[Residential rehabilitation]. / Wohnortnahe Rehabilitation.

In recent years new avenues of medical rehabilitation have been made possible in order to allow a more flexible and better care for patients. This includes day care and outpatient treatment additional to inpatient services. A further new development are centers which provide "residential rehabilitation". It allows a continuous cooperation with physicians and therapists who send patients or take care of them after discharge. Cooperation with acute care hospitals is easier. Inpatient care, day care and outpatient care can be better integrated. The social network of the patient can easier be taken into account in treatment planning. Patients can be supported when going back to work. Contact with self-help groups can be arranged while the patient is still in treatment.

Determination of polar pharmaceuticals in sewage water of Greece by gas chromatography-mass spectrometry.

Sewage influents and effluents of different urban areas of Greece, were analyzed for polar pharmaceutical residues, used in human medicine. Drugs investigated were the anti-inflammatory drugs diclofenac and ibuprofen, the metabolite of the drugs clofibrates used as blood lipid regulators, clofibric acid and the analgesics phenazone and propyphenazone. Analysis was carried out using capillary gas chromatography-mass spectrometry with selected ion monitoring. The method used was involved solid phase extraction (C(18)) and derivatization with pentafluorobenzyl bromide. Diclofenac was detected in every sewage effluent sample.

Longitudinal follow-up of patients with alpha(1)-protease inhibitor deficiency before and during therapy with IV alpha(1)-protease inhibitor.

BACKGROUND: The efficacy of IV augmentation therapy with human alpha(1)-protease inhibitor (alpha(1)-Pi) in patients with severe alpha(1)-Pi deficiency is still under debate. STUDY OBJECTIVES: To evaluate the progression of emphysema in patients with alpha(1)-Pi deficiency before and during a period in which they received treatment with alpha(1)-Pi. DESIGN: Multicenter, retrospective cohort study. SETTING: Outpatient clinics of 26 university clinics and pulmonary hospitals. PATIENTS: Ninety-six patients with severe alpha(1)-Pi deficiency receiving weekly augmentation therapy with human alpha(1)-Pi, 60 mg/kg of body weight, had a minimum of two lung function measurements before and two lung function measurements after augmentation therapy was started. Lung function data were followed up for a minimum of 12 months both before and during treatment (mean, 47.5 months and 50.2 months, respectively). MEASUREMENTS AND RESULTS: Patients were grouped according to the severity of their lung function impairment. The change in FEV(1) was compared during nontreatment and treatment periods. In the whole group, the decline in FEV(1) was significantly lower during the treatment period (49.2 mL/yr vs 34.2 mL/yr, p = 0.019). In patients with FEV(1) > 65%, IV alpha(1)-Pi treatment reduced the decline in FEV(1) by 73.6 mL/yr (p = 0.045). Seven individuals had a rapid decline of FEV(1) before treatment, and the loss in FEV(1) could be reduced from 256 mL/yr to 53 mL/yr (p = 0.001). CONCLUSION: Some patients with severe alpha(1)-Pi deficiency and well-preserved lung function show a rapid decline in FEV(1). These patients profit from weekly IV therapy with human alpha(1)-Pi and have less rapid decline if treated. Early detection of patients at risk and early start of augmentation therapy may prevent accelerated loss of lung tissue.

Calibrationless determination of creatinine and ammonia by coulometric flow titration.

A precise and sensitive working microflow titration procedure was developed to determine creatinine and ammonia in urine samples. This procedure is based on enzymatic conversion of creatinine, gas diffusional membrane separation of the released ammonia into an acid acceptor stream, and coulometric titration of ammonia with hypobromite. The hypobromite is formed after the electrogeneration of bromine in an electrolyte containing 1.0 M NaBr and 0.1 M sodium borate adjusted to pH 8.5. The electrolysis current follows a triangle-programmed current-time course. An amperometric flow detector records the resulting mirror symmetrical titration curves, which show two equivalence points. The analyte concentration is calculated from the time difference between the equivalence points. For quantitative conversion of creatinine and quantitative separation of present and released ammonia no calibration is necessary to get accurate results. Both ammonia/ammonium and creatinine were determined in the range between 2 microM and 2 mM with relative standard deviations between 3.0 and 1.0% (n = 5). High recoveries were obtained for the analysis of diluted urine samples for both creatinine and ammonia.

Precise and sensitive determination of nitrite by coulometric backtitration under flow conditions.

A novel method performing for coulometric backtitrations in flow channels was developed, which was applied for the precise and sensitive determination of low concentrations of nitrite. Under acid conditions nitrite is reacting stoichiometrically with hydrazine, the remained excess of which is backtitrated with electrogenerated bromine. The titration course is recorded either amperometrically or chemiluminometrically. Hydrazine can be determined precisely and accurately in the range between 0.1 microM and 1 mM without calibration. Nitrite is reduced by hydrazine according to the reaction 2 NO2- + 2 H+ + NH2-NH2 --> N2O + N2 + 3 H2O. Applying the amperometric and the chemiluminometric end-point location nitrite was determined accurately and precisely in the ranges 0.25-65 microM and 0.10-50 microM, respectively. The method was applied to the determination of nitrite in tap and river water.

Twenty-four-hour blood pressure monitoring, diurnal blood pressure profile and drug therapy under hospital care conditions.

OBJECTIVES: To elucidate the prevalence of nondipping in 24 h blood pressure monitoring (BPM) during hospital care with respect to antihypertensive drug therapy, diabetes, renal artery stenosis, and inverse diurnal blood pressure profiles. METHODS: Prospective, consecutive categorization of routine 24 h BPM was performed according to nondipping, drug therapy, normotension, severity of hypertension, diabetes, and inverse diurnal profile for 2 years. Retrospective analysis of patients examined by intraarterial renal artery angiography were performed. Nondipping was defined as a drop in night-time blood pressure (2200-0600 h) by less than 10% of the daytime values. Normotension was considered a daytime 24 h BPM value below 135/85 mmHg without antihypertensive therapy. RESULTS: We categorized 2105 24 h BPM protocols for patients of mean age 59 years. Nondipping was found for 26% of the normotensives, 38% of hypertensive patients not being administered medication, and 48% of drug-treated hypertensives. The significant increase in nondipping among patients under drug therapy applied for patients with daytime blood pressures below and above 135/85 mmHg and was thus independent of the severity of hypertension. Among the subgroup of 561 predominantly type 2 diabetic patients the prevalence of nondipping was increased significantly only for those patients who were hypertensive and being administered antihypertensive drugs. Subgroup analysis of patients using intraarterial angiography did not find different prevalences of nondipping for patients with and without renal artery stenosis. Patients with an inverse diurnal blood pressure profile and an increase in night-time blood pressure by more than 5% of the daytime values presented as a high-risk group because of morbidity associated with renal, cardiac, and cerebral disease. CONCLUSION: Nondipping is a common phenomenon among hospital patients. Drug therapy of hypertension should be directed not only towards the daytime blood pressure, but also toward alleviation of night-time hypertension.

A PC-based titrator for flow gradient titrations.

This paper describes a PC (personal computer) based titrator which was developed for gradient flow titrations. Concentration gradients were generated electrolytically or volumetrically in small tubes. Complete titration curves can be recorded on-line and evaluated automatically. The titrator can be used with all liquid flow detectors with low axial dispersion. The titrator was evaluated for the titration of thiosulphate with electrogenerated triiodide and for the titration of ammonia with electrogenerated hypobromite after continuous gas dialytic separation of ammonia from the sample solution.

A monoclonal antibody specific for conidia and mycelium wall layer of Penicillium and Aspergillus.

A monoclonal antibody was obtained from BALB/c mice immunized with Penicillium frequentans mycelium. The specificity of the antibody was evaluated by enzyme-linked immunosorbent and indirect immunofluorescence assays against the same mycelium. This IgM antibody cross-reacted with various strains of the Penicillium and Aspergillus genera. By indirect immunofluorescence assays, the antibody was able to stain about 10% of Penicillium and Aspergillus conidia, but major part of conidia did not absorb the fluorescence-labeled antibody before swelling. During germination of P. frequentans conidia, the germ tube wall which constitutes a continuation of an inner wall layer was also stained. During germination of P. griseofulvum, the protrusion of the germ tube wall was not always recognized by the antibody because the germ tube wall was constituted by a continuation of an outer spore wall layer. The study of the staining patterns of the spores and the protrusions suggests that the antibody specifically recognizes an antigen of the inner spore wall layer. The monoclonal antibody reacts with extracellular galactomannans produced by genera Aspergillus and Penicillium but is not directed against beta-(1,5)-linked galactofuranose units.

Immunological differentiation of Penicillium species.

Antisera were obtained from a rabbit immunized with Penicillium verrucosum var. verrucosum. These antisera were characterized by immunofluorescence and by indirect enzyme-linked immunosorbent assay for their reactivity with 44 strains of moulds. Antigenically, P. verrucosum var. verrucosum (subgenus Penicillium) appears to be similar to strains belonging to subgenus Furcatum, but strongly different from Penicillium frequentans (subgenus Aspergilloides). Specific absorption of antibodies to antigens confirmed the existence of similar biochemical structures on Penicillium frequentans, Aspergillus versicolor, and Aspergillus fumigatus. Immunological procedures may thus significantly contribute to refine the taxonomic classification of moulds.