Erythrocyte sedimentation rate as an independent prognostic factor in mycosis fungoides.

BACKGROUND: Mycosis fungoides has a characteristically indolent clinical course, with a slow progression from patches over plaques to tumours. In advanced stages, with generalized skin involvement or tumours, the prognosis is poor. Well defined prognostic parameters for the individual risc stratifications are rare. OBJECTIVES: To determine prognostic factors for mycosis fungoides. METHODS: In a retrospective monocenter study, we reevaluated 97 consecutive cases of mycosis fungoides seen at our clinic. We correlated various routinely accessed parameters with survival data. The parameters were "sex", "age at time of diagnosis", "age-adjusted erythrocyte sedimentation rate"?(ESR), and "anemia". RESULTS: We identified ESR as a highly significant prognostic marker for MF that also affects overall survival and disease specific survival (P = 0·0014). The five-years disease specific survival was 100% for patients without elevation of ESR, and 52·83% for patients with elevated ESR above normal range (P < 0·001). It is of main interest that the ESR is a significant prognostic marker also in the T2 stage of MF. For the other parameters there was no significant impact on disease specific survival. CONCLUSIONS: ESR has turned out as independent prognostic factor in mycosis fungoides.

Development and validation of a LC-MS/MS method for the simultaneous determination of aflatoxins, dyes and pesticides in spices.

Based on several alerts from European countries over the last years concerning spices, we have been encouraged to establish an accurate method for the determination of dyes, aflatoxins and pesticides in various types of spices using reversed-phase (RP) liquid chromatography-tandem mass spectrometry interfaced with electrospray (LC-ESI-MS/MS). A simple sample treatment procedure entailing the use of an extraction step with acetonitrile without further cleanup has been developed. A C18 column with an aqueous ammonium formate/methanol mixture as the mobile phase was used, and gradient elution was performed. Mass spectral acquisition was done in positive ion mode by applying multiple reaction monitoring of at least two fragmentation transitions per compound to provide a high degree of selectivity. The method was in-house validated in terms of linearity, sensitivity, repeatability, recovery and selectivity on six kinds of spices. Satisfactory results in the majority of the cases were obtained for all analytes and matrices, with practical limits of quantitation acceptable for routine monitoring purposes. Extraction recoveries for most of the compounds ranged from 60% to 140% at spiking levels of 0.05 and 0.5 mg kg(-1). The applicability of the method for the simultaneous determination of dyes, aflatoxins and pesticides in several types of spices was demonstrated, and the method successfully applied to a limited number of products from the local market.

Risk-profile and outcome of small papillary and follicular thyroid carcinomas (

AIM: According to the procedure guidelines of the German Society of Nuclear Medicine no radioiodine ablation is necessary in patients with papillary microcarcinomas in case of limited surgical resection. Few data are available with respect to the optimal management of patients with small follicular thyroid carcinomas. It was the aim to compare risk-profile and outcome of patients with small papillary (PTC) and follicular thyroid carcinomas (FTC)

[Case allocation of extensive operations on head and neck within the German DRG system 2004-2007: what is the net result of the continued developments in case allocation?]. / Analyse der Abbildungsqualität grosser operativer Eingriffe an Kopf und Hals in den G-DRG-Systemen 2004-2007: Was hat die Weiterentwicklung der Fallpauschalen gebracht?

BACKGROUND: When the German DRG system was implemented there was some doubt about whether patients with extensive head and neck surgery would be properly accounted for. Significant efforts have therefore been invested in analysis and case allocation of those in this group. The object of this study was to investigate whether the changes within the German DRG system have led to improved case allocation. METHODS: Cost data received from 25 ENT departments on 518 prospective documented cases of extensive head and neck surgery were compared with data from the German institute dealing with remuneration in hospitals (InEK). Statistical measures used by InEK were used to analyse the quality of the overall system and the homogeneity of the individual case groups. RESULTS: The reduction of variance of inlier costs improved by about 107.3% from the 2004 version to the 2007 version of the German DRG system. The average coefficient of cost homogeneity rose by about 9.7% in the same period. Case mix index and DRG revenues were redistributed from less extensive to the more complex operations. Hospitals with large numbers of extensive operations and university hospitals will gain most benefit from this development. CONCLUSION: Appropriate case allocation of extensive operations on the head and neck has been improved by the continued development of the German DRG system culminating in the 2007 version. Further adjustments will be needed in the future.

Solventogenic enzymes of Clostridium acetobutylicum: catalytic properties, genetic organization, and transcriptional regulation.

The enzymes acetoacetate decarboxylase and coenzyme A transferase catalyse acetone production from acetoacetyl-CoA in Clostridium acetobutylicum. The adc gene encoding the former enzyme is organized in a monocistronic operon, while the ctf genes form a common transcription unit with the gene (adhE) encoding a probable polyfunctional aldehyde/alcohol dehydrogenase. This genetic arrangement could reflect physiological requirements at the onset of solventogenesis. In addition to AdhE, two butanol dehydrogenase isozymes and a thiolase are involved in butanol synthesis. RNA analyses showed a sequential order of induction for the different butanol dehydrogenase genes, indicating an in vivo function of BdhI in low level butanol formation. The physiological roles of AdhE and BdhII most likely involve high level butanol formation, with AdhE being responsible for the onset of solventogenesis and BdhII ensuring continued butanol production. Addition of methyl viologen results in artificially induced butanol synthesis which seems to be mediated by a still unknown set of enzymes. Although the signal that triggers the shift to solventogenesis has not yet been elucidated, recent investigations suggest a possible function of DNA supercoiling as a transcriptional sensor of the respective environmental stimuli.

[Is the Canadian CT head rule for minor head injury applicable for patients in Germany?]. / Lässt sich die Canadian CT Head Rule für das leichte Schädel-Hirn-Trauma auf Deutschland übertragen?

PURPOSE: To evaluate the applicability of the Canadian CT Head Rule (CCHR) on head trauma patients in a German university hospital. METHODS: 122 patients (m = 74; f = 48; 40 +/- 19 years) were examined with cranial CT due to minor head trauma. The need for cranial CT according to the CCHR was evaluated retrospectively. RESULTS: With a sensitivity of 98.9 % and a specificity of 46.6 % all patients with the need for neurosurgical intervention were detected by applying the major criteria of the CCHR. Also, every patient with severe brain injury was detected by the extended criteria with a sensitivity of 99.6 % and a specificity of 34.1 %. This would have led to a reduction in the rate of cranial CT examinations by 45.1 % for the major and 22.1 % for the extended criteria. No patient with severe brain injury would have been missed by application of the criteria. CONCLUSION: The Canadian CT Head Rule for patients with minor head trauma is applicable with a very high sensitivity and the potential of significantly reducing the rate of cranial CT examinations in these patients.

A comparison of the CPAP performance characteristics of the Puritan-Bennett 7200a and a prototype continuous pressure-regulating ventilator.

BACKGROUND: A prototype demand-flow medical ventilator for intensive care unit (ICU) applications has been developed with the ability to maintain continuous pressure regulation of proximal airway pressure during both inspiratory and expiratory respiratory phases. The performance of this system was investigated in laboratory tests of continuous positive airway pressure (CPAP) mode, a ventilatory mode in which airway pressure regulation is strongly challenged. MATERIALS & METHODS: Comparative tests of the pressure-regulating ventilator (PRV) prototype and a Puritan-Bennett 7200a (PB7200a) ventilator were made in three performance categories: pressure-volume product error, peak pressure error during inspiration, and peak pressure error during expiration. Testing was performed on a Bio-Tek VT-2 test lung modified to simulate spontaneous breathing, at CPAP levels of 0, 10, and 20 cm H2O. Results were obtained at a lung compliance of 50 mL/cm H2O and at three parabolic airway resistance levels (Rp10, Rp20, and Rp50 cm H2O.L-2.s2 per ANSI Z79.7-1976). RESULTS: The PRV prototype achieved reductions in pressure-volume product error of more than 0.111 joules (43%) for all test conditions, relative to the PB7200a. Peak pressure errors were reduced by at least 4.0 cm H2O (55%) during inspiration and 4.9 cm H2O (38%) during expiration. CONCLUSIONS: An ICU ventilator utilizing continuous regulation of proximal airway pressure has been shown to provide statistically significant improvements in CPAP performance relative to the PB7200a in laboratory tests. Further testing will be required to quantify the clinical significance of these results.

Loupe microsurgical tubal sterilization reversal. Experience at a community-level naval hospital.

OBJECTIVE: To evaluate the success rates of loupe microsurgical tubal sterilization reversal procedures performed by a generalist obstetrician-gynecologist at a community-level naval hospital. STUDY DESIGN: Consecutive patients who underwent microsurgical tubal anastomosis under loupe magnification by the author during a 16-month period were subjected to a review for outcome in this case series report. RESULTS: Twenty-three patients who underwent reversal of tubal ligation by the author were examined for outcome. By 29 months after the last case studied, the overall conception rate was 78.3% and intrauterine pregnancy rate 68.6%. The miscarriage and ectopic rates were 13.0% and 8.7%, respectively. CONCLUSION: Loupe microsurgical tubal reversal by a properly trained generalist obstetrician-gynecologist at a community hospital rendered success rates comparable to those published in the literature.

PIP: To assess the effectiveness of loupe microsurgical tubal sterilization reversal, outcomes in the 23 women who underwent this procedure at a community naval hospital in Florida over a 16-month period during 1991-92 were reviewed. All reversals were performed by the same general obstetrician-gynecologist. 19 (83%) of these women had undergone an isthmic/ampullary anastomosis sterilization procedure. By 29 months after the last reversal, 18 women (78.3%) had conceived and 13 (56.5%) had experienced a live birth; 3 (13.0%) had a spontaneous abortion and 2 (8.7%) an ectopic pregnancy. The term delivery rates were highest in reversals of tubal ligations involving Pomeroy partial salpingectomy (7/10, 70%), the Krohner method (1/1, 100%), and electrocoagulation (3/5, 60%). Four of the 5 women who failed to conceive demonstrated unilateral or bilateral tubal patency at postoperative hysterosalpingography. Overall, these results are comparable to those reported in the literature.

[Foreign research position in the career development of academic surgeons]. / Der Forschungsaufenthalt im Ausland im Berufsweg des akademischen Chirurgen.

Since there are no data concerning the results/efficiency of research stipends in foreign countries, the aim of this study was to analyze the experience of German surgeons doing research work abroad. Seventy-four fellows (residents) in surgical training who conducted research outside Germany between 1986 and 1995 were interviewed using a detailed questionnaire. Back in Germany, the results and experience gained from research abroad led in the majority of cases to a PhD degree ("habilitation"), a high number of publications, and intensified research efforts in the same field using the methods learned abroad. In Germany, better support for researchers in terms of better clinical and scientific perspectives is urgently needed according to numerous comments.

[Citation characteristics of German authors in "Der Chirurg": hegemony of the impact factor]. / Zitierverhalten deutscher Autoren in "Der Chirurg": Publizieren unter der Dominanz des Impact-Faktors.

Characteristics of citation and language in publications of German authors from the journal "Der Chirurg" (vol 78, 2007) were analysed. Out of a total of 3,342 citations, 756 (22.62%) were from German authors with 248 (32.8) self-citations. The hegemony of the impact factor in science, research and education is critically discussed. The imbalance between the number of surgeons in the US and United Kingdom (66,032) and surgeons in the German speaking countries in Europe (25,300) is compared with respect to the counting methods used to create the impact factor of a journal. The creation of an independent impact factor in Europe and the development of an EU-based citation data bank which allows unselected access to national language scientific literature are strongly needed.

[The medical profession against Anglicization in medicine. Results of a survey]. / Arzteschaft gegen Anglisierung in der Medizin - Ergebnisse einer Umfrage -

BACKGROUND AND OBJECTIVE: The growing Anglicization of the German language especially affects medicine. This is true not only in medical research but also for congresses and publications. This leads to far-reaching consequences also for continuing medical education. This questionnaire study obtained the opinions by a selected group of doctors attending a general medical congress. METHODS: Questionnaires were distributed to 365 attendees of the 51. Doctors' Congress in Berlin in June 2002. In addition 345 questionnaires were sent to doctors working at 3 university clinics, 27 clinics at teaching hospitals and 9 at communal clinics throughout Germany. Answers were divided by work place (clinical or non-clinical) and age. RESULTS: There were 360 respondents (188 non-clinical, 172 clinical; 51.1%): 20% reported good self appraised knowledge of written and spoken English. 84.7% were against English as the only language at meetings of German medical societies, while 98.3% were against it for national congresses (except for foreign guests). 84.3% agreed that German and English should be the languages, both of talks and discussions, at international congresses held in Germany. English as the language of specialist journals was less strongly rejected by young respondents. There was no age-related difference regarding the other questions. CONCLUSIONS: The respondents considered it as self-evident that German be the only language at German national congresses and of journals by German publishers directed at German doctors, but certain exception were acceptable. At international congresses held in Germany, both German and English are equally acceptable in order to avoid a large part of the interested German medical community being disadvantaged in their acquisition of medical-scientific information were English to be the sole language.

Cloning, sequencing, and molecular analysis of the sol operon of Clostridium acetobutylicum, a chromosomal locus involved in solventogenesis.

A DNA region of Clostridium acetobutylicum contiguous with the adc operon has been cloned and sequenced. Structural genes encoding the acetoacetyl coenzyme A:acetate/butyrate:coenzyme A transferase (ctfB and ctfA) and an alcohol/aldehyde dehydrogenase (adhE) could be identified. These three genes together with a small open reading frame (ORF) of unknown function (upstream of adhE) formed an operon (sol operon), as shown by mRNA analyses. The complete sol operon was transcriptionally induced or derepressed before the onset of solventogenesis, thus confirming earlier results of Northern hybridizations with a ctfB gene probe (U. Gerischer and P. Dürre, J. Bacteriol. 174:426-433, 1992). Upstream of the sol operon, we identified two putative promoters that were located in regions with possible stem-loop structures formed by several inverted repeats. The distal promoter P1 showed only minor transcription initiation in solventogenic C. acetobutylicum cells but was recognized in Escherichia coli, presumably because of its high similarity to the sigma 70 consensus sequence. The adhE-proximal promoter P2 directed the major transcription start point in solventogenic C. acetobutylicum but was not recognized in E. coli. The clostridial AdhE showed high similarity to a novel family (type III) of alcohol dehydrogenases. Two other ORFs (ORF 5 and ORF 6) were found on the cloned DNA region that showed no significant similarity to sequences in various available data bases. mRNA studies revealed that ORF 5 formed a monocistronic operon and showed increased expression before onset of solventogenesis.

[Length of overseas research sojourn in the career path of academic surgeons]. / Der Forschungsaufenthalt im Ausland im Berufsweg des akademischen Chirurgen.

Since there are no data concerning the results/efficiency of research stipends in foreign countries, the aim of this study was to analyze the experience of German surgeons doing research work abroad. Seventy-four fellows (residents) in surgical training who conducted research outside Germany between 1986 and 1995 have been interviewed using a detailed questionnaire. Back in Germany, the results and the experience gained from research abroad led in the majority of cases to a post doctoral degree, a high number of publications, as well as to intensified research efforts in the same field, using the methods learned abroad. Back home, the possibilities of pursuing research were often compromised by clinical workload. In general, better support for researchers in terms of better clinical and scientific perspectives is urgently needed, a demand that is voiced in numerous comments.

Identification of two genes encoding putative new members of the ECF subfamily of eubacterial RNA polymerase sigma factors in Clostridium acetobutylicum.

Two genes from Clostridium acetobutylicum DSM 792 were identified which are predicted to encode new members of the ECF subfamily of eubacterial RNA polymerase sigma factors. The sigX gene has the potential to encode a 184-amino acid protein with a molecular mass of 21,870 Da and with the highest overall similarity to Fecl of Escherichia coli (27 % identical residues). The second gene, which is predicted to encode an alternative sigma factor of the ECF subfamily, is the previously described orf2 gene (Gerischer and Dürre, 1990) located in the adc gene region of C. acetobutylicum. The deduced protein of orf2 has significant similarity to SigX of C. acetobutylicum (22 % identical residues) and shares structural features with other alternative sigma factors. Therefore, it is proposed to rename orf2 as sigY. Analysis of the phylogenetic relationship revealed that SigX from C. acetobutylicum, together with sigmaE from Streptomyces coelicolor and SigX from Bacillus subtilis, form a gram-positive cluster within the ECF subfamily and that SigY from C. acetobutylicum together with UviA from Clostridium perfringens, form a separate cluster located between the gram-positive cluster and the sporulation sigma factor sigmaH from B. subtilis.