[ZSE-DUO - dual guidance structure at the centre for rare diseases]. / ZSE-DUO ­ duale Lotsenstruktur im Zentrum für Seltene Erkrankungen.

BACKGROUND: Patients with an unclear diagnosis and suspected rare disease pose special challenges to physicians, among others. AIM OF THE STUDY (RESEARCH QUESTION): The ZSE-DUO project aims to establish whether patient care under the joint supervision of a somatic expert and a mental health expert can improve diagnostic efficacy and precision, as well as shorten the time to diagnosis. MATERIAL AND METHODS: ZSE-DUO has successfully recruited more than 1000 patients at eleven national centres for rare diseases in a control and an intervention group. The findings are being analysed by three evaluating institutions. RESULTS AND DISCUSSION: The study is currently in its final phase. The results will be published in further papers.

Unintentional weight loss is the most important indicator of malnutrition among surgical cancer patients.

BACKGROUND: Disease-related malnutrition is highly prevalent in hospital patients and varies from 25-40%. Early nutritional screening of patients at admission helps to improve recognition of malnourished patients to allow early interventions and enhance clinical outcomes. METHOD: A total of 104 preoperative surgical patients with oesophageal (34), stomach (17) or pancreatic cancer (53) were recruited in our study. The risk of malnutrition was examined using the quick-and-easy Malnutrition Universal Screening Tool (MUST). Anthropometric data and information on percent weight change over the past six months, unintentional weight loss, dietician referrals, and history of nutritional intervention were collected. RESULTS: A total of 75% of our participants were at high malnutrition risk with a mean (±SD) percentage weight loss of 5.18 (±6.23)%, despite a mean BMI of 26.09 (±5.73) kgm-2. Participants with a significantly higher percent weight loss, unintentional weight loss, dietician referral and nutritional intervention had a higher risk of malnutrition (p<0.05). Presence of unintentional weight loss was the only significant predictor (OR 3.22; 95%CI 1.23, 8.40) associated with risk of malnutrition after adjusted for all confounders. CONCLUSION: In conclusion, our findings highlight the importance of routine screening of malnutrition in oncology patients. Medical personnel must be aware that unintentional weight loss is an important predictor of malnutrition risks even if the patient's BMI is not suggestive of malnutrition.

Microbial degradation of phenanthrene by addition of a sophorolipid mixture.

The influence of sophorolipids on microbial degradation of poorly soluble phenanthrene in liquid and soil suspension culture was evaluated in the work presented. Experiments were carried out in two parts. In the first part, important basic physico-chemical characteristics of the biosurfactant and the pollutant used were determined. The critical micelle concentration (CMC) and the solubilization ratio of the biosurfactant were found to be in a good range compared with synthetic surfactants. Also, a reduction to 71% of the detectable amount of phenanthrene was measured within 4 d in soil suspension without any biotic influence. In the second part, culture experiments were done with Sphingomonas yanoikuyae, the bacterium used throughout the work presented here with the aim to assess the toxicity of the sophorolipids on these bacteria and the effect of the surfactant on biodegradation. In exponential growth tests, no toxicity up to 1 g l(-1) sophorolipids could be detected, whereas in an agar plate test, slight growth hindrance was measured at a lower concentration of 250 mg l(-1). The above mentioned data were important for planning further experiments. In the following cultivations with liquid and soil suspension media, enhancements of the biodegradation with surfactant addition were measurable. Fluorescence measurements showed that this effect was not due to an increasing biomass, but to an augmentation of bioavailability of the phenanthrene through increasing the apparent dissolved pollutant. Surfactant addition had the consequence of decreasing the residual detectable pollutant concentration (after 36 h 0.5 compared with 2.3 mg l(-1) soil suspension) and increasing the maximal degradation rate (127 instead of 80 mg l(-1) soil suspension x 10 h). Therefore, the two main problems of biological soil remediation techniques, longer process time and residual pollutants, may be solved by the use of surfactants.

[Use of the laryngeal mask in oral and dental surgery]. / Die Anwendung der Larynxmaske in der Mund-, Kieferund Gesichtschirurgie.

OBJECTIVE: The suitability of the laryngeal mask (LM) for anesthesia in oral and dental surgery of the face was investigated considering in particular the risks of aspiration and dislocation. We also examined acceptability to the surgeon. METHODS: In a prospective study, a total of 105 patients (ASA I-III) was included. Provided with flexible LMs, patients were operated upon the third molars (n = 64), around the dentoalveolar area (n = 32) and extraorally (n = 9). The number of placing efforts, preoperative leakage pressure, cuff pressure and complications occurring during the course of anesthesia were recorded. After the operation, the procedure was compared to endotracheal anesthesia (ETA) by the surgeon. A retrospective study comparing LM with ETA was performed on 1395 patients examining the time in between two operations, the period from the end of operation to the beginning of control of vital signs in the recovery room, and the time spent in the recovery room. The number of patients necessitating a change of anesthesia from LM to ETA was recorded. RESULTS: In 33 patients (31%), intraoperative leakage due to dislocation was observed. 33 patients (31%) had obstruction of the airway. Only when leakage occurred together with obstruction of the airway, SaO2 fell below 94% (n = 11). This was seen in particular during exposure of the wisdom teeth. In 2 of these cases, SaO2 decreased below 70 or 34% respectively. Aspiration of blood, gastric juice or dental and bone fragments was not observed. In one case, ETA became necessary. 19 patients complained of local pains (cough, sore throat, dysphagia). Operative conditions for the surgeon were comparable to oral ETA in 79% of the cases. The time in between two operations decreased about 35%, the period from the end of operation until first control of vital signs in the recovery room was reduced of about 41%, and the time spent in the recovery room decreased by 37% when compared to ETA. Out of 1111 anesthesias performed with the LM, 17 had to be exchanged for ETA. CONCLUSION: Leakage due to dislocation of the LM and airway obstruction only leads to a relevant risk of SaO2 to drop if both components occur simultaneously. With increasing experience and close cooperation between surgeon and anesthesiologist, they may be almost completely avoided so that even exposure of the lower, wisdorri teeth will seldom iiecessiiate the LM to be replaced by ETA. In relation to the tongue depressor, cuff pressure should be kept at low levels in order to obtain better flexibility of the LM. The LM provides sufficient protection against aspiration of intraoperative fluid in the pharynx. Acceptability to the surgeon is high because of good operative conditions and shortened periods in between two operations when compared to ETA. Improved protective reflex responses after the operation and its advantages when used in patients with tightness of the jaw make the LM a suitable instrument for anesthesia in oral and dental surgery.

[Cervical actinomycosis. A rare differential diagnosis of parotid tumor]. / Die zervikale Aktinomykose. Eine seltene Differentialdiagnose des Parotistumors.

Actinomycosis is currently an uncommonly diagnosed human disease. However, it can still complicate trauma to the respiratory and digestive tracts, including operative procedures. A patient with cervicofacial actinomycosis commonly gives a history of recent dental manipulation which usually, involves extraction of a mandibular molar. The common initial symptoms of infection--such as, sudden onset of cervicofacial pain, swelling, erythema, edema and suppuration--can be absent. Infection due to actinomyces is a well-known mimic of malignancy is clinical, radiological and pathological findings. In the case described a 65-year-old man had a mass in his right parotid area. Because of its painless rapid growth with infiltration of the mandible as demonstrated by clinical findings and CT and MRI scans, we established an initial diagnosis of salivary gland malignancy. Salivary gland biopsy then revealed a histological picture of infection due to actinomyces. Therapy was initiated with intravenous amoxicillin and sulbactam. After 20 days of treatment diseased soft tissues and bone were resected. To prevent a relapse the patient received oral clindamycin for 6 weeks. After a followup of two years, the patient has remained free of disease.

[Functional stability of Champy miniplate osteosynthesis in mandibular angle fractures]. / Die Funktionsstabilität der Miniplattenosteosynthese nach Champy bei Kieferwinkelfrakturen.

This paper presents the results of the treatment of fractures of the mandibular angle using miniplate osteosynthesis. From 1984 to 1993 347 patients with 358 fractures were operated in the department of Maxillofacial Surgery at the University of Cologne. In all cases total bone healing could be observed while complications were rare.

Isolation, characterization and RFLP linkage mapping of a DNA repeat family of Solanum spegazzinii by which chromosome ends can be localized on the genetic map of potato.

In a random sample of 2263 cloned genomic DNA fragments of the wild potato species Solanum spegazzinii six related, highly repetitive fragments (SPG repeat family) were identified that were present in much higher copy numbers in S. spegazzinii when compared with the closely related cultivated potato S. tuberosum. The SPG repeat family was organized in long arrays of multiple copies. Cross hybridization experiments with 29 wild and cultivated Solanum species and with the related tomato showed specificity of the SPG repeat family for tuber-bearing Solanum species. Among tuber bearing Solanum species a high degree of variation was observed for restriction fragment length and copy number. The variation in copy number was not correlated with established taxonomic relationships between tuber-bearing Solanum species. DNA sequence analysis revealed a subrepeat structure of 120-140 base pairs embedded in longer repeat units of variable length. Length polymorphisms between highly repeated restriction fragments detected by the SPG probes were used for segregation- and linkage analysis in four mapping populations of potato, for which RFLP maps had been constructed. Twelve loci were identified, eleven of which mapped to the distal ends of nine linkage groups. All the evidence suggested that the SPG repeat family represents a satellite repeat members of which are localized in the subtelomeric region of potato chromosomes. The SPG repeat family could be used, therefore, for completing the genetic map of potato.

[Dento-alveolar surgery of the irradiated jaw: is infected osteoradionecrosis a preventable complication?]. / Dentoalveoläre Chirurgie im bestrahlten Kiefer: ist die infizierte Radioosteonekrose eine vermeidbare Komplikation?

In spite of preventive procedures before, during and after radiotherapy, profound caries and periodontal breakdown of healthy teeth occur. In the course of dentoalveolar surgery in the region of irradiated bone, the risk of development of an infected osteoradionecrosis can be reduced by prophylactic antibodies, prevention of extensive detaching of the periosteum careful osteotomy or extraction, complete smoothing of sharp alveolar ridges and epiperiosteal plastic coverage. When extensive dentoalveolar surgery is necessary, the application of prophylactic pre- and postoperative hyperbaric oxygen may reduce the rate of complications even more.

Quantitative resistance to Phytophthora infestans in potato: a case study for QTL mapping in an allogamous plant species.

Phytophthora infestans is the most important fungal pathogen in the cultivated potato (Solanum tuberosum). Dominant, race-specific resistance alleles and quantitative resistance--the latter being more important for potato breeding--are found in the germplasm of cultivated and wild potato species. Quantitative trait loci (QTLs) for resistance to two races of P. infestans have been mapped in an F1 progeny of a cross between non-inbred diploid potato parents with multiple alleles. Interval mapping methods based on highly informative restriction fragment length polymorphism markers revealed 11 chromosome segments on 9 potato chromosomes showing significant contrasts between marker genotypic classes. Whereas phenotypically no difference in quantitative resistance response was observed between the two fungal races, QTL mapping identified at least one race specific QT locus. Two QT regions coincided with two small segments on chromosomes V and XII to which the dominant alleles R1, conferring race specific resistance to P. infestans, Rx1 and Rx2, both inducing extreme resistance to potato virus X, have been allocated in independent mapping experiments. Some minor QTLs were correlated with genetic loci for specific proteins related to pathogenesis, the expression of which is induced after infection with P. infestans.

Segregation analysis and RFLP mapping of the R1 and R3 alleles conferring race-specific resistance to Phytophthora infestans in progeny of dihaploid potato parents.

Phytophthora infestans (Mont.) de Bary is the most important fungal pathogen of the potato (Solanum tuberosum). The introduction of major genes for resistance from the wild species S. demissum into potato cultivars is the earliest example of breeding for resistance using wild germplasm in this crop. Eleven resistance alleles (R genes) are known, differing in the recognition of corresponding avirulence alleles of the fungus. The number of R loci, their positions on the genetic map and the allelic relationships between different R variants are not known, except that the R1 locus has been mapped to potato chromosome V. The objective of this work was the further genetic analysis of different R alleles in potato. Tetraploid potato cultivars carrying R alleles were reduced to the diploid level by inducing haploid parthenogenetic development of 2n female gametes. Of the 157 isolated primary dihaploids, 7 set seeds and carried the resistance alleles R1, R3 and R10 either individually or in combinations. Independent segregation of the dominant R1 and R3 alleles was demonstrated in two F1 populations of crosses among a dihaploid clone carrying R1 plus R3 and susceptible pollinators. Distorted segregation in favour of susceptibility was found for the R3 allele in 15 of 18 F1 populations analysed, whereas the R1 allele segregated with a 1:1 ratio as expected in five F1 populations. The mode of inheritance of the R10 allele could not be deduced as only very few F1 hybrids bearing R10 were obtained. Linkage analysis in two F1 populations between R1, R3 and RFLP markers of known position on the potato RFLP maps confirmed the position of the R1 locus on chromosome V and localized the second locus, R3, to a distal position on chromosome XI.

The R1 gene conferring race-specific resistance to Phytophthora infestans in potato is located on potato chromosome V.

Late blight in potato is caused by the fungus Phytophthora infestans and can inflict severe damage on the potato crop. Resistance to P. infestans is either based on major dominant R genes conferring vertical, race-specific resistance or on "minor" genes inducing horizontal, unspecific resistance. A dihaploid potato line was identified which carried the R1 gene, conferring vertical resistance to all P. infestans races, with the exception of those homozygous for the recessive virulence allele of the locus V1. The F1 progeny of a cross between this resistant parent P(R1) and P(r), a line susceptible to all races, was analysed for segregation of R1 and of restriction fragment length polymorphism (RFLP) markers distributed on the potato RFLP map comprising more than 300 loci. The R1 locus was mapped to chromosome V in the interval between RFLP markers GP21 and GP179. The map position of R1 was found to be very similar to the one of Rx2, a dominant locus inducing extreme resistance to potato virus X.

[Outpatient dental surgery under anesthesiological monitoring. Investigation with 1022 patients at risk]. / Ambulante zahnärztliche chirurgische Eingriffe unter anasthesiologischer Monitorüberwachung. Untersuchung an 1022 Risikopatienten.

The aim of the study was to explore retrospectively the risks of ambulatory treatment under local anaesthesia during dental operations of elderly patients. Anaesthetic care was divided into control and therapeutical measures. Among the previous disorders the hypertension and its sequelae proved to be the main risk factors. The need of anaesthetic intervention doubled, when the time of operation exceeded 30 min. Due to good interdisciplinary cooperation, 99.3% of the operations took their proper course.