to improve its discriminatory power. Specifically, patients with >5% LGE should be carefully monitored and might be adequate candidates for primary prevention implantable cardioverter-defibrillator during the clinical long-term course.

Increased extracellular water measured by bioimpedance analysis and increased serum levels of atrial natriuretic peptide in polymyalgia rheumatica patients : Signs of volume overload

BACKGROUND

Water retention is a typical feature of acute inflammatory episodes, chiefly implemented by the sympathetic nervous system (SNS) and the hypothalamic-pituitary-adrenal (HPA) axis. This is an important compensatory mechanism counteracting expected water loss, e.g., due to sweating. Both the SNS and HPA axis are activated in polymyalgia rheumatica (PMR). As retention mechanisms may similarly apply in this disease, we hypothesized increased water retention in PMR.

METHODS

Using bioimpedance analysis body composition was investigated in 64 healthy controls and 32 treatment-naive PMR patients. All PMR patients satisfied the 2012 EULAR/ACR classification criteria for PMR. 32 PMR patients were tested before and after 7 days of glucocorticoid-based therapy. Serum levels of pro-atrial natriuretic peptide (proANP) were investigated in all PMR patients and 15 healthy controls.

RESULTS

Extracellular water (ECW) was markedly higher in PMR patients than in controls (mean ± SD: 49.1 ± 6.0% versus 36.3 ± 2.5% of total body water, p < 0.001). Patients with PMR demonstrated significantly higher serum levels of proANP compared to controls. Even before glucocorticoid treatment was initiated, systolic and diastolic blood pressure were higher in PMR patients compared to controls. Extracellular water levels did not change in PMR patients upon 7 days of intensified treatment.

CONCLUSION

This study demonstrated increased extracellular water and elevated serum levels of proANP as signs of fluid overload in patients with PMR. Volume changes are imprinted as long-lasting mechanisms as water distribution is not affected by short-term anti-inflammatory therapy.

Dual targeting improves capture of ultrasound microbubbles towards activated platelets but yields no additional benefit for imaging of arterial thrombosis

Platelets can be found on the surface of inflamed and ruptured atherosclerotic plaques. Thus, targeting of activated platelets may allow for molecular imaging of vulnerable atherosclerotic lesions. We here investigated microbubbles (MB) functionalized with the selectin ligand sialyl Lewis^a individually (MB_sLea) or dually with sLe^a and an antibody targeting ligand-induced binding sites of the activated GPIIb/IIIa receptor (MB_Dual). Assessed by in vitro flow chamber, targeted MB exhibited increased adhesion to platelets as compared to MB_Control. While MB_sLea rolled slowly on the platelets’ surface, MB_Dual enhanced the percentage of firm adhesion. In vivo, MB were investigated by ultrasound in a model of ferric chloride induced non-occlusive carotid artery thrombosis. MB_sLea and MB_Dual revealed a higher ultrasound mean acoustic intensity than MB_Control (p < 0.05), however MB_Dual demonstrated no additional increase in mean signal intensity as compared to MB_sLea. The degree of carotid artery stenosis on histology correlated well with the ultrasound acoustic intensity of targeted MB (p < 0.05). While dual targeting of MB using fast binding carbohydrate polymers and specific antibodies is a promising strategy to support adhesion to activated platelets under arterial shear stress, these advantages seem not readily translatable to in vivo models.

Comparative testing of disinfectant efficacy on planktonic bacteria and bacterial biofilms using a new assay based on kinetic analysis of metabolic activity

AIMS

The aim of our study was to develop a new reproducible method for disinfectant efficacy testing on bacterial biofilms and to evaluate the efficacy of different disinfectants against biofilms. Clinical multidrug-resistant strains were chosen as test isolates to ensure practical relevance.

METHODS AND RESULTS

We compared the standard qualitative suspension assay for disinfectant testing, which does not take into account biofilm formation, to the new biofilm viability assay that uses kinetic analysis of metabolic activity in biofilms after disinfectant exposure to evaluate disinfectant efficacy. In addition, the efficacy of four standard disinfectants to clinical isolates was tested using both methods. All tested disinfectants were effective against test isolates when in planktonic state using the standard qualitative suspension assay, while disinfectants were only weakly effective against bacteria in biofilms.

CONCLUSIONS

Disinfectant efficacy testing on planktonic organisms ignores biofilms and overestimates disinfectant susceptibility of bacteria. However, biofilm forming, e.g. on medical devices or hospital surfaces, is the natural state of bacterial living and needs to be considered in disinfectant testing.

SIGNIFICANCE AND IMPACT OF THE STUDY

Although bacterial biofilms are the predominant manner of bacterial colonization, most standard procedures for antimicrobial susceptibility testing and efficacy testing of disinfectants are adapted for application to planktonic bacteria. To our knowledge, this is the first study to use a newly developed microplate-based biofilm test system that uses kinetic analysis of the metabolic activity in biofilms, after disinfectant exposure, to evaluate disinfectant efficacy. Our study shows that findings obtained from disinfectant efficacy testing on planktonic bacteria cannot be extrapolated to predict disinfectant efficacy on bacterial biofilms of clinically relevant multidrug-resistant organisms.

Determinants for persistence of Pseudomonas aeruginosa in hospitals: interplay between resistance, virulence and biofilm formation

Pseudomonas aeruginosa (Pa) is one of the major bacterial pathogens causing nosocomial infections. During the past few decades, multidrug-resistant (MDR) and extensively drug-resistant (XDR) lineages of Pa have emerged in hospital settings with increasing numbers. However, it remains unclear which determinants of Pa facilitated this spread. A total of 211 clinical XDR and 38 susceptible clinical Pa isolates (nonXDR), as well as 47 environmental isolates (EI), were collected at the Heidelberg University Hospital. We used RAPD PCR to identify genetic clusters. Carriage of carbapenamases (CPM) and virulence genes were analyzed by PCR, biofilm formation capacity was assessed, in vitro fitness was evaluated using competitive growth assays, and interaction with the host's immune system was analyzed using serum killing and neutrophil killing assays. XDR isolates showed significantly elevated biofilm formation (p < 0.05) and higher competitive fitness compared to nonXDR and EI isolates. Thirty percent (62/205) of the XDR isolates carried a CPM. Similarities in distribution of virulence factors, as well as biofilm formation properties, between CPM+ Pa isolates and EI and between CPM- and nonXDR isolates were detected. Molecular typing revealed two distinct genetic clusters within the XDR population, which were characterized by even higher biofilm formation. In contrast, XDR isolates were more susceptible to the immune response than nonXDR isolates. Our study provides evidence that the ability to form biofilms is an outstanding determinant for persistence and endemic spread of Pa in the hospital setting.

Costs and possible benefits of a two-tier infection control management strategy consisting of active screening for multidrug-resistant organisms and tailored control measures

BACKGROUND

Multidrug-resistant organisms (MDROs) are an economic burden, and infection control (IC) measures are cost- and labour-intensive. A two-tier IC management strategy was developed, including active screening, in order to achieve effective use of limited resources. Briefly, high-risk patients were differentiated from other patients, distinguished according to type of MDRO, and IC measures were implemented accordingly.

AIM

To evaluate costs and benefits of this IC management strategy.

METHODS

The study period comprised 2.5 years. All high-risk patients underwent microbiological screening. Gram-negative bacteria (GNB) were classified as multidrug-resistant (MDR) and extensively drug-resistant (XDR). Expenses consisted of costs for staff, materials, laboratory, increased workload and occupational costs.

FINDINGS

In total, 39,551 patients were screened, accounting for 24.5% of all admissions. Of all screened patients, 7.8% (N=3,104) were MDRO positive; these patients were mainly colonized with vancomycin-resistant enterococci (37.3%), followed by meticillin-resistant Staphylococcus aureus (30.3%) and MDR-GNB (28.3%). The median length of stay (LOS) for all patients was 10 days (interquartile range 3-20); LOS was twice as long in colonized patients (P<0.001). Screening costs totalled 255,093.82€, IC measures cost 97,701.36€, and opportunity costs were 599,225.52€. The savings of this IC management strategy totalled 500,941.84€. Possible transmissions by undetected carriers would have caused additional costs of 613,648.90-4,974,939.26€ (i.e. approximately 600,000-5 million €).

CONCLUSION

Although the costs of a two-tier IC management strategy including active microbiological screening are not trivial, these data indicate that the approach is cost-effective when prevented transmissions are included in the cost estimate.

Hydrodynamic interactions induce anomalous diffusion under partial confinement

Under partial confinement, the motion of colloidal particles is restricted to a plane or a line but their dynamics is influenced by hydrodynamic interactions mediated by the unconfined, three-dimensional flow of the embedding fluid. We demonstrate that this dimensionality mismatch induces a characteristic divergence in the collective diffusion coefficient of the colloidal subsystem. This result, independent of the specific interparticle forces in the colloid, is solely due to the kinematical constraint on the colloidal particles, and it is different from the known divergence of transport coefficients in purely one or two-dimensional fluids.

Coastal changes in the Arctic

The arctic environment is changing: air temperatures, major river discharges and open water season length have increased, and storm intensities and tracks are changing. Thirteen quantitative studies of the rates of coastline position change throughout the Arctic show that recently observed environmental changes have not led to ubiquitously or continuously increasing coastal erosion rates, which currently range between 0 and 2 m/yr when averaged for the arctic shelf seas. Current data is probably insufficient, both spatially and temporally, however, to capture change at decadal to sub-decadal time scales. In this context, we describe the current understanding of arctic coastal geomorphodynamics with an emphasis on erosional regimes of coasts with ice-rich sedimentary deposits in the Laptev, East Siberian and Beaufort seas, where local coastal erosion can exceed 20 m/yr. We also examine coasts with lithified (rocky) substrates where geomorphodynamics are intensified by rapid glacial retreat. Coastlines of Svalbard, Greenland and the Canadian Archipelago are less frequently studied than ice-rich continental coasts of North America and Siberia, and studies often focus on coastal sections composed of unlithified material. As air temperature and sea ice duration and extent change, longer thaw and wave seasons will intensify coastal dynamics in the Arctic.

Expression of the CXCR6 on polymorphonuclear neutrophils in pancreatic carcinoma and in acute, localized bacterial infections

The chemokine receptor CXCR6 has been described on lymphoid cells and is thought to participate in the homing of activated T-cells to non-lymphoid tissue. We now provide evidence that the chemokine receptor CXCR6 is also expressed by activated polymorphonuclear neutrophils (PMN) in vivo: Examination of biopsies derived from patients with pancreatic carcinoma by confocal laser scan microscopy revealed a massive infiltration of PMN that expressed CXCR6, while PMN of the peripheral blood of these patients did not. To answer the question whether CXCR6 expression is a property of infiltrated and activated PMN, leucocytes were collected from patients with localized soft tissue infections in the course of the wound debridement. By cytofluorometry, the majority of these cells were identified as PMN. Up to 50% of these PMN were also positive for CXCR6. Again, PMN from the peripheral blood of these patients were nearly negative for CXCR6, as were PMN of healthy donors. In a series of in vitro experiments, up-regulation of CXCR6 on PMN of healthy donors by a variety of cytokines was tested. So far, a minor, although reproducible, effect of tumour necrosis factor (TNFalpha) was seen: brief exposure with low-dose TNFalpha induced expression of CXCR6 on the surface of PMN. Furthermore, we could show an increased migration of PMN induced by the axis CXCL16 and CXCR6. In summary, our data provide evidence that CXCR6 is not constitutively expressed on PMN, but is up-regulated under inflammatory conditions and mediates migration of CXCR6-positive PMN.

[D3 versus D2 dissection in stomach carcinoma. A case-control study of postoperative morbidity, survival and early oncologic outcome]

INTRODUCTION

In western countries, the benefit of the Japanese extended D3 lymph node dissection in gastric cancer patients who have been operated on in curative intent has not been proven and higher rates of side effects are expected. The present matched-pair study retrospectively compared the new D3 method (1995-1999) with the historic D2 dissection (1982-1995).

METHODS

Two 1:1 matched-pair populations were created: (1) regarding intra- and postoperative course, morbidity and mortality, 2 x 67 patients stratified to "age", "gender", "surgical procedure", "splenectomy" and "extended resections"; and (2) regarding early oncologic outcome, 2 x 32 patients additionally stratified to "UICC-stage" and "Laurén-classification". The D3 dissection was performed according to the Japanese method without routine pancreaticosplenectomy.

RESULTS

D3 dissection harvested significantly (P = 0.004) more lymph nodes per patient: 56.4 vs. 46.8. Postoperative mortality was 3% (n = 2) in both groups, the overall complication rate of 30% (D3) vs. 25% (D2) was equivalent (P = 0.678) and the rate of surgical complications was identical (21%). Non-surgical complications of 21% after D3 dissection were not significantly elevated (vs. 10%; P = 0.143). Operative time [289 min (D3) vs. 218 min (D2); P = 0.0001] and postoperative stay [17.4 days (D3) vs. 14.5 days (D2); P = 0.003] were significantly longer after the extended procedure. The were no statistically significant differences between 2-year overall survival, locoregional-, distant- and overall recurrence-free survival.

CONCLUSIONS

Compared to the D2 method, D3 dissection is feasible without disadvantages in the patients. However, D3 dissection cannot routinely be recommended because--possibly due to the short follow-up period and the small number of patients so far observed--an oncologic benefit could not be shown.

T-cell and monocyte subsets, inflammatory molecules, rejection, and hemodynamics early after cardiac transplantation

BACKGROUND

In the early period after cardiac transplantation, differential diagnosis of graft failure due to rejection, infection, and other causes is important but difficult.

METHODS

In 22 consecutive patients undergoing heart transplantation, we prospectively determined levels of interleukin-6 as well as T-cell and monocyte subsets at eight points in time during biopsy and right heart catheterization and within 12 hr of echocardiography during the first 3 months after transplantation.

RESULTS

Worse hemodynamic parameters, as characterized by dichotomization according to median values (pulmonary capillary wedge pressure >10 mmHg, mean pulmonary arterial pressure > 18 mmHg, pulmonary vascular resistance > 115 dyn x sec x cm(-5), right atrial pressure > 5 mmHg, cardiac index <3 L/min/m2, early mitral deceleration time < 135 msec, and isovolumic relaxation time <80 msec), were associated with higher levels of interleukin-6, C-reactive protein, polymorphonuclear cells, CD71+/CD14+ monocytes, and IgM levels and, in contrast, with lower levels of immunocompetence markers such as CD3+ T cells, CD4+ T cells, CD8+ T cells, CD3+/CD25+ T cells, CD4+/ CD45RO+ T cells, NK cells, and lower biopsy scores.

CONCLUSION

Early after cardiac transplantation, elevated levels of inflammatory cells and soluble inflammatory molecules and lower levels of immunocompetence markers are associated with impaired allograft function in the absence of cellular rejection.

Coronary compliance in patients following orthotopic heart transplantation. An intravascular ultrasound study

BACKGROUND

The aim of this study was to investigate coronary compliance in patients early and 71.8 weeks after orthotopic heart transplantation.

METHODS

Thirty patients (mean age 51.4 years, women n = 6) underwent coronary angiography early after orthotopic heart transplantation (mean interval 11.6 +/- 5.5 weeks), by which time 12 recipients had already been treated for episodes of rejection. A total of 153 different coronary segments were investigated using a mechanical 30 MHz intravascular ultrasound system. In all segments, the intimal index and the circumferential extension of the vessel wall, which had a three-layered appearance, were assessed. Systolic-diastolic changes in area, and pressure with respect to vessel wall area, were used to study normalized compliance. All measurements were repeated in a subgroup of 13 patients 71.8 +/- 10.7 weeks after transplantation.

RESULTS

At the first investigation, the mean intimal index of all estimated cross-sectional areas was 0.07 +/- 0.10. The mean circumferential extension of the 'three-layered' coronary vessel wall was 74 degrees +/- 101 degrees. No correlation could be found between normalized compliance and the intimal index (r = -0.322, P < 0.001) or between normalized compliance and the circumferential extension of the three-layered vessel wall (r = -0.362, P < 0.001). Donor age did not correlate with normalized compliance either (r = -0.515, P = 0.004). In 12 patients with proven rejection periods before the first investigation, normalized compliance was significantly lower (1.76 +/- 0.81 mmHg-1) than in those without rejection (2.95 +/- 1.22 mmHg-1, P = 0.005). Both the intimal index and the circumferential extension of the three-layered architecture of the vessel wall were significantly higher in recipients with rejection periods. A comparison of the subgroup of 13 recipients between first and second investigation showed that the intimal index increased slightly from 0.03 +/- 0.03 to 0.09 +/- 0.13 (ns) 71.8 weeks after transplantation, but that normalized compliance did not differ significantly between the first and the follow-up investigation.

CONCLUSIONS

Early after orthotopic heart transplantation, normalized compliance does not correlate with donor age or the extent of atherosclerotic vessel alterations identifiable by intravascular ultrasound. Early rejection periods are associated with reduced coronary arterial compliance. Using intravascular ultrasound, this adverse functional effect on arterial compliance can be observed together with an increase in the intimal index.

Heart transplant candidates at high risk can be identified at the time of initial evaluation

The increasing discrepancy between the numbers of patients selected for cardiac transplantation and the available donor organs requires validation of markers of high risk at the time of initial evaluation that may help to determine which patients profit from aggressive therapy. We retrospectively examined the case records of 91 heart transplant candidates selected out of a total of 140 consecutive patients referred for evaluation. Of these 91 patients, 48 were transplanted during follow-up. Of the remaining 43 patients, 25 died after a mean survival time of 1.6 +/- 2.5 months. The causes of death were pump failure in 18 (72%) and sudden cardiac death in 7 (28%). Multivariate analysis identified 4 out of 26 parameters at initial evaluation that distinguished the 25 nonsurvivors from the 18 survivors. These were: mean arterial pressure (P = 0.03), pulmonary capillary wedge pressure (P = 0.002), mean pulmonary artery pressure (P = 0.001), and fractional shortening (P = 0.007). The mode of death could not be predicted. We conclude that there are prognostic markers at initial evaluation that allow more restrictive selection of patients for cardiac transplantation and mechanical bridging.

[Initial experiences with dobutamine stress echocardiography in heart transplant patients]

Cardiac allograft vasculopathy (CAV) has become one of the primary obstacles to long-term survival of patients after heart transplantation. The low sensitivity of currently available noninvasive tests still remains a problem in the early diagnosis of the disease. To assess the feasibility, safety, and usefulness of dobutamine stress echocardiography as a noninvasive predictor of cardiac allograft vasculopathy, we examined 20 patients (3 female) 3-35 months after orthotopic heart transplantation. All patients underwent coronary angiography within 2 weeks of dobutamine stress echocardiography.

RESULTS

89% of the segments examined could be evaluated for wall motion abnormalities. Under increasing doses of dobutamine (5 to max. 30 micrograms/kg/min), heart rate increased from 88 +/- 13 bpm to 141 +/- 16 bpm. and systolic blood pressure from 139 +2- 14 mm Hg to 154 +/- 28 mm Hg. Two of 4 patients with angiographically detected CAV developed new wall motion abnormalities under dobutamine; their wall motion score increased from 1.23 +/- 0.22 to 1.31 +/- 0.24. In the other patients without CAV, the wall motion score remained almost unchanged (1.01 +/- 0.3 to 1.02 +/- 0.4). Dobutamine was well tolerated, and there were no serious complications. Thus, dobutamine stress echocardiography seems to be feasible and safe in patients after heart transplantation. Our results suggest that it might be useful for the detection of cardiac allograft vasculopathy. The final determination of its clinical usefulness in the diagnosis of cardiac allograft vasculopathy needs further extensive investigations.

ASA-induced release of histamine from nasal mucous membranes in analgesic intolerance and polyposis nasi

Tissue samples from the polypous mucous membrane and the inferior nasal concha were taken from 13 patients with polyposis nasi and from 12 other patients with an additional intolerance to analgesics. The tissue of the inferior nasal concha from patients without polyposis nasi served as a control. The relative histamine content of the samples (in ng/mg dry weight) and the relative histamine release (in %) after addition of acetylsalicylic acid (ASA) were determined. A significantly higher relative histamine content in the tissue samples of polyp patients without an intolerance to analgesics was seen in comparison to the other two groups. The relative histamine release of both patient groups with nasal polyposis was comparable. The control group exhibited both an increased spontaneous release of histamine as well as a higher relative histamine release from the tissue of the inferior nasal concha.

[Short time in-situ preservation of the ischemic kidney by a simple initial hypothermic perfusion with various cold solutions. An animal experimental study]

In unilateral nephrectomized beagle dogs the remaining kidney was subjected to 2 hrs of ischemia in situ. The ischemic organ was cooled to 22--23 degrees C by initial hypothermic perfusion over a 5-F catheter introduced into the renal artery via the carotid artery. It was then left in the open abdominal wound without any further attempts of cooling. Three perfusates were used: an isoosmolar Dextran solution (Eisenberger), a hyperosmolar, "intracellular" electrolyte solution (Sacks), and a hyperosmolar, "extracellular" electrolyte solution. There was a mean postoperative increase in serum creatinine levels of 0.6 mg-%. By the 3rd p.o. day at latest the serum creatinine was again within normal limits. The inulin and PAH clearances on the 7th and 14th p.o. day showed no significant differences to preoperative determinations. No definite advantage or disadvantage was noted among the three perfusates. All control dogs whose kidneys were made ischemic for 2 hrs without perfusion died due to acute tubular necrosis. Apparently the homogenous cooling and flushing by the initial perfusion is of more importance for good preservation in this situation than the composition of the perfusate.