[Urogeriatric thinking using the example of antiandrogen therapy for prostate cancer]. / Urogeriatrisches Denken am Beispiel der antiandrogenen Therapie des Prostatakarzinoms.

The geriatric patient is defined by an age of over 75 years and multimorbidity or by an age of over 80 years. These patients exhibit a particular vulnerability, which, in the incidence of side effects or complications, leads to a loss of autonomy. Treatment sequalae, once they have arisen, can no longer be compensated. It is important to recognize and document treatment requirements among geriatric patients with the help of screening instruments such as the Identification of Seniors at Risk (ISAR) and Geriatric 8 (G8) scores. If a treatment requirement is identified, oncologic treatment should not be commenced uncritically but rather a focus placed on identification of functional deficits relevant to treatment, ideally using a geriatric assessment but at least based on a detailed medical history. These deficits can then be presented in a structured, examiner-independent, and forensically validated manner using special assessments. A planned treatment requires not only consideration of survival gains, but also knowledge of specific side effects and, in geriatric patients in particular, their impact on everyday life. These considerations should be compared with the patient's individual risk profile in order to prevent side effects from negating the effect of the treatment, for example by worsening the patient's self-help status. With regard to androgen deprivation in prostate cancer-which often is used uncritically-it is important to consider possible side effects such as osteoporosis, sarcopenia, anemia, and cognitive impairment in terms of a possible fall risk; an increase in cardiovascular mortality and the triggering of a metabolic syndrome on the basis of preexisting cardiac diseases or risk constellations; and to carry out a careful risk-benefit analysis.

[Guidelines for consultations regarding incontinence care products]. / Leitlinie Hilfsmittelberatung bei Harninkontinenz.

An investigation of the German consumer organisation "Stiftung Warentest" in 2017 confirmed significant deficiencies in the information, advice and supply of incontinence care products received by urinary incontinence patients. The German Society of Urology (DGU) thereupon drafted and later published guidelines concerning the consultation of patients in the context of incontinence care. Important aspects of the consultation process include the determination of the type of incontinence as well as its severity, clinical examination, and advice regarding possible curative treatments. However, the advice appointment takes centre stage and should ideally be conducted by a qualified person in a separate room granting sufficient privacy and time. Furthermore, repeated supply of a selection of samples for differing degrees and types of incontinence, accommodating the patient's individual preferences and anatomical features, is crucial in order to ensure optimal incontinence care. In the case of commercial health care service providers, transparency relating to the financial implications of e.g. expensive products is key, which is what has been intended by German health insurance providers. The new guidelines concerning urinary incontinence care consultation constitute a step towards the improvement and structuring of processes in the consultation regarding, and the supply of, incontinence care products.

North Atlantic ocean circulation and abrupt climate change during the last glaciation.

The most recent ice age was characterized by rapid and hemispherically asynchronous climate oscillations, whose origin remains unresolved. Variations in oceanic meridional heat transport may contribute to these repeated climate changes, which were most pronounced during marine isotope stage 3, the glacial interval 25 thousand to 60 thousand years ago. We examined climate and ocean circulation proxies throughout this interval at high resolution in a deep North Atlantic sediment core, combining the kinematic tracer protactinium/thorium (Pa/Th) with the deep water-mass tracer, epibenthic δ(13)C. These indicators suggest reduced Atlantic overturning circulation during every cool northern stadial, with the greatest reductions during episodic Hudson Strait iceberg discharges, while sharp northern warming followed reinvigorated overturning. These results provide direct evidence for the ocean's persistent, central role in abrupt glacial climate change.

Early development of the facial nerve in human embryos at stages 13-15.

Study was made on 16 human embryos at developmental stages 13-15 (fifth week). The facial nerve was traced on serial sections made in three planes (sagittal, frontal and horizontal) and stained with routine histological methods and impregnated with silver. In embryos at stage 13 the facial ganglion forms a complex structure with the vestibulocochlear ganglion. It is of fusiform shape in contact with epipharyngeal placode and is located anteriorly and ventrally to the vestibulocochlear ganglion. In embryos at stage 14 the facial ganglion separates from the vestibular and cochlear ganglia and the chorda tympani as the first branch appears. During stage 15 the main trunk of the facial nerve elongates and the greater petrosal nerve originates at the level of the facial ganglion and above the origin of the chorda tympani.

Evolution of ocean temperature and ice volume through the mid-Pleistocene climate transition.

Earth's climate underwent a fundamental change between 1250 and 700 thousand years ago, the mid-Pleistocene transition (MPT), when the dominant periodicity of climate cycles changed from 41 thousand to 100 thousand years in the absence of substantial change in orbital forcing. Over this time, an increase occurred in the amplitude of change of deep-ocean foraminiferal oxygen isotopic ratios, traditionally interpreted as defining the main rhythm of ice ages although containing large effects of changes in deep-ocean temperature. We have separated the effects of decreasing temperature and increasing global ice volume on oxygen isotope ratios. Our results suggest that the MPT was initiated by an abrupt increase in Antarctic ice volume 900 thousand years ago. We see no evidence of a pattern of gradual cooling, but near-freezing temperatures occur at every glacial maximum.

Determination of composition and structure of spongy bone tissue in human head of femur by Raman spectral mapping.

Biomechanical properties of bone depend on the composition and organization of collagen fibers. In this study, Raman microspectroscopy was employed to determine the content of mineral and organic constituents and orientation of collagen fibers in spongy bone in the human head of femur at the microstructural level. Changes in composition and structure of trabecula were illustrated using Raman spectral mapping. The polarized Raman spectra permit separate analysis of local variations in orientation and composition. The ratios of ν2PO4³â»/Amide III, ν4PO4³â»/Amide III and ν1CO3²â»/ν2PO4³â» are used to describe relative amounts of spongy bone components. The ν1PO4³â»/Amide I ratio is quite susceptible to orientation effect and brings information on collagen fibers orientation. The results presented illustrate the versatility of the Raman method in the study of bone tissue. The study permits better understanding of bone physiology and evaluation of the biomechanical properties of bone.

Early development of the human palate in stages 16 and 17.

A study was performed on 12 human embryos at developmental stages 16 and 17 (6(th) week). In the investigated embryos the primary palate is formed from medial nasal, lateral nasal, and maxillary processes. The medial and lateral nasal processes merge and form the nasal fin at stage 16. This fin regresses and at stage 17 and persists as the oronasal membrane. The primordia of the secondary palate appear at stage 17.

8.6Mb interstitial deletion of chromosome 4q13.3q21.23 in a boy with cognitive impairment, short stature, hearing loss, skeletal abnormalities and facial dysmorphism.

We describe a 16-year-old boy with an 8.6Mb interstitial deletion of chromosome 4q 13.3q21.23 identified by oligo array-CGH. The patient presents psychomotor developmental delay, absent speech, marked progressive growth restriction, hearing loss, skeletal defects and minor facial anomalies. The patient required surgical treatment for cleft lip and palate, bilateral cryptorchidism and a neurofibroma. The analysis of the presented patient against previously published cases allowed us to expand further on the phenotype and to reevaluate previously proposed critical overlapping region at 4q21. As an addition to PRKG2 and RASGEFIB genes, we propose to include BMP3 gene as the principal determinant of the observed common phenotype. BMP3 haploinsufficiency appears to be causative of hearing loss and peculiar skeletal abnormalities including hemivertebrae and brachydactyly.

Differentiation of the facio-vestibulocochlear ganglionic complex in human embryos of developmental stages 13-15.

A study was made on 18 embryos of developmental stages 13-15 (5(th) week). Serial sections made in horizontal, frontal, and sagittal planes were stained with routine histological methods and some of them were treated with silver. In embryos of stage 13, the otic vesicle is at the rhombomere 5, and close to the vesicle is the facial-vestibulocochlear ganglionic complex in which the geniculate, vestibular, and cochlear ganglion may be discerned. These ganglia are well demarcated in embryos of stage 14. In the last investigated stage (15(th)) the nerve fibres of the ganglia reach the common afferent tract.

Identification of novel deletion breakpoints bordered by segmental duplications in the NF1 locus using high resolution array-CGH.

BACKGROUND: Segmental duplications flanking the neurofibromatosis type 1 (NF1) gene locus on 17q11 mediate most gene deletions in NF1 patients. However, the large size of the gene and the complexity of the locus architecture pose difficulties in deletion analysis. We report the construction and application of the first NF1 locus specific microarray, covering 2.24 Mb of 17q11, using a non-redundant approach for array design. The average resolution of analysis for the array is approximately 12 kb per measurement point with an increased average resolution of 6.4 kb for the NF1 gene. METHODS: We performed a comprehensive array-CGH analysis of 161 NF1 derived samples and identified heterozygous deletions of various sizes in 39 cases. The typical deletion was identified in 26 cases, whereas 13 samples showed atypical deletion profiles. RESULTS: The size of the atypical deletions, contained within the segment covered by the array, ranged from 6 kb to 1.6 Mb and their breakpoints could be accurately determined. Moreover, 10 atypical deletions were observed to share a common breakpoint either on the proximal or distal end of the deletion. The deletions identified by array-CGH were independently confirmed using multiplex ligation-dependent probe amplification. Bioinformatic analysis of the entire locus identified 33 segmental duplications. CONCLUSIONS: We show that at least one of these segmental duplications, which borders the proximal breakpoint located within the NF1 intron 1 in five atypical deletions, might represent a novel hot spot for deletions. Our array constitutes a novel and reliable tool offering significantly improved diagnostics for this common disorder.

Schwann units in the human foetal phrenic nerve.

In three human foetuses aged 15, 17, and 23 weeks the number of axons surrounded by single Schwann cells was counted. These Schwann cell/axon complexes form the Schwann units. The largest Schwann units in the foetus aged 15 weeks contained 232 axons, in the foetus of 17 weeks the number was 140 and in the foetus of 23 weeks the largest units contained 65 axons.

Lack of role for nitric oxide in cholinergic modulation of myocardial contractility in vivo.

Despite intensive investigation, the role of nitric oxide (NO) in cholinergic modulation of myocardial contractility remains unresolved. The left anterior descending coronary artery of 34 anesthetized, open-chest dogs was perfused via an extracorporeal circuit. Segmental shortening (SS) was measured with ultrasonic crystals and coronary blood flow (CBF) was measured with an ultrasonic flow transducer. An intracoronary infusion of ACh (20 microg/min) was performed, with CBF held constant, under baseline and during dobutamine, CaCl(2), or amrinone at doses increasing SS by approximately 50% (10 microg/min, 15 mg/min, and 300 microg/min ic, respectively). ACh-induced responses during dobutamine were also assessed following treatment with the NO synthase inhibitor N(G)-nitro-L-arginine methyl ester (L-NAME; 300 microg/min ic for 15 min). The effects of sodium nitroprusside (SNP; 80 microg/min ic), an exogenous NO donor, bradykinin (2.5 microg/min ic), a nonmuscarinic releaser of endothelial NO, and bilateral vagal stimulation (before and after L-NAME) were evaluated during dobutamine. ACh had no effect on SS under baseline or during CaCl(2), but it decreased SS during dobutamine or amrinone (-23 +/- 4% and -30 +/- 5%, respectively). Vagal stimulation also reduced SS during dobutamine. L-NAME did not alter the ACh- or vagal-induced decreases in SS during dobutamine. Neither SNP nor bradykinin affected SS during dobutamine. In conclusion, ACh and vagal stimulation have a negative inotropic effect during stimulation of the beta-adrenergic receptors that is independent of NO. The persistence of this effect during amrinone suggests that a mechanism downstream from adenylate cyclase is involved.

Comparative analysis of phenolic acids in mistletoe plants from various hosts.

Phenolic acids present in mistletoe plants collected from various hosts were analysed with the use of HPLC. The following numbers of compounds were found in the mistletoe plant material gathered from respective hosts: Sorbus aucuparia- 12 compounds; Acer plantanoides--14 compounds: Malus domestica, Pyrus communis and Populus nigra--13 compounds each; Quercus robur--15 compounds. Altogether 21 phenolic acids were chromatographically identified in the tested material. The compounds were either free or combined as esters or glycosides. Comparative chromatography revealed qualitative differences in the investigated compounds between the various plant materials. For example o-coumaric acid was only found in mistletoe hosted by Quercus robur. Digallic acid was only found in the plant material hosted by Acer plantanoides. Qualitative and quantitative composition of mistletoes hosted by Malus domestica and Pyrus communis showed considerable similarities as far as phenolic acids were concerned. Moreover. vanillic acid. absent in all other batches of plant material, seemed to be characteristic of the above mistletoes. Quantitative HPLC analysis demonstrated a considerable content of salicylic acid (39.55 mg%) in mistletoe hosted by Sorbus aucuparia. Apart from the above material, this compound was only present in small quantities in plants hosted by Populus nigra (15.63 mg%) and Quercus robur (2.63 mg%).

[Principles of qualifying children for planned surgical procedures]. / Zasady kwalifikacji dzieci do planowych zabiegów operacyjnych.

Children are prone to greater preoperative stress and more frequent accidents during anaesthesia. To reduce stress--a preoperative visit, information for child and parents, premedication and parental presence during induction of anaesthesia have all been successfully used. Surgery can often be performed as a "day case", there is no need for longer than 6 hour fasting (2-3 hours in infants and after fluids only) before induction of anaesthesia, and needle sticks are often avoided before the child loses consciousness. Laboratory tests are also not needed in children with good general health status planned for minor procedures. There is less emphasis on minimal hemoglobin level of 10 g/dl, the physician assessment of circulatory status is preferred rather than stiff laboratory values. Less stress for children means also less problems during induction and recovery as well as less need for prolonged postoperative care.

Predominant staphylococci in the intensive care unit of a paediatric hospital.

Coagulase-negative staphylococci cause a significant number of infections, especially in immunocompromised patients, including premature neonates. Nosocomial strains present in the environment create a special risk.We studied staphylococci isolated from the intensive care unit of a paediatric teaching hospital over the period of six months in 1997. Biotyping and species identification were performed; resistance to methicillin and other beta-lactam antibiotics and patterns of resistance to antimicrobial agents were determined. Staphylococcus cohnii was the predominant species of 147 isolates of staphylococci recovered from the ward environment. Strains were resistant to several antibiotics and 97% were resistant to methicillin. In isolates from infants (72) methicillin-resistant strains of Staphylococcus epidermidis were predominant. Susceptibility to beta-lactams (penicillin, amoxycillin, amoxycillin-clavulanic acid and cephalosporins: cephalothin, cefuroxime and cefotaxime) showed differences between the two species. Some S. cohnii were susceptible to penicillin and amoxycillin despite methicillin-resistance. S. epidermidis were relatively susceptible to amoxycillin-clavulanic acid and cephalosporins. All strains investigated were susceptible to vancomycin, but nearly 30% demonstrated high-level resistance to mupirocin. The search for strains of the same origin showed clones belonging to S. epidermidis, S. hominis and S. saprophyticus but not S. cohnii.A large number of multiresistant, phenotypically different S. cohnii strains surviving in the ward environment may provide a reservoir of antimicrobial resistance genes.

Direct coronary vasomotor effects of sevoflurane and desflurane in in situ canine hearts.

BACKGROUND: An extracorporeal system was used to investigate the direct coronary vasomotor effects of sevoflurane and desflurane in vivo. The role of the adenosine triphosphate-sensitive potassium channels (KATP channels) in these effects was evaluated. METHODS: Twenty-one open-chest, anesthetized (fentanyl-midazolam) dogs were studied. The left anterior descending coronary artery was perfused at controlled pressure (80 mmHg) with normal arterial blood or arterial blood equilibrated with either sevoflurane or desflurane. Series 1 (n = 16) was divided into two groups of equal size on the basis of whether sevoflurane (1.2, 2.4, and 4.8%) or desflurane (3.6, 7.2, and 14.4%) was studied. The concentrations for the anesthetics corresponded to 0.5, 1.0, and 2.0 minimum alveolar concentration (MAC), respectively. Coronary blood flow (CBF) was measured with an ultrasonic, transit-time transducer. Local coronary venous samples were obtained and used to evaluate changes in myocardial oxygen extraction (EO2). In series 2 (n = 5), changes in CBF by 1 MAC sevoflurane and desflurane were assessed before and during intracoronary infusion of the KATP channel inhibitor glibenclamide (100 microg/min). RESULTS: Intracoronary sevoflurane and desflurane caused concentration-dependent increases in CBF (and decreases in EO2) that were comparable. Glibenclamide blunted significantly the anesthetic-induced increases in CBF. CONCLUSIONS: Sevoflurane and desflurane have comparable coronary vasodilative effects in in situ canine hearts. The KATP channels play a prominent role in these effects. When compared with data obtained previously in the same model, the coronary vasodilative effects of sevoflurane and desflurane are similar to those of enflurane and halothane but considerably smaller than that of isoflurane.

Patient-initiated, pressure-regulated, volume-controlled ventilation compared with intermittent mandatory ventilation in neonates: a prospective, randomised study.

OBJECTIVE: To compare the effects of patient-initiated, pressure-regulated, volume-controlled ventilation (PRVC) with pressure-preset intermittent mandatory ventilation (IMV) in neonates with respiratory failure. DESIGN: Randomised, prospective study. SETTING: Intensive care unit (14 beds) in a 300-bed paediatric teaching hospital. PATIENTS: 60 neonates with respiratory distress syndrome (RDS) or congenital pneumonia, weighing < 2500 g and requiring mechanical ventilation. INTERVENTIONS: Ventilatory support until extubation via either IMV (n = 30) or PRVC (n = 27). In PRVC, the tidal volume (VT) was preset and pressure-controlled breaths delivered with peak inspiratory pressure values adapted to achieve the preset VT. MEASUREMENTS AND RESULTS: Main outcome measures were duration of ventilation and incidence of bronchopulmonary dysplasia (BPD). Pulmonary air leaks and intraventricular haemorrhage (IVH) were considered major adverse effects. Demographic data, ventilation parameters and arterial/alveolar oxygen tension ratio were similar at randomisation. Duration of ventilation and incidence of BPD were not decreased by the use of PRVC. Air leaks occurred in 3 neonates in the PRVC group and in 7 babies treated with IMV (NS). The incidence of IVH grade > II was lower in babies treated with PRVC (p < 0.05). In a subgroup of neonates weighing < 1000 g, the duration of ventilation and incidence of hypotension were reduced in the PRVC group (p < 0.05). CONCLUSION: Patient-initiated, pressure-regulated, volume-controlled ventilation can be safely used in neonates and may contribute to a lower incidence of complications.

Circulatory and diuretic effects of dopexamine infusion in low-birth-weight infants with respiratory failure.

OBJECTIVE: To investigate the effects of infusion of dopexamine hydrochloride, a new synthetic catecholamine, on cardiopulmonary status and urine output in neonates with respiratory and circulatory failure. DESIGN: Prospective clinical study with each patient serving as his own control. SETTING: Intensive care unit (14 beds) in a 300-bed paediatric teaching hospital. PATIENTS: Seventeen neonates with low birth weight (LBW) requiring mechanical ventilation in the first 4 days of life, who initially had two of the following symptoms: hypotension, oliguria, metabolic acidosis with base deficit >10 and failure to respond to volume loading. INTERVENTIONS: Cardiopulmonary variables, diuresis and acid-base status were measured before and after volume loading, in patients who did not improve infusion of dopexamine was started at a dose of 2 microg kg-1 min-1 which was titrated to achieve blood pressure, urine output, and base deficit in normal range. Observations were continued for a period of 5 h. MEASUREMENTS AND RESULTS: Systolic blood pressure increased significantly after 3 h. of dopexamine infusion and remained elevated up to the end of the study period. Diastolic and mean blood pressure increased slightly (NS). Diuresis increased significantly from the 4th h of dopexamine infusion. Arterial blood pH increased significantly from baseline at 5 h after the start of dopexamine administration. There was also a significant improvement in the PtcO2/PaO2 index. CONCLUSION: In neonates with respiratory and circulatory failure, dopexamine increases blood pressure and improves arterial pH and urine output.