Asymptomatic venous thrombosis in cancer patients--a problem often overlooked. Results of a retrospective and prospective study.

BACKGROUND: Venous thrombosis with and without pulmonary embolism is a frequent complication of malignancies and second among the causes of death in tumour patients. Its incidence is reported to be 10 to 15%. Since for methodological reasons, this rate can be assumed to be too low and to disregard asymptomatic venous thrombosis, a combined retrospective and prospective study was performed to examine the actual frequency of venous thrombosis in tumour patients. PATIENTS AND METHODS: The histories of 409 patients (175 women, 234 men, mean age 69 years [19 to 96 years]) with different tumours, consecutively enrolled in the order of their altogether 426 inpatient treatments, were checked in retrospect for the frequency of venous thrombosis and pulmonary embolism. Subsequently, 97 tumour inpatients (36 women, 61 men, mean age 70 years [42 to 90 years]) were systematically screened, by means of duplex sonography and/or venography, for venous thromboses in the veins of the pelvis and both legs. RESULTS: In the retrospective analysis, where no systematic screening for thromboses was performed and only symptomatic thrombosis was recorded, venous thrombosis was found in 6.6% of all tumour patients, whereas in the prospective examination with systematic duplex sonography and / or venography of all patients, the percentage was 33%. In the prospective study, 31.3% of venous thromboses were symptomatic and 68.7% asymptomatic. In 39.3% of the cases in the retrospective analysis and 25% in the prospective analysis, venous thrombosis occurred during chemotherapy, surgery or radiation therapy. Venous thrombosis was most often seen in metastasizing tumours and in colorectal carcinoma (40%), haematological system diseases (28.6%), gastric cancer (30%), bronchial, pancreas and ovarian carcinoma (28.6%), and carcinoma of the prostate (16.7%). CONCLUSION: Regular screening for thrombosis is indicated even in asymptomatic tumour patients because asymptomatic venous thrombosis is frequent, can lead to pulmonary embolism and has to be treated like symptomatic venous thrombosis. This is particularly true for metastasization during chemotherapy, surgical interventions, or radiation.

Auditory evoked responses in control subjects and in patients with problem-tinnitus.

Auditory brainstem responses (ABRs) and middle latency responses (MLRs) recorded from problem-tinnitus patients were compared with responses from normal hearing, hearing loss, and elderly subjects. Ten stimulus frequencies were presented in counterbalanced sequence and all frequencies were presented before any given frequency was presented again. The variables of importance were problem-tinnitus, hearing loss, subject age and stimulus frequency. Repeated measures analysis of variance showed a significant difference only in the latency of ABR wave 7. The intrinsically high variability in the problem-tinnitus and elderly groups rendered standard statistical analyses ineffective with the sample sizes used. Alternative analyses were employed in which the MLR waves of the normal hearing subjects were taken as the standard against which the other groups were compared. Very large MLR waves occurred in some, but not all, of the subjects in the problem-tinnitus and elderly groups. Different MLR waves were large in different subjects without correspondingly large ABR potentials. These results suggest: (1) selective alteration of MLR generators in different forms of tinnitus; and (2) differing effects of age on auditory physiology. Stimulus frequency and hearing loss contributed to this multivariate picture. Another variable, the average sound pressure level of the long-term acoustic environment, may also be important.

Frequency of asymptomatic peripheral arterial disease in patients entering the department of general and internal medicine of a general-care hospital.

BACKGROUND: The fact that a high prevalence of asymptomatic peripheral arterial disease (PAD) in the population has repeatedly been noted in recent years, without there being data as to how often asymptomatic PAD has to be anticipated in inpatients treated for divergent internal diseases led us now to performing a screening study in a general-care hospital. PATIENTS AND METHODS: The study population consisted of 990 patients (51.8% women, 48.2% men) with a mean age of 65.2 years (40-93 years) who had to be treated in a hospital for various internal diseases in the period from January 1994 to January 1995. Their case histories were taken, and their clinical findings and the ankle/brachial indices as calculated from Doppler ultrasonographic measurements of the systolic pressures in the malleolar and brachial arteries were used to ascertain how many of the patients presented with asymptomatic and symptomatic PAD. Further the frequency of risk factors (smoking, hypertension, diabetes mellitus, lipid disorders) was recorded for either patient group. RESULTS: The study showed that 6% of the 990 patients suffered from symptomatic PAD and that of the remaining 931 patients, 43.7% were diagnosed, on the basis of the ankle/brachial index (ABI) (< or = 0.9), to have asymptomatic PAD, while 56.3% showed no indication of PAD. CONCLUSIONS: The high number of cases of asymptomatic PAD among inpatients who underwent internal treatment--a percentage well above the figures published so far for outpatients--allows the conclusion that the determination of the ABI is well suited to screen patients older than 50 years even in a hospital setting so that early secondary prophylaxis can be initiated.

Assessment of a sequential phase extraction procedure for uranium-series isotope analysis of soils and sediments.

The study of uranium-series (U-series) isotopes in soil and sediment materials has been proposed to quantify rates and timescales of soil production and sediment transport. Previous works have studied bulk soil or sediment material, which is a complex assemblage of primary and secondary minerals and organic compounds. However, the approach relies on the fractionation between U-series isotopes in primary minerals since they were liberated from the parent rock via weathering. In addition, secondary minerals and organic compounds have their own isotopic compositions such that the composition of the bulk material may not reflect that of primary minerals. Hence, there is a need for a sample preparation procedure that allows the isolation of primary minerals in soil or fluvial sediment samples. In this study, a sequential extraction procedure to separate primary minerals from soils and sediments was assessed. The procedure was applied to standard rock sample powders (TML-3 and BCR-2) to test whether it introduced any artefactual radioactive disequilibrium. A new step was introduced to remove the clay-sized fraction (<2 µm). Significant amounts (5-14%) of U and Th were removed from the rock standards during the procedure. No significant alteration in ((234)U/(238)U) and ((230)Th/(238)U) activity ratios of the rock standards occurred during the procedure. Aliquots of soil sample were subjected to the sequential extraction process to test how each step modifies the uranium-series activity ratios and mineralogy. Although no secondary minerals were detected in the unleached soil aliquots, the sequential leaching process removed up to 17% of U and Th and modified their activity ratios by up to 3%. The modification of the activity ratios poses a demand for careful means to avoid redistribution of isotopes back to the residual phase during phase extraction.

Magnetic properties of uncultivated magnetotactic bacteria and their contribution to a stratified estuary iron cycle.

Of the two nanocrystal (magnetosome) compositions biosynthesized by magnetotactic bacteria (MTB), the magnetic properties of magnetite magnetosomes have been extensively studied using widely available cultures, while those of greigite magnetosomes remain poorly known. Here we have collected uncultivated magnetite- and greigite-producing MTB to determine their magnetic coercivity distribution and ferromagnetic resonance (FMR) spectra and to assess the MTB-associated iron flux. We find that compared with magnetite-producing MTB cultures, FMR spectra of uncultivated MTB are characterized by a wider empirical parameter range, thus complicating the use of FMR for fossilized magnetosome (magnetofossil) detection. Furthermore, in stark contrast to putative Neogene greigite magnetofossil records, the coercivity distributions for greigite-producing MTB are fundamentally left-skewed with a lower median. Lastly, a comparison between the MTB-associated iron flux in the investigated estuary and the pyritic-Fe flux in the Black Sea suggests MTB play an important, but heretofore overlooked role in euxinic marine system iron cycle.

[Management of Salmonella typhi and paratyphi carriers using Sulprim]. / Zur Behandlung von Thyphus- und Paratyphusausscheidern mit Sulprim.

The sanation of carriers of Salmonella germs by means of bactericidal chemotherapy in combination with cholecystectomy is not to be expected in many patients with older age or when concomitant diseases are present. Therefore was tested, whether an exclusive therapy with trimethoprim-sulphamethoxazol (sulprim) is an effective method for the sanation of carriers of the salmonella germs with renunciation of cholecystectomy. Since 1973 up to now 20 carriers of germs have been treated for 12 weeks with daily 2 X 2 tablets of sulprim. Of these patients 84-year-old female patient died of massive pulmonary.

[Effects of traffic-induced emissions on the pediatric respiratory tract]. / Wirkungen verkehrsbedingter Immissionen auf kindliche Atemwege.

The aim of this study was to investigate the relationship between paediatric pulmonary function and air pollution. For this purpose, 511 primary schoolchildren (mean age 9 years) from areas with different emission data in Austria were submitted to pulmonary function testing every 2 months in the period 1987/1988. Emission data were provided for NO2, SO2, and O3 by permanent measuring stations for the whole of the period under observation. Statistical analysis using the Mantel-Henzel procedure revealed an independent significantly significant effect of NO2 concentration 2 to 6 hours before the function test on the prevalence of obstructive function.

Effectiveness of preoperative sedation with rectal midazolam, ketamine, or their combination in young children.

To determine which of three types of rectal sedation was most effective preoperatively in facilitating parental separation and intravenous cannulation in young children, 100 children 3.0 +/- 1.7 (mean +/- SD) yr of age were randomly assigned to four equal groups. One group (M-K-A) received rectal midazolam (0.5 mg/kg), ketamine (3 mg/kg), and atropine (0.02 mg/kg). The other sedation groups received the same doses of midazolam and atropine (M-A) or ketamine and atropine (K-A) alone, and the control group (A) received only rectal atropine. Most children in either the M-K-A (100%) or M-A (92%) groups separated easily from their parents without struggling or crying, significantly more than in the K-A (60%) or A (64%) groups. However, more children in the M-K-A group (44%) were asleep during separation than in the M-A group (8%; P < 0.05). Only 20% of the children in the M-A or M-K-A groups cried during intravenous catheter placement, significantly less than in the K-A (56%) or A (92%) groups. Intravenous catheter placement was also successful significantly more often in the M-A (80%) and M-K-A (84%) groups than in the K-A (48%) or A (40%) groups. Complications were similar among the groups, but there was evidence that midazolam prolonged recovery time in some patients. Rectal midazolam with or without ketamine is a useful technique when intravenous catheter placement before induction of anesthesia is desired.