Fungal quinones: diversity, producers, and applications of quinones from Aspergillus, Penicillium, Talaromyces, Fusarium, and Arthrinium

Quinones represent an important group of highly structurally diverse, mainly polyketide-derived secondary metabolites widely distributed among filamentous fungi. Many quinones have been reported to have important biological functions such as inhibition of bacteria or repression of the immune response in insects. Other quinones, such as ubiquinones are known to be essential molecules in cellular respiration, and many quinones are known to protect their producing organisms from exposure to sunlight. Most recently, quinones have also attracted a lot of industrial interest since their electron-donating and -accepting properties make them good candidates as electrolytes in redox flow batteries, like their often highly conjugated double bond systems make them attractive as pigments. On an industrial level, quinones are mainly synthesized from raw components in coal tar. However, the possibility of producing quinones by fungal cultivation has great prospects since fungi can often be grown in industrially scaled bioreactors, producing valuable metabolites on cheap substrates. In order to give a better overview of the secondary metabolite quinones produced by and shared between various fungi, mainly belonging to the genera Aspergillus, Penicillium, Talaromyces, Fusarium, and Arthrinium, this review categorizes quinones into families such as emodins, fumigatins, sorbicillinoids, yanuthones, and xanthomegnins, depending on structural similarities and information about the biosynthetic pathway from which they are derived, whenever applicable. The production of these quinone families is compared between the different genera, based on recently revised taxonomy. KEY POINTS: • Quinones represent an important group of secondary metabolites widely distributed in important fungal genera such as Aspergillus, Penicillium, Talaromyces, Fusarium, and Arthrinium. • Quinones are of industrial interest and can be used in pharmacology, as colorants and pigments, and as electrolytes in redox flow batteries. • Quinones are grouped into families and compared between genera according to the revised taxonomy.

Collecting Validity Evidence for the Assessment of Mastery Learning in Simulation-Based Ultrasound Training

PURPOSE

To collect validity evidence for the assessment of mastery learning on a virtual reality transabdominal ultrasound simulator.

MATERIALS AND METHODS

We assessed the validity evidence using Messick's framework for validity. The study included 20 novices and 9 ultrasound experts who all completed 10 obstetric training modules on a transabdominal ultrasound simulator that provided automated measures of performance for each completed module (i. e., simulator metrics). Differences in the performance of the two groups were used to identify simulator metrics with validity evidence for the assessment of mastery learning. The novices continued to practice until they had attained mastery learning level.

RESULTS

One-third of the simulator metrics discriminated between the two groups. The median simulator scores from a maximum of 40 metrics were 17.5 percent (range 0 - 45.0 percent) for novices and 90.0 percent (range 85.0 - 97.5) for experts, p < 0.001. Internal consistency was high, with a Cronbach's alpha value of 0.98. The test/retest reliability gave an intra-class correlation coefficient (ICC) of 0.62 for novices who reached the mastery learning level twice. Novices reached the mastery learning level within a median of 4 attempts (range 3 - 8) corresponding to a median of 252 minutes of simulator training (range 211 - 394 minutes).

CONCLUSION

This study found that validity evidence for the assessment of mastery learning in simulation-based ultrasound training can be demonstrated and that ultrasound novices can attain mastery learning levels with less than 5 hours of training. Only one-third of the standard simulator metrics discriminated between different levels of competence.

Sustained effect of simulation-based ultrasound training on clinical performance: a randomized trial

OBJECTIVE

To study the effect of initial simulation-based transvaginal sonography (TVS) training compared with clinical training only, on the clinical performance of residents in obstetrics and gynecology (Ob-Gyn), assessed 2 months into their residency.

METHODS

In a randomized study, new Ob-Gyn residents (n = 33) with no prior ultrasound experience were recruited from three teaching hospitals. Participants were allocated to either simulation-based training followed by clinical training (intervention group; n = 18) or clinical training only (control group; n = 15). The simulation-based training was performed using a virtual-reality TVS simulator until an expert performance level was attained, and was followed by training on a pelvic mannequin. After 2 months of clinical training, one TVS examination was recorded for assessment of each resident's clinical performance (n = 26). Two ultrasound experts blinded to group allocation rated the scans using the Objective Structured Assessment of Ultrasound Skills (OSAUS) scale.

RESULTS

During the 2 months of clinical training, participants in the intervention and control groups completed an average ± SD of 58 ± 41 and 63 ± 47 scans, respectively (P = 0.67). In the subsequent clinical performance test, the intervention group achieved higher OSAUS scores than did the control group (mean score, 59.1% vs 37.6%, respectively; P < 0.001). A greater proportion of the intervention group passed a pre-established pass/fail level than did controls (85.7% vs 8.3%, respectively; P < 0.001).

CONCLUSION

Simulation-based ultrasound training leads to substantial improvement in clinical performance that is sustained after 2 months of clinical training. © 2015 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.

Objective assessment of gynecologic laparoscopic skills using the LapSimGyn virtual reality simulator

BACKGROUND

Safe realistic training and unbiased quantitative assessment of technical skills are required for laparoscopy. Virtual reality (VR) simulators may be useful tools for training and assessing basic and advanced surgical skills and procedures. This study aimed to investigate the construct validity of the LapSimGyn VR simulator, and to determine the learning curves of gynecologists with different levels of experience.

METHODS

For this study, 32 gynecologic trainees and consultants (juniors or seniors) were allocated into three groups: novices (0 advanced laparoscopic procedures), intermediate level (>20 and <60 procedures), and experts (>100 procedures). All performed 10 sets of simulations consisting of three basic skill tasks and an ectopic pregnancy program. The simulations were carried out on 3 days within a maximum period of 2 weeks. Assessment of skills was based on time, economy of movement, and error parameters measured by the simulator.

RESULTS

The data showed that expert gynecologists performed significantly and consistently better than intermediate and novice gynecologists. The learning curves differed significantly between the groups, showing that experts start at a higher level and more rapidly reach the plateau of their learning curve than do intermediate and novice groups of surgeons.

CONCLUSION

The LapSimGyn VR simulator package demonstrates construct validity on both the basic skills module and the procedural gynecologic module for ectopic pregnancy. Learning curves can be obtained, but to reach the maximum performance for the more complex tasks, 10 repetitions do not seem sufficient at the given task level and settings. LapSimGyn also seems to be flexible and widely accepted by the users.

Nondestructive identification of cold and extremely localized single molecular ions

We demonstrate a simple and nondestructive method for identification of a single molecular ion sympathetically cooled by a single laser cooled atomic ion in a linear Paul trap. The technique is based on a precise nondestructive determination of the molecular ion mass through a measurement of the eigenfrequency of a common motional mode of the two ions. The demonstrated mass resolution is sufficiently high that molecular ion mass doublets can potentially be distinguished from each other. The obtained results represent an important step towards single molecule gas phase chemical physics.

Entanglement and quantum teleportation with multi-atom ensembles

Atomic ensembles containing a large number of atoms have been proved to be an effective medium for quantum-state (quantum information) engineering and processing via their coupling with multi-photon light pulses. The general mechanism of this coupling, which involves continuous quantum variables for light and atoms, is described. The efficient quantum interface between light and atoms has led to the recent demonstration of an entangled state of two macroscopic atomic objects, more precisely two caesium gas samples. Based on this result, a proposal for teleportation of an entangled state of two atomic samples (entanglement swapping) is presented.

Recording quantum properties of light in a long-lived atomic spin state: towards quantum memory

We report an experiment on mapping a quantum state of light onto the ground state spin of an ensemble of Cs atoms with the lifetime of 2 ms. Recording of one of the two quadrature phase operators of light is demonstrated with vacuum and squeezed states of light. The sensitivity of the mapping procedure at the level of approximately 1 photon/sec per Hz is shown. The results pave the road towards complete (storing both quadrature phase observables) quantum memory for Gaussian states of light. The experiment also sheds new light on fundamental limits of sensitivity of the magneto-optical resonance method.

[Problem-based learning in medical education. Experiences from a department of gynecology]

INTRODUCTION

Problem-based learning (PBL) is an educational method based on a clinical problem, where students define their learning objectives, research these objectives, and report back. The aim of the present study was to compare PBL with other learning methods during a pregraduate clinical course.

METHODS

PBL was applied to six groups of students (n = 35) during a pregraduate clinical course in obstetrics and gynaecology and compared with other learning methods, such as traditional lectures, participation in the clinical work of the department, and a training course in communication and clinical skills with simulated patients and phantoms. The learning methods were scored on a scale from zero to five.

RESULTS

The educational methods were evaluated differently (p < 0.01). PBL reached a score of at least four more often (33/35) than did traditional lectures (25/34), p < 0.05. Most of the students enjoyed PBL, although they found it time consuming. Twenty-one preferred the mixture of PBL and lectures, whereas 13 preferred more PBL and one solely preferred lectures.

DISCUSSION

The present study shows that it is possible to implement PBL sessions in clinical courses and the method is positively evaluated by both students and teachers.

Synthesis of novel gamma-aminobutyric acid (GABA) uptake inhibitors. 5.(1) Preparation and structure-activity studies of tricyclic analogues of known GABA uptake inhibitors

On the basis of the SAR of a series of known gamma-aminobutyric acid (GABA) uptake inhibitors, including 4 (SKF 89976), new tricyclic analogues have been prepared. These novel compounds are derivatives of nipecotic acid, guvacine, and homo-beta-proline, substituted at the nitrogen of these amino acids by various lipophilic moieties such as (10,11-dihydro-5H-dibenz[b,f]azepin-5-yl)alkoxyalkyl or (10,11-dihydro-5H-dibenzo[a,d]cyclohepten-5-ylidene)alkoxyalkyl. The in vitro values for inhibition of [(3)H]-GABA uptake in rat synaptosomes was determined for each compound in this new series, and it was found that several of the novel compounds showed a high potency comparable with that of the reference compounds 4, 5 (tiagabine), and 6 (CI-966). Several of the novel compounds were also evaluated for their ability in vivo to inhibit clonic seizures induced by a 15 mg/kg (ip) dose of methyl 6,7-dimethoxy-4-ethyl-beta-carboline-3-carboxylate (DMCM). One compound, (R)-1-(2-(2-(10,11-dihydro-5H-dibenz[b,f]azepin-5-yl)ethoxy)ethyl)-3-piperidinecarboxylic acid (23), was selected for further biological investigations and showed a protective index comparable to or slightly better than that of the recently launched anticonvulsant product 5 ((R)-1-(4,4-bis(3-methyl-2-thienyl)-3-butenyl)-3-piperidinecarboxylic acid).

[Ogilvie syndrome after Cesarean section]

INTRODUCTION

Ogilvie's syndrome, acute pseudo-obstruction of the colon, can lead to perforation of the caecum and death. The syndrome is not well known and diagnosis can be difficult to make in time.

METHODS

We analysed seven cases of Ogilvie's syndrome with the aim of improving diagnostics.

RESULTS

All had prolonged labour before cesarean section, which was complicated by bleeding. All were treated with syntocinon, a hormone that may influence gastrointestinal motility. All patients developed abdominal meteorism within a few days of operation, which increased despite the passing of flatus and stool. Five cases resulted in caecum perforation before the correct diagnosis and treatment were made. Perforation occurred on days 3-4, day 5, or probably days 8-10 after the operation. One of these patients, who suffered from severe adipositas, died.

CONCLUSION

It is very important to make an early diagnosis, as the condition can progress quickly. Diagnosis should be made on the history, clinical assessment, and abdominal X-ray. Intermittent flatus and stool are characteristic of this truly non-obstructive condition and should not therefore delay a diagnostic X-ray.

[Emergency contacts with a gynecologic department. Therapeutic and examination requirements]

Emergency room contacts serviced by the Dept. of Gynaecology at Copenhagen County Hospital, Glostrup, are increasing in number. During a 12-week period we conducted a prospective survey of these contacts using a structured questionnaire. Subsequently and based on case sheets a specialist evaluated the relevance of each contact. We found that nine out of ten contacts presented problems relevant to gynaecology; of these one half presented problems in early pregnancy. In 81.7% of all contacts it was found that care could safely have been postponed to daytime hours. Compared to daytime activity the emergency room patient experienced a longer waiting and treatment time, and patients were more often cared for by a junior gynaecological physician without supervision. We concluded that a majority of emergency room calls serviced by our gynaecological department could safely be referred to daytime hours with advantages for both patients and physicians in training.

Synthesis of novel GABA uptake inhibitors. 4. Bioisosteric transformation and successive optimization of known GABA uptake inhibitors leading to a series of potent anticonvulsant drug candidates

By bioisosteric transformations and successive optimization of known GABA uptake inhibitors, several series of novel GABA uptake inhibitors have been prepared by different synthetic approaches. These compounds are derivatives of nipecotic acid and guvacine, substituted at the nitrogen of these amino acids by various lipophilic moieties such as diarylaminoalkoxyalkyl or diarylalkoxyalkyl. The in vitro values for inhibition of [(3)H]GABA uptake in rat synaptosomes was determined for each compound, and it was found that the most potent compound from this series, (R)-1-(2-(3,3-diphenyl-1-propyloxy)ethyl)-3-piperidinecarboxyli c acid hydrochloride (29), is so far the most potent parent compound inhibiting GABA uptake into synaptosomes. Structure-activity results confirm our earlier observations, that an electronegative center in the chain connecting the amino acid and diaryl moiety is very critical in order to obtain high in vitro potency. Several of the novel compounds were also evaluated for their ability in vivo to inhibit clonic seizures induced by a 15 mg/kg (ip) dose of methyl 6, 7-dimethoxy-4-ethyl-beta-carboline-3-carboxylate (DMCM). Some of the compounds tested show a high in vivo potency comparable with that of the recently launched anticonvulsant product 6 ((R)-1-(4, 4-bis(3-methyl-2-thienyl)-3-butenyl)-3-piperidinecarboxylic acid).

[An outpatient unit for early pregnancy. Establishment and effects on the pattern of hospital admissions]

The aim of the study was to evaluate the effect of an assessment of complications in early pregnancy in an "early pregnancy unit" opened in May 1993. The purpose of the "early pregnancy unit" was to avoid routine admission of women with pain/bleeding in early pregnancy. All general practitioners were informed of the possibility of referring patients to examination and ultrasonography in the "early pregnancy unit" during daytime, instead of acute admission to the ward. Data was compiled from the hospital admission and the emergency unit register for the years 1992-1996. These showed that admissions for early pregnancy complications decreased from 714 (1992) to 315 (1996) accounting for 41% (1992) and 16% (1996) of total admissions to the department, and 23% (1992) and 10% (1996) of the numbers of deliveries, respectively. Women referred between 00:00 hours and 7 a.m. accounted for 23% (1992) and 9% of admissions of total admissions or of deliveries (1996). It is concluded that initiation of the early pregnancy assessment unit resulted in a reduction in the number of admissions. The hospital staff experienced a reduced workload during the night.

Spectroscopy on a modulated magneto-optical trap

We demonstrate a new type of high-resolution two-photon frequency modulation (FM) spectroscopy with cold atoms in a magneto-optical trap. Instead of modulating the probe as in ordinary FM spectroscopy, we modulate the trap itself by FM of the trapping beams. We present theoretical as well as experimental results for both absorption and polarization rotation spectroscopy. Finally, we demonstrate two-photon FM spectroscopy, using the intrinsic phase noise of the trapping diode lasers.

[Principles for thrombosis prevention at surgery departments in Denmark]

In 1995 all surgical departments in Denmark were asked to reply to a questionnaire about their use of postoperative thromboprophylaxis. Response rate was 95%. Ninety-two percent of the departments performing major surgery routinely used prophylaxis, in 84% of these according to prior written instructions, but still only 36% use prophylaxis in emergency surgery. The indications and methods used are in accordance with recommendations in the literature. The use of aspirin as prophylaxis against venous thromboembolism should be avoided, and the use of prophylaxis in emergency surgery should be improved. The most commonly used method was low molecular weight heparin (82%) often in combination with graduated elastic stockings. There is no longer any doubt about the need for prophylaxis. The tasks of the future are to identify the risk groups and establish the duration of prophylaxis.

[Pressure sores. Background and therapeutic strategy]

A pressure ulcer is based on local tissue pressure and other pathological conditions in the patient. Pressure-reducing devices can reduce the incidence of pressure sores. The staff must be familiar with the strategies for prevention and treatment of pressure sores. Conservative treatment is used for pressure sores with the potential for spontaneous healing in regions where unphysiological pressure can be avoided. Split skin transplantation is only useful in superficial, granulating pressure sores in regions where pressure and shear will be limited after healing and where a short healing time is desirable. Musculocutaneous flaps are indicated in regions suffering pressure or other mechanical strain or in certain risk patients. Pressure-reducing devices should be administered according to guidelines and used from the beginning of the period where they are needed.

Early- and late-onset pelvic inflammatory disease among women with cervical Chlamydia trachomatis infection at the time of induced abortion--a follow-up study

After termination of a double-blind, randomized study on erythromycin in the prevention of post-abortion infection, 34 women (14 treated with erythromycin, 20 not treated with erythromycin) harbouring Chlamydia trachomatis were followed up within 6 weeks and again 2 to 24 months after the abortion in order to detect an early- and late-onset pelvic inflammatory disease (PID). For statistical analysis survival analysis by Kaplan-Meir estimates and Mantel-Cox test were carried out. Untreated women with C. trachomatis infection at the time of abortion had a cumulative risk of 72% of developing early and/or late PID, if observed for 24 months. This cumulative risk was significantly reduced to 8% if the C. trachomatis infection was treated at the time of the abortion. Screening for and treatment of C. trachomatis is warranted, especially in women < or = 25 years old, to avoid early and late-onset PID after induced first trimester abortion.

Cutaneous and subcutaneous blood flow rates in paraplegic humans investigated by 133xenon wash-out. Methodological considerations

In a methodological study including 14 paraplegics and seven normal controls cutaneous and subcutaneous blood flow rates were investigated by 133Xenon wash-out after atraumatic labelling. In paraplegics, areas suffering pressure sores were included. The method was found applicable for the authors' purposes. In seven paraplegics median (95% confidence limits) cutaneous blood flow was 5.2 (2.4-8.5) ml (100 g min)-1 and subcutaneous 4.3 (2.0-13.2) ml (100 g min)-1. This did not differ from normal controls. In seven paraplegics with ischial pressure sores a trend for increased cutaneous blood-flow rates from areas adjacent to sores was obvious (P = 0.06). During 70 degrees head-up tilt, elimination-rate constants were reduced by a factor of 0.54 (0.50-0.70). A proximal blockade or infiltration of the 133Xenon depots with lidocaine did not inhibit employment of the method. The proximal block did not alter the local blood flow rate, but infiltration increased it in both paraplegics and normal individuals. Intra- and interdepot coefficients of variation were about 11% and 40% respectively. Interindividual coefficients of variation varied between 25% and 46%.

A semiconductor silicon PIN diode matrix detector for measurement of 133Xe washout in small regional skin areas

Local variations in microvascularization are expected in lesions and lesion-free skin of patients with pressure sores. To investigate these variations, methods for studies of the regional blood flow rate within small skin areas are needed. Regional blood flow can be estimated by measuring the washout of 133Xe from the tissue. This study describes a 2 x 12 Si PIN diode matrix detector capable of 133Xe detection, and equipped with a collimator to improve the spatial resolution. Thus the regional blood flow in subcutaneous skin areas down to about 2 cm2 can be investigated when the atraumatic epicutaneous labelling technique is used. The capability of the matrix detector and its collimator is described by laboratory investigations. In pilot investigations three normal subjects and three paraplegics with pressure sores were studied. In each individual study the detector matrix was divided into six square areas containing four diode detectors each. Thus six 133Xe disappearance rate constants from adjacent subcutaneous tissue could be determined simultaneously.

[Genital Chlamydia trachomatis infection in abortion seekers. Strategy of examination and treatment in order to reduce the sequelae of the infection]

Among women applying for termination of pregnancy, 5-17% are infected with Chlamydia trachomatis. The prevalence is higher among women under 20 years of age (12-30%), in nulliparae and when Neisseria gonorrhoeae are found simultaneously. If women applying for termination of pregnancy with Chlamydia infection are not treated, 10-60% will develop pelvic infection after abortion. Salpingitis caused by Chlamydia runs a milder clinical course than salpingitis caused by gonococci or other etiology but salpingitis due to Chlamydia is regarded as one of the most important causes of tubal infertility and extrauterine pregnancy. The symptoms may be discharge and dysuria or objective findings such as cervicitis and pathological findings in wet smears of the cervical secretion. The majority of women applying for termination of pregnancy with Chlamydia infection have no symptoms. Only few investigations have analysed Chlamydia infection in connection with sexual behaviour and association between Chlamydia infection and the number of sexual partners has been demonstrated. Direct immune fluorescent microscopic examination or enzyme immune examination of material from the cervix and urethra may be employed in women applying for termination of pregnancy on account of the rapid results. Tetracyclines and erythromycin may be employed for treatment of demonstrated Chlamydia infection. Completion of treatment prior to abortion is probably not necessary. The sexual partners should be treated.

[Presence of genital Chlamydia trachomatis in abortion seekers--correlates with young age and nulliparity but not with previous genital infection]

Out of 432 women applying for termination of pregnancy, 7.9% (34/428) had cervical Chlamydia trachomatis and 0.7% (3/431) genital Neisseria gonorrhoeae. The prevalence of Chlamydia was 19.2% among the women applying for termination who were under 20 years and 12.8% among those aged 21-25 years. The finding of Chlamydia among nulliparae was 14.5%. Only 2.8% of the women with Chlamydia had previously had pelvic infections. Women with Chlamydia did not have significantly greater frequency of previous venereal diseases. It is concluded that women under the age of 25 years and nulliparae who apply for termination of pregnancy should be examined for Chlamydia and should be treated in connection with the intervention. Previous pelvic infections are observed significantly more rarely in women with Chlamydia applying for termination and thus do not constitute an indication for examination for Chlamydia. It is not yet elucidated whether women with previous venereal diseases should be examined for Chlamydia. On account of the low prevalence, there are no indications for performing routine smears in women applying for termination of pregnancy for gonococci but, on the other hand it appears relevant to examine women with Chlamydia for gonococci as double infections are frequently present.

Internal fixation of femoral neck fractures. Dynamic Hip and Gouffon screws compared in 73 patients

A prospective, randomized study comparing the Dynamic Hip screws and the Gouffon screws in the treatment of femoral neck fractures was terminated before the planned number of patients had been admitted, owing to a preponderance of early failure of the Gouffon screws (P 0.014); thus only 73 patients entered the study. After three years' follow-up, 25/38 Gouffon screws and 12/35 Dynamic Hip screws had failed. Six patients treated with Gouffon screws and 14 treated with Dynamic Hip screws had died. The outcome still favoured the use of Dynamic Hip screws (P 0.02).

A double-blind randomized study of the effect of erythromycin in preventing pelvic inflammatory disease after first trimester abortion

OBJECTIVE

To assess the prophylactic use of erythromycin in prevention of post-abortal pelvic inflammation disease (PID) in first trimester abortion.

DESIGN

Double-blind, randomized controlled trial.

SETTING

Department of Surgery, County Hospital, Denmark.

SUBJECTS

Four hundred and thirty two women who were to undergo induced abortion before 12 weeks gestation were randomized to be treated either with prophylactic erythromycin or a placebo.

INTERVENTION

The women were randomized to receive a placebo or erythromycin, 500 mg twice a day for 7 1/2 days starting the evening before the abortion. All the women were investigated for Chlamydia trachomatis and Neisseria gonorrhoea before the abortion.

MAIN OUTCOME MEASURES

Frequency of cervical C. trachomatis and N. gonorrhoea and frequency of PID after abortion.

RESULTS

Fifty four women were excluded after randomization. The frequency of PID was 11% (20/189) in the erythromycin group and 16% (30/189) in the placebo group (P = 0.13, chi 2-test). The prevalence of C. trachomatis was 19% (15/78) in women less than or equal to 20 years of age, 13% (14/109) in women between 21 and 25 years and 2% (5/241) in women greater than or equal to 26 years of age. In women positive for C. trachomatis erythromycin prophylaxis significantly reduced the frequency of PID to 8% (1/13) compared with 43% (6/14) in the placebo group (P = 0.051, logistic regression analysis). Erythromycin had no effect on other potential high risk groups (first pregnancy, nulliparous, less than 20 years of age, and women with previous PID).

CONCLUSION

Prophylactic erythromycin is not warranted for all women having an abortion. Cervical C. trachomatis is a risk factor for postabortal PID, and prophylaxis with erythromycin significantly reduces the frequency of PID. However, only a few women with PID had cervical C. trachomatis, and the prevention of post-abortal PID remains a major challenge requiring further studies.

Temporary arteriovenous shunt prior to free flap transfer

The establishment of a temporary arteriovenous shunt (TAVS) near a recipient site with inadequate local vessels may facilitate the subsequent re-vascularization of a free flap. In nine patients a TAVS was constructed prior to the transfer of free flaps. The indication was either the absence of vessels or inadequate recipient vessels. In eight of the nine patients the establishment of the shunt proved successful. In one patient a re-creation of the shunt was necessary owing to thrombosis caused by infection. In another patient the shunt thrombosed and no further microvascular surgery was possible. The construction of a TAVS increases the possibility of more extensive application of free flap transfer. Should the creation of the shunt prove futile, the donor flap may still be salvaged for further application. A staged transfer of a free flap after the primary establishment of a TAVS gives the best changes for adequate vascularization of the flap and reduces the risk of thrombosis.

Subcutaneous silicone implants in pectus excavatum

In seventeen patients presenting funnel chest a subcutaneous implantation of silicone prostheses was performed. In nine patients seromas were aspirated postoperatively. Five patients were reoperated, one for correction of a displacement of the prosthesis, one for size reduction and one for implant removal, because of various complaints not related to the prosthesis. At the final evaluation sixteen out of seventeen patients expressed satisfaction with the result.

Albumin and beta 2-microglobulin excretion in patients on long-term lithium treatment

Albumin and beta 2-microglobulin excretions were studied in 85 unselected patients treated with lithium for more than 6 months. In 15 patients a lithium-induced impaired renal concentrating ability was found, 13 of these patients revealed a chronic interstitial nephropathy on renal biopsy. There was no significant increase in albumin excretion, and a markedly increased beta 2-microglobulin excretion was seen in only 1 patient. This study supports the hypothesis that the lithium-induced renal lesion in confirmed to the distal part of the nephron.

Therapeutic effect and side effects in patients with endogenous depression treated with oral nortriptyline once a day

Out of 24 patients with endogenous depression, 21 completed the treatment with nortriptyline 150 mg as once-a-day dosage. The therapeutic effect was good and at any rate not inferior to that of dosages several times a day. Side effects were only little pronounced and at any rate not more marked than after dosages several times a day. Out of regard for the administrative and psychological advantages of the once-a-day dosage this form should be preferred, not least in the out-patient treatment with nortriptyline of endogenous depression.

Chronic interstitial nephropathy in patients on long-term lithium treatment

One-hundred and ten patients treated with lithium for more than six months were studied in order to determine the prevalence of lithium induced nephropathy. Eighteen of 69 patients (26 per cent) who had been treated for more than two years presented a chronic interstitial nephropathy characterized by a marked decrease in renal concentrating ability with a disproportionate preservation of glomerular filtration rate. Histologically, increased amounts of fibrotic tissue in the medulla and the cortex were found together with tubular atrophy. In 40 per cent of the patients who underwent renal biopsy, cystic formations in the cortex were found. The impairment of renal concentrating ability could be related to the duration of lithium treatment and the degree of tubular damage correlated with the degree of impairment of renal concentrating ability. Lithium induced, chronic nephropathy is a rather common complication of long-term lithium treatment and reduces the patients capacity to regulate water and electrolyte metabolism. As water and electrolyte loss appears to precede the slowly progressing lithium intoxication, the main hazard of lithium induced nephropathy is lithium intoxication.