[Treatment reality of aortic diseases in Switzerland]. / Versorgungsrealität von Aortenerkrankungen in der Schweiz.

BACKGROUND: Due to the federally organized healthcare system in Switzerland, aortic interventions are performed in many different hospitals, presumably sometimes with a very small number of cases per institution. The aim of this study was to present the treatment reality of aortic diseases based on the aortic interventions recorded in Switzerland's vascular registry Swissvasc. METHODS: All interventions on the aorta that were carried out between January 2018 and December 2020 in Switzerland and entered in the Swissvasc registry were included in this overview. Interventions for the treatment of isolated pathologies of the iliac vessels as well as interventions on the ascending aorta and the proximal aortic arch were excluded. RESULTS: Open aortic surgery was performed in 28 hospitals and endovascular aortic repair (EVAR) in 33. Just under half of these hospitals achieved the recommended minimum number of cases for abdominal aortic aneurysms (AAA) of 30 open and endovascular interventions per year, which are currently discussed in the literature. In line with the literature 67% of the elective treatments for AAA were performed by EVAR. Corresponding to the current literature, 11% of the AAA were ruptured in the 3­year observation period. In contrast to the recommendations of the current guidelines almost 60% of the ruptured AAA were treated by open repair. There was a certain tendency for a spontaneous centralization in the treatment of thoracic aortic pathologies as 87% of the interventions were carried out in only 5 hospitals. CONCLUSION: This study shows that many clinics in Switzerland treat aortic pathologies, some with a very small caseload. Further investigations of the quality of care in the treatment of aortic pathologies are urgently needed.

Effects of glycerol-induced hyperhydration prior to exercise in the heat on sweating and core temperature.

Hypohydration reduces exercise performance and thermoregulatory capacity in the heat. Hyperhydration prior to exercise may decrease, delay, or eliminate the detrimental effects of hypohydration. The rapid clearance of excess fluid makes hyperhydration of subjects with common beverages difficult. Glycerol, a natural metabolite which is rapidly absorbed, has osmotic action, and is evenly distributed within the body fluid compartments, was tested as a possible hyperhydrating agent. In six subjects, the following fluid regimens at time 0 were randomly administered on three separate days: in trial 1, glycerol (1 g.kg-1 body weight) plus water (21.4 ml.kg-1 body weight); in trial 2, water (21.4 ml.kg-1); and in trial 3, water (3.3 ml.kg-1) was ingested at time 0. The subjects performed moderate exercise (equivalent to 60% VO2max in a comfortable environment) in a hot dry environment. The exercise started at 2.5 h after the fluids were ingested. The urine volume prior to exercise was decreased when glycerol was ingested, thus resulting in glycerol-induced hyperhydration. During the exercise following the glycerol-induced hyperhydration, there was elevated sweat rate and lower rectal temperature during the moderate exercise in the heat. There were no changes in hemoglobin, hematocrit, or serum electrolyte concentrations following glycerol intake. These data support the hypothesis that glycerol-induced hyperhydration reduces the thermal burden of moderate exercise in the heat.

A theory of follicle selection: II. Computer simulation of estradiol administration in the primate.

A theory of follicle selection (Lacker, 1981) is tested in the primate by simulating the effects of estradiol administration at different times, strengths, and durations during the follicular phase of the menstrual cycle (Clark et al., 1981; Zeleznik, 1981; Dierschke et al., 1985). The theory can account for the observed atretogenic effects of circulating estradiol on follicle development including full, partial, and delayed atresia of the dominant follicle (Dierschke et al., 1985) and can explain why similar estradiol doses achieve different qualitative effects when given at different times during the cycle. The theory predicts that recovery from early atresia may be possible, and it can also account for the loss of control in the number of maturing follicles that has been observed when estradiol antibodies are given in the midfollicular phase (Zeleznik et al., 1985). These results support the hypothesis that the selection mechanism in the primate is a consequence of feedback involving an essentially equipotent follicle population interacting through circulating estradiol and pituitary gonadotropins. A quantitative test of the theory awaits experimental identification of the maturation surfaces that are predicted by it. An experimental design for this purpose is proposed.

Experimental evidence supporting a mathematical theory of the physiological mechanism regulating follicle development and ovulation number.

In higher vertebrates, follicular development is regulated so that the number of follicles that periodically mature and ovulate is controlled within a narrow range. Lacker has proposed a simple mathematical model of follicle development that can account for the regulation of ovulation number. To support the assumption of the theory that follicle interactions are mediated by estradiol acting as a chemical messenger to communicate follicular maturity to the pituitary and other follicles, we have presented data to demonstrate that in the rabbit physiological concentrations of circulating estradiol inhibit follicle maturation. Implants containing estradiol were placed subcutaneously after surgical rupture of the existing follicles that were 1 mm in diameter or larger. Serum estradiol concentrations were maintained near physiological concentrations by the implants. Concentrations of circulating estradiol were 74 +/- 5.7 pg/ml in the untreated groups, whereas the concentrations with the implants were increased by approximately 50 pg/ml/implant over this basal concentration with a range of 100-300 pg/ml. In the control groups, the average number of follicles before surgical rupture was 27 +/- 2.9 and there was no significant difference (p greater than 0.05) in the number of follicles, 26 +/- 1.9, three days after follicle rupture. The follicles ranged in size from 1 mm to 4 mm, and only those over 3 mm were considered mature. In the first group of animals with implants, the total number of follicles before surgery was 19 +/- 3; three days after follicle rupture, the number of follicles was only 9 +/- 1.1.(ABSTRACT TRUNCATED AT 250 WORDS)

A theory of follicle selection: I. Hypotheses and examples.

A theory of follicle selection is developed in which all follicles, ovulatory and atretic, inherit the same developmental plan for responding to circulating concentrations of estradiol and gonadotropins. In the model, this plan is represented by a maturation surface that determines the rate of follicle growth as a function of follicle maturity and circulating hormone concentration. Examples of maturation surfaces are constructed for single and multiple spontaneous ovulators. When model follicles are activated from the reserve pool at random times, spontaneous and coordinated cycles of maturation develop in which the number of ovulatory follicles is controlled within a small and predictable range. For a given maturation surface, this range is nearly independent of the number of follicles in the interacting population, their activation times, and their initial maturities. The theory is therefore consistent with Lipschütz's Law of Follicular Constancy. The theory can account for certain statistical effects that occur with age on the timing of ovulation and the control of ovulation number. Maturation surfaces are also constructed that exhibit spontaneous transitions from cyclic to steady anovulatory behavior. The theory predicts an important regulatory role for atretic follicles in controlling both the timing of maturation and the number of follicles that reach ovulatory maturity.