[V. A. C. INSTILL® therapy - new option in septic thoracic surgery]. / V. A. C.-INSTILL®-Therapie - neue Wege in der septischen Thoraxchirurgie.

BACKGROUND: The V. A. C. INSTILL® therapy is an innovative process for treating chronic wounds that are not optimally accessible to a systemic antibiotic therapy or infected with multi-resistant pathogens. We report on our first experience and applications of V. A. C. INSTILL® therapy in the field of septic thoracic surgery. MATERIALS AND METHODS: V. A. C. INSTILL therapy was used in 11 cases between 11/2009 and 01/2012. Three patients had sternum osteomyelitis (2 MRSA, 1 Finegoldia magna). In 3 patients chronic pleural empyema after lobectomy (1 Streptococcus viridans, 1 mixed infection with MRSA among others) and after pneumectomy (1 MRSA) were detected. In 2 cases there was an acute pleural empyema with extensive phlegmona in the region of the thoracic soft tissues (2 streptococci). In 1 patient a chronic pleural empyema with MRSA infection was treated. Septic arthritis of the sternoclavicular joint with joint destruction and extensive phlegmona in the region of the cervical soft tissues (1 Streptococcus pneumoniae, 1 Staphylococcus aureus) was treated in 2 patients. In all cases instillation of the wound was performed with Lavasept 0.2 %. Swabs of the wound were taken before starting and after ending V. A. C. INSTILL® therapy as well as before wound closure. RESULTS: Mean patient age was 48.8 ± 18.9 years. V. A. C. INSTILL® therapy was performed for 6.5 ± 1.7 days. Instillation time amounted to 21.7 ± 5.7 s. The duration of action was standardised at 18 min in all cases. In 2 cases (1 MESA, 1 finegoldia) the V. A. C. INSTILL® therapy was repeated. In 10 patients a sterile wound status was achieved before secondary wound closure. All wounds underwent secondary closure without recurrence. CONCLUSIONS: Chronic osteomyelitis with MRSA infections as well as chronically infected residual cavities after empyema surgery and extensive phlegmona are possible indications for V. A. C. INSTILL® therapy in order to help eradicating the infection as quickly and as completely as possible.

Selenium metabolism and supplementation in patients with muscular dystrophy.

We studied selenium metabolism in patients with Duchenne muscular dystrophy and in contrast to previous reports found no significant abnormalities in these patients. Supplementation of muscular dystrophy patients and control subjects with sodium selenite (1 mg selenium/day) induced a variable rise in the activity of the selenium-dependent enzyme glutathione peroxidase in plasma and red cells, but no significant change in muscle glutathione peroxidase activities. There was no effect of selenium supplementation on disease activity in the patients with muscular dystrophy. Thiobarbituric acid-reacting substances (an index of free radical-mediated lipid peroxidation) were elevated in the muscle of patients with Duchenne muscular dystrophy in contrast to patients with other forms of muscular dystrophy and control subjects. This elevation was unaffected by selenium supplementation.

Hirsutism-skeletal dysplasia-mental retardation syndrome with abnormal face and a uric acid metabolism disorder.

We report on a German boy, born to nonconsanguineous parents, with an apparently new combination of multiple congenital anomalies including extraordinary hirsutism, marked brachycephaly, abnormal position of thumbs, pedes excavati with claw-toes, an abnormal face, and mental retardation. Additionally the boy manifests a disorder of uric acid metabolism. This sporadic case may represent a new syndrome due to a fresh autosomal or X-linked mutation, or chance-isolated case due to segregation of an autosomal recessive gene.

Trace element concentrations (Cu, Zn, Fe) in sera from patients with dilated cardiomyopathy.

The trace element concentrations (Cu, Zn, Fe) in sera from patients with dilated cardiomyopathy are reported. Patients with dilated cardiomyopathy have high copper and low zinc concentrations in serum compared to healthy controls. The trace element concentration profile is different from that of other heart diseases like myocardial infarction and coronary heart disease. The copper concentration in serum shows a highly significant inverse relationship with the ejection fraction and the cardiac index. Pathophysiological processes which raise the copper concentration in serum may influence the ejection fraction and the cardiac index.

The aluminium content of human serum determined by atomic absorption spectroscopy with a graphite furnace.

A method is described for the determination of aluminium in serum by atomic absorption spectroscopy with a graphite furnace. The serum sample is diluted with a diluent of Triton X-100 and HNO3. The dilution enables shorter drying and charring times and a lower charring temperature. The detection limit of the method is 2.5 microgram Al/l serum. Precautions for sample handling are discussed and instrument settings are defined. The direct determination of aluminium in serum is compared with the standard addition method. A good correlation between the two methods was found. Serum from 37 healthy persons was investigated. The serum contained less than 4 microgram Al/l with a range of less than 2.5 microgram to 7 microgram Al/l. The aluminium content of 50 serum samples from hemodialysis patients was determined. The aluminium content of the serum of the hemodialysis patients was in the range of 8 to 713 microgram Al/l. A mean value of 87.7 microgram Al/l (S.D. 122.8) was found.

A methodological comparison of hydride and carbon furnace atomic absorption spectroscopy for the determination of selenium in serum.

Two methods based on different chemical and physical principles for the determination of selenium in serum are elaborated, evaluated and compared--the hydride atomic absorption (AAS) technique and the carbon furnace technique. For the hydride AAS technique a wet destruction method is described. The sensitivity of the method is 10 micrograms Se/1. The carbon furnace technique makes use of the fact that selenium forms refractory selenides when nickel compounds are added. The sensitivity of the carbon furnace technique is 11 micrograms Se/1. The determination of selenium in serum by the hydride AAS and carbon furnace technique correlates satisfactorily (correlation coefficient 0.94; mean value for the hydride AAS 69.1 micrograms Se/1; mean value for the carbon furnace 67.4 micrograms Se/1) indicating that with the carbon furnace technique total selenium (inorganic and organic) is determined. A reference range was established with 99 persons (42 men and 57 women) which show an average selenium content in serum of 80.55 (SD 13.78) micrograms Se/1 [1.02 (0.17) mumol Se/1].

Congestive cardiomyopathy and the selenium content of serum.

A deficiency of selenium is suspected to be involved in the pathogenesis of congestive cardiomyopathy. Therefore the serum selenium content of 20 patients with proven congestive cardiomyopathy was measured and compared to that of a healthy control group. The serum selenium content of the patients with cardiomyopathy was found to be different from that of the healthy control group. The mean value of selenium in serum for the control group was 80.1 micrograms Se/1 (SD +/- 13.2) within a range of 53 and 117 micrograms Se/1. From the 20 patients with congestive cardiomyopathy six patients showed selenium concentrations in the normal value range of the control group; in the serum of 14 patients a distinct lower selenium content was found (mean value 47.8 micrograms Se/1 (SD +/- 16.2)) within a range of 23 and 70 micrograms Se/1. A positive correlation was found between serum selenium content and the left ventricular ejection fraction. Our results suggest that a deficiency of selenium may be present in a number of patients with congestive cardiomyopathy.

Increase in proto-oncogene raf expression precedes differentiation induction in different clonal rhabdomyosarcoma subpopulations.

Three clonal rat rhabdomyosarcoma subpopulations (A, B, C) with a block of differentiation at different levels of rhabdomyogenesis were exposed to the differentiation inducers retinoic acid (RA), N-methylformamide (NMF) and sodium butyrate (NaBut). Since an increased expression of c-raf and c-fos had recently been demonstrated for subpopulation C after exposure to RA and NMF (1), the mRNA expression of c-raf, c-fos and retinoic acid receptor (RAR) alpha, beta and gamma was compared in all three subpopulations. After exposure to RA, NMF or NaBut, subpopulation C exhibited a significant (p = 0.0001) increase in creatine kinase (CK) activity and in morphological differentiation. In subpopulation B, the response was confined to a significant (p = 0.0001) increase in creatine kinase activity, whereas subpopulation A proved to be differentiation-refractory. On the molecular level, a uniform increase in c-raf expression became evident in all three subpopulations after 6 to 12 hours, persisting at an elevated level throughout the observation period of 120 hours. In contrast, the pattern of c-fos expression observed after exposure to RA, NMF or NaBut was heterogeneous. Expression of RAR alpha and gamma was detected in all subpopulations, whereas RAR beta mRNA was not expressed. Summarizing our results, the uniform pattern of c-raf expression might suggest a participation of c-raf in differentiation signal transduction. Since the three subpopulations differ markedly in their degree of differentiation, the block of differentiation characteristic for each subpopulation supposedly becomes effective only after the action of the c-raf gene product.

Bronchopleural fistula in the surgery of non-small cell lung cancer: incidence, risk factors, and management.

BACKGROUND: The incidence of a bronchopleural fistula (BPF) as a major complication after non-small cell lung carcinoma (NSCLC) surgery has decreased in recent years, due to new surgical refinements and a better understanding of the bronchial healing process. We reviewed our most recent experience with BPFs and tried to determine methods which may effectively reduce its occurrence. METHODS: Data on 490 patients with lung resections for NSCLC over a period from 1990 to 1999 were retrospectively reviewed. Details regarding surgery and the subsequent treatment were carefully reviewed. Particular attention was paid to factors possibly affecting the occurrence of BPFs: the technique of the initial bronchial closure, previous radiation and/or chemotherapy, need for postoperative ventilation and presence of residual carcinomatous tissue at the bronchial suture line. Information about age, sex, clinical diagnosis, associated conditions, TNM stage, period between primary operation and rethoracotomy and postoperative outcome was also recorded. RESULTS: The overall BPF incidence was 4.4% (22/490). There were 21 (95.5%) males and 1 (4.5%) female, mean age was 57.8 years. BPFs occurred after pneumonectomy in 12 (54.6%), after lobectomy in 9 (40.9%) patients and after sleeve resections in 1 (4.5%) patient. Mortality rate was 27.2% (6/22). Right-sided pneumonectomy and postoperative mechanical ventilation were identified as risk factors for BPFs (p<0.05). Initial chest re-exploration was performed in 20 (90.9%) patients. After debridement, the bronchial stump was reclosed by hand suture in 10 (45.4%) patients. All 10 (45.4%) patients with a post-lobectomy- and sleeve resection BPF necessitated completion surgery. The BPF was additionally covered with a vascularized flap in 20 (90.9%) patients. In 2 (9%) patients with small BPFs and poor overall condition the initial treatment was endoscopic. In both the fistula persisted and the stump had to be surgically resutured. CONCLUSIONS: A BPF remains a major complication in the surgery of NSCLC because of its high mortality and morbidity rate. A BPF is more common after right-sided pneumonectomy and is frequently associated with postoperative mechanical ventilation. The management varies according to the initial type of surgery, the size of the BPF, the overall patient condition and that of the remaining lung. Endoscopic treatment is reserved only for small fistulas associated with poor general condition.

The renal excretion of selenium.

The excretion of selenium in urine was determined in West German healthy volunteers. Women excrete 17.7 +/- 4.2 micrograms Se/d and men 19.0 +/- 9.0 micrograms Se/d. The daily selenium excretion per gram creatinine is 13.5 +/- 3.8 micrograms Se/g crea for women and 9.8 +/- 3.3 micrograms Se/g crea for men. The clearance of selenium from the plasma is calculated with 0.18 mL/min. The selenium excretion per day is positively correlated with the 24 h excretion of urea and creatinine. The correlation of the selenium excretion with the urea excretion is most probably owing to the fact that the selenium intake of West Germans is linked primarily to foods with high protein contents. That the selenium excretion is directly correlated with the creatinine excretion is an indicator that the muscle, which accounts for nearly 50% of the whole body selenium in West German adults, influences the selenium excretion in urine. The positive correlation of the selenium excretion with the potassium excretion also indicates that the muscle mass contributes significantly to the selenium excretion in urine. Another indicator that the selenium excretion is influenced by the muscle is that after intensive muscular activity (running), selenium excretion is enhanced. The 24 h selenium excretion is dependent on the glomerular filtration rate of the kidney characterized by the creatinine clearance. This result is important, because if the selenium excretion is used as parameter for the selenium status of humans, the kidney function should be known. This is a limitation for the use of the urinary selenium excretion as parameter for the selenium status. This is especially important for patients whose glomerular filtration rate is low. The 24 h selenium excretion is further influenced by the 24 h urine volume. Selenium losses via urine may be concomitant with protein losses in urine.

Selenium and cardiovascular disease.

For humans, ecological and epidemiological results are reported that show a relationship between the serum selenium concentration and cardiovascular disease in populations where low serum selenium concentrations are found, e.g., in Eastern Finland. From clinical studies done in Germany (FRG and GDR), Finland, and Sweden, subnormal serum selenium and partially whole blood selenium concentrations are reported in patients with acute myocardial infarction. For patients with coronary arteriosclerosis, subnormal serum selenium concentrations are reported from the USA and Germany and subnormal whole blood selenium concentrations from Germany. Subnormal serum and subnormal whole blood selenium concentrations of patients with cardiomyopathy are reported from non Keshan disease affected areas in Germany, France, and China. In selenium deficiency, an accumulation of lipid peroxides in the heart may occur, especially under ischemic conditions and if ischemic tissue is reperfused. Lipid peroxides in the heart may damage the cell membrane and may lead to an impaired calcium transport with an uncontrolled calcium accumulation in the cell. This may result in an activation of phospholipids, and, in consequence, to an enhanced formation of arachidonic acid. An increased concentration of lipid peroxides owing to selenium deficiency may shift the prostaglandin synthesis from prostacyclin to thromboxane, causing enhanced blood pressure and platelet aggregability. From animal experiments, it is known that selenium protects against cardiotoxic elements, cardiotoxic xenobiotics, and viral infections that affect the heart. Selenium deficiency may also be a secondary factor in the causation of hypertension and myocardial ischemia.

The daily dietary selenium intake of West German adults.

The selenium content of food consumed in the Federal Republic of Germany (FRG) was determined for the estimation of the dietary selenium intake of West German adults. The daily dietary selenium intake of men is 47 micrograms (micrograms) and that of women 38 micrograms, corresponding to 0.67 microgram/kg body weight per day for both men and women. Animal protein is the main source of dietary selenium, accounting for 65.5% of the total selenium intake. Pork contributes 25.1% to the total Se intake, reflecting the current consumption and the selenium supplementation of feedstock rather than the availability of selenium from natural dietary sources. The selenium intake of adults in West Germany is only slightly higher than in New Zealand, Finland, and Italy, nearly equal to that in Belgium and France, and distinctly lower than in Great Britain, the USA, Canada, and Japan.

The organ distribution of selenium in German adults.

The selenium concentrations were determined in liver, kidney, skeletal muscle, heart, brain, prostate, testis, bile, lung, and spleen of German traffic accident victims. In addition, the nitrogen and phosphorus contents were determined in the same organs and tissues. On a per-weight unit basis, the highest selenium concentration was found in kidney. However, this corresponds to only 4% of the total body selenium. Most of the whole body selenium (50%) is present in skeletal muscle, which thus appears to act as a selenium storage organ. However, there is also evidence that selenium is required for muscle function. In plasma and interstitial fluid, .450 mg of Se, or 7.5% of the total body selenium is present. A comparison of the organ Se concentrations of the German traffic accident victims with the selenium concentrations of the same human organs as reported in different countries indicates that the organ concentrations of West Germans are comparable to that of the population of New Zealand, a low-Se country, and significantly lower than that observed in the organs of American, Canadian, and especially Japanese subjects. The international comparison of the organ selenium concentrations also revealed that the selenium uptake of kidney is higher at low- and adequate dietary Se intakes and lower if the dietary Se supply is high, as is the case for Japanese subjects. Estimates of the daily excretion of selenium with the bile indicate that the amounts are three times higher than the daily urinary losses and in the same order of magnitude as the daily dietary selenium intakes. Enterohepatic reabsorption of selenium from the bile appears to be a significant mechanism of conserving dietary selenium and to maintain Se balance at comparatively low dietary Se intakes.

Correlations of blood selenium with hematological parameters in West German adults.

The serum selenium and the whole blood selenium of 72 healthy persons (47 women, 25 men) was determined. There exist sex specific differences of the whole blood selenium between men (98 +/- 19 micrograms Se/L) and women (89 +/- 17 micrograms Se/L). The serum selenium did not show sex specific differences, but sex specific differences are found if the total amount of extracellular selenium is calculated by correction of the serum selenium with the hematocrit. Women have more extra-cellular selenium/L whole blood (40 +/- 8 micrograms Se) than men (36 +/- 7 micrograms Se). Men have more intraerythrocyte selenium (cellular selenium = 67 +/- 14 micrograms Se) in one L whole blood than women (52 +/- 17 micrograms Se). There exist also sex specific differences if the cellular selenium is calculated/g hemoglobin (men .44 micrograms Se/g Hb, women .37 micrograms Se/Hb) or per erythrocyte (men 136.1 x 10(-19) g Se/Ery, women 113.9 x 10(-19) g Se/Ery). In the cellular compartment of one L whole blood on the average 1.56 times more selenium is present than in the extracellular compartment. Most of the intraerythrocyte selenium is hemoglobin bound (84%) and utmost 16% glutathione peroxidase associated. An erythrocyte contains about 3500 mol glutathione peroxidase, or, for every 80000 mol hemoglobin one mol glutathione peroxidase. A standard man needs about 2.5 micrograms selenium/d for the synthesis of the hemoglobin and the erythrocyte. The hematological parameters hemoglobin and the erythrocyte number are correlated with the cellular selenium and the ratio cellular selenium/extracellular selenium. Positive significant correlations are found that are best if a parabolic model is used to interpret the shape of the curves. From the shape of the best correlation lines it can be concluded that selenium may be beneficial for hemoglobin synthesis and erythropoesis. The extracellular selenium may have influence on the volume of the erythrocyte by protecting the outer erythrocyte membrane from lipid peroxidation. A method is reported based on the carbon furnace atomic absorption spectroscopy, which is able to determine without wet digestion selenium in whole blood.

[The direct determination of mercury in urine by cold vapor atomic absorption spectroscopy (author's transl)]. / Zur direkten Bestimmung von Quecksilber im Urin nach der Kaltdampf-Atomabsorptionsspektrometrie-Methode.

A method is described for the determination of mercury in urine by atomic absorption spectroscopy. The organically bound mercury is oxidized by treatment of the urine with KMnO4, followed by dilution with a mixture of HNO3 and H2SO4. The sample is then treated with NaBH4 to release the mercury vapor. This procedure measures total mercury (inorganic and organically bound) in the urine. The method was compared with the standard addition method and with the determination after wet digestion with concentrated HNO3. A good correlation was found between the three methods. Other organic and inorganic compounds present in urine do not interfere. Using 1 ml urine samples, the detection limit is 2 micrograms/l Hg. Sensitivity is also 2 micrograms/l Hg. Urinary mercury in a non-exposed population (30 men, 30 women) was found to be less than 4 micrograms/l Hg.

The arsenic content of human semen.

Arsenic concentration was measured by atomic absorption spectrometer in ejaculates of 13 subfertile men, 6 control individuals and pool-ejaculate of 24 further andrological patients. While the detection limit was 1 microgram/l, arsenic concentration amounted to 2 micrograms AS/l in ejaculates. In the cellular fractions of seminal fluid, concentration of arsenic was under the detection limit. Arsenic concentration of smokers and non-smokers did not differ.

Purification of histone F3 by covalent chromatography.

The arginine-rich histone F3 has been purified by covalent affinity chromatography. By the use of activated Thiol-Sepharose 4B for the purification of cysteine containing histone F3 a highly purified protein was obtained. The simple purification procedure offers the opportunity to get larger amounts of pure histone F3 within short time.