Outpatient total body irradiation prior to bone marrow transplantation in pediatric patients: a feasibility analysis.

Outpatient total body irradiation (TBI) prior to bone marrow transplantation has been accomplished in a total of 68 pediatric patients. The TBI regimen was fractionated with a total dose of 12 Gy in eight fractions twice daily. Antiemetic therapy consisted of oral ondansetron three times daily throughout the TBI course. Eight patients experienced mild nausea without vomiting, and four patients experienced mild nausea and vomiting. One patient required intravenous hydration after severe nausea and vomiting. Another patient experienced intractable diarrhea and dehydration which required inpatient management. Outpatient TBI prior to bone marrow transplantation is feasible in pediatric patients.

Acceptability of bio-engineered vaccines.

For hundreds of years bacterial and viral vaccines have been-in a way-bioengineered and were generally well received by the public, the authorities, and the medical profession. Today, additional tools, e.g. molecular biology, enable new approaches to the development of better and safer products. Various vaccines derived from gene technology have now been licensed for commercial use and are acknowledged within the scientific community. Acceptance by the public and the politicians is, however, negatively influenced by the discussions encompassing gene manipulation in man and animals, transgenic plant, and "novel food". Lack of information leads to confusion and fear. Concurrently, the absence of spectacular and life-threatening epidemics limits the perceived value of immune prophylaxis and its benefits. Scientists in institutes and industry are in a position to stimulate acceptability of bio-engineered vaccines by following some simple rule: (1) adherence to the principles of safety; (2) establishment of analytical and control methods; (3) well functioning regulatory and reporting systems; (4) demonstration of usefulness and economic benefits; (5) open communication; and (6) correct and prudent wording.

[Electron microscopic virus detection in fecal samples from swine with enteric diseases between 1981 and 1987]. / Elektronenmikroskopischer Virusnachweis in Kotproben von enteritisch erkrankten Schweinen zwischen 1981 und 1987.

Results of electron microscopical studies of 517 fecal samples from diarrhoeic pigs out of the years 1981 and 1987 were reported. Coronavirus was found in 26.3%, rotavirus in 4.3%, parvovirus in 2.1%, coronavirus like particles in 2.9% and picornavirus like particles in 2.3% of the samples. In some cases (2.3%) double infections could be detected occurring as well between corona- and rotavirus, parvovirus or picornavirus like particles as between rotavirus and parvovirus and picornavirus like particles, respectively. The results were reported annually.

[Emergency medicine--medicine for an ageing society. A contribution to the context of emergency missions for elderly people]. / Notfallmedizin--Medizin für eine alternde Gesellschaft. Beitrag zum Kontext von Notarzteinsätzen bei alten Menschen.

Due to fundamental demographic as well as social changes, the emergency medical services (EMS) have to respond to an increasing number of geriatric emergencies. By means of some typical case histories the practical problems arising in preclinical emergency medical intervention and the central role of context factors like social isolation, reduced mental capabilities and the resulting need for help are demonstrated. It is discussed how emergency medical services (EMS) can contribute to the problems of an ageing society beyond the scope of a system which is dedicated only to the individual. One possibility is the epidemiological analysis of geriatric emergencies, the accompanying context factors and the development of an adequate infrastructure which is adapted to the needs of the elderly. The EU project EMERGE is an example of how emergency medical expertise is utilized in an interdisciplinary cooperation. An automatically working system based on ambient sensor technology is developed for early detection and prevention of emergency situations in the home environment. Supportive technology ("assisted living") should enable the elderly to live a safe and self-determined life as long as possible. Integration of this additional information into the processes of Emergency Medical Services (EMS) is the logistic prerequisite to establish a social medical assistance tailored to the needs of an ageing society.

[Nausea and vomiting in the postoperative phase. Expert- and evidence-based recommendations for prophylaxis and therapy]. / Ubelkeit und Erbrechen in der postoperativen Phase. Experten- und evidenzbasierte Empfehlungen zu Prophylaxe und Therapie.

There are no consensus guidelines for the management of postoperative nausea and vomiting (PONV) in German speaking countries. This meeting was intended to develop such guidelines on which individual health care facilities can derive their specific standard operating procedures (SOPs). Anesthesiologists reviewed published literature on key topics which were subsequently discussed during two meetings. It was emphasized that recommendations were based on the best available evidence. The clinical relevance of individual risk factors should be viewed with caution since even well proven risk factors, such as the history of PONV, do not allow the identification of patients at risk for PONV with a satisfactory sensitivity or specificity. A more useful approach is the use of simplified risk scores which consider the presence of several risk factors simultaneously. Most individual antiemetic interventions for the prevention of PONV have comparable efficacy with a relative risk reduction of about 30%. This appears to be true for total intravenous anesthesia (TIVA) as well as for dexamethasone and other antiemetics; assuming a sufficiently high, adequate and equipotent dosage which should be weight-adjusted in children. As the relative risk reduction is context independent and similar between the interventions, the absolute risk reduction of prophylactic interventions is mainly dependent on the patient's individual baseline risk. Prophylaxis is thus rarely warranted in patients at low risk, generally needed in patients with a moderate risk and should include a multimodal approach in patients at high risk for PONV. Therapeutic interventions of PONV should be administered promptly using an antiemetic which has not been used before. The group suggests algorithms where prophylactic interventions are mainly dependent on the patient's risk for PONV. These algorithms should provide evidence-based guidelines allowing the development of SOPs/policies which take local circumstances into account.

[A factorial trial of six interventions for the prevention of postoperative nausea and vomiting]. / Eine faktorielle Studie von 6 Interventionen zur Vermeidung von Ubelkeit und Erbrechen nach Narkosen Ergebnisse des "International Multicenter Protocol to assess the single and combined benefits of antiemetic strategies in a controlled clinical trial of a 2x2x2x2x2x2 factorial design" (IMPACT).

BACKGROUND: Untreated, one third of patients who undergo surgery will have postoperative nausea and vomiting. Although many trials have been conducted, the relative benefits of prophylactic antiemetic interventions given alone or in combination remain unknown. METHODS: In a randomized, controlled trial of factorial design, 5,199 patients at high risk for postoperative nausea and vomiting were randomly assigned to 1 of 64 possible combinations of 6 prophylactic interventions: 1) 4 mg of ondansetron or no ondansetron; 2) 4 mg of dexamethasone or no dexamethasone; 3) 1.25 mg of droperidol or no droperidol; 4) propofol or a volatile anesthetic; 5) nitrogen or nitrous oxide; 6) remifentanil or fentanyl. The primary aim parameter was nausea and vomiting within 24 h after surgery, which was evaluated blindly. RESULTS: Ondansetron, dexamethasone, and droperidol each reduced the risk of postoperative nausea and vomiting by about 26%, propofol reduced the risk by 19%, and nitrogen by 12%. The risk reduction with both of these agents (i.e., total intravenous anesthesia) was thus similar to that observed with each of the antiemetics alone. All the interventions acted independently of each other and independently of the patients' baseline risk. Consequently, the relative risks associated with the combined interventions could be estimated by multiplying the relative risks associated with each intervention. However, absolute risk reduction was a critical function of patients' baseline risk. CONCLUSIONS: Because antiemetic interventions are similarly effective and act independently, the safest or least expensive should be used first. Prophylaxis is rarely warranted in low-risk patients, moderate-risk patients may benefit from a single intervention, and multiple interventions should be reserved for high-risk patients.

BSE--a risk for man through pharmaceutical products? Position and politics of the German pharmaceutical industry.

Since BSE is not a zoonosis and the occurrence is with some exceptions extremely low or absent, the risk to man through pharmaceuticals is remote. However, the agent of BSE is very resistant and the disease in cattle is always lethal, as are analogous diseases of man. Therefore, the German pharmaceutical industry, through a working group, actively contributes to reasonable measurements leading to a further reduction of any theoretical risk. This theoretical risk has to be evaluated by a balanced consideration of various risk and safety factors. Process validation should be reserved for occasional single cases, since it is still time-consuming and contradicts animal protection. Industry prefers further research into the characteristics and behaviour of the BSE agent. The "Note for Guidance..." recently established by the EC commission seems a reasonable approach for a harmonized attitude of both industry and authorities. The German pharmaceutical industry would appreciate a balanced consideration of both pharmaceutical and food industries, which would also re-establish the confidence of the public.

In vitro studies on Borna virus. II. Properties of the virus.

Successful cultivation and titration of Borna disease virus in cell cultures enabled detailed studies of the virus properties. Borna virus is labile towards treatment with heat, pH 3.0 and lipid solvents. It is relatively stable at low temperatures and in frozen state. It is easily inactivated by ultraviolet light as e.g. vesicular stomatitis virus. After ultrafiltration studies, the size of the infectious virus unit is between 80 and 100 nm. Its buoyant density in cesium chloride is 1.165 g per ml. The one step multiplication curve shows that Borna virus has a replication cycle of about 2 days in BSC 1 cells. In growth experiments using antimetabilites it behaves like certain RNA containing viruses. As its multiplication is not inhibited by bromo- and iododeoxyuridine and actinomycin D, no DNA step seems to be involved in virus synthesis. Regarding these properties and the intracellular antigen distribution as shown by fluorescent antibodies, it is not possible to attribute Borna virus to any of the established virus groups.

[Abolition of compulsory vaccination against smallpox. Increased danger to humans from animal smallpox? (author's transl)]. / Aufhebung der Pflichtimpfung gegen Pocken. Erhöhte Gefährdung des Menschen durch Tierpocken?

After the world-wide eradication of human smallpox, compulsory vaccination against smallpox will no longer be applicable in future in most countries. Although the human smallpox virus (variola virus) appears to have no animal reservoir, humanity is increasingly endangered in future by animal smallpox viruses pathogenic in man against which he has been so far protected by the general smallpox vaccination. This is a virus type of the Genus Orthopox virus. The risk from animal pox viruses, which are not related to the Orthopox virus, remains unchanged. Of the animal Orthopox viruses the monkey pox viruses deserve special attention; possibly rodents also play a decisive role in transmission of smallpox.

Oral immunization against pox. Studies on fowl pox as a model.

Oral vaccination against fowl pox is both effective and harmless. A suitable vaccine strain is the attenuated HP-1 strain in the 200th to 400th tissue culture passage. For optimal immunization virus of the 200th to 270th passage level should be applied twice at an interval of 3 to 4 weeks. Vaccination dose should contain 10(7.0)TCID50. Chickens may be effectively immunized already at 5 days. Immunity is against both homologous and heterologous virus and proves equally resistant to oral, cutaneous and intravenous challenge. Protection of mucous membranes of the upper respiratory and digestive tract forms faster than after cutaneous immunization. Compared to conventional fowl pox vaccination, drinking water vaccination facilitates the technicalities of vaccination; there are immunological advantages and risks of complications are avoided. It can therefore be recommended as a model for vaccination against smallpox in man.

Vaccination against pox diseases under immunosuppressive conditions.

Pox diseases, caused either by smallpox virus or zoonotic pox viruses or animals, continue to be of potential danger to a non-vaccinated population. Mass vaccinations will become necessary and will then also be administered to persons with immunological aberrations. The vaccines which are presently used against smallpox cause severe complications in such hosts. In contrast, the attenuated vaccinia virus strain MVA is safe even under the conditions of immunosuppression and is recommended for the production of smallpox vaccines. Because of the special epizootic situations and the numerous immunosuppressive factors present in developing countries, the use of such a safe pox vaccine there is of crucial importance.

[Experiences with a new cat coryza-panleukopenia-rabies combined vaccine]. / Erfahrungen mit einem neuen Katzenschnupfen-Panleukopenie-Tollwut-Kombinationsimpfstoff.

The development of a new combined vaccine against cat flu, panleukopenia and rabies should lead to a simplification of the vaccination calendar in small animal practice. In order to judge the suitability of the new vaccine, its efficacy, local tolerability, and safety were evaluated. All vaccinated cats developed high antibody titres against herpes-, calici-, panleukopenia- and rabies virus that persisted well during the trial of 18 months. In comparison to other vaccines containing a smaller number of antigens the suitability of the vaccine on trial could be shown.

[Virologico-serologic studies in horses with respiratory tract diseases]. / Virologisch-serologische Untersuchungen bei Pferden mit Atemwegserkrankungen.

Of 1081 acute and chronically respiratory diseased as well as clinically normal horses 824 sera and 257 paired serum samples collected 1986 and 1987 were tested for antibodies against several different respiratory viruses such as influenza virus A/equi 1 and 2 (Influenza 1 a. 2), equine herpesvirus type 1/4 (EHV 1/4), mammalian reovirus type 1-3 (Reovirus 1-3), equine rhinovirus type 1 (ERV 1), equine adenovirus type 1 (EAdV 1), and equine arteritis virus (EAV). The investigations resulted in an antibody prevalence of 57.2% (Influenza 1), 59.5% (Influenza 2), 81.5% (EHV 1/4), 50.3% (Reovirus 1), 43.0% (Reovirus 2), 75.9% (Reovirus 3), 97.6% (EAdV 1), 82.5% (ERV 1) and 8.7% (EAV). With exception of EAV and EAdV 1 the ratios usually were higher in diseased animals than in clinically normal horses. Antibodies to EAV and EAdV 1 were present in all groups to almost the same amount. Of 257 horses with acute respiratory illness 3 showed a significant rise of the antibody titer against Influenza 1, 30 against Influenza 2, 54 against EHV 1/4, 1 against Reovirus 1 and 3, respectively, 11 against EAdV 1 and 26 against ERV 1.

In vitro studies on Borna virus. I. The use of cell cultures for the demonstration, titration and production of Borna virus.

Borna virus produces non-lytic infections in a wide spectrum of primary cell cultures and cell lines. The sensitivity and virus yields vary with the different cell systems. Accurate virus titrations can be performed in the RK 13 cell line by counting immunoflourescent microfoci between the 5th and 10th day after infection. Since the virus is not released from the cells and does not spread via the culture medium, the use of a semisolid overlay in unnecessary in virus titrations. The cell line most productive for Borna virus is the CV 1 line. The conditions for optimum virus production include a prolonged cultivation period of at least two weeks with regular changes of medium, and an incubation temperature of 35 degrees C. Harvest of the virus requires thorough disruption of the infected cells, preferably by ultrasonication, since Borna virus seems to be closely associated with cellular structures.