Effect of selenium on early outcomes after cardiopulmonary resuscitation : A preliminary report from a retrospective data evaluation.

BACKGROUND: Administration of selenium, a trace element with antioxidative properties, has been shown to be beneficial in critically ill patients. OBJECTIVE: In this retrospective study, we analyzed the influence of selenium treatment on the outcome of patients after cardiopulmonary resuscitation (CPR) following cardiac arrest. PATIENTS AND METHODS: We retrospectively analyzed selenium plasma levels, neurological performance by Cerebral Performance Categories (CPC), and survival to discharge of 28 resuscitated patients receiving selenium treatment of any cause 24, 48, or 72 h after CPR. All patients received a 1000 µg selenium bolus, followed by a 1000 µg continuous intravenous infusion during a 24 h period. Results were compared to matched controls of resuscitated patients without selenium administration within the first 72 h after CPR. RESULTS: There were clearly distinct time courses of selenium plasma levels between the selenium and the control groups, and between the selenium groups depending on the timepoint of selenium administration after cardiac arrest. Patients receiving selenium within the first 48 h-and especially those with selenium administration within the first 24 h after CPR-showed significantly better neurological outcome, reflected by CPC, and significantly higher survival compared to controls. CONCLUSION: This small observational study gives an indication of a possible improvement in neurological outcome and survival rate with early selenium treatment in patients after CPR.

Internal Controlling of a Radiology Department.

Caused by legal reform initiatives there is a continuous need to increase effectiveness and efficiency in hospitals and surgeries, and thus to improve processes.Consequently the successful management of radiological departments and surgeries requires suitable structures and optimization processes to make optimization in the fields of medical quality, service quality and efficiency possible.In future in the DRG System it is necessary that the organisation of processes must focus on the whole clinical treatment of the patients (Clinical Pathways). Therefore the functions of controlling must be more established and adjusted. On the basis of select Controlling instruments like budgeting, performance indicators, process optimization, staff controlling and benchmarking the target-based and efficient control of radiological surgeries and departments is shown.

[Position paper for a reform of medical emergency care in German emergency departments]. / Positionspapier für eine Reform der medizinischen Notfallversorgung in deutschen Notaufnahmen.

The hospital emergency departments play a central role for the in- and outpatient care of patients with medical emergencies in Germany. In this position paper we point out some general financial and organizational problems of German emergency departments and urge for a higher significance of emergency care in the German health system as an element of public services. The corresponding reform proposals include a change in hospital financing towards a more budget-based system for the emergency departments, an improved structural planning for regional and transregional emergency care, an intensified cooperation with the emergency services of the ambulatory care physicians, a better organizational representation of emergency care within the hospitals and an advancement of emergency medicine in postgraduate medical education.

[Definitions and goals in palliative medicine]. / Definitionen und Ziele in der Palliativmedizin.

Especially in the last 15 years Palliative Care and Palliative Medicine in Germany have increasingly attracted professional and public attention and made remarkable progress. One of the characteristics of Palliative Care in Germany is the differentiation of palliative care from hospice care. Under different viewpoints structure, target groups and aims of Palliative Care have been under discussion in the last 30 years, which made an impact on different forms in the provision of care. Palliative therapy should be distinguished from supportive care and palliative medicine. The revised WHO-definition of Palliative Care broadened the aspects of care in a comprehensive and more holistic understanding of the social, emotional and spiritual needs of patients and their families, including bereavement; and, finally, interdisciplinary and team working issues. It is important to differentiate the palliative care approach from general and specialized palliative care provision for patients with incurable progressive illness and in old age. In Germany 10-12% of all dying patients per year are in need of a specialized palliative care service. The growth in the group of the "very old" will be an important challenge for palliative care in the near future.

[Limits of curation and palliation]. / Wollen, dürfen, sollen, können, müssen. Die Grenzen von Kuration und Palliation.

Informed consent is the condition for treating a patient, in curative and palliative settings. If, due to the medical situation, a valid consent cannot be acquired a substituted judgement based on information about the patients preferences will be applied. Accordingly the mobile palliative team of Caritas Socialis requires that patients are informed about their disease condition and agree to palliative measures. The team asks for clear communication about end of life situations, death and dying, which is sometimes difficult for relatives and patients. Sometimes defense mechanisms appear to deny the true situation in order to cope with the disease. The case report shows an example of a particular problematic challenge to combine palliative ideas with impossible curative hopes. An open discussion tries to clarify positions and seeks for future solutions.

[Active music therapy for chronic pain: a prospective study]. / Aktive Musiktherapie bei chronischen Schmerzen. Eine prospektive Untersuchung.

There are only few publications about the effect of music therapy on pain relief. The intention of this prospective study is to demonstrate the influence of the Nordoff/Robbins method of active music therapy in a group of 12 patients with fibromyalgia, myofascial pain syndromes and polyarthritis on pain reduction, life quality and coping. The clinical parameters of each patient were related to the observations in the audio- and video-documented music therapy settings and to the self-reported changes in pain intensity and pain behaviour. There was a significant reduction of pain intensity and pain-related disability in the music group compared to a control group, but no change in the depression and anxiety score. The influence of music therapy could be even better demonstrated in the systematic analysis of the single cases by individual profiles. Active music therapy affects especially the communicative and emotional dimension of chronic pain. Psychophysiological and psychodynamic models are presented to explain the effectiveness of music therapy on pain reduction. Clinical studies on music therapy as well as on other "art therapies" should relate the analysis of clinical parameters to the descriptive-phenomenological documentation of the therapeutic process to demonstrate systematically the influence of music and art in the individual case.

Combinatorial effects of monoclonal anti-p120 antibody (MAbp120), liposomes and hyperthermia on MCF-7 and LOX tumor cell lines.

The human nucleolar protein p120 is highly expressed in human cancers. Its high expression in breast cancer correlates with a poor prognosis, and its overexpression in 3T3 mouse fibroblasts causes malignant transformation. This study reports that a combination of monoclonal anti-p 120 antibody (MAbp120), liposomes (Lipo), and hyperthermia (HT) resulted in enhanced antitumor effects in cultured human breast adenocarcinoma (MCF-7) and human amelanotic melanoma (LOX) cells. Monoclonal antibody uptake and intracellular localization of the protein p120 were monitored by double labeling indirect immunofluorescence. Cell growth inhibition by the combination of MAbp120 + Lipo + HT was 65% for MCF-7 cells and 96% for LOX cells. When tested on LOX cells, monoclonal antibodies (MAbB23, MAbC23) to other nucleolar proteins (B23, C23) produced only slight cytotoxicity with similar treatment protocols.

Cloning and electrophysiological analysis of KST1, an inward rectifying K+ channel expressed in potato guard cells.

Potassium uptake by guard cells represents part of the osmotic motor which drives stomatal opening. Patch-clamp measurements have identified inward rectifying K+ channels capable of mediating K+ uptake in guard cells and various other plant cell types. Here we report the molecular cloning and characterization of a voltage-dependent K+ channel (KST1) from potato (Solanum tuberosum L.) guard cells. In situ hybridization shows expression of kst1 in guard cells. Two-electrode voltage-clamp and patch-clamp studies of the gene product after cRNA injection into Xenopus oocytes identified KST1 as a slowly activating, voltage-dependent, inward rectifying K+ channel. The single channel current voltage curve was linear in the range -160 to +20 mV, with a deduced single channel conductance of 7 pS in symmetrical 100 mM K+. This channel type, modulated by pH changes within the physiological range, required ATP for activation. In line with the properties of a K(+)-selective channel, KST1 was permeable to K+, Rb+ and NH4+ and excluded Na+ and Li+. Cs+ at submillimolar concentrations blocked the channel in a voltage-dependent manner. Related studies on potato guard cell protoplasts confirmed the biophysical characteristics of the kst1 gene product (KST1) in the heterologous expression system. Therefore, KST1 represents a major K+ uptake channel in potato guard cells.

Riboflavin-responsive complex I deficiency.

Three patients from a large consanguineous family, and one unrelated patient had exercise intolerance since early childhood and improved by supplementation with a high dosage of riboflavin. This was confirmed by higher endurance power in exercise testing. Riboflavin had been given because complex I, which contains riboflavin in FMN, one of its prosthetic groups, had a very low activity in muscle. Histochemistry showed an increase of subsarcolemmal mitochondria. The low complex I activity contrasted with an increase of the activities of succinate dehydrogenase, succinate-cytochrome c oxidoreductase and cytochrome c oxidase. Isolated mitochondria from these muscle specimens proved deficient in oxidizing pyruvate plus malate and other NAD(+)-linked substrates, but oxidized succinate and ascorbate at equal or higher levels than controls. Two years later a second biopsy was taken in one of the patients, and the activity of complex I had increased from 16% to 47% of the average activity in controls. In the four biopsies, cytochrome c oxidase activity correlated negatively with age. We suspect that this is due to reactive oxygen species generated by the proliferating mitochondria and peroxidizing unsaturated fatty acids of cardiolipin. Three of the four patients had low blood carnitine, and all were found to have hypocarnitinemic family members.

Digital radiography: comparison of different methods for imaging of the thorax and the gastrointestinal tracts.

In evaluating the image quality of the chest, four different analog and digital methods were compared. For peripheral lung field, the advanced multiple beam equalization radiography (AMBER) system was given the best score, followed in order by the storage-phosphor, conventional, and asymmetric film/screen systems. For the mediastinal field, the highest image quality was given to the AMBER system, followed by storage phosphor and asymmetric film/screen system. The best overall image quality, especially with regard to demonstration of pathologic alteration, was given to the AMBER system, followed by the storage-phosphor, conventional, and asymmetric film/screen radiography systems. In conclusion, AMBER demonstrated the highest image quality. The storage-phosphor system provided better results in the peripheral and mediastinal fields in comparison with conventional film/screen systems. Other digital systems including selenium chest radiography system and image intensifier digital radiography were also discussed.

Inward rectifier potassium channels in plants differ from their animal counterparts in response to voltage and channel modulators.

We have investigated the electrophysiological basis of potassium inward rectification of the KAT1 gene product from Arabidopsis thaliana expressed in Xenopus oocytes and of functionally related K+ channels in the plasma membrane of guard and root cells from Vicia faba and Zea mays. The whole-cell currents passed by these channels activate, following steps to membrane potentials more negative than -100 mV, with half activation times of tens of milliseconds. This voltage dependence was unaffected by the removal of cytoplasmic magnesium. Consequently, unlike inward rectifier channels of animals, inward rectification of plant potassium channels is an intrinsic property of the channel protein itself. We also found that the activation kinetics of KAT1 were modulated by external pH. Decreasing the pH in the range 8.5 to 4.5 hastened activation and shifted the steady state activation curve by 19 mV per pH unit. This indicates that the activity of these K+ channels and the activity of the plasma membrane H(+)-ATPase may not only be coordinated by membrane potential but also by pH. The instantaneous current-voltage relationship, on the other hand, did not depend on pH, indicating that H+ do not block the channel. In addition to sensitivity towards protons, the channels showed a high affinity voltage dependent block in the presence of cesium, but were less sensitive to barium. Recordings from membrane patches of KAT1 injected oocytes in symmetric, Mg(2+)-free, 100 mM-K+, solutions allowed measurements of the current-voltage relation of single open KAT1 channels with a unitary conductance of 5 pS. We conclude that the inward rectification of the currents mediated by the KAT1 gene product, or the related endogenous channels of plant cells, results from voltage-modulated structural changes within the channel proteins. The voltage-sensing or the gating-structures appear to interact with a titratable acidic residue exposed to the extracellular medium.

The contrast-detail behaviour of a photostimulable phosphor based computed radiography system.

Contrast-detail measurements were performed on a computed radiography imaging system as a function of detector entrance air kerma over the dose range from 0.743 microGy (0.085 mR) to 277 microGy (31.8 mR). A theoretical model of contrast-detail behaviour for a photostimulable phosphor computed radiography system has been derived, which is based on a modified version of the Rose theory of threshold detection. Included in the model are both system and x-ray quantum noise terms, as well as the response of the eye. The zero-frequency noise power of the computed film images was measured with a double-beam scanning microdensitometer. For a given detector dose, good agreement was found between the predicted and measured data when this measurement of system noise was included in the model. The contrast-detail results obtained for the computed radiography system were also compared with contrast-detail results for an image intensifier-TV based digital imaging system and a conventional film-screen system.

Pain: a kaleidoscope of ideas, concepts and approaches.

The following pages contain summaries and short statements on chronic pain providing further material for reflection and debate, namely: a) synopses of recent findings on: the physiology and biochemistry of pain; the contribution of psychoneuroimmunology; b) some views on a sociology of pain; c) analysis of various concepts and approaches which consider pain as: a symptom of disease a form of behaviour a psychosomatic reaction and a social learning process a communication phenomenon a symptom of disintegrated life a disruption in the integrity of the system a signal of broken unity a breach in the wholeness of the individual; d) a holistic approach in pain therapy; e) some unanswered questions.

[Art therapy in chronic pain.]. / Künstlerische Therapien bei chronischem Schmerz.

In the therapy of chronic disease and functional disorders, art therapy is considered to be of increasing importance. The idea behind this type of therapy is that the stimulation of creative activities promotes the healing process and rehabilitation. Music therapy in particular has a long tradition in the treatment of pain and health disorders. In patients, whose perception of disease and treatment expectation is determinated by the idea that their pain results from physical causes alone, compliance in music therapy is usually better than direct psychotherapeutic approaches. In addition to music therapy, the creative arts, creative dance and movement-based creative therapy have also been used in the treatment of patients with chronic pain. A model of chronic pain as a changeable phenomenon of consciousness which depends on subjective perception, communication and coping is the basis for understanding art therapy. The conceptual framework of art therapy offers various explanations for the integration of these forms of therapy in complementary, supportive pain management programs: (1) enhancing the activity level and creative capacity as a healing source; (2) stimulation of positive emotional experience; (3) experiencing social communication and interaction; (4) facilitating projective coping; (5) stimulation of imaginative experience and awareness; (6) promotion of suggestive elements. Anecdotical experience indicates that there could be a broad field for the use of art therapy in pain management programs. The need to validate this form of therapeutic approach by appropriate methodological studies and well-documentated single case series is emphasized.

Ca2+ and nucleotide dependent regulation of voltage dependent anion channels in the plasma membrane of guard cells.

Using the patch-clamp technique we discovered that the voltage dependent anion channels in the plasma membrane of guard cells are activated by a rise in cytoplasmic Ca2+ in the presence of nucleotides. Upon activation, these anion channels catalyse anion currents 10-20 times higher than in the inactivated state, thus shifting the plasma membrane from a K+ conducting state to an anion conducting state. Prolonged stimulation by depolarizing voltages results in the inactivation of the anion current (t1/2 = 10-12 s). We suggest that activation of the anion channel by Ca2+ and nucleotides is a key event in the regulation of salt efflux from guard cells during stomatal closure.

[Bipolar impulses or direct current as an adjuvant treatment of incisional hernia? Comparative experimental animal study]. / Bipolare Impulse oder Gleichstrom als adjuvante Behandlung von Narbenhernien? Tierexperimentelle Vergleichsuntersuchungen.

The electrostimulation of the cicatricial healing in the abdominal wall were tested in 119 Wistar rats by means of bipolar rectangularly pulsed current (0.87 Hz, +/- 25 mu A) and direct current (1 mu A). Doubling of the fascia of an abdominal wall hernia was carried out in three groups of rats. In the first group the operational region was stimulated by rectangularly pulsed current, strong proliferated cicatrices were formed with premature production of fibroblasts and collagenous fibres, fast maturation, and high strength. In the second group it was stimulated by direct current, a less exact longitudinal orientation of the collagenous fibres and a slower cicatricial maturation were shown. The third group applied as a control showed a cicatricial distension up to 5 mm. The electrostimulation of the proliferation of connective tissue and cicatricial healing could be pointed out between different tissues (peritoneum and fascia).

Carnitine deficiency, mitochondrial dysfunction and the heart. Identical defect of oxidative phosphorylation in muscle mitochondria in cardiomyopathy due to carnitine loss and in Duchenne muscular dystrophy.

Cardiomyopathies are often caused by a metabolic defect. Carnitine deficiency and mitochondrial defects in the metabolism of acyl-CoA, including defects in oxidative phosphorylation, start the same circular mechanism of mitochondrial doom. Patients with cardiomyopathy due to carnitine loss are cured by carnitine supplementation. In such a patient we found defective oxidative phosphorylation in isolated muscle mitochondria. The stimulation of the respiratory rate with all substrates by ADP was decreased, probably the cause of inhibition of the adenine nucleotide translocator by accumulating long-chain acyl-CoA. The same condition was encountered in patients with Duchenne muscular dystrophy, who often get cardiomyopathy in the course of the disease process.

[False-negative antiglobulin-(Coombs-) test caused by anticomplement bovine albumin batches in the transfusion preparation]. / Falsch-negativer Antiglobulin-(Coombs-) Test durch antikomplementär wirkende Rinderalbuminchargen bei der Transfusionsvorbereitung.

Different brands of bovine albumins were tested as reagent in the second step of the so called 3-stage-screening test for irregular blood group antibodies. In 3 of 9 brands of bovine albumin there was anticomplementary activity which was the cause of diminished or negative reactions in the third stage of the screening test (antiglobulin stage). The disadvantageous brands of bovine albumin contained Na2-EDTA which revealed to be responsible for the anti-complementary activity.