[Structured or protocol-based dispatching programs]. / Strukturierte bzw. standardisierte Notrufabfrage: Leisten die Systeme tatsächlich, was sie vorgeben zu leisten?

BACKGROUND: The increasing introduction of standardized emergency call systems in German-speaking countries follows the recommendations of the European Resuscitation Council (ERC) and German Resuscitation Council (GRC), according to which the emergency call shall be queried using specified protocols. Although there may be a need for improvement in terms of sensitivity and specificity with regard to the detection of special clinical pictures, standardized products are preferred for emergency call inquiries, which can enable constant call processing regardless of user, time and situation during the day. This increases both patient safety and the legal security of the control center staff and the company management. OBJECTIVES: Do such systems deliver what they are expected to perform? METHODS: Research of current literature. RESULTS: Emergency call interrogation systems are performing as expected. The compliance of the tele communicator has a significant impact on the quality of a call. CONCLUSION: There is a need for optimization of the establish standards for the use of the structured and protocol-based systems and in improving user training.

Screening for Acromegaly in Patients with Carpal Tunnel Syndrome: A Prospective Study (ACROCARP).

Early diagnosis of acromegaly prevents irreversible comorbidities and facilitates surgical cure. Carpal tunnel syndrome (CTS) is common in acromegaly and patients have often undergone surgery for CTS prior to the diagnosis of acromegaly. We hypothesized that screening CTS-patients for acromegaly could facilitate active case-finding. We prospectively enrolled 196 patients [135 women, 56.9 (range 23-103) years] who presented with CTS for surgery. Patients were asked about 6 symptoms suggestive of acromegaly using a questionnaire calculating a symptom score (0-6 points), and insulin-like-growth factor 1 (IGF-1) was measured. If IGF-1 was increased, IGF-1 measurement was repeated, and random growth hormone (GH) and/or an oral glucose tolerance test (OGTT) with assessment of GH-suppression were performed. The mean symptom score was 1.7±1.3 points. Three patients reported the maximal symptom score of 6 points, but none of them had an increased IGF-1. There was no correlation between the symptom score and IGF-1-SDS (standard deviation score) (r=0.026; p=0.71). Four patients had an IGF-1>2 SDS. In 2 patients acromegaly was ruled out using random GH and OGTT. One patient had normal IGF-1 and random GH at follow-up. One patient refused further diagnostics. In this prospective cohort of patients with CTS, the observed frequency of acromegaly was at most 0.51% (95% CI 0.03 to 2.83%). In this prospective study, none of the 196 patients with CTS had proven acromegaly. Thus, we see no evidence to justify general screening of patients with CTS for acromegaly.

Comparison of oral glucose tolerance test (OGTT) 100 g with OGTT 75 g for evaluation of acromegalic patients and the impact of gender on test reproducibility.

CONTEXT: Growth hormone (GH) measurements during an oral glucose tolerance test (OGTT) are essential for the diagnosis and follow-up management of acromegaly. However, both 100 g glucose (OGTT(100) ) and 75 g glucose (OGTT(75) ) test variants are in clinical use. Whether the tests are interchangeable concerning GH nadir and test interpretation is unclear. Furthermore, information on test reproducibility and the impact of gender is scarce. OBJECTIVE: To compare both tests in acromegalic patients and to evaluate test reproducibility with respect to gender. DESIGN, SUBJECTS AND METHODS: OGTT(100) and OGTT(75) were performed on two consecutive days in 54 acromegalic patients (46·9 ± 1·8 years, 30 women). OGTT(75) was repeated on three different occasions in 11 healthy men and 13 healthy women at different phases of the menstrual cycle. RESULTS: GH nadirs were comparable between tests [2·40 ± 0·52 (OGTT(100) ) and 2·46 ± 0·54 µg/l (OGTT(75) ); P = 0·356]. There were no differences at any time point in the mean values of GH, serum glucose or insulin between the two test variants. Test interpretation was highly consistent between the OGTT(100) and OGTT(75) [area under the receiver operated curve (ROC) = 0·995]. In men, GH, insulin and glucose measurements during OGTT(75) were highly reproducible. In women, however, basal and GH nadirs were significantly higher midcycle (P < 0·05). CONCLUSIONS: In acromegalic patients, there is no difference in GH nadirs and test interpretation after the ingestion of 100 g or 75 g glucose. The OGTT(75) is highly reproducible in men, but in women, it should be performed preferably in the early follicular phase.

Potential detection of low-dose transdermal testosterone administration in blood, urine, and saliva.

Administration of low amounts of endogenous hormones - so-called micro-dosages - are supposed to represent a major challenge in doping analysis. To model such a situation, we have studied transdermal administrations of 2.4 mg/24 h testosterone patches and examined various steroid concentrations in blood, urine, and saliva of 11 volunteers. Multiple samples were collected at t = 0, 3, 6, 9, 24, 48, and 72 h in four different phases, i.e., all combinations with/without physical exercise and with/without testosterone. Testosterone was analyzed by enzyme-linked-immuno-assay as well as by mass spectrometry and validated in an accredited anti-doping laboratory. Circadian controls with and without exercise did not provoke prominent alterations of whole, free, and salivary testosterone. Testosterone application for 24 h led to a significant (all p < 0.001) mean increase above controls: total testosterone (median: 5.2 vs. 8.0 ng/mL), free testosterone (median: 11.3 vs. 15.6 pg/mL), and salivary testosterone (median: 62.4 vs. 99.9 pg/mL). Additionally, all three testosterone measurements indicated significant correlations to each other (all r > 0.538, all p < .001). Circadian-matching showed peaking testosterone values after 6 h and 9 h, reaching highest augmentation up to 252.6 ± 123.5% in saliva after 9 h. After removal of the testosterone patch, all testosterone levels in blood, saliva, and urine returned to baseline within 24 h. Different techniques of hormone detection (enzyme-linked immunosorbent assay (ELISA), gas chromatography-tandem mass spectrometry (GC-MS/MS), liquid chromatography-tandem mass spectrometry (LC-MS/MS)) indicated significant correlations. Results indicate that saliva, blood, and urine exhibit comparable hormone augmentation during micro-dose testosterone application, indicating a possible consideration in future doping analysis. The inter-individual variability was high in all biofluids, requiring the use of an individual biological passport rather than statistical values. Copyright © 2016 John Wiley & Sons, Ltd.

Secretion of free and protein-bound leptin from subcutaneous adipose tissue of lean and obese women.

Leptin circulates as a free (FL) and a protein-bound (BL) form, with the soluble leptin receptor (LR) as an important binding compound. Here we measured these components of leptin in serum and in the incubation medium of sc adipose tissue in healthy lean (n = 10) and obese (n = 13) female subjects using recently developed specific RIA systems. In addition, immunostaining for FL, BL, and LR in adipose tissue was performed. Serum FL levels were increased in the obese subjects (P < 0.0001), whereas BL and LR concentrations in serum of lean and obese subjects were similar. Both FL and BL were secreted from human preadipocytes and increased in parallel to the differentiation of the cells. In sc fat cell explants LR antibodies predominantly stained the fat cell membrane, whereas FL and BL antibodies revealed intracytoplasmatic adipocyte staining. The release of FL, BL, and LR from adipose tissue was increased in obese compared with lean subjects (P < 0.005 for FL; P < 0.02 for BL, and P < 0.01 for LR). In summary, fat cells are capable of releasing not only FL, but also BL and LR.

Incidental detection of familial medullary thyroid carcinoma by calcitonin screening for nodular thyroid disease.

Serum calcitonin screening has recently been found to be a useful supplement to fine-needle aspiration biopsy, ultrasound and radionuclide imaging in the evaluation of thyroid nodules. We describe a case where introduction of routine calcitonin screening in nodular thyroid disease led to the detection of a family with medullary thyroid carcinoma. The benefits and problems of basal and stimulated serum calcitonin testing and ret-proto-oncogene mutation studies are exemplified and we discuss the appropriate use and interpretation of these tests. We conclude that routine basal serum calcitonin measurement in nodular thyroid disease and thoughtful use of ret-mutation analysis is cost-effective in detecting medullary thyroid carcinoma and multiple endocrine neoplasia type II.

Menin mutations in patients with multiple endocrine neoplasia type 1.

Multiple endocrine neoplasia type 1 (MEN-1) is a familial cancer syndrome with parathyroid, pituitary and enteropancreatic tumors. The disease phenotype segregates with markers on chromosome 11q13. Very recently a new gene was cloned from this region and was found to carry mutations in 14 of 15 unrelated MEN-1 patients. The gene was termed menin and is predicted to code for a tumor suppressor protein of 610 amino acids, but its precise function is totally unknown. To confirm this finding we used PCR from genomic DNA and direct sequencing to analyze exons 2 through 10 of the menin gene in eight patients from four pedigrees with MEN-1 syndrome or an affected relative. We identified four different heterozygous mutations, three of them are novel: one nonsense mutation, one large deletion of 32 bp and two insertions, all of them located in exon 2. Our results confirm that patients with MEN-1 carry mutations in the menin gene.

Serum leptin and weight reduction in female obesity.

Leptin, an adipocyte-derived hormone, induces a decrease in food intake and increases energy expenditure via hypothalamic interactions. In animal models obesity can be caused by leptin deficiency or by a dysfunction of the hypothalamic leptin receptor. Using a radioimmunoassay for the determination of leptin in human serum, we measured serum leptin levels in 227 otherwise healthy normal weight (N = 78; body mass index = 16.1-27.7 kg/m2) or obese women (N = 149; body mass index = 27.8-56.7 kg/m2). Fifty-three subjects were followed over a period of 12 weeks under weight reduction (800 kcal/day) and a subgroup of 33 for another 13 weeks after termination of the diet. Body mass index and serum leptin concentrations were measured longitudinally and compared to female controls not under diet. Under baseline conditions, log serum leptin levels were positively related to body mass index with a best fit using a non-linear regression (p < 0.001), indicating an attenuated increase in serum leptin levels with high body mass index. No subgroup with low serum leptin levels could be identified. Weight reduction induced a rapid decrease in serum leptin levels within the first 3 weeks to levels significantly lower than in body mass index-matched controls under normal diet (p < 0.001). This pattern was consistent after 6 and 12 weeks. Serum leptin levels increased again after the end of the diet but remained significantly lower than in the controls despite unrestricted calorie intake over 7 weeks. The rapid and persistent decrease in serum leptin to lower levels than expected from matched controls may explain the pertinent difficulties of obese subjects to cope with weight reduction.

Cytogenetic studies in a canine mammary tumor.

In a 9-year-old female dog (Basset Artesian Normand) with a mammary adenocarcinoma, cytogenetic evaluation of tumor cells showed a chromosome number of 76 in most metaphases (95%). The following abnormalities were found: symmetric metacentric chromosomes 1 and 6, centric fusion 3/38, a marker X-chromosome (Xmar) and a biarmed small marker chromosome (mar). In the remaining metaphases (5%) there were additional biarmed marker chromosomes present.

Extended recombinant bacterial ghost system.

Controlled expression of cloned PhiX174 gene E in Gram-negative bacteria results in lysis of the bacteria by formation of an E-specific transmembrane tunnel structure built through the cell envelope complex. Bacterial ghosts from a variety of bacteria are used as non-living candidate vaccines. In the recombinant ghost system, foreign proteins are attached on the inside of the inner membrane as fusions with specific anchor sequences. Ghosts have a sealed periplasmic space and the export of proteins into this space vastly extends the capacity of ghosts or recombinant ghosts to function as carriers of foreign antigens. In addition, S-layer proteins forming shell-like self assembly structures can be expressed in candidate vaccine strains prior to E-mediated lysis. Such recombinant S-layer proteins carrying foreign epitopes further extend the possibilities of ghosts as carriers of foreign epitopes. As ghosts have inherent adjuvant properties, they can be used as adjuvants in combination with subunit vaccines. Subunits or other ligands can also be coupled to matrixes like dextran which are used to fill the internal lumen of ghosts. Oral, aerogenic or parenteral immunization of experimental animals with recombinant ghosts induced specific humoral and cellular immune responses against bacterial and target components including protective mucosal immunity. The most relevant advantage of recombinant bacterial ghosts as immunogens is that no inactivation procedures that denature relevant immunogenic determinants are employed in this production. This fact explains the superior quality of ghosts when compared to other inactivated vaccines. The endotoxic component of the outer membrane does not limit the use of ghosts as vaccine candidates but triggers the release of several potent immunoregulatory cytokines. As carriers, there is no limitation in the size of foreign antigens that can be inserted in the membrane and the capacity of all spaces including the membranes, peri-plasma and internal lumen of the ghosts can be fully utilized. This extended recombinant ghost system represents a new strategy for adjuvant free combination vaccines.

Successful jejunal nutrition therapy in a pregnant patient with apallic syndrome.

A 41-year-old woman was admitted in the 8th pregnancy week as a consequence of a left-sided media infarction. After alloprothetic aortic valve replacement, she had discontinued deliberately the mandatory anticoagulation treatment. Following an initial clinical stabilisation, a second insult with right-sided media total infarction occurred 3 weeks after admission. In the further course, she developed an apallic syndrome and required respirator therapy. The initial enteral nutrition therapy via naso-gastric tube, was continued via percutaneous endoscopic gastrostomy (PEG). Due to recurrent vomiting from the 24th pregnancy week, the PEG was changed into a PEG with jejunal position of the tube (JET-PEG). Via this access and simultaneous body impedance analysis (BIA) control, the further nutrition therapy could be continued uneventfully. In the 27th pregnancy week, the patient gave birth to a female newborn (birth weight: 820 g) by Caesarean section in pre-eclampsia. The foetal development was in accordance with the gestational period and uncomplicated in the further course. The mother could be released into ambulatory care where the above nutrition therapy was continued. Reports on a successful nutrition therapy of pregnant comatose patients are rare. To the best of our knowledge, this is the first case where JET-PEG and monitoring by repeated BIA measurement were used for the control of the enteral nutrition.

Influences of surface chemistry on the separation behavior of stationary phases for reversed-phase and ion-exchange chromatography: a comparison of coated and grafted supports prepared by ring-opening metathesis polymerization.

A series of poly(norborn-2-ene) (poly-NBE), poly(7-oxanorborne-2-ene-5,6-dicarboxylic acid) (poly-ONDCA), as well as poly(norborn-2-ene-co-7-oxanorborne-2-ene-5,6-dicarboxylic acid) (poly-NBE-co-ONDCA) based silica supports were prepared via ring-opening metathesis polymerization (ROMP) using both coating and grafting techniques. Poly-NBE-grafted and poly-NBE-coated supports were used for the reversed-phase separation of phenols; poly-NBE, poly-ONDCA as well as poly-NBE-co-ONDCA-grafted supports were used for comparative studies on the separation of a series of anilines and lutidines. As expected, grafted supports possess superior separation capabilities compared to their coated analogues. Compared to pure poly-NBE- and poly-ONDCA-grafted stationary phases, supports consisting of poly-NBE-co-ONDCA block-copolymers possess both hydrophobic and ion-exchange sites and represent optimum stationary phases for the separation of isomeric basic analytes.

Chiral beta-cyclodextrin-based polymer supports prepared via ring-opening metathesis graft-polymerization.

A series of norborn-2-ene-derivatized beta-cyclodextrins (beta-CDs), 6-O-(norborn-2-ene-5-carboxyl)-beta-CD (1), tetrakis(6-O-norborn-2-ene-5-carboxyl)-beta-CD (2), (3), 6-O-(6-norborn-2-ene-5-car-6-O-(7-oxanorborn-2-ene-5-carboxyl)-beta-CD bonylaminohexoyl)-beta-CD (4), 6-O-(norborn-2-ene-5-ylmethoxymethylsilyl)-beta-CD (5), tris(6-O-norborn-2-ene-5-ylmethoxymethylsilyl)-beta-CD (6), tetrakis(6-O-norborn-2-ene-5-ylmethoxymethylsilyl)-beta-CD (7) and hexakis(6-O-norborn-2-ene-5-ylmethoxymethylsilyl)-beta-CD (8), have been synthesized. Compounds 1-3 were prepared via reaction of beta-CD with norborn-2-ene-5-carboxylic chloride and 7-oxanorborn-2-ene-5-carboxylic chloride, respectively; compounds 5-8 were synthesized from norborn-2-ene-5-yl-methyldichlorosilane and beta-CD, respectively. Compound 4 was accessible by reaction of norbom-2-ene-5-carboxylaminohexoyl chloride with beta-CD. Compounds 1-8 were surface grafted onto norborn-2-ene-derivatized silica-based supports using ring-opening metathesis polymerization employing the ruthenium-based initiator bis(tricyclohexylphosphino)benzylideneruthenium dichloride [Cl2Ru(CHC6H5)(PCy3)2, Cy=cyclohexyl, 9]. Generally speaking, the resulting chiral stationary phases (CSPs) I-VIII may be prepared with high reproducibility and may be used within a pH of 2-10. Thus, relative standard deviations (sigman-1) of the mean resolution (Rs) are <7%. The CSPs were used for the enantioselective separation of beta-blockers, N-dansyl-, N-3,5-dinitrobenzoyl- and Fmoc-protected amino acids and were characterized in terms of chemical stability, selectivity (alpha') and resolution (Rs). Additionally, the role of the spacer as well as influences of capacity and the degree of substitution of the beta-CD moiety on the separation characteristics were determined.

Spontaneous rosette formation of pig and guinea pig thymocytes and peripheral blood lymphocytes: influence of proteases, oxidising and reducing agents, cytochalasin B and carbohydrates.

Spontaneous rosette formation (SRF) of pig and guinea pig thymocytes (Th) and thymus derived peripheral blood lymphocytes (PTL) was tested under different experimental conditions. Treatment with different proteases (trypsin, chymotrypsin, protease type VII) showed that SRF of pig Th and PTL is inhibited to a much higher extent than that of guinea pig Th and PTL. Cytochalasin B (CB) inhibited SRF of PTL of both species to a higher degree as compared to Th. Different carbohydrates neither influenced SRF of Th nor of PTL in both species indicating that simple carbohydrates are not the recognized component of SRF receptors. Treatment with oxidising and reducing agents did not influence SRF.

Circulating immune cells and immune complexes in peripheral blood of healthy and of bovine leukemia virus-infected cows and lymphosarcomatous calves.

The peripheral blood (lymphocytes and immune complexes (IC) from 20 healthy cows, 5 healthy calves, 10 bovine leukemia virus-infected cows and 4 lymphosarcomatous calves was investigated using 4 different immunological techniques. A highly significant increase in the percentage of surface immunoglobulin (SIg)-bearing peripheral blood lymphocytes of persistent lymphocytosis-cows could be demonstrated while the percentage was decreased in the lymphosarcomatous calves. Percentages of spontaneous sheep red blood cells(SRBC)-rosettes (E-rosettes) were not elevated. Antibodies to bovine leukemia virus-antigen were detected in the sera (immuno-diffusion test) of all the leukotic cows but not of the lymphosarcomatous calves. Although there seems to be an increased level of IC in the advanced stage, as compared to the beginning of the disease, there was no statistically significant difference in comparison with the control individuals. In the lymphosarcomatous calves as well as in the leukemic cows there was no statistical difference in the IC values between diseased animals and controls.

Polymorphisms of NORs and Heterochromatin in the Horse and Donkey.

Chromomycin A3 (CMA3) banding in mitotic sets of the Equidae horse and donkey were used to demonstrate both constitutive heterochromatin and R-banding. Intra and Interindividual variation In the size of the heterochromatic blocks was observed In many cases. CMA3-posittve telomeric heterochromatin blocks appeared on several chromosomes of the horse and donkey. Some of them were especially spectacular in the donkey. A sequential silver NOR-chromomycin A3/distamycln A-DAPI (CDD) staining procedure led to the detection of the localization of active nucleolus-organizing regions (NORs) and to the identification of chromosomes. The data revealed individual specific NOR patterns in both species.

Subtracted versus non-subtracted digital imaging in peripheral angiography.

Digital subtraction angiography (DSA) plays an important role in the management of vascular diseases of the lower extremities. A disadvantage is the lack of an automatically moving table top. We used a 1,024 x 1,024 matrix with a large-screen intensifier system and an automated "stepping" facility. In 161 examinations of the arteries of the lower extremity digital peripheral arteriography was performed with and without the subtraction technique. We compared the influence of different iodine concentrations in DA and DSA. Peripheral DA proved to be equal to peripheral DSA in the region of the pelvis, thigh and knee, with no adequate contrasting being obtained merely in the region of the lower leg arteries in about 45%. It is necessary to use contrast medium at a concentration of 300 mg I/ml. The installation of an automated "stepping" facility reduces the amount of contrast medium needed and the exposure time.

Preoperative evaluation of bronchogenic carcinoma: value of MR in T- and N-staging.

Seventy consecutive patients with a bronchogenic carcinoma, in whom chest radiographs did not allow a sufficient evaluation of primary tumor localization or extension were examined by MR (1T). All diagnoses were confirmed by operation and histopathologic examination (Stage T1: 6 patients, Stage T2: 36 patients, Stage T3: 19 patients, Stage T4: 9 patients). T-staging was correct in 79% of patients. Significant infiltration of major bronchi, of the pericardium, heart, mediastinal fat and chest wall can be visualized with a reasonable degree of accuracy. N-staging based on lymph-node size was correct in 56%. A correlation between lymph-node size and metastatic involvement was not found. MR is limited by the spatial resolution, by the lack of tissue specificity and by artifacts. MR is a useful diagnostic tool in the evaluation of the primary tumor extension, however, especially in borderline cases histopathologic examination is required. A reliable N-staging is not possible based on lymph-node size measurement.

[Potentialities and limitations of sonographic diagnosis of the chest in childhood]. / Möglichkeiten und Grenzen der sonographischen Diagnostik des Thorax im Kindesalter.

The advantages and limitations of the sonographic examination of the chest in 16 children are described. Partial opacification of the chest has been found in nine, a total "white" hemithorax in 7 children. Sonographic guided taps of the chest were performed in 3 children. Necessity, extent and yield of additional radiological examinations, especially computed tomography of the thorax, are discussed in detail.

[Value of conventional tomography and computerized tomography in the diagnosis of tumors of the bronchial system]. / Wertigkeit von konventioneller Tomographie und Computertomographie in der Diagnostik von Tumoren des Bronchialsystems.

66 patients with suspected bronchial tumors were examined by conventional tomography and by CT. The results were evaluated separately by two radiologists (A and B). All diagnoses were confirmed by bronchoscopy or surgery. In evaluating individual bronchi, conventional tomography had a sensitivity of 88% (A) or 87% (B) and a specificity of 97% (A) or 95% (B); CT had a sensitivity of 95% (A and B) and a specificity of 99% (A and B). If CT is available, our experience indicates that conventional tomography is no longer indicated.