The Manchester Triage System in a Pediatric Emergency Department of an Austrian University Hospital: A Retrospective Analysis of Urgency Levels

OBJECTIVES

The Manchester Triage System (MTS) has entered widespread international use in emergency departments (EDs). This retrospective study analyzes urgency of patient visits (PV) at the ED of the Clinic for Pediatrics at the Medical University of Innsbruck.

METHODS

We collected demographic and outcome information, including PV urgency levels (UL) according to the MTS, for 3 years (2015-2018), separating PV during regular office hours (ROH; 8:00 am to 5:00 pm) from PV during afternoon and night hours (5:00 pm to 8:00 am), and PV on weekdays from PV on weekends and bank holidays (WE).

RESULTS

A total of 56,088 PV were registered with a UL. Most (68.4%) PV were classified as nonurgent. During ROH, more PV per hour (PV/h) were recorded than during afternoon and night hours (3.0 PV/h vs 1.6 PV/h), with a higher proportion of less urgent cases during ROH. On WE, the amount of PV/h was higher than on weekdays (3.6 PV/h vs 2.8 PV/h), with a higher proportion of nonurgent cases (74.6% vs 68.6%). Likelihoods of inpatient admission and hospital stay lengths increased in step with UL.

CONCLUSIONS

The MTS proved useful for delineating UL distributions. The MTS analyses may be of value in managing EDs. Prompted by the results of our study, a general practice pediatric care unit was established to support the ED during WE.

Infektionen mit dem humanen Immundefizienzvirus bei Kindern in Deutschland, 1999–2016

Hintergrund

Mutter-Kind-Übertragungen von humanem Immundefizienz Virus (HIV) sind durch antiretrovirale Therapie der Schwangeren und weitere medizinische Maßnahmen (Sectio-Entbindung, Postexpositionsprophylaxe beim Neugeborenen, Stillverzicht) verhinderbar. Weiterhin erfolgende Übertragungen sind überwiegend Folge mangelhafter Umsetzung der bekannten wirksamen Maßnahmen. Stand und Probleme bei der Erreichung einer Eliminierung von Mutter-Kind-Übertragungen von HIV in Deutschland werden beschrieben.

Methoden

Hauptquelle der Daten sind pseudonymisierte Meldedaten des HIV-Melderegisters am Robert Koch-Institut (RKI). Mittels einer intensivierten Surveillance für HIV-Meldungen zu Kindern werden Angaben zum Geburtsland, zum mütterlichen Herkunftsland und zur Kenntnis und zum Management der mütterlichen HIV-Infektion in der Schwangerschaft bei seit 1999 geborenen, mit HIV infizierten Kindern erhoben.

Ergebnisse

Bis Ende 2018 wurden bei zwischen dem 01.01.1999 und dem 31.12.2016 geborenen Kindern im Alter unter 15 Jahren in Deutschland 331 HIV-Diagnosen gemeldet. Bei 313 war eine Mutter-Kind-Übertragung der wahrscheinlichste Übertragungsweg. Von diesen 313 Kindern wurden 162 (52 %) in Deutschland geboren, aber nur 26 % der Mütter waren deutscher Herkunft. Die HIV-Übertragungshäufigkeit bei in Deutschland geborenen Kindern sank von 1,8/100.000 Lebendgeburten im Zeitraum 1999–2007 auf 0,8/100.000 im Zeitraum 2008–2016. Bei 59 % der in Deutschland geborenen Kinder war der HIV-Status der Mutter den betreuenden Ärzt*innen zum Zeitpunkt der Geburt nicht bekannt.

Schlussfolgerung

Ein fehlendes HIV-Testangebot für die Schwangere war Hauptursache für Übertragungen bei bis 2007 geborenen Kindern; bei später geborenen Kindern waren die Gründe vielfältiger und hingen oft mit mütterlicher Migration und Zugangsbarrieren in das Versorgungssystem zusammen.

[What Surgeons Need to Know About Forensic Medicine]

Background: Forensic medicine finds more and more resonance due to requests and queries from clinicians and acts as a mediator between the individual medical disciplines, in particular with regard to legal issues, and as an interface between the fields of medicine, police and judiciary. The aim of this short narrative overview is to make surgeons aware of the forensic aspects of their work, which is usually focused on clinical and curative aspects. Crucial points: Traditionally, the basic work in forensic medicine comprises sudden and unexpected deaths, for which it is important to definitely clarify the mode of death based on the detected cause of death. In addition to violent and unnatural deaths, there are sudden natural deaths, which are natural, but also unsolved. Clinical forensic medicine basically concentrates on the examination of victims of violence, which may comprise various types of bodily harm including sexual crime, child maltreatment and traffic accidents. The investigational results (autopsy findings, injury patterns, results from the investigation of traces) need to be presented and interpreted in public procedures at court by forensic medicine specialists, who act as experts answering questions while retaining a neutral position. Conclusion: Specialists in forensic medicine should not only be consulted for issues related to the inspection of corpses and to issue a death certification. Much rather, they should also be consulted as specialised partners of surgeons and other clinicians, e.g. for the documentation of specific findings and the description of injury patterns in injured persons who are still alive.

Implementation of a multidisciplinary infectious diseases team in a tertiary hospital within an Antimicrobial Stewardship Program

BACKGROUND

In January 2011, as part of an antimicrobial stewardship program the Antimicrobial Management Team (AMT) at the Ghent University Hospital initiated a multidisciplinary Infectious Diseases Team (MIT) consisting of infectious diseases physicians, clinical microbiologists, and clinical pharmacists. The aim of this study is to describe the type and acceptance rate of recommendations provided by the MIT.

METHOD

Prospective, observational study in a tertiary care, university teaching hospital with 1062 beds in non-consecutive hospitalized adult patients, excluding intensive care units and paediatrics.

RESULTS

The MIT communicated 432 recommendations in 87 days observed. Of the 293 patients for whom a recommendation was made, the median age was 57 years (range: 16-91 years) and 169 (57·7%) were male. Skin or soft tissue infections (14%), respiratory tract infections (13%), infections without known focus (11%), abdominal infections (11%), and bone infections (8%) were most common. Recommendations were made to perform additional clinical investigation(s) [N = 137 (27%)], to adjust the dose of an antimicrobial drug [N = 42 (8%)], to stop an antimicrobial drug [N = 104 (21%)], to switch from a parenteral to an oral drug [N = 39 (8%)] or to initiate an antimicrobial drug [N = 178 (36%)], with an acceptance rate of 73·0%, 83·3%, 81·7%, 76·9%, and 84·0%, respectively.

CONCLUSIONS

The MIT formulated about five recommendations a day primarily focusing on pharmacotherapy, but also on clinical investigations. In both fields, a high acceptance rate was observed.

[What a surgeon needs to know of the work of a medical ethics committee/institutional review board]

Ethical committees or institutional review boards are interdisciplinary committees to assess the ethical, social, legal and medical aspects of research involving human subjects. The ethics commission is to protect both the patient as well as the investigators and other personnel involved in the implementation of scientific projects. According to the professional code (Berufsordnung) every physician is obliged to consult an ethics committee to get a an approval before carrying out a research project. Concerning the Declaration of Helsinki, the advice of physicians is an international standard before carrying out a research project. In addition to the advisory function the ethics committee has an authorisation function within the pharmaceutical and medical device law. In the present publication the advisory and authorisation functions of an German ethics committee are briefly explained.

Evaluation of tooth preparations - a comparative study between faculty members and pre-clinical students

INTRODUCTION

Preparation of teeth is a basic technique for dental treatment and plays an essential role in pre-clinical education. The purpose of this study was to evaluate whether undergraduate students' evaluations of prepared teeth were consistent with faculty assessments and correlated with students' performance in test preparations.

MATERIALS AND METHODS

Thirty four of 52 dental students having attended a pre-clinical course on basic prosthodontic topics including tooth preparation volunteered to participate in this study. The students were given 10 casts each containing one tooth with an intentionally applied preparation fault of a certain type prepared by an experienced clinician. The students were asked to mark on a list the fault type found in every tooth. The association of students' ratings with their performance during the course was analysed by means of a contingency table, and a generalised linear model was used to compare students' and faculty ratings (α = 0.05).

RESULTS

No significant difference between students' and faculty ratings could be found by analysis of deviance (P = 0.953). Significant deviations of fault detection probabilities from their group mean were found for six of ten fault types. No significant association between students' performance in test preparations and students ratings could be found (P = 0.564).

DISCUSSION

It was possible to achieve a level of calibration within the group of students, which was comparable to that in the group of faculty members.

CONCLUSIONS

Calibration of both students and examiners remains to be an issue with the teaching concepts applied in this study.

Student attitudes towards computer-aided testing

INTRODUCTION

  Computer-aided learning (CAL) is a viable alternative to traditional teaching methods. While CAL is used for teaching only, computer-aided testing (CAT) can be applied as a computer-based examination method. The aim of the present study was to evaluate students' attitude towards CAT as compared to written multiple choice tests.

MATERIALS AND METHODS

  Forty-one undergraduate dental students underwent a mock examination consisting of 15 written multiple choice questions and 15 questions delivered using the interactive MobiTed® system. A questionnaire based on an eight-item seven-point Likert scale was used to evaluate the students' attitude towards CAT. The students' performance in both tests was analysed using paired t-tests. Correlations between test performance and questionnaire were expressed by Pearson correlation coefficients.

RESULTS

  Despite study-design-related differences, students' test performance between written multiple choice and MobiTed® was comparable. No correlations between test results and questionnaire could be set up. Students rated MobiTed® to be equivalent to written multiple choice and had no difficulties with the CAT set up. The pre-defined sequence of questions with each question being shown only once was considered to be a major disadvantage of the CAT system. Complex questions should be displayed longer compared to short questions.

DISCUSSION

  Computer-aided testing appeared to be equivalent to written multiple choice tests not only in terms of student performance but also to their perception. This is consistent with previous studies.

CONCLUSIONS

  Interactive multiple choice tests may provide an alternative to written tests, but should allow examinees to have control over the sequence, as well as the length of time the questions are displayed.

Electronic transport and structure of microcrystalline silicon deposited by the VHF-GD technique

Electronic transport parallel and perpendicular to growth direction has been studied in a series of microcrystalline silicon samples obtained by various dilutions of silane in hydrogen. It is clearly shown that the transport properties (dark conductivity, drift mobility, ambipolar diffusion length and photoconductivity) under dark and under illumination conditions are enhanced as the dilution is increased. Furthermore, these films exhibit no degradation upon light-soaking. X-Ray diffraction patterns of the samples confirm that there is a correlation between the amount of crystalline fraction in the samples and the transport properties, as well as a preferential orientation along the growth direction. A similar correlation is found with the shift of the Si-H stretching mode peak of the infrared spectra (IR). Because transport properties have been measured by different techniques (dark conductivity, ambipolar length and photoconductivity in the direction perpendicular to growth direction, drift mobility in the direction parallel to growth direction), no statement can be made about a possible anisotropy in transport, as it would be expected from the columnar shape of the crystallites.

Optical and Electrical Properties of Undoped Microcrystalline Silicon Deposited by the VHF-GD with Different Dilutions of Silane in Hydrogen

We show that the optical and electrical properties of microcrystalline silicon (μc-Si:H) deposited by the VHF-GD technique at 110 MHz can considerably be tuned by changing the dilution ratio of silane to hydrogen.

With increasing silane dilution we observe enhanced optical absorption for energies below 2 eV due to the transition of the material from amorphous / microcrystalline mixture to a pure microcrystalline phase. Simultaneously, the light scattering and the defect absorption increases. Strong dilution also promotes the incorporation of impurities into the material, leading to a pronounced extrinsic behaviour as seen from the decrease of the activiation energy of the electrical conductivity.

The electrical properties were investigated in the dark by the Time of Flight technique. We measured drift mobilities at room temperature which slightly increase with dilution, reaching values of 3 cm2/Vs for electrons and 1.2 cm2/Vs for holes. The ratio between electron and hole drift mobilities is found to be around 2 for all samples studied, similar to that of crystalline silicon.

Furthermore, post-transient Time of Flight measurements revealed detrimental electron deep traps in low dilution material.

The “Micromorph” Cell: a New Way to High-Efficiency-Low-Temperature Crystalline Silicon Thin-Film Cell Manufacturing?

In the past, microcrystalline silicon (μc-Si:H) has been successfully used as active semiconductor in entirely μc-Si:H p-i-n solar cells and a new type of tandem solar cell, called the “micromorph” cell, was introduced [1]. Micromorph cells consist of an amorphous silicon top cell and a microcrystalline bottom cell. In the paper a micromorph cell with a stable efficiency of 10.7 % (confirmed by ISE Freiburg) is reported.

Among sofar existing crystalline silicon-based solar cell manufacturing techniques, the application of microcrystalline silicon is a new promising way towards implementing thin-film silicon solar cells with a low temperature deposition. Microcrystalline silicon can, indeed, be deposited at temperatures as low as 220°C; hence, the way is here open to use cheap substrates as, e.g. plastic or glass. In the present paper, the development of single and tandem cells containing microcrystalline silicon is reviewed. As stated in previous publications, microcrystalline silicon technique has at present a severe drawback that has yet to be overcome: Its deposition rate for solar-grade material is about 2Å/s; in a more recent case 4.3 Å/s [2] could be obtained. In the present paper, using suitable mixtures of silane, hydrogen and argon, deposition rates of 9.4 Å/s are presented. Thereby the dominating plasma mechanism and the basic properties of resulting layers are described in detail. A first entirely microcrystalline cell deposited at 8.7 Å/s has an efficiency of 3.15%.

Microcrystalline Silicon Solar Cells at Higher Deposition Rates by the VHF-GD

A 7.7 % single junction cell efficiency for an entirely microcrystalline silicon (μc-SiH) device has recently been reported by our group [1]. This was achieved by applying the purifier technique, a technique which is indeed easier to handle than the earlier used “microdoping” approach. The purpose of the present paper is twofold: First to show in detail the impact on device performance when a gas purifier is used; and second to illustrate that the deposition rate of the active, absorbing i-layer can be increased from the former 1.55 Å/s up to 4.3 Å/s while still maintaining reasonable device performances. In the latter case a first n-i-p solar cell structure on an aluminium sheet could be fabricated with an efficiency of 4.9 %.

Transport Properties of Compensated μc-Si:H

Electron and hole transport in completely microcrystalline silicon (μc-Si) p-i-n cells and in intrinsic or near intrinsic μc-Si layers have been investigated, for the first time, by time of flight (TOF) at temperatures between 100 and 400 K.At room temperature, both electron and hole drift mobilities were found to be between 0.2 and 1 cm2 V-ls-1. No trace of anomalous dispersive transport was observed, neither for electrons nor for holes, down to 100 K. A decrease of the drift mobility was observed when the temperature was raised from room temperature to 400 K as usually observed in crystalline semiconductors. However, these experimental values of the drift mobilities appear more puzzling than helpful for the comprehension of this “new” photovoltaic material.

[Partial allotransplantation of the face including the mandible: a feasibility study]

OBJECTIVE

Facial grafts are useful in that they allow the repair of severe facial defects in one step in contrast to the actual available techniques which require staged procedures with limited cosmetic and functional results. The aim of our study was to determine whether it would be possible to include part of the mandible in a partial allotransplant of the face.

MATERIAL AND METHODS

An anatomical study on the arterial and venous vascularisation of the face and the mandible was performed on 7 heads. Then nine heads were used to describe an anatomical model of harvesting two-thirds of the lower face.

RESULTS

The study determined that a graft could be viable with a facial artery, inferior dental artery and two veins facial. Thus, a reliable method for harvesting hemi-mandible and total mandible is developed. The average sampling time was 4 hours and thirty minutes. Harvesting a total mandibular graft was more tedious because of the loss of joint laxity caused by the absence of mandibular osteotomy.

CONCLUSION

Partial allotransplant of the face including the mandible is feasible. In such transplantations, functional difficulties related to the temporo-mandibular joint and orthognathic problems need to be overcome.

[Acute group A beta-hemolytic streptococcus membranous laryngotracheobronchitis in an adult]

OBJECTIVE

To describe the first case of a group A beta-hemolytic streptococcus laryngotracheobronchitis as well as the other possible etiologies in a case of acute dyspnea.

METHODS

We report the case of a 46-year-old woman with a doubtful vaccination status who presented clinical features of croup (laryngotracheobronchitis). She developed respiratory distress and required endotracheal intubation.

RESULTS

The endoscopy demonstrated a great deal of crust and pseudomembrane detachment. Bacterial culture grew group A beta-hemolytic streptococcus. Progression was good with antibiotics and corticosteroid treatment.

CONCLUSION

Bacterial acute pseudomembranous croup (laryngotracheobronchitis) is rare. We must search for the most frequent diagnoses such as diphtheria and epiglottitis. This is the first case to be reported in the literature.

Comparison between computer-aided testing and traditional multiple choice: an equivalence study

AIMS

Computer-aided learning (CAL) is a viable alternative to traditional teaching methods. While CAL is used for teaching only, computer-aided testing (CAT) can be applied as a computer-based examination method. The aim of the present study was to compare the performance of undergraduate students in computer-interactive tests and traditional multiple choice tests and to evaluate the influence of question length and language skills on test results.

MATERIALS AND METHODS

Fifty-two native German-speaking students and five non-native speaking students were randomly assigned to two groups. They were required to answer 20 conventional multiple choice questions and 20 questions using the interactive MobiTed system. An analysis of variance and t-tests (alpha = 0.05) were used to compare scores.

RESULTS

Non-native speakers scored significantly lower on the interactive test compared with the native speaking students (P = 0.048 for long questions and P = 0.003 for short questions). There were no significant group differences on the conventional multiple choice test (P = 0.052 for long questions and P = 0.089 for short questions). Based on the results of the native speaking students neither test method nor question length had an influence on overall performance.

CONCLUSION

Interactive multiple choice tests may provide an alternative to written tests, especially when considering time expenditure. Language skills and question length should be taken into account when setting time limits for examination.

Chlamydia psittaci pneumonia presenting as acute generalised peritonism

A 63 year old man presented with the signs of acute generalised peritonism in the presence of a clear chest radiograph. At laparotomy no abnormal findings were noted. Further inquiries revealed a history of recent acquisition of budgerigars, over the following days the chest radiograph developed patchy opacification. Subsequently IgG immunofluorescence confirmed the diagnosis of Chlamydia psittaci. The presentation of psittacosis with gastrointestinal features is well recognised. This is believed to be the first account in the literature of a human case of Chl psittaci pneumonia presenting with acute generalised peritonism indicating an exploratory laparotomy. It is suggested that Chl psittaci pneumonia should be considered in the differential diagnosis of an acute abdomen in the presence of a history of exposure to psittacine birds.

[Day care treatment of 2 siblings with elective mutism]

OBJECTIVES

This case report deals with the day care treatment of two seven- and eight-year-old siblings with elective mutism. Their treatment entails a combination of psychopharmacological and intensive behavior therapy. The multimodal therapeutic process is presented together with continuing psychosocial steps. Behavioral intervention focuses on building verbal expressive capacity, reducing speech anxiety in social situations and generalization to non-therapeutic situations. The case report is discussed in the context of the current literature on elective mutism.

Ferroxidases and xanthine oxidase in plasma of healthy newborn infants

In the neonatal period, there is a high iron load, while both the level and molar oxidase activity of ceruloplasmin are low. On the other hand, the neonatal xanthine oxidase (XO) activity is higher than later in life and XO has a significant iron-oxidizing capacity. We therefore studied the physiological contribution of XO to the ferroxidase activity of the plasma in 20 full-term newborn infants. Ferroxidase activity was measured spectrophotometrically, with Fe++ as substrate. The uric acid formed by XO was assayed by means of HPLC, with electrochemical detection. The total ferroxidase activity in the plasma was about one-fourth of the adult level and rapidly increased doubling within 3 days after birth. About 90% of the plasma ferroxidase activity was due to ceruloplasmin, the remainder being accounted for by ferroxidase II. The XO activity underwent a 30% (statistically non-significant) elevation at 24 h, though ferroxidase activity attributable to XO was not detected at any time. Accordingly, XO does not seem to add substantially to the total iron-oxidizing capacity of the plasma in the neonatal period. The high molar ferroxidase activity is probably of importance at the endothelial cell surface.

"Anxious suicidality": a new subtype of childhood suicide ideation?

The current study examined the presence of anxiety in children with suicide ideation. From a sample of 100 inpatients, children who displayed suicide ideation (n = 27) were selected and divided into two groups, high and low anxiety. Findings indicated that children with suicide ideation and anxiety were less happy and satisfied, experienced more negative life events, and were more distractible and intense than children with suicide ideation only. Additionally, according to their self-reports, parents of children with high anxiety reported more obsessive-compulsive and anxiety symptoms as well as greater hostility than parents of children with low anxiety. The authors have identified a subgroup of children with suicide ideation who are highly anxious and can be termed as experiencing "anxious suicidality."

Population data on the X chromosome short tandem repeat locus HumHPRTB in two regions of Germany

This report contains the results of two population studies on the X chromosome STR HumHPRTB carried out in a Northern and a Southern region of Germany. The numbers of unrelated individuals were 443 and 335, respectively. Eight alleles (alleles 9 to 16) were found. In female individuals 29 different genotypes were encountered. In German populations the HumHPRTB STR was characterized by the following data: PIC = 0.750; HET = 0.769: MEC = 0.556. Allele distribution met the Hardy-Weinberg expectations. The Northern and Southern populations did not show any significant differences.

Enantioselective high-performance liquid chromatographic method for the determination of methadone and its main metabolite in urine using an AGP and a C8 column coupled serially

A simple and sensitive method for the enantioselective high-performance liquid chromatographic determination of methadone and its main metabolite, EDDP, in human urine is described. (-)-(R)-Methadone, (+)-(S)-methadone, (+)-(R)-EDDP, (-)-(S)-EDDP and imipramine as an internal standard are detected by ultraviolet detection at 200 nm. The enantiomers of methadone and EDDP were extracted from human urine by a simple liquid-liquid extraction procedure. The extracted sample was reconstructed in mobile phase and the enantiomers of methadone and EDDP were quantitatively separated by HPLC on a short analytical LiChrospher RP8 column coupled in series with a chiral AGP column. Determination of all four enantiomers was possible in the range of 0.03 to 2.5 microM. The recoveries of methadone enantiomers and EDDP enantiomers added to human urine were about 90% and 80%, respectively. The method was applicable for determination of methadone enantiomers and the enantiomers of its main metabolite in urine samples from methadone maintenance patients and patients suffering from severe chronic pain.

[Hyperkinetic syndrome and behavioral disorders in street traffic: a case control pilot study]

In the present pilot study we addressed the question of whether young people diagnosed with attention deficit hyperactivity disorder (ADHD) as children violate traffic regulations and are involved in traffic accidents more frequently than those in a control group without previous psychiatric disorders. The subjects in the ADHD group tended to be involved in traffic accidents more frequently than those in the control group. Furthermore, they had a significantly higher rate of involvement in traffic accidents before getting their driver's license. The two groups did not differ in the number of traffic violations, alcohol consumption or various attitudes related to driving. Split attention and reactive endurance were assessed with a computer-aided program. The ADHD group partly did significantly worse than the control group. Deficits on such performance measures and a lack of cognitive control in traffic may therefore be mediating factors for being accident-prone in traffic. Regardless of which group subjects were in initially, those reporting severe ADHD symptoms at the time of the study tended to be at an increased risk of causing traffic accidents and of being involved in more than one accident.

Newcastle disease virus-infected intact autologous tumor cell vaccine for adjuvant active specific immunotherapy of resected colorectal carcinoma

An active specific immunization (ASI) procedure with two types of autologous tumor cell vaccines (ATVs) is tested for adjuvant immunotherapy of resected colorectal carcinoma to provide preliminary information on local immunological skin responses, side effects, and 2-year survival rates. For vaccine preparation, the tumor-derived freshly isolated and cryopreserved cells were thawed, purified by Percoll density centrifugation, and depleted of tumor-infiltrating lymphocytes by immunomagnetic beads. After inactivation by 200 Gy, the cells of this ATV were either infected by Newcastle disease virus (NDV) or they were admixed with Bacillus Calmette Guérin (BCG) organisms. Vaccination was performed in the arm beginning 6-8 weeks after operation, three times at 2-week intervals. Of 57 patients that received ASI, 48 were treated by virus-infected ATV (ATV-NDV) and 9 were treated with the BCG-admixed vaccine (ATV/BCG). The mean value of delayed hypersensitivity skin reactions from ATV-NDV-treated patients was 18 mm for the first vaccination and 26 and 29 mm for the succeeding ones. Although the application of ATV-NDV was associated with only mild side effects, the ATV/BCG vaccine led to long-lasting ulcers and to more serious side effects. The 2-year survival rate obtained with ATV-NDV was 97.9%, whereas the survival rate with ATV/BCG was 66.7%. The mean survival of 661 patients from a historical control was 73.8%. These data suggest that the type and quality of the tumor vaccine for ASI treatment is important. The findings with ATV-NDV necessitate corroboration in a prospective, randomized controlled study.

Bilateral carcinoma of the breast

In a retrospective review of 2820 patients with breast carcinoma seen at the Combined Breast Clinic of St George's Hospital over a 23-year period 101 cases were bilateral of which 52 (1.8%) presented synchronously and 49 (1.7%) metachronously. Twenty deaths occurred in the synchronous group after a mean follow-up of 56.2 months and 15 deaths in the metachronous group after a mean follow-up of 48.5 months following diagnosis of the second tumour. If timed from initial presentation patients with metachronous tumours fared better than those with unilateral disease (P < 0.01). There was no significant difference in survival between patients with metachronous (if timed from the second tumour), synchronous or unilateral breast carcinoma.

[Conservative therapy of ruptures of the medial collateral ligament of the knee. Results of a comparative follow-up study]

The rupture of the medial collateral ligament of the knee joint due to sports injuries is the most common lesion of ligaments of the knee in athletes. The treatment is usually non-operative. We compared in a retrospective study the conservative treatment of these ruptures by two different methods. One group of patients was immobilised in a plaster cast for six weeks, one group of patients was partially immobilised with a brace, initiating early functional therapy. The results proved that the group of early mobilisation was significantly better in late results, in shorter rehabilitation and in all other aspects regarded as important for the treatment of such an injury. Therefore we feel the treatment with plaster casting for isolated ruptures of medial collateral ligaments as the knee should be abandoned.

Incremental response to repetitive stimulation in Guillain-Barré syndrome

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[Animal experiment studies of carcinogen-induced tumor development in colotomies in relation to suture materials]

To assess the possible risk of cancer in the operated colon after stapling compared with vicryl sutures, the influence of the nickel-containing staples was tested in caecum-resected and carcinogen-treated rats. The nickel-containing staples were seen as a cocarcinogen. The aim of the study was to determine whether a higher incidence of cancer occurs at the anastomotic suture line depending on stapler vs. vicryl sutures after subcutaneous application of carcinogens (dimethylhydrazine). The results show that there is no increased risk of cancer following mechanical stapling.

Gastrointestinal tumours after stapler vs vicryl anastomoses in carcinogen-treated rats

Since nickel is a potent carcinogen the influence of nickel-containing staples on the frequency of gastrointestinal tumour formation was tested in caecum-resected and carcinogen-treated rats. Tumour formation was elevated after stapling compared with simple laparotomy or vicryl sutures. This demonstrates a potential hazard of stapling techniques. In the vicryl group there was only one suture line carcinoma.

Effects of music and imagery on physiologic and self-report of analogued labor pain

Two studies were conducted to examine the effects of music on analogued labor pain using volunteer nulliparous subjects who were randomly assigned to treatment groups (n = 10 per group). Assessments of the treatments were made in a 1-hour session involving twenty 80-second exposures to a laboratory pain stimulus patterned to resemble labor contractions. In the first experiment, it was hypothesized that subjects listening to easy-listening music would report lower pain ratings and cardiovascular responses than subjects listening to rock music, self-selected music, or a dissertation (placebo-attention) and subjects in a no-treatment control group. No significant group effects were found; significant time effects were found for heart rate, systolic and diastolic blood pressure. Subjects spontaneously reported using imagery as a pain reduction technique. In the second study a combination of music and imagery was examined by randomly assigning subjects to one of five groups: self-generated imagery with music (SIM), guided imagery with music (GIM), self-generated imagery without music (SI), guided imagery without music (GI), or no-treatment control. Again, no significant group effects were obtained. Significant time effects were obtained for heart rate, systolic and diastolic blood pressure.