Role of antibiotic treatment after surgical debridement of superficial hand infections in 180 patients.

Considering the rising prevalence of antimicrobial resistance and the lack of recommendations on antibiotic treatment, the present study evaluated the necessity of local and systemic antibiotic therapy in addition to surgical debridement in superficial hand infections. Superficial hand infections were defined as not involving tendons, joints or bone. Data were analyzed for 180 patients, assigned to three study groups according to postoperative antimicrobial treatment. Patients in group I were treated with both systemic and local antibiotics; in group II antimicrobial therapy was limited to local antibiotics in the form of subcutaneous gentamicin bead chains; group III did not receive any antibiotic treatment after surgical debridement. Patients were followed up at two weeks and at three months. Immobilization time and length of stay were longer in group I, but there were no significant differences between the groups in terms of revision rate or recovery of hand function assessed by measurement of finger mobility, grip strength and the Disabilities of the Arm, Shoulder and Hand score at follow-up. Antibiotic treatment of hand infections should be considered carefully and reserved for specific indications: e.g., severe infections and selected patients such as those with diabetes or immunocompromising diseases.

Adrenal cancer: relevance of different grading systems and subtypes.

PURPOSE: The subclassification of adrenal cancers according to the WHO classification in ordinary, myxoid, oncocytic, and sarcomatoid as well as pediatric types is well established, but the criteria for each subtype are not sufficiently determined and the relative frequency of the different types of adrenal cancers has not been studied in large cohorts. Therefore, our large collection of surgically removed adrenal cancers should be reviewed o establish the criteria for the subtypes and to find out the frequency of the various types. METHODS: In our series of 521 adrenal cancers the scoring systems of Weiss et al., Hough et al., van Slooten et al. and the new Helsinki score system were used for the ordinary type of cancer (97% of our series) and the myxoid type (0.8%). For oncocytic carcinomas (2%), the scoring system of Bisceglia et al. was applied. RESULTS: Discrepancies between benign and malignant diagnoses from the first thee classical scoring systems are not rare (22% in our series) and could be resolved by the Helsinki score especially by Ki-67 index (more than 8% unequivocally malignant). Since all our cancer cases are positive in the Helsinki score, this system can replace the three elder systems. For identification of sarcomatoid cancer as rarest type in our series (0.2%), the scoring systems are not practical but additional immunostainings used for soft tissue tumors and in special cases molecular pathology are necessary to differentiate these cancers from adrenal sarcomas. According to the relative frequencies of the different subtypes of adrenal cancers the main type is the far most frequent (97%) followed by the oncocytic type (2%), the myxoid type (0.8%) and the very rare sarcomatoid type (0.2%). CONCLUSIONS: The Helsinki score is the best for differentiating adrenal carcinomas of the main, the oncocytic, and the myxoid type in routine work. Additional scoring systems for these carcinomas are generally not any longer necessary. Signs of proliferation (mitoses and Ki-67 index) and necroses are the most important criteria for diagnosis of malignancy.

Gastrointestinal intramural hematoma, a complication of endoscopic injection methods for bleeding peptic ulcers: a case series.

In a prospective study, all patients with peptic ulcer bleeding were documented between February 1984 and April 1992. A total of 227 patients were treated by local injection of epinephrine followed by laser application and injection of polidocanol or fibrin tissue adhesive. In five of these patients, intramural hematomas developing at the former bleeding site one to three days after endoscopic treatment were observed. The presenting symptoms were abdominal pain, nausea, and vomiting. The diagnosis was established by endoscopy, abdominal ultrasound, computed tomography, or laparotomy. In four of our five patients, the bleeding site and hematoma were located in the duodenum. All patients suffered from severe underlying diseases, and showed a clear disturbance of coagulation parameters. In three patients, acute pancreatitis occurred concurrently with the hematoma, probably due to obstruction of the papilla of Vater or compression of the pancreas caused by the hematoma.

[Treatment strategy and results in primary inoperable rectal cancer]. / Behandlungsstrategie und Ergebnisse beim primär inoperablen Rectumcarcinom.

The authors report their experience with laparotomy in patients with rectal carcinoma to identify those patients with locally non-resectable primary cancer of the rectum who may be treated initially by high-dose radiotherapy. The goal of this so-called "staging laparotomy" is to assess mobility and tumor size by means of bimanual palpation, to stage the abdominal cavity and to create total fecal diversion by performing an endcolostomy in order to condition these patients for maximum tolerance during the protracted radiotherapy course (greater than 50 Gy/5-6 weeks). The formation of an endcolostomy seems to avoid severe morbidity and even mortality of high-dose radiotherapy without delay of further surgery. Twenty-two patients with locally advanced rectal carcinoma were treated in this way. The tumor was resectable in 18 of the 20 patients who underwent relaparotomy after high-dose radiotherapy. Six out of the 13 patients with a radical resection died with evidence of disease during the follow-up (2 with local disease). One patient died with no evidence of disease after 5 years and 6 patients are still alive without disease after an average of 37 months (15-67 months).

Is the Forrest classification a useful tool for planning endoscopic therapy of bleeding peptic ulcers?

A prospective controlled study was carried out to determine the validity of the Forrest classification in terms of improved laser therapy. Out of 153 consecutive patients with bleeding peptic ulcers, 137 patients--74 with arterial ulcer bleeding and 63 with non-arterial ulcer bleeding--were included in the trial. In arterial ulcer bleeding a significantly lower rate of permanent hemostasis was achieved, and the frequency of urgent surgery and mortality was higher than in non-arterial ulcer bleeding. Patients with spurting arterial bleeding (Forrest Ia) and those with large non-bleeding visible vessels (Forrest IIa) include almost all patients at risk of further bleeding and death. Combined laser therapy clearly minimizes the risk of rebleeding and death in small non-bleeding visible vessels (Forrest IIa). In contrast, decreased hemoglobin and a requirement for blood transfusion are of limited prospective value for the individual emergency patient. Overall, our results demonstrate that Forrest criteria are essential for proper planning of endoscopic therapy and urgent surgery in bleeding peptic ulcers. Emergency endoscopy must therefore be performed as early as possible.

Specific analysis of trace organics in water using gas chromatography and mass spectroscopy.

For the characterization of a broad range of compounds in water, various methods have been combined into a procedure. The reliability and limitations of this approach have been discussed in this paper. This combined procedure represents only a preliminary solution to the problem of organic materials in water. Future improvements will be possible as new columns, instruments, and software become available. Physico-chemical constants of trace organic compounds have been used to predict and interpret their extraction and pre-separation in an analytical scheme where purge/trap and solvent extraction methods are combined to measure a broad range of organic materials. This approach is limited by the scarcity of thermodynamic data; such data must be generated if predictive models of pollutant behavior in analytical as well as environmental systems are to be developed. In summary, the basic requirements for analyzing trace organic compounds in tertiary effluents and drinking waters include: The analysis must be based on a small sample size (up to 1 liter). Samples of one gallon or more are costly to ship and difficult to process and store. Samples of one liter or less can be shipped at moderate cost and stored in medium-sized refrigerators. The detection limit for most trace contaminants must be in the lower nanogram per liter range. At detection limits of 1 microgram/l and above, the removal (or formation) of many contaminants cannot be determined precisely. For conclusive results, variabilities of the procedure, the compound, and concentration at a sampling point have to be considered and investigated. Generally, approximately 30 samples are needed to establish a concentration distribution (1).

Regional distribution of Na-K-ATPase specific activity in the large intestine of the rat and man.

Segmental heterogeneity of colonic electrolyte transport has been demonstrated in rat and man. We determined whether this is reflected by regional differences in Na-K-ATPase activity. In rats, Na-K-ATPase specific activity was significantly lower in the caecum than in the proximal colon, distal colon, and rectum. In man, biopsy specimens of macroscopically intact mucosa in 26 subjects showed no difference in Na-K-ATPase specific activity along the colon axis. We conclude that Na-K-ATPase distribution may contribute to electrolyte transport differences between rat caecum and colon but not between colonic segments in either rat or man. In an additional series of 11 patients with proximal intestinal resections colonic Na-K-ATPase specific activity was slightly but significantly higher than in controls, possibly representing an adaptive process.

Effect of timolol on aqueous humor protein concentration in the human eye.

We performed a double-masked, controlled study investigating the increase in the protein concentration in aqueous humor after topical timolol maleate administration. Forty patients scheduled to undergo intracapsular cataract surgery were included in the study. Either timolol ophthalmic solution or the vehicle of timolol alone (control) were applied topically in a randomized fashion, and aqueous humor was collected during surgery. Protein concentrations were determined by gel-filtration chromatography. The total protein concentration as well as the concentration of high and medium molecular weight proteins were significantly elevated in the timolol-treated group. The relation of the levels of the three different molecular weight classes did not differ significantly between the two groups, indicating that undisturbed protein filtration in the face of reduced aqueous humor production--and not a change in the permeability of the blood-aqueous barrier--is responsible for the increase in concentration.

[Corneal epithelial cells and human conjunctival cell line (Chang) produce an interleukin 3-like factor]. / Hornhautepithelzellen und eine humane Bindehautzellinie (Chang) produzieren einen Interleukin 3-ähnlichen Faktor.

Tissue mast cells play a central role in the pathogenesis of allergic eye diseases. In the study reported here the authors investigated whether human corneal epithelial cells and a human epitheloid conjunctival cell line (Chang) can produce an interleukin 3 (IL 3)-like mast cell-activating factor. The activity was detected at a m.w. of 15 and 30 kD, the isoelectric points were located at a pH of 7.85, 7.15 and 6.75. The authors believe that this cytokine, which is produced by epithelial cells of the cornea and conjunctiva, might play an important role in the pathogenesis of allergic ocular diseases.

[Human corneal fibroblasts and a human conjunctival cell line (Chang) produce a thymocyte-activating factor (TAF) in vitro]. / Humane Hornhautfibroblasten und eine humane Bindehautzellinie (Chang) produzieren einen thymozytenaktivierenden Faktor (TAF) in vitro.

A variety of distinct cells such as fibroblasts, epidermal cells, glioblastoma cells and corneal epithelial cells have been shown to produce Interleukin 1-like thymocyte-activating factors. Under in vitro conditions these cytokines influence a multiplicity of different cell types, including lymphocytes, fibroblasts, PMN and hepatocytes. In the present study human corneal fibroblasts, as well as the human epitheloid conjunctival Chang cell line were found to produce thymocyte-activating factors (TAF). The molecular weight of the corneal fibroblasts-TAF was found in the 670 kD region, with minor peaks of activity at 30, 17 and 4 kD. TAF from the Chang-cell line eluted at 15-25 kD. Chromatofocusing revealed the pI of the fibroblast-TAF to be at 6.7 and 5.2 and the pI of the conjunctival cells to be at 7.0, 5.3 and 5.0. The latter cells produced prostaglandin E2 upon stimulation. The immunomodulating properties of these cytokines make an important in vivo role in the pathogenesis of inflammatory corneal and conjunctival diseases probable.

Monitoring immunocompetent cells in the peripheral blood of stomach cancer patients after splenectomy and gastrectomy.

The status of lymphocyte subpopulations in splenectomized (Sx) stomach cancer patients (SCa-patients), assessed by monoclonal antibodies, has not been evaluated so far. Therefore subsets of peripheral white blood cells were monitored prior to and following surgical treatment in gastrectomized (Gx) and Sx (n = 64) as well as in non-Sx patients (n = 39). Postoperative surgical complications were more frequent in the Sx group. However, the 2-year survival rate of this group was higher than in non-Sx patients. Lymphocytes were significantly decreased in both groups of patients during the early postoperative period. Monocytes and polymorphonuclear cells (PMN) increased correspondingly. A significant loss of lymphocytes and their subsets in Sx patients was observed during the 1st-3rd postoperative days as compared to the Gx only patients. The OKT4/OKT8 ratios did not differ in either group of patients, whereas the OKT3+anti-B-Ly2 ratio was significantly increased in Sx patients 1 to 3 days postoperatively.

Effect of diphenolic laxatives on Na+-K+-activated ATPase and cyclic nucleotide content of rat colon mucosa in vivo.

1. The effect of bisacodyl and oxyphenisation on the Na+-K+- and Mg2+-activated ATPase and on the mucosa levels of cAMP and cGMP was investigated in transporting ligated loops of the rat colon in acute studies and in chronic feeding experiments 2. The specific activity of the Na+-K+-ATPase was lowered in both types of experiments, concomitantly with a reduction in net sodium absorption. The specific activity of the Mg2+-activated ATPase was unaffected. 3. The cAMP content per mg protein was elevated and the cGMP content decreased in the acute experiments in which the effect on transport was most marked. The content of cyclic nucleotides returned to normal within 2 h whereas absorption, Na+-K+-ATPase specific activity and the mucosal potential difference were still significantly depressed at that time. In chronic experiments with bisacodyl, cAMP was not affected and cGMP was increased in colon loops exhibiting reduced absorption. 4. The results indicate that the inhibition of the Na+-K+-activated ATPase by diphenolic laxatives may play a role in the inhibition of intestinal fluid absorption caused by these compounds. The increase of cAMP in acute experiments could point to a cAMP-mediated stimulation of secretory processes under this condition.