[Opioid rotation: from theory to practice. Interdisciplinary recommendations from the Geneva University Hospitals pain network]. / Rotation des opioïdes: de ta théorie à la pratique. Recommandations interdisciptinaires du réseau douleur des HUG.

Opioids are widely used to treat moderate to severe pain of cancer or non cancer origin. Although opioids provide an adequate analgesia in many patients, their use can be limited by inefficacy and/or intolerable side effects. Opioid rotation is one of the strategies that have been proposed to overcome these therapeutic difficulties. This article revisits the concept of opioid rotation, from pharmacological rational to clinical application.

Yeast RSP5 and its human homolog hRPF1 potentiate hormone-dependent activation of transcription by human progesterone and glucocorticoid receptors.

We have developed a system in Saccharomyces cerevisiae in which agonist-dependent transcriptional activity of the human progesterone receptor (hPR) is elevated to the point that it compromises cell growth. Screens for suppressors of this phenotype led to the demonstration that RSP5 is involved in hPR transactivation. Expression of RSP5 in yeast cells potentiated hPR and human glucocorticoid receptor (hGR) transcriptional activity and increased the efficacy of weak agonists of these receptors. Remarkably, expression of this yeast protein in mammalian cells had a similar effect on PR and GR transcriptional activity. Importantly, a human homolog of RSP5, hRPF1, functioned identically in mammalian cells. Previously, it has been demonstrated that RSP5 overexpression in yeast cells suppressed mutations within SPT3, a protein which interacts with the TATA-box-binding protein (TBP), suggesting that RSP5 and SPT3 operate in the same regulatory pathway. In support of this observation, we have shown that SPT3 enhances the activity of RSP5 on GR and PR when tested in yeast or mammalian cells. We conclude from these experiments that the regulatory pathways in which RSP5 and SPT3 operate in yeast cells are conserved in higher eukaryotes. Additionally, since SPT3 has been shown to contact yeast TBP directly and is the likely homolog of human TBP-associated factor TAFII18, we propose that RSP5/hRPF1 and SPT3 establish a functional link between activated PR and GR and the general transcription apparatus.

Poor late prognosis of bleeding peptic ulcer.

BACKGROUND AND AIMS: Long-term course of peptic ulcer bleeding is unclear. Because of a more aged and more diseased ulcer population, the long-term prognosis may be expected as poor. MATERIALS AND METHODS: In a prospective study, all patients with peptic ulcer bleeding treated at the Department of Surgery of the Heinrich-Heine-University in Düsseldorf were included between 1986 and 1995. Follow-up covered hospital mortality, 1-month mortality, 1-year mortality, and 5-years mortality. Significant prognostic parameters for death were investigated in univariate and multivariate analysis. RESULTS: One hundred and seventy-one out of 192 patients with peptic ulcer bleeding could be followed up. One-month mortality was similar to hospital mortality with 12.3%, 1-year mortality was 28.7%, and the 5-years mortality was 46.8%! In univariate analysis, statistically significant prognostic factors for death were ages beyond 70 years, concomitant diseases, risk-related drugs, postinterventional complications, and recurrent bleeding. In multivariate analysis, age, postinterventional complications, and type of admission were statistically significant parameters for death. CONCLUSION: Long-term prognosis of peptic ulcer bleeding is poor! The majority of deaths after hospital stay is probably not because of ulcer bleeding, but because of more aged patients with severe concomitant diseases.

Prevention of recurrent bacterial urinary tract infections by intravesical instillation of hyaluronic acid.

OBJECTIVE: To evaluate the efficacy of vesical instillation of hyaluronic acid against recurrent urinary tract infections. METHODS: Twenty women with a history of recurrent urinary tract infections each received 9 intravesical instillations of hyaluronic acid over 6 months. Their status was assessed prospectively over 47.6 weeks and compared with a retrospective review of patient charts covering 36.2+/-6.2 weeks. RESULTS: The total numbers of urinary tract infections were 67 before and 10 after treatment (p<0.001). Thirteen patients (65%) were free of recurrences until the end of the study. One had a recurrence during treatment, and 6 (30%) during follow-up. The number of infections per year per patient was reduced from 4.99+/-0.92 to 0.56+/-0.82 (p<0.001). In women with recurrences, time to recurrence was 178.3+/-25.5 days, compared with 76.7+/-24.6 days before treatment (p<0.001). CONCLUSION: Intravesical instillation of hyaluronic acid is effective in preventing recurrent urinary tract infections.

Propolis solution for the treatment of chronic vaginitis.

OBJECTIVE: To evaluate the efficacy of 5% propolis solution in recurrent vaginitis. METHOD: Fifty-four patients with recurrent vaginal infections having undergone at least one cycle of antibiotic treatment were instructed to apply a 5% aqueous propolis solution as a vaginal douche for seven days. Vaginal smears and specific symptoms were evaluated at baseline and 14 days after treatment. Long-term well-being was assessed by telephone interview six months after follow-up. RESULT: At the follow-up, the vaginal smears of 41 patients (75.9%) had improved. Forty-seven patients (87%) reported reliefs concerning at least one complaint. Associated improvement of smear and well-being was observed in 36 women (66.7%). After 6 months, 33 patients (61.1%) were satisfied with their condition without having undergone further treatment. CONCLUSION: Propolis may have a role as an alternative treatment for chronic vaginal infection.

An alternative insert of three amino acids is incorporated into collagen XIV in a developmentally regulated fashion.

We have identified a novel splice variant of chicken collagen XIV which contains an insert of three amino acids (Val-Arg-Thr) in the sixth fibronectin type III-like (FNIII) domain. The codons for these amino acids are inserted into the mRNA by skipping of a splice donor site and usage of another donor site 9 bp further downstream in the collagen XIV gene. The percentage of the new splice variant in the total collagen XIV mRNA varies between 22 and 46% in different embryonic tissues. After hatching, however, this percentage increases dramatically and reaches 86% in adult skeletal muscle and 58% in adult gizzard, indicating developmental regulation of this splicing event. Computer modeling suggests that the three extra amino acids cause an increase in the size of a flexible loop connecting two beta-strands in the sixth FNIII domain. This increase might affect the exact arrangement of the FNIII domain in the collagen XIV molecule, thereby modulating its interactions with other matrix molecules.

The importance of the effect of underlying disease on rejection outcomes following orthotopic liver transplantation.

Despite major advances in immunopharmacology, virtually all patients receive the same center-specific immunosuppressive regimen following orthotopic liver transplantation (OLT). The present analysis was performed on the hypothesis that the original disease representing the indication for OLT leads to a different initial immunological situation of the patient. The type of original disease might therefore be a predisposing factor for acute rejection episodes and influence graft and patient survival. From January 1988 to July 1994, 34 patients received OLT at our institution for end-stage primary biliary cirrhosis (group 1) and 66 patients for end-stage alcoholic cirrhosis (group 2). Overall survivals at 1 and 5 years in group 1 versus group 2 were 67% versus 80% and 50% versus 68%, respectively (P<0.04). Retransplantation was performed in 21% of patients from group 1 and in 6% from group 2. The estimated risk for freedom from acute rejection amounts to 38% in group 1 compared with 59% in group 2 (P<0.02). Multivariate regression analysis of potential risk factors identified only the underlying disease as independent predictor. Analysis of cumulative rates of clinically relevant rejection episodes stratified by group revealed 0.29 and 0.05 episodes per patient at one month and 0.80 and 0.06 at six months (P<0.009) respectively. In our clinical experience it was possible to confirm the hypothesis that the underlying disease is the reason for a significantly different incidence of acute rejection episodes and that it subsequently influences graft and patient survival. This approach to an individually adapted immunosuppressive therapy should be taken into consideration and other appropriate parameters investigated.

Effects of interleukin-1, -2, -4, -6, interferon-gamma and granulocyte/macrophage colony stimulating factor on human vascular endothelial cells.

Human vascular endothelial cells (HUVEC) exhibit various immunological functions, i.e. expression of HLA class-II antigens after incubation with IFN-gamma or antigen presenting function. It has also been reported that HUVEC are able to produce IL-1, IL-6, GM-CSF and immunologically active cleavage products of arachidonic acid. In our study we investigated whether various cytokines, namely IL-1, IL-2, IL-6, GM-CSF and IFN-gamma, do alter the proliferative capacity of HUVEC, the production of van Willebrandt factor (vWF) and the expression of MHC class-II antigens. HUVEC were prepared by the collagenase digestion of human umbilical veins. Monolayers of cells were incubated with cytokines in different concentrations for 24 and 48 h. IFN-gamma inhibits the HUVEC [3H]thymidine uptake in a dose-dependent manner. Suppression of proliferation (40.1%) could be observed after 24 h incubation with 100 U IFN-gamma/ml. IL-1 was a more effective inhibitor of HUVEC proliferation (54% at 10 U/ml and 24 h incubation and 48.4% after 48 h) than IFN-gamma. IL-6 and GM-CSF showed an increasing effect on proliferation with 226% and 151% of the control group, respectively. IFN-gamma after an incubation period of 12 h and IL-1 after 24 h reduced the vWF content by about 30%. Bright MHC class-II expression was induced only by IFN-gamma. In conclusion, some of the immunoregulative cytokines might play an important role in the control of HUVEC proliferation.

Are T cells from healthy heart really only passengers? Characterization of cardiac tissue T cells.

Numerous studies have dealt with occurrence of dendritic cells in various nonlymphoid organs such as kidney, liver or heart, whereas lymphocyte patterns in these organs have not been analyzed in detail. In the present study, leukocytes were quantified as cells/mm2 in the perivascular, interstitial and parenchymal tissue sections of normal heart. We measured an overall mean leukocyte count in normal heart tissue of 17.0 +/- 2.7 CD45+ leukocytes/mm2, 9.1 +/- 1.8 thereof being CD4+ T-helper cells (Th). By comparison, CD8+ T-cytotoxic/suppressor cells (Ts) and CD14+ macrophages each accounted for only approximately 2.5 cells/mm2, and CD20+ B cells for only 1.3 cells/mm2. These T cells were further characterized as either CD45RA+ naive T cells or as CD45RO+ memory T cells. Segmentation of the tissue as defined in Section 2 yielded an ascending number of CD45RO+ memory T cells from perivascular (0.4 +/- 0.2 cells/mm2) through parenchymal (12.8 +/- 3.0 cells/mm2) to interstitial (21.0 +/- 5.3/mm2). By contrast, the number of CD45RA+ and Leu-8+ cells decreased from perivascular to parenchymal. Peripheral T cells showed a reverse pattern of CD45RA/CD45RO antigen expression. Only approximately 3% of T cells expressed activation markers IL-2R and IL7R. Our data demonstrate that the majority of T cells in normal heart tissue are resting memory tissue T cells and are not contaminating T cells from the peripheral blood. The increase in CD45RO+ cells from perivascular to parenchymal with a corresponding decrease in CD45RO+ and Leu-8+ heart-tissue T cells argues in favor of T-cell traffic in normal heart tissue.

Serum-soluble CD4 as clinical and immunological marker in patients with dilated cardiomyopathy.

Serological markers of cell-mediated immunity, i.e., soluble CD4, soluble interleukin-2 (Il-2) receptor and beta 2-microglobulin, were determined in 60 patients with dilated cardiomyopathy. Compared with normal healthy donors (n = 30) and controls who had coronary artery disease with preserved left ventricular function (n = 20), significantly increased levels associated with the New York Heart Association functional classes have been found in the cardiomyopathy patients, irrespectively of the etiology. Out of the immunological variables tested, serum-soluble CD4 most closely reflected the clinical and hemodynamic stage, predicted the presence of lymphocytic aggregates in the myocardium and correlated with the CD4/CD8 ratios of endomyocardial lymphocytes (r = 0.6, P < 0.05). Conversely, focal mononuclear infiltration of the myocardium was associated with significantly elevated CD4/CD8 ratios (2.1 +/- 0.6 vs. 1.3 +/- 0.2, P < 0.05), higher total numbers and percentages of endomyocardial lymphocytes expressing the pan T-markers CD2 and CD3, more CD45RO/UCHL1-positive cells and more CD4-positive T-helper cells, compared with non-reactive cases the lymphocytes of which were scattered throughout the myocardium. In conclusion, in a subset of cardiomyopathy patients lymphocytic clusters in the myocardium indicated an enhanced cellular immune response predominantly mediated by CD4-positive T-helper lymphocytes with active memory function. This immunopathological condition in the heart can be monitored by serum-soluble CD4.

Cloning of a Chironomus tentans cDNA encoding a protein (cEcRH) homologous to the Drosophila melanogaster ecdysteroid receptor (dEcR).

We have cloned a cDNA sequence coding for a Chironomus tentans steroid hormone receptor homologue which exhibits extensive amino acid sequence co-linearity with the ecdysteroid receptor of Drosophila melanogaster (dEcR; cell 67, 59-77). The DNA-binding domain has 95% and the hormone-binding domain 75% amino acid sequence identity with the cloned dEcR. The gene for this C. tentans protein is located on chromosome II, region 17C, as determined by in situ hybridization to polytene chromosomes of salivary glands. On Northern blots cDNA probes of the cloned gene hybridize to polyadenylated RNA of ca 4.2 kb. The expression of the cloned gene seems to be developmentally regulated and correlates to changes in ecdysteroid titer. Transfection of this C. tentans protein into D. melanogaster Schneider's line 2 cells leads to transcriptional interference with endogenous dEcR on an ecdysteroid-regulated promoter.

Functional characterization of two Ultraspiracle forms (CtUSP-1 and CtUSP-2) from Chironomus tentans.

Two forms, CtUSP-1 and CtUSP-2, of the Chironomus tentans homolog of Ultraspiracle (new nomenclature: Chironomus NR2B4) were described and verified as components of the functional ecdysteroid receptor. The two forms differed from each other in the most N-terminal regions of the A/B domain and were tested for several properties. Both forms showed the ability to heterodimerize with CtEcR and interact with a variety of direct repeat and palindromic EcREs, and both conferred specific ligand binding when heterodimerized with EcR. CtUSP-2 showed a twofold higher ponasterone-binding potential than CtUSP-1. Both USP forms demonstrated the ability to activate ecdysteroid-inducible transcription in HeLa cells and the variations in the A/B domain of these forms were not associated with detectable differences in transcriptional activation. Thus, the two forms function similarly. Among species for which USP forms have been reported, Chironomus is the most closely related one evolutionarily to Drosophila. Despite this proximity, a variety of structural differences were noted in both the A/B and E domains of USP between the two species. The Chironomus USP forms lack many of the amino acid residues associated with the ligand-dependent AF2 transactivation function found in all other RXRs and USPs reported so far.

Cellular mechanisms which distinguish between hormone- and antihormone-activated estrogen receptor.

The use of reverse genetics has permitted a definition of the structural features within estrogen receptor required for its productive association with the transcription apparatus. These sequences, transactivation function 1 (TAF1) in the amino terminus and TAF2 at the carboxyl terminus, display distinct transcriptional functions. Using specific receptor mutations it has been shown that on some promoters both TAF1 and TAF2 are required for maximal transcriptional activity, whereas on others, additional factors bound to the target promoter can functionally substitute for TAF1 or TAF2. Estrogen functions as an ER agonist by promoting functional synergism between TAF1 and TAF2. Conversely, 4-OH-tamoxifen inhibits TAF2 activity and functions as an antagonist in cell contexts where TAF2 is required. Alternatively, if a 'TAF2 function' is supplied by another factor, 4-OH tamoxifen can manifest ER agonist activity. These data indicate that alterations in the cellular expression of proteins which mimic TAF1 or TAF2 activity can have a profound effect on the pharmacology of ER modulators. Thus the identification of the cellular proteins which interact with ER and its TAF regions will allow a definition of the mechanism used by the cell to distinguish between hormone- and antihormone-activated estrogen receptor.

Video assistance reduces complication rate of thoracoscopic sympathicotomy for hyperhidrosis.

BACKGROUND: Thoracoscopic sympathicotomy has proved successful in the treatment of palmar hyperhidrosis. However, up to 8% of patients experience Horner's syndrome, and about 50% show compensatory sweating. This study evaluates the role of video assistance in thoracoscopic sympathicotomy for primary hyperhidrosis of the upper limb. METHODS: Six hundred fifty-six thoracoscopic sympathicotomies were performed from below T1 to T4 in 369 patients. Of the operations, 558 were done under direct view (CTS group) and 98, with video assistance (VATS group). Follow-up was complete for 78.3% of patients after a median observation period of 16 years. RESULTS: Dry limbs were immediately achieved in 93% of the CTS group and 98% VATS group (p = 0.98). In the CTS group, Horner's syndrome occurred after 2.2% of all operations and rhinitis in 8.3%. No patient in the VATS group showed any symptom of Homer's triad (p = 0.03 versus CTS group) or rhinitis (p = 0.02 versus CTS group). Compensatory sweating was observed in 66.8% in the CTS group versus 69% in the VATS group (p = 0.73) and gustatory sweating, in 50.4% versus 27.6%, respectively (p = 0.01). CONCLUSIONS: In performing thoracoscopic sympathicotomy for excessive upper-limb hyperhidrosis, we observed a significant decrease in the incidence of Horner's syndrome, rhinitis, and gustatory sweating when the procedure was guided by video imaging.

Development of stable cell lines for production or regulated expression using matrix attachment regions.

One of the major hurdles of isolating stable, inducible or constitutive high-level producer cell lines is the time-consuming selection procedure. Given the variation in the expression levels of the same construct in individual clones, hundreds of clones must be isolated and tested to identify one or more with the desired characteristics. Various boundary elements (BEs), matrix attachment regions, and locus control regions (LCRs) were screened for their ability to augment the expression of heterologous genes in Chinese hamster ovary (CHO) cells. Of the chromatin elements assayed, the chicken lysozyme matrix-attachment region (MAR) was the only element to significantly increase stable reporter expression. We found that the use of the MAR increases the proportion of high-producing clones, thus reducing the number of clones that need to be screened. These benefits are observed both for constructs with MARs flanking the transgene expression cassette, as well as when constructs are co-transfected with the MAR on a separate plasmid. Moreover, the MAR was co-transfected with a multicomponent regulatable beta-galactosidase expression system in C2C12 cells and several clones exhibiting regulated expression were identified. Hence, MARs are useful in the development of stable cell lines for production or regulated expression.

Low dose oral contraceptives and quality of life.

This study investigated the effects of a low dose oral contraceptive (OC) (Mercilon) on women's satisfaction and quality of life based on a detailed questionnaire. A total of 614 first-time users of oral contraceptives were enrolled by 102 gynecologists for a treatment period of > or = 4 months. The Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) was filled in both before and during pill intake. The total quality of life score was significantly increased under OC intake. In contrast to older preparations, modern low dose OCs appear to act favorably on a number of psychological parameters, thus increasing satisfaction with various aspects of daily life and, consequently, improving quality of life.

PIP: A study was conducted to determine the tolerability of a low-dose oral contraceptive (OC) containing 20 mcg ethinyl estradiol and 150 mcg desogestrel (Mercilon) among first-time users and to evaluate its effects on women's satisfaction and quality of life. The study was conducted between January 1997 and May 1998 using the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) submitted to 614 first-time users of OCs. Results showed that modern low-dose OCs act favorably on a number of psychological parameters by comparison with older preparations. The total quality of life rating increased significantly with use of OC. The improvement in patient satisfaction and quality of life observed in this study is a significant finding with respect to the matter of OC acceptability and patient compliance.

Long-term results after laparoscopic unroofing of solitary symptomatic congenital liver cysts.

BACKGROUND: Reports about laparoscopic management of symptomatic nonparasitic liver cysts are increasing, proving the procedure feasible and safe. However, late results of endoscopic unroofing currently are not available. The primary aim of the study was to offer long-term results with a follow-up of more than 5 years. Two diagnostic pitfalls are presented. METHODS: Preoperatively, diagnosis was established by sonography, computed tomography (CT) scan, echinococcus serology, and tumor-marker measurement. The outcome of 12 laparoscopic fenestrations in 11 patients with symptomatic solitary liver cysts is presented. Nine patients were reexamined after a median observation time of 3.1 years (range, 0.6-6.4 years) by clinical investigation and ultrasonography, CT scan, or magnetic resonance imaging (MRI), respectively. RESULTS: All operations could be finished laparoscopically, and no death occurred. Simultaneous cholecystectomy was performed in six cases. All patients experienced immediate relief of symptoms. Postoperatively, no complications were observed except one patient with unilateral brachial vein thrombosis. Histologically, we discovered one hydatide cyst and one cystadenoma underlying the cystic disorder leading to further therapy. At follow-up, one of the remaining seven patients (14.3%) suffered symptomatic recurrence and successfully underwent reoperation endoscopically. CONCLUSIONS: The results of this study confirm the outcome reported previously after short- and intermediate-term follow-up showing that laparoscopic management of symptomatic solitary nonparasitic liver cysts is permanently successful in a large majority of cases when diagnosis is correct.

Long-term results of 45 thoracoscopic sympathicotomies for primary hyperhidrosis in children.

BACKGROUND/PURPOSE: Thoracoscopic sympathicotomy (TS) is successful in treatment of excessive hyperhidrosis of the upper limb after limited follow-up observation. The aim of the study was to assess for the first time long-term results of TS in children. METHODS: A total of 26 children (9 boys, 17 girls) aged 11 to 17 years with severe palmar or axillar hyperhidrosis underwent TS, and 19 patients were treated bilaterally. A total of 19 patients were observed after a median follow-up period of 16 years by questionnaire or clinical examination. RESULTS: Permanent relief from palmar hyperhidrosis was given in all examined patients. Twelve patients had compensatory and 12 patients gustatory sweating. Postoperatively, 1 subcutaneous emphysema and 1 temporary miosis and ptosis were noted. Eleven patients were fully satisfied with the result. Seven patients were only partially satisfied because of compensatory or gustatory sweating but would again undergo operation. One patient was not satisfied because of excessive compensatory sweating. CONCLUSIONS: TS is a safe and efficient procedure even after long-term follow-up. Severe palmar hyperhidrosis often starts in childhood; thus, early surgical treatment can improve social development. Compensatory and gustatory sweating are the most frequent and enduring side effects and should be mentioned in preoperative patient and parent information.

[The coronary sinus as a source of activated T-lymphocytes in patients after orthotopic heart transplantation]. / Der Sinus coronarius als Quelle aktivierter T-Lymphozyten bei Patienten nach orthotoper Herztransplantation.

Mononuclear cells are the component of blood responsible for allograft recognition, rejection and acceptance. Shifts in the patterns of various mononuclear cell subpopulations were often used as a diagnostic tool in detection of heart rejection. The specificity of mononuclear cell monitoring has remained a controversial point until today, because infections led to similar changes as organ rejection. In this study we investigated whether mononuclear cells taken from coronary sinus blood give more information about the immunological status of the transplanted heart than those taken from central verous blood. After endomyocardial biopsy, coronary sinus blood was sampled by catheterization under X-ray control. Blood from the right atrium was taken for control measurement. Mononuclear cells obtained by density gradient cytocentrifugation were stained with monoclonal fluorescein conjugated antibodies detecting CD4- (T helper)-, CD8- (T suppressor)-, CD25- (Interleukin-2 receptor), and the CD71- (Transferrin receptor) antigens. Endomyocardial biopsies were graded according to the Billingham scheme. In the absence of rejection, the phenotypes of mononuclear cells from the coronary sinus did not differ from those of right atrial cells. Mild rejection led to a statistically insignificant increase of CD4- CD25- and CD7-antigen bearing cells in the coronary sinus blood, whereas the CD8 positive cells remained stable as compared to mononuclear cells from the right atrium. However, patients with moderate rejection showed a significant elevation of CD4 positive cells and activated T-cells (CD15-, CD71-positive cells) in the coronary sinus as compared with cells from the right atrium. The T helper/suppressor ratio (Th/s-ratio) shifted towards the T-helper population.(ABSTRACT TRUNCATED AT 250 WORDS)

[The intensive care gallbladder--a transient phenomenon or a problem requiring therapy?]. / Die Intensivgallenblase--passageres Phänomen oder therapiebedürftiges Problem?

Acute acalculous cholecystitis (AAC) is a well-known complication in postoperative and severely traumatized patients. Existing data of AAC originate from retrospective analyses and episodic case reports. In a prospective study 45 polytraumatized patients admitted to our intensive care unit between January 1, 1989 and June 30, 1990 were clinically and sonographically screened for this condition at defined time-intervals. A clinical and sonographical follow-up was performed annually (1991-1993). Trauma scoring was performed according to the Injury Severity Score (ISS) and Polytrauma Score (PTS). AAC was defined as a combination of hydrops of the gallbladder, an increased mural thickness (> 3.5 mm) and the demonstration of sludge. We were able to demonstrate this diagnostic triad in 8 out of 45 patients (18%). As a consequence early elective cholecystectomy was performed in one patient. The remaining patients were treated conservatively. Incidence of AAC in severely traumatized patients is probably higher than figures so far published suggest. The systematic search for this condition using serial sonographic examinations and defined sonomorphological criteria may select individual cases for elective cholecystectomy. Ultrasound is a reliable method of early detection and follow-up of this complication. Trauma and following intensive care therapy induce a lithogenetic factor, developing gallstone disease in 27% of patients within an 2-3-year interval.