[Pathoanatomical and clinical aspects of the placenta in preterm birth]. / Pathologisch-anatomische und klinische Aspekte der Plazenta bei Frühgeburt.

BACKGROUND: Prematurely born children show a clearly elevated risk for perinatal morbidity, long-term pediatric morbidities and development of chronic diseases in adulthood compared to babies born at term. The pathoanatomical investigation of placentas from preterm births is useful for assessing the etiology, the risk of recurrence and the prognosis for the child. AIMS: The focus is on presenting the clinical and pathoanatomical characteristics of acute chorioamnionitis as a frequent cause of preterm induction of labor and pregnancy-induced hypertension, in particular preeclampsia as a frequent reason for elective cesarean section. Other lesions, sometimes of unclear etiology associated with preterm birth and substantially elevated risk of recurrence are reviewed. The clinical correlations and therapeutic options of the various diseases are discussed taking the risk of recurrence into consideration. MATERIAL AND METHODS: Examination of placentas, association with the clinical course and a literature search. RESULTS AND DISCUSSION: Acute chorioamnionitis and omphalovasculitis can be histologically subdivided into different stages which correlate with the clinical severity and the prognosis for the newborn child. Chronic deciduitis, chronic chorioamnionitis, villitis of unknown etiology, massive perivillous fibrin deposition and chronic histiocytic intervillositis are entities of unclear etiology associated with recurrent abortion and preterm birth. Autoimmune diseases and thrombophilia are occasionally associated with these pathologically defined lesions. Pregnancy-associated hypertensive disease and particularly preeclampsia as the cause of intrauterine developmental delay and elective cesarean section often show characteristic pathoanatomical placental lesions, which can give indications for the severity and duration of the disease and the prognosis for the child. Early onset (<34 weeks of gestation) and late onset preeclampsia show clinical and morphological differences. Subsequent pregnancies are classified as being at risk and screening for preeclampsia should be clinically performed.

The role of business size in assessing the uptake of health promoting workplace initiatives in Australia.

BACKGROUND: Worksite health promotion (WHP) initiatives are increasingly seen as having potential for large-scale health gains. While health insurance premiums are directly linked to workplaces in the USA, other countries with universal health coverage, have less incentive to implement WHP programs. Size of the business is an important consideration with small worksites less likely to implement WHP programs. The aim of this study was to identify key intervention points and to provide policy makers with evidence for targeted interventions. METHODS: The worksites (n = 218) of randomly selected, working participants, aged between 30 and 65 years, in two South Australian cohort studies were surveyed to assess the practices, beliefs, and attitudes regarding WHP. A survey was sent electronically or by mail to management within each business. RESULTS: Smaller businesses (<20 employees) had less current health promotion activies (mean 1.0) compared to medium size businesses (20-200 employees - mean 2.4) and large businesses (200+ employees - mean 2.9). Management in small businesses were less likely (31.0 %) to believe that health promotion belonged in the workplace (compared to 55.7 % of medium businesses and 73.9 % of large businesses) although half of small businesses did not know or were undecided (compared to 36.4 and 21.6 % of medium and large businesses). In total, 85.0 % of smaller businesses believed the health promotion activities currently employed in the worksite were effective (compared to 89.2 % of medium businesses and 83.1 % of large businesses). Time and funding were the most cited responses to the challenges to implementing health promoting strategies regardless of business size. Small businesses ranked morale and work/life balance the highest among a range of health promotion activities that were important for their workplace while work-related injury was the highest ranked consideration for large businesses. CONCLUSION: This study found that smaller workplaces had many barriers, beliefs and challenges regarding WHP. Often small businesses find health promotion activities a luxury and not a serious focus of their activities although this study found that once a health promoting strategy was employed, the perceived effectiveness of the activities were high for all business regardless of size. Tailored low-cost programs, tax incentives, re-orientation of work practices and management support are required so that the proportion of small businesses that have WHP initiatives is increased.

[Massive perivillous fibrin deposition, chronic histiocytic intervillositis and villitis of unknown etiology: Lesions of the placenta at the fetomaternal interface with risk of recurrence]. / Massive perivillöse Fibrinabscheidungen, chronisch-histiozytäre Intervillositis, Villitis unbekannter Ätiologie : Plazentaläsionen bei Störungen der fetomaternalen Einheit mit Rezidivrisiko.

BACKGROUND: Maternal floor infarction/massive perivillous fibrin deposition (MFI/MFD), chronic histiocytic intervillositis (CHIV) and villitis of unknown etiology (VUE) are lesions of the placenta which are characterized morphologically. The cause is thought to be pathological immunotolerance/rejection reaction at the fetomaternal interface. The risk of recurrence is elevated and the lesions can lead to severe pediatric diseases. AIM: This article provides an overview of the pathological and anatomical characteristics of each of these lesions, including diagnostic criteria, suspected etiology, clinical relevance and suggested therapy options. MATERIAL AND METHODS: A selective search of the literature was carried out and experiences from own diagnostic clientele are presented. RESULTS AND DISCUSSION: While MFI/MFD and CHIV occur more rarely, VUE is relatively common occurring in up to 15 % of placentas at term. Both MFI/MFD and CHIV can occur in the first and second trimester, while VUE typically manifests in the third trimester. All lesions can lead to intrauterine growth retardation or abortion and have a tendency towards disease recurrence. Furthermore, VUE and MFI/MFD can be associated with an adverse neurodevelopmental outcome in the children. For all these entities potential therapy strategies have been reported, which are mainly based on anticoagulation and immunosuppression in subsequent pregnancies.

Pathological characteristics of a series of rare chronic histiocytic intervillositis of the placenta.

Chronic histiocytic intervillositis of the placenta (CHI) is a rare and poorly understood pathology which may occur in all trimesters. The most conspicuous feature is a histiocytic infiltration of the intervillous space without involvement of the villous parenchyma. In this report on CHI, we re-evaluate a series of four cases and focus on histological, immunohistological and fluorescence in situ hybridisation-derived findings, fetal status and clinical data for previously unrecognised CHI-associated features. Our approach revealed that assisted reproduction-induced pregnancy had been performed in 2 of 4 CHI cases, but other factors and comorbidities are likely to contribute to CHI.

Synthesis of derivatives of C-nucleoside analogues using 'push-pull' functionalized monosaccharides.

7-Deoxy-1,2:3,4-di-O-isopropylidene-alpha-D-galacto-heptopyranos-6-ulose (1) reacted with carbon disulphide and methyl iodide in the presence of a base to furnish 7,8-dideoxy-1,2:3,4-di-O-isopropylidene-8,8-[bis(methylthio)]-alpha-D-galacto-oct-7-enopyranos-6-ulose (2). This 'push-pull' activated unsaturated monosaccharide underwent a ring closure reaction with hydrazine hydrate to give the 'inversed' C-nucleoside analogue 3. Compound 1 and malononitrile yielded the 7-cyano-6,7-dideoxy-1,2:3,4-di-O-isopropylidene-6-methyl-alpha-D-galacto-oct-6-enopyranurononitrile (4). Treatment of 4 with carbon disulphide and methyl iodide in the presence of a base afforded the sugar 'push-pull' butadiene 5 which was transformed into the pyridine nucleoside analogue 6.

Surgery as primary treatment in patients with liver metastases from carcinoid tumors: a retrospective, unicentric study over 13 years.

BACKGROUND: The heterogeneous nature of carcinoid tumors makes it difficult to develop a standardized treatment strategy for the primary tumor itself and for probable liver metastases. However, prolongation of the 5-year survival rate (5-ysr) and amelioration of the incapacitating symptoms after resection of the primary tumor and its metastases demonstrate that surgical intervention must be the treatment of choice in these tumors. METHODS: The data of 31 patients (17 patients with midgut carcinoids, 10 patients with an endocrine carcinoma (carcinoid) of the pancreas, and 4 patients with carcinoids of the lung) who underwent liver operation for metastatic carcinoid tumors between 1983 and 1996 were analyzed, with special regard to factors influencing postoperative survival. RESULTS: Ten patients underwent curative resection (5-ysr, 86%), and palliative operations were performed in 21 patients (5-ysr, 26%). The overall 5-ysr was 47%, with a mean postoperative follow-up of 3.5 years (range, 4 months to 10.8 years). Postoperative morbidity rate was 13%. Size of liver metastases, radicality of the operation and localization of the primary tumor were factors influencing postoperative survival. CONCLUSIONS: Surgery for metastatic carcinoid tumors may be curative or palliative, with a potential for cure in some cases and prolongation of survival and amelioration of symptoms in the majority of patients.

[Assessment of the effective dose for routine protocols in conventional CT, electron beam CT and coronary angiography]. / Abschätzung der effektiven Dosis für Routineprotokolle beim konventionellen CT, Elektronenstrahl-CT und bei der Koronarangiographie.

PURPOSE: To compare the effective dose applied by sequential CT (SEQ), spiral CT (SCT), electron beam CT (EBT) and coronary angiography for investigations of the chest, abdomen and the heart. METHODS: The Alderson Phantom was used to compare the effective dose for all modalities. In addition, the effective dose for conventional CT (SEQ and SCT) was estimated with a mathematical phantom. RESULTS: For CT investigation of the chest and abdomen the dose was highest for the EBT (11 mSv and 25 mSv, respectively) and slightly lower for the SEQ (7.8 mSv and 21.5 mSv, respectively), whereas spiral CT required the least dose (5.3 mSv and 8.8 mSv, respectively). For coronary calcium screening (0.8 mSv) and EBT coronary angiography (1.7 mSv) the dose was lower than for coronary catheter angiography (3.3 mSv). For conventional CT the difference between the effective dose derived by the mathematical phantom and by the Alderson phantom was 2% to 20%. CONCLUSIONS: For investigations of the chest and abdomen the effective dose applied by SCT is significantly lower than that with EBT and SEQ. For investigation of the coronary arteries the effective dose applied by EBT is lower than that for coronary catheter angiography.

[Virtual colonoscopy using CT and MRI]. / Virtuelle CT- und MRT-Koloskopie.

PURPOSE: To evaluate experimentally and in patients the sensitivity and effective dose of virtual electron-beam tomography (EBT) colonoscopy for detecting small colon tumors and to compare the methods and results with virtual colonoscopy using spiral CT and MR imaging in a review of the literature. MATERIALS AND METHODS: Six polyps with diameters between 3 and 12 mm were created and randomly placed in resected pig colon. After distension with air, the pig colon was scanned with continuous volume scanning (CVS, 3 mm collimation) and a pitch of 0.4, 0.8 and 1.5. Twenty patients positive for the fecal blood test were examined after rectal CO2 insufflation and i.v. administration of 1 mg glucagon. A 13 s CVS scan was used to cover the entire colon within one breath-hold. 3D volume-rendered fly-throughs were evaluated by two independent radiologists. Effective dose equivalent was estimated using an Alderson phantom equipped with thermoluminescence dosimeters. RESULTS: In the tumor model, all polyps were detectable at a pitch of 1.5. A further reduction of the pitch ratio did not improve the conspicuity of the polyps. In patient studies, all tumors (n = 4) and polyps (n = 3) were correctly identified on 3D fly-throughs. Two false positive results were obtained. Effective dose equivalent was calculated at 3.2 mSv per scan. CONCLUSIONS: Our preliminary results indicate that virtual EBT colonoscopy holds promise for fast screening for colon polyps. The best technique for virtual colonoscopy (Spiral CT, EBT, MRI) has not yet been determined and the future role of virtual colonoscopy must still be defined.

[Radiation exposure during CT examination of thorax and abdomen. Comparison of sequential, spiral and electron beam computed tomography]. / Strahlenexposition bei der CT-Untersuchung des Thorax und Abdomens. Vergleich von Einzelschicht-, Spiral- und Elektronenstrahlcomputertomographie.

Comparison of radiation exposure applied by different types of CT scanners for the investigation of the chest and abdomen. Determination of radiation exposure applied by multi-phase spiral CT. Estimation of the dose in air in the system axis of the scanner, the CT dose index (CTDI) and the effective dose for electron beam tomography (EBT) and two conventional CT scanners (sequence, SEQ; spiral, SCT). For EBT, dose in system axis for investigation of the abdomen was above 50 mGy. Effective dose for investigation of the chest and abdomen was higher with EBT (11 and 26 mSv, respectively) than with conventional CT (SEQ, 4 and 20 mSv; SCT, 2 and 7 mSv). The effective dose for a biphasic investigation (liver 5 mSv, kidney 4 mSv) was below, for a triphasic investigation (liver 7 mSv) above the effective dose of the investigation of the abdomen (6 mSv). Investigation of the abdomen with the EBT should only be performed for certain indications. With spiral CT, effective dose is much lower than with EBT.

Induction of telomerase activity in stimulated human lymphocytes precedes expression of topoisomerase II alpha.

Telomerase activity has been demonstrated in human immortal cell lines and in tumors, whereas it is generally absent from normal tissues, with the exception of germ cells. Low levels have also been detected in blood and skin cells. In this report we describe up-regulation of telomerase activity in normal human blood lymphocytes by mitogen stimulation. After 24 h of mitogen treatment a strong induction was detectable using the PCR-based telomeric repeat amplification protocol. The level of activity remained almost constant when the cultivation lasted 72 h. By contrast, topoisomerase II alpha was induced later with a maximum expression after 48-72 h. Our data show that telomerase can be induced in normal peripheral lymphocytes prior to expression of the S-phase typical protein topoisomerase II alpha indicating that telomere elongation might be initiated before DNA replication.

[Clonal analysis in cells using PCR and laser microdissection]. / Klonalitätsanalysen in Geweben durch PCR und Laser-Mikrodissektion.

Clonality represents one of the hallmarks of neoplastic cell growth. X-chromosomal inactivation patterns have been used to determine clonality in various tumors. This approach is limited by admixture of polyclonal non-tumor stroma cells among which the monoclonal proliferation may be missed. In order to overcome this limitation, we combined a sensitive PCR based DNA analysis with a highly selective microdissection technique using a laser beam. In sections of intraductal mammary carcinomas tumor cell complexes of at least 100 cells were isolated by removing the surrounding stroma by laser irradiation. Thereby, tumor cells could be isolated without contaminating non-neoplastic elements. Clonality in these cells was determined using two X-chromosomal polymorphic sites-phosphoglycerate kinase 1 (PGK1) and human androgen receptor (HUMARA). Control experiments could show the polyclonal nature of the surrounding tissue. Moreover, complete destruction of DNA by laser irradiation was assured. The technique requires a certain amount of cells and DNA in order to avoid artefacts that result from preferential amplification of exclusively one X-chromosomal allele in small samples. We conclude that combination of laser-microdissection with PCR analysis of X-chromosomal inactivation patterns enables the detection of clonal cell populations in heterogeneous tissues. Studies of clonality in borderline cases between reactive and neoplastic proliferations or premalignant lesions are made possible by this technique.

[Investigation of outer membrane proteins of Pasteurella. 2: Iron-regulated outer membrane proteins of Pasteurella multocida and Pasteurella haemolytica]. / Untersuchungen zu den Proteinen der äusseren Membran von Pasteurellen 2. Mitteilung: Eisenregulierte Proteine der äusseren Membran bei Pasteurella multocida und Pasteurella haemolytica.

Pasteurella multocida and Pasteurella haemolytica produce specific proteins in the outer membrane under iron-depleted conditions. Pasteurella multocida serovar A expresses these proteins of molecular masses of 76 and 96 kDa as determined by electrophoresis. The analogous serovar D produces a further iron-regulated protein of 85 kDa. The Pasteurella haemolytica strains of serovar A1, A6 and T contain iron-regulated outer membrane proteins of molecular masses of 71, 77 and 100 kDa. These proteins possess binding positions for iron ions. Both Pasteurella multocida and Pasteurella haemolytica strains utilize iron from porcine and bovine transferrin, but not from haemin and haemoglobin.

Postoperative irradiation treatment and bioresorbable implants in orthopaedic surgery: an experimental in vitro study.

The influence of applied radiation on the degradation of a polyglycolide (PGA) test specimen was studied in vitro. There was no significant difference in the time-dependent degradation behaviour between the irradiated test specimen and controls. Mandatory irradiation of an operation site following surgery therefore does not contradict the employment of bioresorbable implants in orthopaedic surgery.

[Total skin electron beam irradiation in cutaneous T-cell lymphoma]. / Ganzhautelektronenbestrahlung des kutanen T-Zell Lymphoms.

PURPOSE: Patients with cutaneous T-cell lymphoma are treated in Germany mostly by dermatological local therapy like corticosteroids or PUVA-irradiation. Total skin electron beam irradiation is used rarely, even though it has a potentially curative character. We present an analysis of patients, who received a total skin electron beam irradiation after having progressive disease following other treatment modalities. PATIENTS AND METHODS: Twenty-one patients (mean age 58.9 years) in different stages were treated (stage IB and IIA n = 4, stage IIB n = 8, stage III n = 3, stage IV n = 6). All patients had progressive disease under other forms of local therapy. The irradiation was performed from 6 directions per hemibody using 2 axial fields which have each an 18 degree angle to the horizontal level. Six and 7 MeV fast electrons were used. Total dose was between 8 and 36 Gy in single dosis of 1 x 4 up to 5 x 2 Gy per week. In underdosed areas and areas of tumors of the skin boost irradiation with small fields was given. RESULTS: All patients had a good tumor regression (complete remission: n = 10, partial remission: n = 11). With the follow-up between 4 and 93 months total- and recurrence-free survival was 18 and 7 months (median). Patients in early stages with slow but complete remission of the symptoms had the best prognosis. Because of the small case number there was no significant difference between the groups. There were no severe side effects of the radiotherapy noted. CONCLUSION: Our analysis shows on a small patient number, that total skin electron beam irradiation has a good palliative effect on patients who have progressive disease following other types of treatment like PUVA or corticosteroids. The recurrence-free survival of 2 out of 4 patients with early stage disease (I-IIA) up to 93 month shows the potentially curative character of the treatment.

[Proteins from the outer membrane of Pasteurella--1. Polyacrylamide gel electrophoresis of outer membrane proteins--a possibility for differentiation of Pasteurella haemolytica strains]. / Untersuchungen zu den Proteinen der äusseren Membran von Pasteurellen--1. Mitteilung: Polyacrylamidgelelektrophorese von Proteinen der äusseren Membran--eine Möglichkeit der Differenzierung von Pasteurella-haemolytica-Stämmen.

Using the sodium laurylsarcosinate method, outer membrane proteins (OMPs) of 63 Pasteurella haemolytica strains are isolated and their protein patterns obtained by SDS polyacrylamide gel electrophoresis (SDS-PAGE) are compared. A high degree of similarity became evident both within A and T biotypes in the molecular weight range of 25 to 50 KDa. Strain-to-strain variations are mainly limited to quantitative differences in individual protein bands. It is concluded that within both the A and T biotype groups equal sets of major proteins are present with differing amounts of individual constituents. Biotypes A and T can be clearly distinguished on the basis of marked variations in OMP profiles. OMPs of those AT strains included in comparative studies are exhibiting no general homogeneity, but a relative heterogeneity due to different protein compositions, which are, however, clearly distinct from the patterns of biotypes A and T. It is established unambiguously that isolates belonging to biotypes A or T, as well as AT strains, can be clearly distinguished from each other on the basis of SDS-PAGE analysis of OMP extracts. Thus, polyacrylamide gel electrophoresis of outer membrane proteins can be used for differentiation.