Robotic partial nephrectomy: a multi-institutional analysis.

Laparoscopic partial nephrectomy for kidney tumors has demonstrated durable oncologic and functional outcomes. The feasibility of robotic partial nephrectomy (RPN) has been demonstrated in several small, single-institution studies. We performed a large, multi-institutional analysis to determine early oncologic results and perioperative outcomes after RPN. Between October, 2002 and September, 2007, 148 patients underwent RPN at six different centers by nine different primary surgeons for localized renal tumors. Medical and operative records were reviewed for clinical characteristics, pathologic findings, and follow-up information. A total of 148 patients underwent RPN. Mean tumor size was 2.8 cm. Renal hilar clamping was utilized in 120 patients, with a mean warm ischemia time of 27.8 min. Positive surgical margins were identified in six patients (4%), of which two had cautery artifact obscuring the margin after off-clamp cautery excision and one underwent completion radical nephrectomy with no evidence of cancer. There is no evidence of tumor recurrence at mean follow-up of 7.2 months (range 2-54 months) overall, and mean follow-up of 18 months (range 12-23 months) for patients with positive surgical margin. Complications occurred in nine patients (6.1%), including hematoma requiring drainage (n = 1), prolonged ileus (n = 3), pulmonary embolus (n = 2), prolonged urine leak (n = 2), and rhabdomyolysis (n = 1). Two patients underwent open conversion for failure to progress, one patient with morbid obesity and one patient with adhesions from prior ureterolithotomy. Mean hospital stay was 1.9 days. In this multi-institutional series of surgeons beginning their initial experience in RPN, the procedure is a feasible option for minimally invasive, nephron-sparing surgery, with immediate oncologic results and perioperative outcomes comparable with more mature laparoscopic series.

[Surveillance of infectious foodborne diseases after enactment of the German Protection against Infection Act in 2001. Potentials and requirements]. / Surveillance Lebensmittel-übertragener Infektionserkrankungen durch das Infektionsschutzgesetz: Möglichkeiten und Anforderungen.

The epidemiology of infectious foodborne diseases has changed. Outbreaks more frequently occur geographically dispersed or protractedly over longer periods of time, and they often appear as a scatter of seemingly sporadic cases. This hampers and delays the identification of their epidemiological link. The surveillance of infectious foodborne diseases has to be refined accordingly to be able to detect these diffuse outbreaks. The German Protection against Infection Act, enacted in 2001, offers the potential of increased sensitivity due to timely electronic reporting of individual cases and detailed data accompanying each report. In addition to a timely and comprehensive reporting system, subtyping of pathogens has become an invaluable tool in identifying epidemiologically linked cases, i.e. outbreaks. Still, the sensitivity of foodborne disease surveillance still hinges on the willingness of physicians to order stool testing for enteric pathogens (and to report suspected outbreaks to local health departments). Without the active participation of physicians, the chance of detecting outbreaks and successfully investigating them is markedly reduced. Consequently, the general preventive strategy would be jeopardised, namely to understand the (often new) mechanisms by which contamination and disease transmission occur well enough to interrupt them.

Miniaturization (0.2 g) and evaluation of attachment techniques of telemetry transmitters.

We have developed a miniaturized very high frequency (VHF) transmitter design for radio-tagging small animals. The average mass of the circuitry is 0.084 g (range 0.081-0.087), hence, with the smallest power cell, complete tags weigh 0.2 g and have a life of 18-22 days. We further demonstrate that with such small tags the technique of attaching the device to the animal's body strongly affects the effective radiated power, and thus transmission ranges. Ideally the attachment couples the electronics to the animal's body as a ground plane for improved radiation. The transmitter allows the application of radio-tracking to be expanded to new taxa whose spatial behaviour and population dynamics are largely unknown, for example arthropods, reptiles or amphibians. The new design is also suitable for miniature implants and signal modulation with sensors.

Outbreak of Salmonella Goldcoast infections linked to consumption of fermented sausage, Germany 2001.

Salmonella Goldcoast (SGC), an uncommon serotype in Germany, was identified in 25 isolates between 1 April and 7 May 2001. To determine the cause of the outbreak, we conducted a matched case-control study including 24 cases and 51 controls. In a multivariable regression model, only consumption of a raw fermented sausage manufactured by a local company remained significant (adjusted odds ratio 20.0, 95 % confidence interval 2.7-302.5). SGC isolated from case-patients shared an indistinguishable pulsed-field gel electrophoresis pattern. A part of the produced raw fermented sausage was sold after only 4 days of fermentation. Samples from the premises and products of the company were negative for SGC. However, short-time raw fermented sausage is more likely to contain pathogens. Irradiation of raw ingredients is not accepted by German consumers, thus strict adherence to good manufacturing practices, the use of HACCP programmes as well as on-farm programmes remain crucial to reduce Salmonella.

Measurement of spin-correlation parameters ANN, ASS, and ASL at 2.1 GeV in proton-proton elastic scattering.

At the Cooler Synchrotron COSY/Jülich spin-correlation parameters in elastic proton-proton (pp) scattering have been measured with a 2.11 GeV polarized proton beam and a polarized hydrogen atomic beam target. We report results for A(NN), A(SS), and A(SL) for c.m. scattering angles between 30 degrees and 90 degrees. Our data on A(SS)--the first measurement of this observable above 800 MeV--clearly disagrees with predictions of available pp scattering phase-shift solutions while A(NN) and A(SL) are reproduced reasonably well. We show that in the direct reconstruction of the scattering amplitudes from the body of available pp elastic scattering data at 2.1 GeV the number of possible solutions is considerably reduced.

[Spread of zoonotic agents by foods of animal origin]. / Verbreitung von Zoonoseerregern durch Lebensmittel tierischer Herkunft.

Due to the expansion of the international trade with food, there is a great and increasing danger of transmitting zoonotic agents with these foods over long distances from one region to another. However, in concrete cases it is difficult to determine which zoonotic agents are transmitted through which foodstuffs and how great the emergency is. The worldwide distribution of most of these agents, the easing up of import controls for goods coming from certain export countries, and the abstinence from evaluating epidemiological data in cases of detection of agents in foods are responsible for this. Merely, the transmission path of Vibrio spp. (V. cholerae, V. parahaemolyticus, V. vulnificus) can be significantly traced from the East Asian countries to Europe via fish products.

Five meters of H(2)O: the pressure at the urinary bladder neck during human ejaculation.

BACKGROUND: There are no data in the literature on pressure changes in the prostatic urethra during ejaculation. In healthy men, it has always been postulated that there must be a pressure gradient in order to prevent retrograde ejaculation, but scientific proof for that is pending. METHODS: In five healthy male volunteers, the pressure profile in the prostatic urethra was registered during ejaculation, using a 10 French balloon catheter with 16 pressure channels. The channels were arranged in pairs at 5-mm intervals, beginning just below the balloon at the bladder neck and extending down to the external urethral sphincter. RESULTS: In the proximal part of the prostatic urethra, a pressure of up to 500 cm of H(2)O was measured in all subjects. Contrary to that, pressures did not exceed 400 cm of H(2)O distally to the verumontanum. CONCLUSIONS: A novel method to register the pressure profile in the lower urinary tract during ejaculation (ejaculomanometry) is presented. This study adds to the knowledge of the normal physiology of reproductive function and may be useful in the evaluation of male sexual and reproductive disorders.

On the pathogenesis of atherosclerosis: enzymatic transformation of human low density lipoprotein to an atherogenic moiety.

Combined treatment with trypsin, cholesterol esterase, and neuraminidase transforms LDL, but not HDL or VLDL, to particles with properties akin to those of lipid extracted from atherosclerotic lesions. Single or double enzyme modifications, or treatment with phospholipase C, or simple vortexing are ineffective. Triple enzyme treatment disrupts the ordered and uniform structure of LDL particles, and gives rise to the formation of inhomogeneous lipid droplets 10-200 nm in diameter with a pronounced net negative charge, but lacking significant amounts of oxidized lipid. Enzymatically modified LDL (E-LDL), but not oxidatively modified LDL (ox-LDL), is endowed with potent complement-activating capacity. As previously found for lipid isolated from atherosclerotic lesions, complement activation occurs to completion via the alternative pathway and is independent of antibody. E-LDL is rapidly taken up by human macrophages to an extent exceeding the uptake of acetylated LDL (ac-LDL) or oxidatively modified LDL. After 16 h, cholesteryl oleate ester formation induced by E-LDL (50 micrograms/ml cholesterol) was in the range of 6-10 nmol/mg protein compared with 3-6 nmol/mg induced by an equivalent amount of acetylated LDL. At this concentration, E-LDL was essentially devoid of direct cytotoxic effects. Competition experiments indicated that uptake of E-LDL was mediated in part by ox-LDL receptor(s). Thus, approximately 90% of 125I-ox-LDL degradation was inhibited by a 2-fold excess of unlabeled E-LDL. Uptake of 125I-LDL was not inhibited by E-LDL. We hypothesize that extracellular enzymatic modification may represent an important step linking subendothelial deposition of LDL to the initiation of atherosclerosis.

Differentiation between fresh and thawed meat by an enzyme profile test.

Exudates from fresh (stored at +4°C) and thawed pork and beef (frozen and stored below -20°C) was assayed by the rapid test kit API-ZYM(TM) to determine enzyme profiles. The test kit consists of 20 wells for different enzyme substrates. Of altogether 1040 results, only few reactions of the enzymes differed in their intensity between frozen and thawed pork or beef. Fresh pork showed a more intensive ß-galactosidase and N-acetyl-ß-glucosaminidase reaction while with fresh beef a more intensive reaction could only be detected for N-acetyl-ß-glucosaminidase. Only N-acetyl-ß-glucosaminidase showed significant differences between fresh and frozen meat in both species (α = 0·01). Considering the indistinct results of the test kit differentiation between frozen and thawed meat, the API-ZYM(TM) test kit is considered not suitable for distinguishing frozen from thawed pork or beef.

The dipole density plot (DDP), a technique to show concentrations of dipoles.

To analyse spontaneous multichannel slow-wave MEG activity a tool was developed to extract focal abnormal activity with a higher spatial dipole density across time. The first version works on discrete volume units, the second version avoids a possible location error, works continuously and can be adjusted for individual slices three-dimensionally. The first version is used for screening and the second version is used to go into more detail. The dipole density plot (DDP) is not limited to single foci, nor to the single-dipole model; neither is it limited to the MEG. The DDP seems to be a valuable tool for detecting and locating lesions three-dimensionally within the brain.

Functional 3D localization of cerebrovascular accidents by magnetoencephalography (MEG).

Spontaneous magnetic slow wave brain activity can be used to locate the underlying sources with sufficient accuracy by using the single current dipole model. To locate focal sources from spontaneous activity a tool had to be developed to extract focal densities of dipoles across time-the dipole density plot. The first version works on discrete volume units and is used for screening. The second version avoids a possible localization error and works continuously and this even is done on individual slices. The DDP seems to be a valuable tool for extracting and separating different focal sources from the background activity. Not only brain infarctions and haemorrhages (and cysts and angiomas) could be located, but also functional sources associated with TIAs even one week after the symptoms. First results let us assume that clinically silent TIAs also (in analogy to clinically silent brain infarctions) could be detected and located.

Notes on technical progress in veterinary public health.

Scientific and technical progress in the field of veterinary public health (VPH) over the last one hundred years has contributed to the protection of consumer health and the environment. This report presents examples of the success achieved in the control of epizootics of tuberculosis, brucellosis, rabies and trichinellosis, which are also zoonotic diseases. The discussion also considers hygiene measures in relation to Listeria in food as well as certain challenges resulting from the spread of latent infections among farm animals. The increasing incidence of Salmonella infections among humans is also considered. Other important VPH tasks include the control of chemical residues of varying origin and of toxic biological substances in foods. Examples are also presented of measures taken and problems which arise in connexion with ensuring that meat is produced under hygienic conditions (meat inspection). The principles involved in efficient controls of establishments and products are outlined. Technical progress in consumer protection is exemplified by the processes of pasteurisation, cooling and freezing, and the limitation of additives. Other important tasks arise in the disposal of animal carcasses and wastes, and in the fields of animal welfare and genetic engineering. Future activities in VPH will depend upon proper education, onward and postgraduate training for veterinarians, and suitable infrastructures for research, examination and surveillance.

[Perioperative antibiotic prophylaxis in allo-arthroplasty]. / Die perioperative Antibiotikaprophylaxe bei Alloarthroplastik.

Since 1984 the perioperative prophylaxis was carried out using the antibiotics Oxacillin or Halospor in artificial joint replacement of the hip. We started with 1 g Oxacillin at the very beginning of the anaesthesie. Further 0.5 g Oxacillin were administered 2 and 6 hours later. 964 hip joints operated between 1982-1988 were followed up. We observed a marked decrease of the rate of infection from 7.2% to 1.0% after the introduction of the perioperative prophylaxis.

Serovars of Listeria monocytogenes and Listeria innocua from food.

The increase of listeriosis outbreaks in recent years has mainly been due to the consumption of contaminated dairy products. This prompted a revision of prevention and control measures. Cheese and other foods (meat, poultry meat) were investigated. For isolation, samples were prepared and investigated according to the recommendations of the FDA with some modifications including, in particular, sub-enrichment. Suspicious colonies were tested biochemically followed by serological identification with factor sera. Out of 100 chicken (95 broilers, 5 layers) Listeria monocytogenes was isolated from 85 carcases. The contamination rate for minced beef and pork (n = 76) was approximately 30%. That for selected ripened soft cheeses (n = 89) was 9%. The counts of Listeria in red meat were usually very low (approximately 10/g). Serovar 1/2a was predominant (78 out of 102 strains). Further serovars detected were: 1/2b, 1/2c, 3a, 4a, 4b, 4d. For comparison, isolated strains of L. monocytogenes and Listeria innocua were inoculated into chicken embryos. In contrast to the former, L. innocua did not kill the embryos.