[Prevalence of acetylsalicylic acid (ASA) - low response in vascular surgery]. / Prävalenz der ASS-Low-Response in der Gefäßchirurgie.

BACKGROUND: Research has revealed that a decreased antiplatelet effect (low response [LR]/high on-treatment platelet reactivity [HPR]) of acetylsalicylic acid (ASA) and clopidogrel is associated with an increased risk of thromboembolic events. There are extensive ASA low response (ALR) and clopidogrel low response (CLR) prevalence data in the literature, but there are only a few studies concerning vascular surgical patients. The aim of this study was to examine the prevalence and risk factors of ALR and CLR in vascular surgical patients. MATERIALS AND METHODS: We examined n = 154 patients with an antiplatelet long-term therapy, who were treated due to peripheral artery occlusive disease (PAD) and/or arteria carotis interna stenosis (CVD). To detect an ALR or CLR, we examined full blood probes with impedance aggregometry (ChronoLog® Aggregometer model 590). Risk factors were examined by acquisition of concomitant disease, severity of vascular disease, laboratory test results and medication. RESULTS: We found a prevalence of 19.3 % in the ALR group and of 21.1 % in the CLR group. Risk factors for ALR were an increased platelet and leucocyte count and co-medication with pantoprazole. We found no significant risk factors for a decreased antiplatelet effect of clopidogrel treatment. CONCLUSION: The investigated prevalence for ALR and CLR are in the range of other studies, particularly based on cardiological patients. More investigations are needed to gain a better evaluation of the risk factors for HPR and to develop an effective antiplatelet therapy regime to prevent cardiovascular complications.

Quality Control of Boar Sperm Processing: Implications from European AI Centres and Two Spermatology Reference Laboratories.

In recent years, increased automatization has resulted in a higher efficiency of boar semen processing in AI laboratories. Sophisticated laboratory management and efficient quality control programmes are needed for current tendencies in major pork-producing countries to reduce the sperm number per AI dose, to lengthen semen storage times and to adopt responsible methods for bacterial control and prevention of the development of multiresistant bacteria. The objective of the present review was to outline current trends in boar semen production and the critical steps in semen processing which affect sperm quality. In addition, integrated elements of a quality assurance programme in use by thirty European AI centres in association with the two German spermatology reference laboratories are described.

Challenges and Limits Using Antimicrobial Peptides in Boar Semen Preservation.

Antibiotics are of great importance for the preservation of ejaculates for livestock breading. The use of antibiotics, however, is not an appropriate compensation for a lack of hygiene standards in artificial insemination (AI) centres. Sophisticated hygiene management and the proper identification of hygienic critical control points (HCCPs) at AI centres provide the basis for counteracting the development of antibiotic resistance in contaminant bacteria and their settlement in AI centres. In recent years, efforts have been made to use antimicrobial peptides (AMPs) in the preservation of boar semen. Investigations have included the testing of synthetic magainin derivatives and cyclic hexapeptides. One prerequisite for the application of AMPs is that they have a minor impact on eukaryotic cells. Bacterial selectivity, proteolytic stability, thermodynamic resistance, and mechanisms including synergistic interaction with conventional antibiotics have made cyclic hexapeptides highly promising candidates for potential application as peptide antibiotics for semen preservation.

In Vitro Measures for Assessing Boar Semen Fertility.

Optimization of artificial insemination (AI) for pig production and evaluation of the fertilizing capacity of boar semen are highly related. Field studies have demonstrated significant variation in semen quality and fertility. The semen quality of boars is primarily affected by breed and season. AI centres routinely examine boar semen to predict male fertility. Overall, the evaluation of classical parameters, such as sperm morphology, sperm motility, sperm concentration and ejaculate volume, allows the identification of ejaculates corresponding to poor fertility but not high-efficiency prediction of field fertility. The development of new sperm tests for measuring certain sperm functions has attempted to solve this problem. Fluorescence staining can categorize live and dead spermatozoa in the ejaculate and identify spermatozoa with active mitochondria. Computer-assisted semen analysis (CASA) provides an objective assessment of multiple kinetic sperm parameters. However, sperm tests usually assess only single factors involved in the fertilization process. Thus, basing prediction of fertilizing capacity on a selective collection of sperm tests leads to greater accuracy than using single tests. In the present brief review, recent diagnostic laboratory methods that directly relate to AI performance as well as the development of a new boar fertility in vitro index are discussed.

Rotation of Boar Semen Doses During Storage Affects Sperm Quality.

It is common practice to rotate boar semen doses during storage for prevention of sperm sedimentation. In this study, the effect of rotation of boar semen doses during storage on sperm quality was investigated. Manual turning twice daily and automatic rotation five times per hour resulted in the following effects: alkalinization of the BTS-extender, loss of membrane integrity at day 3, and loss of motility and changes in sperm kinematics during a thermoresistance test at day 5. Using a pH-stabilized variant of BTS extender, sperm motility and velocity decreased in continuously rotated samples, whereas membrane integrity and mitochondrial activity remain unaffected. It is concluded that rotation of semen samples adversely affects sperm quality and, therefore, should no longer be recommended for AI practice.

Analysis of hygienic critical control points in boar semen production.

The present study addresses the microbiological results of a quality control audit in artificial insemination (AI) boar studs in Germany and Austria. The raw and processed semen of 344 boars in 24 AI boar studs were analyzed. Bacteria were found in 26% (88 of 344) of the extended ejaculates and 66.7% (18 of 24) of the boar studs. The bacterial species found in the AI dose were not cultured from the respective raw semen in 95.5% (84 of 88) of the positive samples. These data, together with the fact that in most cases all the samples from one stud were contaminated with identical bacteria (species and resistance profile), indicate contamination during processing. Microbiological investigations of the equipment and the laboratory environment during semen processing in 21 AI boar studs revealed nine hygienic critical control points (HCCP), which were addressed after the first audit. On the basis of the analysis of the contamination rates of the ejaculate samples, improvements in the hygiene status were already present in the second audit (P = 0.0343, F-test). Significant differences were observed for heating cabinets (improvement, P = 0.0388) and manual operating elements (improvement, P = 0.0002). The odds ratio of finding contaminated ejaculates in the first and second audit was 1.68 (with the 95% confidence interval ranging from 1.04 to 2.69). Furthermore, an overall good hygienic status was shown for extenders, the inner face of dilution tank lids, dyes, and ultrapure water treatment plants. Among the nine HCCP considered, the most heavily contaminated samples, as assessed by the median scores throughout all the studs, were found in the sinks and/or drains. High numbers (>10(3) colony-forming units/cm(2)) of bacteria were found in the heating cabinets, ejaculate transfer, manual operating elements, and laboratory surfaces. In conclusion, the present study emphasizes the need for both training of the laboratory staff in monitoring HCCP in routine semen production and audits in such AI centers for the external control of hygiene parameters.

Use of refractometry as a new management tool in AI boar centers for quality assurance of extender preparations.

A study was performed to see if refractometry can be used as a new quality control tool for boar semen extenders. For this the refractive index and osmolality of BTS extender concentrations (EC) were recorded in 10%-steps from 50% to 150% and 200% of the correct amount. Twelve boar ejaculates were evaluated for semen quality. The refractive index for the correctly prepared extender was 4.6±0.0°Bx, corresponded to 316±16mOsmkg(-1), and correlated highly with osmolality (r=0.99; P<0.001). Total sperm motility with 100% EC differed significantly from ≤70% EC (P<0.001) and 200% EC (P<0.001) on day 1 (d1) and d4, respectively. The percentage of motile spermatozoa in a thermoresistance test on d2 showed a significant drop using ≤70% EC (P=0.047) and ≥140% EC (P=0.004). Secondary apical ridge defects were significantly higher using 50% EC (P<0.001) and ≥150% EC (P=0.032) compared to 100% EC, respectively. An increased number of coiled tails were observed using ≤60% EC (P<0.001). Percentages of spermatozoa with intact membranes on d2 resulted in a significant decrease using 50% EC (P<0.001) and ≥150% EC (P=0.005), respectively. The mean percentage of PI negative spermatozoa with active mitochondria on d2 showed a significant difference using ≤60% EC (P=0.016) and ≥140% EC (P<0.001) compared to 100% EC, respectively. Boar sperm quality is affected by inexact extender preparation. The refractive-index is an indicator of osmolality and may be used to verify semen extender preparation. The sensitivity is sufficient to detect deviations from correct extender preparation before negative effects on sperm quality occur.

[Reliability and safety of intravitreal Ozurdex injections. The ZERO study]. / Zuverlässigkeit und Sicherheit von intravitrealen Ozurdex-Injektionen. Die ZERO-Studie.

BACKGROUND: Since July 2010 Ozurdex® is approved in Germany for treatment of macular edema from retinal vein occlusion (RVO). The objective of this observational study was a systemic summary and analysis of clinical experience regarding complications and side effects of intravitreal administration of dexamethasone. PATIENTS AND METHODS: In a retrospective, multicenter study conducted at 10 centers, 342 eyes with RVO were treated with intravitreal dexamethasone (Ozurdex®, Allergan). After treatment the patients were followed-up over a period of 8 months and intraoperative, perioperative and postoperative complications, such as elevated intraocular pressure and dislocation of implants were systematically recorded. RESULTS: No infections, endophthalmitis, perioperative hypotension, intraoperative lens injuries or retinal detachment occurred. Elevated intraocular pressure was the most common complication accounting for nearly 20 %. In 9 % of patients the intraocular pressure increased by more than 10 mmHg compared to baseline and in 6 patients to > 35 mmHg. In cases of known glaucoma intraocular pressure elevation was not significantly more frequent compared to non-glaucoma patients. In four cases a progression of lens opacity led to phacoemulsification and two implant dislocations in the anterior chamber required surgical repositioning in the vitreous cavity. In two cases a postinterventional macular hole was observed. CONCLUSIONS: In the clinical routine Ozurdex treatment has proven to be a therapy method with minimal side effects. In Ozurdex administration intraocular pressure elevation was observed as the most common side effect; however, this generally did not require surgical intervention. Caution is advised in patients with an anterior chamber lens and iridectomy. Macular holes as a rare complication might result from vitreous traction during the administration process. In summary, even in the clinical routine application of Ozurdex the complication rate was not higher than in registration studies.

Temperature management during semen processing: Impact on boar sperm quality under laboratory and field conditions.

Freshly collected boar spermatozoa are sensitive to a fast reduction in temperature because of lipid phase transition and phase separation processes. Temperature management during semen processing may determine the quality of stored samples. The aim of this study was to evaluate the influence of isothermic and hypothermic semen processing protocols on boar sperm quality under laboratory and field conditions. In the laboratory study, ejaculates (n = 12) were first diluted (1:1) with Beltsville Thawing Solution (BTS) at 32 °C, then processed either with isothermic (32 °C) or hypothermic (21 °C) BTS, stored at 17 °C, and assessed on days 1, 3, and 6. Temperature curves showed that 150 minutes after the first dilution, semen doses of both groups reached the same temperature. Two-step hypothermic processing resulted in lower sperm motility on days 1 and 6 (P < 0.05). Concomitantly, hypothermally processed samples contained less membrane intact sperm on days 3 and 6 (P < 0.05). Using AndroStar Plus extender instead of BTS reduced the negative effect of hypothermic processing. In the field study, 15 semen samples from each of 23 European artificial insemination studs were evaluated as part of an external quality control program. Semen quality based on motility, membrane integrity, mitochondrial activity, and a thermoresistance test was higher for stations using one-step isothermic dilutions (n = 7) compared with artificial insemination centers using two-step hypothermic protocols (n = 16). Both studies show that chilling injury associated with hypothermic dilution results in lower quality of stored boar semen compared with isothermic dilution and that the type of semen extender affects the outcomes.

[European Association of Urology guidelines on urinary and male genital tract infections]. / Synoptische Leitlinie der sexuell übertragbaren Erkrankungen (STD) mit Primärsymptomen im männlichen Genitale (S1). Leitinien der Deutschen Gesellschaft für Urologie.

Today, the classical bacteria that cause venereal diseases, e.g. gonorrhea, syphilis, chancroid and inguinal granuloma, only account for a small proportion of all known sexually transmitted diseases (STDs). Other bacteria and viruses as well as yeasts, protozoa and epizoa must also be regarded as causative organisms of STD. Taken together, all sexually transmitted infections comprise more than 30 relevant STD pathogens. However, not all pathogens that can be sexually transmitted manifest diseases in the genitals and not all infections of the genitals are exclusively sexually transmitted. Concise information and tables summarising the diagnostic and therapeutic management of STDs in the field of urology allow a synoptic overview, and are in agreement with the recent international guidelines of other specialist areas. Special considerations (i.e. HIV infection, pregnancy, infants, allergy) and recommended regimens are presented.

[Digitization of conventional x-ray films]. / Digitalisierung konventioneller Röntgenaufnahmen.

The diagnostic value of a digitization system for analogue films based on a charge-coupled-device (CCD) scanner with adjustable resolution of 2.5 or 5 lp/mm was assessed. Some 110 skeletal radiographs, 50 contrast studies, including 25 of patients with Crohn's disease, and 70 abdominal plain films before and after successful lithotripsy for renal stones were digitized. Receiver operating characteristic (ROC) studies showed improved detection of cortical and trabecular defects with contrast-optimized digitized films. Edge enhancement algorithms yielded no additional information. Inflammatory lesions of Crohn's disease were detected equally well by conventional films and digitized images. A statistically significant improvement (p less than 0.05) in the recognition of disintegration after lithotripsy was found for the processed digitized images. On the basis of this initial investigation, the digitization system tested appears to be useful for diagnostic purposes, especially when contrast resolution plays an important part, as with stone fragmentation or cortical defects.

[Microbiological and morphological findings in reactive lymphadenopathy]. / Mikrobiologische und morphologische Befunde bei reaktiver Lymphadenopathie.

An attempt was made by means of microbiological and histomorphological methods for diagnostic elucidation of reactive lymphadenopathies in 52 patients. The serological findings differed from those recorded from clinically intact individuals, in that they included not only increased prevalence of antibodies but also increased antibody titres to cytomegalovirus, influenza virus, and toxoplasma gondii. The dynamic of antibody titres against antigens specific of herpesvirus, influenza virus, and toxoplasma gondii were followed up and enabled positive detection in 11 of 18 patients of active infections with the above pathogens involved. Histologically, the lymph nodes affected were characterised by alterations reminiscent to Piringer lymphadenitis. While, in the course of bacteriological investigations, various bacterial species were isolated from lymph node tissue of 35 patients, direct morphological identification from lymph node sections failed to work. Immature sinus histiocytosis and an increase in phagocytosis activity were among the typical tissue findings.

[Microinvasive stage Ia cancer of the uterine cervix--results of a multicenter clinic based analysis]. / Mikroinvasives Karzinom der Cervix uteri Stadium Ia--Ergebnisse einer multizentrischen Klinikbezogenen Analyse.

A retrospective multicentre study to investigate diagnosis, treatment and end results of treatment of cervical cancer stage Ia, was carried out in 6 departments of gynaecological oncology. After reclassification by a reference pathologist, among the 936 cervical cancer cases primarily diagnosed and treated as stage Ia between 1970 and 1980, only 530 (56.6%) met the criteria of microinvasive cancer stage Ia. Misclassifications concerned all participating centres with statistically significant differences amongst them. Overdiagnosis (reference diagnosis only CIN I-III, 42.5%) was more frequent than underdiagnosis (reference diagnosis stage Ib--0.9%). In comparison to 1970-74, in the period 1975-80 a significant increase of cases detected asymptomatically (86.5%) was observed. The percentage of cases primarily diagnosed by cone biopsy, also increased significantly and amounted to 71.2%. Patients with cervical cancer stage Ia were most frequently treated by surgery alone (93.2%). Radiotherapy alone did not play any important role (5.7%). There were only a few cases treated by combined surgery and radiotherapy (5.7%) with a decreasing trend over time. Women under the age of 45 years were significantly more frequently treated by the conservative method (cone biopsy, simple hysterectomy) than older ones, without any significant relation between depth of invasion and radicality of treatment. A total of 19 (14 local, 5 lymph node) recurrences were diagnosed between 9 and 110 months after primary treatment. Local recurrences could be observed more frequently after limited than extended treatment. There was no significant relation between depth of invasion and frequency of recurrences, but the latter were significantly increased in cases with histologically proven invasion of blood or lymph vessels.(ABSTRACT TRUNCATED AT 250 WORDS)

Demonstration of Epstein-Barr virus in malignant non-Hodgkin's lymphomas.

Lymph nodes or tumor biopsies of 60 persons suspected of having a malignant lymphoma were examined for the presence of Epstein-Barr virus nuclear antigen (EBNA) by anticomplement immunofluorescence. In 8 cases the tissue specimens were also assayed for Epstein-Barr virus (EBV) DNA by nucleic acid hybridization. Serum samples of patients and controls were tested for EBV-related antibodies. The histological tests in 37 cases showed a malignant non-Hodgkin lymphoma, and in 23 cases a reactive lymphadenopathy. A Burkitt lymphoma of a European boy and a polymorphic centroblastoma contained EBNA and approximately 27 or 30 genome equivalents EBV DNA per cell, respectively. EBNA was also demonstrated in about 20% of the cells of a lymph node from a patient with recurrent reactive lymphadenopathy.

Lipase synthesis in the rat pancreas is regulated by secretin.

Conscious rats were infused with optimal doses of secretin (16 clinical units [CU]/kg/h), cerulein (0.25 microgram/kg/h), and both for varying periods of time over 24 h. The presence of zymogen granules in acinar cells and the tissue content of enzymes showed progressive decreases over 3 and 12 h for cerulein and secretin stimulation, respectively. Stimulation with either hormone resulted in a two-fold increase in protein synthesis at 6 and 12 h. Kinetically, the increases observed in protein synthesis were not directly coupled to the observed decreases in tissue content of enzymes. Cerulein stimulation selectively increased the synthesis of anionic trypsinogen forms 1 and 2 and chymotrypsinogen forms 1 (anionic) and 2 (cationic) and decreased the synthesis of amylase. Secretin stimulation selectively promoted the synthesis of lipase and proelastase 2. Lipase synthesis was increased 2.8-, 5.8-, and 4.8-fold at 6, 12, and 24 h, respectively. Proelastase 2 synthesis was increased 2.3-, 3.0-, and 3.4-fold at the same time points. In combination, secretin and cerulein stimulation resulted largely in competitive effects, suggesting that the two hormones exert effects on protein synthesis through different mechanisms. The findings suggest that the anticoordinate changes observed in the synthesis of functional groups of pancreatic enzymes by nutritional substrates in the diet are modulated by specific hormones. Synthesis of the majority of protease zymogens but not cationic trypsinogen or proelastase 2 is modulated by cholecystokinin and its peptide analogs. In contrast, the synthesis of pancreatic lipase and proelastase 2 is regulated by secretin. The findings indicate for the first time that secretin regulates the synthesis of specific proteins in the exocrine pancreas.

In-vivo stimulation of rat pancreatic acinar cells by infusion of secretin. I. Changes in enzyme content, pancreatic fine structure and total rate of protein synthesis.

Infusion of synthetic secretin in conscious unrestricted rats for periods up to 24 h was used to study the structural and functional adaptation of pancreatic acinar cells to this secretagogue. Initial dose-response studies established 16 clinical units (CU) per kg and h (corresponding to 4.64 micrograms X kg-1 X h-1) as optimal dose for persistent stimulation of enzyme discharge. Infusion of this dose led to a slow but progressive depletion of enzyme stores with minimal content by 12 h stimulation. As a result of persistent stimulation total protein synthesis in the acinar cells increased after a lag period of 3 h and reached maximal values 90% above controls by 6 and 12 h secretin infusion. No structural equivalent for pronounced fluid and bicarbonate secretion was observed for either acinar or duct cells over the entire dose range (1 to 64 CU X kg-1 X h-1) and infusion period (1-24 h), except an increased number of coated vesicles in duct cells. Discharge of enzymes from acinar cells was paralleled by a high frequency of exocytotic images at the luminal plasma membrane and was accompanied by the occurrence of membrane fragments in the luminal space, especially after 3 and 6 h secretin infusion. An increased number of lysosomal bodies at these time points especially in the vicinity of the Golgi complex was interpreted in relation to membrane recycling following massive exocytosis. This pattern of structural and functional adaptation of acinar cells following secretin infusion corresponds to previously described changes following caerulein and carbamylcholine stimulation.

In-vivo stimulation of rat pancreatic acinar cells by infusion of secretin. II. Changes in individual rates of enzyme and isoenzyme biosynthesis.

Intravenous infusion of synthetic secretin for periods up to 24 h in conscious rats was combined with in-vitro amino acid incorporation in isolated pancreatic lobules and high-resolution separation of individual enzyme proteins by two-dimensional isoelectric focusing and SDS gel electrophoresis. With this method persistent changes in the biosynthesis of ten enzyme and isoenzyme proteins can be studied as a result of prolonged secretin stimulation. Three major patterns of response were observed: progressive increases in the synthetic rates were found in six out of ten enzyme proteins with most pronounced changes in the synthetic rates of lipase (4.10-fold increase), two forms of proelastase (2.80-fold increase, respectively), the two acidic forms of trypsinogen and chymotrypsinogen (2.60- and 2.40-fold increase, respectively), and of ribonuclease (2.30-fold increase). Only moderate changes (1.30- to 1.90-fold increase) occurred in the synthetic rates of four isoenzymatic forms of procarboxypeptidase and the basic forms of chymotrypsinogen and trypsinogen, respectively. No absolute change in the rate of synthesis was observed in both forms of amylase. These data obtained after secretin stimulation differ significantly from previous results after caerulein stimulation, but it is not clear so far whether this is due to differential effects of the two second messengers released by each of the hormones on the level of transcription or translation.

Remarks on gastroenterologic diagnostics of amoebic liver abscess, peritoneal tuberculosis and tropical splenomegaly.

The amoebic liver abscess, the peritoneal tuberculosis and the "tropical splenomegaly" belong to diseases which are frequent in warm countries but single cases appear also in moderate climate by intercontinental communications. False diagnoses especially in the first both can lead to severe rsp. fatal consequenses. Therefore experiences are dealed with, which have been gained within nearly one year in Ethiopia and which shall illustrate the diagnostic procedures under field conditions in warm countries as well as under conditions of modern hospitals in moderate climates. Amoebic liver abscess is quickly detected and confirmed by sonography and immunodiagnostic. Contrary to it in the fields there is the puncture by means of a i. v.-needle often not only the sole diagnostic but also the first and sometimes life-saving therapeutic procedure in advanced cases. It allows X-ray in double contrast technique if equipment is available. In suitable cases such approved technique shall be used also in modern clinics disposing of methods like sonography and computerized tomography. Concerning peritoneal tuberculosis our examinations agreed with the opinion of literature that the laparoscopy seems to be the most suitable method for quickly detection and safe discrimination from decompensated portal hypertension in liver cirrhosis. By the way the "cope needle" are mentioned which is distributed in warm countries for searching for peritoneal tuberculosis by performance of a blind peritoneal biopsy. It is easier than laparoscopy but not so efficient. - In this connection 31 cases examined by laparoscopy are presented in a table in order to give an impression on further indications to laparoscopy existing in such areas of warm countries.(ABSTRACT TRUNCATED AT 250 WORDS)

Antibodies against herpesviruses in patients with Hodgkin's disease.

The antibody titres to Epstein-Barr virus (EBV), cytomegalovirus (CMV), herpes simplex virus (HSV) and varicella-zoster virus (VZV) were determined in 57 adult patients with Hodgkin's disease and a group of age- and sex-matched controls. In the group of patients, the geometric mean antibody titres to EBV capsid antigen, CMV early and late antigens, and also VZV, were significantly higher than in the healthy controls. Antibodies to early antigens of EBV and CMV were found more commonly in patients than in controls. The raised antibody titres to herpesviruses were taken to be the result of the disturbed cellular immunity in Hodgkin's disease.

[Contribution to the true non-African Burkitt's lymphoma (author's transl)]. / Beitrag zum echten ausserafrikanischen Burkitt-Lymphom.

It is reported on a 6-year-old Middle European boy suffering from a nasopharynx tumor with involvement of a submandibular lymph node. The tumor was classified by morphologic, serologic and virologic data as a true or Epstein-Barr virus-associated Burkitt's lymphoma, resp., which has been, up to now, seldom seen outside Africa. The patient died 3 months after diagnosis. Autopsy has shown tumor involvement of nasopharynx and soft tissues in the left neck region, several lymph nodes, kidneys, liver, spleen, and bone marrow. Cytologic, light and electron microscopic data are reported and the structural change of the tumor is referred to.