Endogenous infection and hospital's civil liability - a case study.

The subject matter of this publication is the legal assessment of endogenous infection - the specific type of hospital infections. The main aim of the publication is to answer the question of whether medical and legal grounds exist for civil liability for endogenous infections and for treating those infections as cases of medical malpractice or medical events. The research method adopted is a case study. The authors have analysed a civil lawsuit for compensation instituted by an infected patient against a Polish hospital, adjudicated in 2013. The main conclusion of the publication is to postulate distinguishing medical malpractice from complications resulting from the reactions of the human body to treatment. The authors argue that endogenous infections should be treated as the latter-mentioned of these two cases.

ASAXS study on the formation of core-shell Ag/Au nanoparticles in glass.

Nanosized metal particles of various configurations embedded in surface regions of glass have great potential as nonlinear optical materials for photonic devices. We have prepared Ag/Au nanoparticles in core-shell configuration in soda-lime silicate glass by double-ion implantation and investigated their structural characteristics by anomalous small-angle x-ray scattering (ASAXS) and transmission electron microscopy. Measurements at x-ray energies slightly below the Au L(3) edge indicate the formation of bimetallic Ag/Au shells in some of the nanoparticles for high-dose ion implantation. An element-specific analysis of the ASAXS results allowed us not only to validate and quantify the core-shell structure, but simultaneously also the composition of the shells. Hollow nanoparticles were found for an Au-Ag implantation sequence, whereas an Ag-Au sequence generates a diluted core composition. The shift of the maximum position of optical absorption of the samples due to surface plasmon resonance of bimetallic nanoparticles, as monitored by optical spectroscopy, revealed the considerable influence of the respective particle configuration.

Silver structure environments in ion-exchanged silicate glasses studied by X-ray absorption fine structure.

X-ray absorption fine structure (XAFS) technique was used to analyze structural geometry of Ag atoms introduced into soda-lime silicate glass and soda aluminosilicate glass by ion-exchange method. The results show that Ag+ ion in soda aluminosilicate glass takes a coordination number of 1.6 with a Ag-O distance of 2.20 A when the ion-exchange ratio x is smaller than 0.47 and of 2.28 A when x is larger than 0.47. The introduced Ag+ ions are stabilized at the non-bridge oxygen (NBO) sites when x is lower than 0.47. The Na+ ions in AlO4 (O4 represents the bridging oxygen) sites are exchanged by Ag+ ions after all Na+ in NBO sites are replaced. The disorder of Ag-O coordination increases gradually with increasing x from 0.24 to 0.47 in soda aluminosilicate glass and increases dramatically when x is larger than 0.47. Ag+ ions takes a coordination number of 1.6 in the ion-exchanged soda-lime silicate glass and of 1.3 after subsequently thermal treatment with the same Ag-O distance of 2.14 A. Debye-Waller factor (DWF) of Ag-O coordination in soda aluminosilicate glass is higher than that in soda-lime silicate glass. Small Ag cluster has a reduced interatomic distance and a larger DWF. Ag nanoparticle in sample Ag-7 is in a state of tensile stress.

Insight on agglomerates of gold nanoparticles in glass based on surface plasmon resonance spectrum: study by multi-spheres T-matrix method.

The formation of a localized surface plasmon resonance (SPR) spectrum of randomly distributed gold nanoparticles in the surface layer of silicate float glass, generated and implanted by UV ArF-excimer laser irradiation of a thin gold layer sputter-coated on the glass surface, was studied by the T-matrix method, which enables particle agglomeration to be taken into account. The experimental technique used is promising for the production of submicron patterns of plasmonic nanoparticles (given by laser masks or gratings) without damage to the glass surface. Analysis of the applicability of the multi-spheres T-matrix (MSTM) method to the studied material was performed through calculations of SPR characteristics for differently arranged and structured gold nanoparticles (gold nanoparticles in solution, particles pairs, and core-shell silver-gold nanoparticles) for which either experimental data or results of the modeling by other methods are available. For the studied gold nanoparticles in glass, it was revealed that the theoretical description of their SPR spectrum requires consideration of the plasmon coupling between particles, which can be done effectively by MSTM calculations. The obtained statistical distributions over particle sizes and over interparticle distances demonstrated the saturation behavior with respect to the number of particles under consideration, which enabled us to determine the effective aggregate of particles, sufficient to form the SPR spectrum. The suggested technique for the fitting of an experimental SPR spectrum of gold nanoparticles in glass by varying the geometrical parameters of the particles aggregate in the recurring calculations of spectrum by MSTM method enabled us to determine statistical characteristics of the aggregate: the average distance between particles, average size, and size distribution of the particles. The fitting strategy of the SPR spectrum presented here can be applied to nanoparticles of any nature and in various substances, and, in principle, can be extended for particles with non-spherical shapes, like ellipsoids, rod-like and other T-matrix-solvable shapes.

Alpha-lipoic acid differently affects the reserpine-induced oxidative stress in the striatum and prefrontal cortex of rat brain.

Antioxidative properties of alpha-lipoic acid (LA) are widely investigated in different in vivo and in vitro models. The aim of this study was to examine whether LA attenuates oxidative stress induced in rats by reserpine, a model substance frequently used to produce Parkinsonism in animals. Male Wistar rats were treated with reserpine (5 mg/kg) and LA (50 mg/kg) separately or in combination. The levels of reduced glutathione (GSH), glutathione disulfide (GSSG), nitric oxide (NO) and S-nitrosothiols as well as activities of glutathione peroxidase (GPx), glutathione-S-transferase (GST) and L-gamma-glutamyl transpeptidase (gamma-GT) were determined in the striatum and prefrontal cortex homogenates. In the striatum and prefrontal cortex a single dose of reserpine significantly enhanced levels of GSSG and NO but not that of S-nitrosothiols when compared with control. In the striatum, LA administered jointly with reserpine markedly increased the concentration of GSH and decreased GSSG level. In the prefrontal cortex, such treatment produced only an increasing tendency in GSH level but caused no changes in GSSG content. In both structures LA injected jointly with reserpine markedly decreased NO concentrations but did not cause significant changes in S-nitrosothiol levels when compared with control. Enzymatic activities of GPx and GST were intensified by LA in the striatum. In the prefrontal cortex, GPx activity was not altered, while that of GST was decreased. Gamma-GT activity was attenuated by reserpine in the striatum while LA reversed this effect. Such changes were not observed in the prefrontal cortex. The mode of LA action in the striatum during the reserpine-evoked oxidative stress strongly suggests that this compound may be of therapeutic value in the treatment of Parkinson's disease.

Evaluation of third trimester uterine artery flow velocity indices in relationship to perinatal complications.

OBJECTIVE: Uterine artery Doppler is becoming a routine part of pregnancy surveillance in high-risk pregnancies. Which blood flow velocity waveform index to measure is debated and the 'notch' in early diastole is not widely accepted, as it is a subjective measure. The aim of the present study was to evaluate the different indices in the prediction of adverse outcome of pregnancies suspected for intrauterine fetal growth restriction (IUGR). METHODS: Uterine artery blood flow was recorded in 217 pregnancies admitted for Doppler ultrasound surveillance due to suspected IUGR. The median gestational age at examination was 38 weeks (range 25-42 weeks). Only cases having bilateral uterine artery notching were included in the evaluation. The uterine artery Doppler spectrum was analyzed for different indices, including evaluation of notch and end-diastolic velocities. Umbilical artery Doppler velocimetry was also performed. The outcome variables chosen were: a small-for-gestational-age (SGA) newborn, preterm birth, and abdominal delivery. ROC-curve calculations were used to compare the different indices. RESULTS: The uterine artery blood velocity pulsatility index (PI) and resistance indices (RI) were the best predictors of adverse outcome of pregnancy. Apart from premature birth, the systolic/end-diastolic ratio was less predictive of adverse outcome. The indices including only diastolic blood velocities were the least predictive of adverse outcome. The group with notch velocity above end-diastolic velocity was compared with those having notch velocity below the end-diastolic velocity. No difference in outcome was seen between the two groups. CONCLUSIONS: RI and PI as measures of third trimester utero-placental vascular impedance are the best predictors of adverse outcome of IUGR-suspected pregnancies.

Blood pressure and arterial stiffness in patients with high sodium intake in relation to sodium handling and left ventricular diastolic dysfunction status.

In a population with high sodium consumption, we assessed relation between brachial and central blood pressures, elastic properties of large arteries, echocardiographic left ventricular diastolic function and sodium reabsorption as fractional urinary lithium excretion in proximal (FELi) and fractional sodium reabsorption in distal tubules assessed using the endogenous lithium clearance. Mean±s.d. age of 131 treated hypertensive patients (66 men and 65 women) was 61.9±7.5 years. We found significant interaction between left ventricular diastolic function and FELi with respect to the values of brachial blood pressure: systolic (SBP), diastolic (DBP) and mean blood pressure (MBP) (all PINT<0.03). In patients with FELi below the median value and impaired left ventricular diastolic function, the values of SBP (149.3 vs 132.5 mm Hg; P=0.005), DBP (85.1 vs 76.1 mm Hg; P=0.001), MBP (106.5 vs 94.9 mm Hg; P=0.001), central SBP (SBPC) (137.4 vs 122.0 mm Hg; P=0.01), central DBP (DBPC) (84.8 vs 76.0 mm Hg; P=0.003), central MBP (MBPC) (106.9 vs 95.9 mm Hg; P=0.007), aortic pulse wave augmentation (18.0 vs 13.5 mm Hg; P=0.03), pulse wave velocity (14.6 vs 12.5 m s(-1); P=0.02) and central aortic pulse wave augmentation index (155.7% vs 140.9%; P=0.01) were significantly higher than in patients with normal left ventricular diastolic function. Such relationships were not observed in the entire group and patients with FELi above the median value. In the hypertensive population with high sodium intake, increased sodium reabsorption in proximal tubules may affect blood pressure parameters and arterial wall damage, thus contributing to the development of left ventricular diastolic function impairment.

High-dose chemotherapy as salvage treatment for seminoma.

Between October 1989 and February 1997, 13 patients with refractory or relapsed seminomas were treated with high-dose chemotherapy (HDCT) as part of consecutive phase I/II studies. Six patients had failed prior cisplatin-based first-line treatments and seven patients had also failed cisplatin-based salvage treatments. After HDCT 4/12 (33%) patients became disease-free, 4/12 (33%) patients achieved partial remissions and 4/12 (33%) patients suffered progressive disease despite HDCT. One patient developed multiorgan failure and died. With a median follow-up of 4.5 years (range 3.4 to 8 years) five patients (38%) are alive and eight patients (62%) have died. Patients with non-pulmonary visceral metastases, with short relapse-free intervals and with cisplatin-refractory tumors were more likely to fail. HDCT can be curative in seminoma patients even if offered as second salvage treatment.

Factors affecting color Doppler energy ultrasound recordings in an in-vitro model.

Compared to conventional color Doppler ultrasound imaging, the new color Doppler modality "color Doppler energy" (CDE) has improved the possibility of visualizing blood vessels having low blood-flow velocities, but appears to be influenced by the settings of the ultrasound instrument and motion artefacts. The aim of this methodological study was to evaluate the effects of the different factors on the CDE signal. The CDE mode of a commercially available ultrasound system (Acuson 128 XP) was tested in an in vitro study. The effect of depth, angle of insonation, flow velocity, instrument power output, gain and other instrument settings were evaluated. The CDE signals obtained were stored on videotape and subsequently subjected to off-line computer analysis. The CDE signal intensity was found to be influenced mainly by fluid flow velocity, but was also affected by depth and instrument settings. Gain and power had, however, limited influence in this setting. Thus, the intensity of the CDE signal is influenced by several factors. Our results emphasize the need for optimum fixed preinstalled instrument settings when attempting to quantify organ perfusion by use of this new technique.

The effect of different regimens of oestrogens on the clotting and fibrinolytic system of the post-menopausal woman.

The effects of six different regimens of hormone replacement therapy on coagulation, fibrinolysis and platelet aggregation were sudied in 33 symptomatic, post-menopausal women. Studies were performed before and after 3 months of therapy in the six treatment groups, Premarin, Progynova, Harmogen, Serial 28, ethynodiol diacetate and a testosterone and oestradiol implant. No changes in any parameter were detected following administration of Premarin, Progynova or an implant of testosterone and oestradiol. Serial 28 produced a significant increase in plasminogen concentration and increased the extent of platelet aggregation in 0.5 micron adrenalin solution. Harmogen produced an increase in the extent of platelet aggregation in 1.0 micron adrenalin solution, but a decrease in the rate of platelet aggregation in 1.0 micron solution. Ethynodiol diacetate caused a significant decrease in the kaolin-cephalin clotting time but decreased the extent of platelet aggregation in 0.5 and 1.0 micron solutions of adrenalin. FDPs developed following therapy in 9 of the 33 patients. These were evenly distributed between the groups. No patients had any change in anti-Xa concentration, platelet count or platelet aggregation in thrombin.

Two types of umbilical venous pulsations and outcome of high-risk pregnancy.

Normally, blood flows evenly in the umbilical vein, without fluctuation. A pulsating pattern has been reported during fetal heart failure and asphyxia. Recently we have noticed two types of pulsating pattern; its relationship to adverse outcome is unclear. In a prospective multicenter study, recording of umbilical cord venous blood flow was conducted in high-risk pregnancies admitted for routine artery Doppler. In cases of pulsating flow or signs of vascular resistance in the umbilical artery, the examination was extended to the intra-abdominal part of the umbilical vein. Venous pulsation, single or double, were noted and correlated to perinatal outcome. Venous flow pulsatility was noted in 83 fetuses during 2 years, 26 had a double pulsating pattern, which was closely related to increased vascular resistance in the umbilical artery and perinatal mortality. A single pulsating venous pattern in one location had a good prognosis. In conclusion a double pulsating venous pattern, especially if extending to the cord, is an ominous finding in high-risk pregnancy associated with poor perinatal outcome. A single pulsating pattern predicted a much better outcome and might be an indication for delivery in the high-risk case.

Middle cerebral artery velocimetry as a predictor of hypoxemia in fetuses with increased resistance to blood flow in the umbilical artery.

About half of all fetuses with increased resistance to blood flow, but with still detectable diastolic blood velocity in the umbilical artery (UA), show signs of imminent asphyxia during labour indicating a need for operative delivery. Fetal brain-sparing during hypoxia is characterized by an increase in diastolic and mean blood flow velocity in the middle cerebral artery (MCA). The aim of this study was to assess whether MCA blood velocity in pregnancies with increased resistance to blood flow in the feto-placental circulation could predict the development of fetal asphyxia during labour. Fifty pregnant women with signs of increased feto-placental vascular resistance between 31 and 42 weeks of gestation were studied serially by Doppler ultrasound and the last examination was correlated to perinatal outcome. The MCA pulsatility index (PI), cerebroplacental PI ratio and mean MCA blood velocity were calculated and correlated to fetal outcome. Fetal brain-sparing was defined as MCA PI < mean -2 S.D., cerebroplacental PI ratio < 1.08 and mean MCA blood velocity >mean + 2 S.D. No significant association was found between signs of fetal brain-sparing and the perinatal outcome. Among fetuses with signs of increased resistance to flow in the umbilical artery, velocimetry of the middle cerebral artery did not identify those that would not withstand the strain of labour.

Ductus venosus velocimetry in high-risk pregnancies.

OBJECTIVE: Umbilical venous (UV) blood velocity pulsations have been considered as a late sign of fetal hypoxemia in high-risk pregnancies. Ductus venosus (DV) functions as a pressure filter as it conducts umbilical blood into the inferior vena cava of the fetus. The aim of this paper was to evaluate whether DV Doppler velocimetry might give earlier indication of fetal hypoxemia than does UV blood velocity. DESIGN: Recording of DV blood velocity in complicated pregnancies referred for umbilical artery (UA) velocimetry as one aspect of fetal surveillance. METHOD: DV and UV blood velocities were recorded serially by Doppler ultrasound in 87 high-risk pregnancies and the results of the last examination before delivery were correlated to perinatal outcome. RESULTS: Abnormal DV blood velocity waveforms recorded in 26 pregnancies were not correlated to perinatal outcome, except for low Apgar score at one minute of life. Abnormal UV blood velocity pulsations in the cord were recorded in 11 fetuses, of which only 6 had abnormal DV velocimetry. UV pulsations were related to adverse perinatal outcome and all these fetuses had abnormal UA velocimetry. CONCLUSION: Abnormal DV blood velocity is more frequently recorded in high-risk pregnancies than UV pulsations, but appears to be a poor indicator of adverse perinatal outcome.

Blood velocity in the fetal vein of Galen and the outcome of high-risk pregnancy.

BACKGROUND: Pulsation in the flow velocity waveform in the umbilical vein is related to perinatal mortality but the flow velocity waveform in the fetal vein of Galen is normally even and without fluctuation. OBJECTIVES: To establish whether blood flow velocity pulsations in the vein of Galen in high-risk pregnancies are related to outcome. STUDY DESIGN: The vein of Galen was located by colour Doppler ultrasound in 102 pregnancies complicated by severe pregnancy-induced hypertension. The blood velocity waveform was recorded by pulsed Doppler within 2 days of delivery and the presence pulsations related to pregnancy outcome, including emergency operative intervention and neonatal distress. Umbilical artery and vein and uterine artery blood flow velocity waveform were also recorded at the same time. The clinicians managing the women were unaware of the venous flow results. RESULTS: Pulsation were present in the vein of Galen in 68 cases and in the umbilical vein in 21. Both were significantly related to adverse outcome. Pulsations in the vein of Galen were seen in all seven perinatal deaths. CONCLUSIONS: Since umbilical venous pulsation are a late sign of fetal compromise, and pulsations in the vein of Galen seem to appear earlier, thus being an intermediate sign of fetal compromise that might be of great value for fetal surveillance.

Quality monitoring, standardized documentation and management with a computerized system in oncology.

Within the last years the prerequisite was prepared to develop a computerized tumor--patient documentation system including quality monitoring and oncological therapy recommendations for every day use. In medicine today, there is an increasing need for quality oriented low cost and transparent management--what is especially true in the field of oncology. The German Federal Authority of Health demands the documentation of all tumor disorders for the establishment of an cancer registry. For these reasons our study group established the program "OncoDoc" in cooperation with the laboratory for Artificial Intelligence of the University Bremen.

[The use of color Doppler ultrasonography in the diagnosis of benign breast tumors]. / Zastosowanie techniki koloroweo Dopplera w diagnostyce Lagodnych schorzen gruczolu sutkowego.

The paper describes Color Doppler Velocity (CDV) technique with clinical implications in examinations of patients with benign breast lesions. Results suggest that CDV might be useful in differentiation of the breast lesions in routine clinical work.

[Evaluation of the clinical value in doing complex analysis of blood flow velocity parameters of the umbilical artery for determining prognosis of fetal status]. / Ocena wartosci klinicznej kompleksowej analizy parametrów przeplywu krwi w tetnicy pepowinowej w prognozowaniu stanu plodu.

Complex analysis of the clinical value of the doppler flow indices was undertaken. A/B, RI and PI were compared separately and in different combinations with fetal status and neonate's condition. Statistical analysis revealed that complex and detailed analysis of few quality indices is of greater clinical value and increases sensitivity, specificity and positive predictive value of the doppler technique in the sense of prognosis of fetal distress and neonate's condition.

[Evaluation of using the B-mode color system in sonomammography with computer analysis of images compared with conventional gray scale modalities]. / Ocena zastosowania systemu B-mode color w sonomammografii wraz z komputerowa analiza obrazów uzyskiwanych w tym systemie w porównaniu z konwencjonalna skala szarosci.

The paper describes B-mode color and B-tag modalities with clinical implications in breast examinations. New color techniques show increased sensitivity of the human eye to color pictures compared to gray scale levels. Computer analysis of pictures obtained in color mode and gray scale supports these findings.

[Predictive value of absent or reverse end-diastolic blood flow in the umbilical artery in the diagnosis of fetal distress]. / Wartosc prognostyczna zaniku lub odwrócenia koncowo-rozkurczowego przeplywu krwi w tetnicy pepowinowej w diagnostyce zagrozenia plodu.

To examine the significance of the absence of reverse of end-diastolic (ARED) velocity in umbilical artery, outcome of pregnancy in 24 women with this complication was evaluated. Acute or chronic hypoxia was evident in 87.5% fetuses with ARED. Such situation is a definable high-risk state that demands intensive surveillance.