Factors of influence upon the SF-36-based health related quality of life of patients following surgery for petroclival and lateral posterior surface of pyramid meningiomas.

OBJECTIVE: To describe the patient's self assessed health related quality of life (saHRQoL) based upon the medical outcome study 36-item short form health survey (SF-36) as well as the factors of influence upon the saHRQoL following surgery for petroclival (PCM) and lateral posterior surface of the pyramid (LPPM) meningiomas. PATIENTS AND METHODS: In a series of 78 patients operated consecutively for PCM (n = 46) or LPPM (n = 32) the preoperative, intraoperative and postoperative data were collected retrospectively. The saHRQoL was obtained by mailing the SF-36 questionnaire to the patients. The SF-36 data of the whole patients group was compared with a healthy population. The SF-36 data of the PCM- and LPPM were compared to each other. The influence of pre-, intra- and postoperative findings upon the SF-36 was assessed by uni- and multifactorial analysis. RESULTS: 58 (69%) out of the 78 patients answered the SF-36 questionnaire at a median postoperative follow-up of 59 months. The patients, who answered the SF-36 questionnaire, had a significant lower perioperative complication rate than those who did not (46% vs. 75%, p = 0.019). The saHRQoL of the LPPM and PCM was reduced on several sub-scales, when compared to the German reference population. The outcome of PCM is, assessed by saHRQoL as well as by conventional neurosurgical grading scales, inferior to that of LPPM. The saHRQoL of LPPM correlated in the uni- and multivariate analysis with the early postoperative KPI on the sub-scales SF1 (physical functioning) and SF5 (vitality). Accordingly, the sub-scale SF2 (role-physical) of PCM correlated with the change of the KPI from preoperative to the last follow up. CONCLUSIONS: The saHRQoL of the evaluable patients was lower than that of the normal population. The saHRQoL score of PCM-patients was lower than that of LPPM-patients. For the future the saHRQol should be assessed routinely; It reflects the patients' perspective upon postoperative outcome and enables the comparison with other treatment modalities of these difficult to treat tumors.

Differences in clinical presentation, intraoperative findings and outcome between petroclival and lateral posterior pyramid meningioma.

OBJECTIVE: The goal of this study was to determine the impact of the location of the most frequent skull base meningioma of the posterior fossa, i.e. petroclival (PCM) and lateral posterior pyramid meningioma (LPPM) on clinical presentation, surgical treatment and treatment results. PATIENTS AND METHODS: We retrospectively reviewed a consecutive series of patients operated on for PCM (n=46) and LPPM (n=32). Uni- and multivariate analyses were performed to identify differences in clinical presentation, surgical treatment and pre-, intra- and postoperative factors of influence upon the outcome parameters: Complications rate, mortality, tumour recurrence/progress, hospital stay, Karnofsky Performance Score (KPS). RESULTS: At Presentation, the rate of dizziness was higher in LPPM (56% vs. 7%, p<0,001) and trigeminal nerve impairment was more frequent in PCM (50% vs. 3%, p<0,001). Complete tumour resections were more often achieved (91% vs. 39%, p<0,001), and surgery lasted shorter (median: 247 min vs. 500 min, p<0,001) with less blood loss (median: 525 ml vs. 1000 ml, p<0,001) in LPPM compared to PCM. The overall complication rates (73% vs. 31%, p<0,001) as well the rate of irreversible complications (57% vs. 9%, p<0,004) were higher in PCM than in LPPM. The most frequent complications of PCM surgery were eye movement (46% vs. 6%, p<0,001), facial nerve (28% vs. 3%, p<0.02) and swallowing impairments (21% vs. 3%, p<0.02). The perioperative mortality was 11% in PCM and 0% in LPPM patients. In the multivariate analyses, KPS at discharge correlate positively with age (p=0.034) and preoperative KPS (p=0.0048) in LPPM and positively with staged resection (p=0.056) and negatively with the occurrence of surgical complications (p=0,0427) in PCM. Hospitalization time correlated with the blood loss (p<0,001) for PCM, negatively with the preoperative KPS (p=0.0002) for PCM and LPPM and positively with tumour diameter (p=0.0001) and non-surgical complications rate (p=0.0001) for LPPM. CONCLUSION: As compared to LPPM, surgical treatment of PCM is associated with higher morbidity and mortality. The outcome of LPPM was primarily influenced by preoperative factors: Patients age, tumour size, preoperative KPS. The outcome of PCM was primarily influenced by intraoperative factors like: blood loss, surgery duration, staged tumour resection and the surgical complications rate.

[Implementation of the Perioperative WHO Safety Checklist at a Maximum Care Hospital - A Retrospective Analysis]. / Implementierung der perioperativen WHO-Sicherheitscheckliste an einem Klinikum der Maximalversorgung - eine retrospektive Analyse.

BACKGROUND: In recent years there has been a significant increase of surgical procedures worldwide. Perioperative complication occurred in approximately 10 %, mortality was about 0.5 %. Half of these adverse events were considered to have been preventable. With the introduction of a perioperative checklist by the WHO in 2008, a significant reduction of morbidity and mortality could be achieved. The aim of this study was to investigate the success of the implementation process of the checklist at a maximum care hospital over a three-year period and to expose and analyse any occurring issues. PATIENTS AND METHODS: At various time points (introduction phase, five months, one year and three years after implementation) a total of 358 operations was investigated. First the presence and the handling of the checklist were investigated followed by an analysis of possible influencing factors on the processing. To examine a potential perioperative malpractice, three typical perioperative errors known from the literature on patient safety were analysed. RESULTS: The presence of the checklist improved significantly during the study. With the exception of the first column (signed by ward nurse) the checklist was processed more often among the participants (anaesthesia nurse, anaesthesia physician, surgeon) over the time. However the "sign out" column edited by the surgeon at the end of the operation fell below expectations. In addition to the duration after implementation the level of experience of the surgeon was a relevant factor for a properly completed checklist. During the study a malpractice was found in two cases, a checklist could not be detected. CONCLUSION: Within the study we could demonstrate the difficulties of introducing a surgical checklist at a maximum care hospital. Therefore involved nursing or medical staff must be aware of the usefulness of the checklist and should be motivated to use it. In addition, periodical lectures, training courses and role modelling of nursing and medical staff are required. The objective must be to establish the checklist into daily routine as it is a simple and efficient tool to reduce perioperative morbidity and mortality.

[Circulatory disorders of the renal and mesenteric arteries]. / Durchblutungsstörungen der Nieren- und Mesenterialarterien.

Symptomatic mesenteric circulatory disorders are potentially life-threatening diseases with an increasing frequency due to the demographic population development. Renal artery stenosis is a well accepted cause of hypertension or at least deterioration of blood pressure control as well as the cause of a progressive course of renal insufficiency if of an atherosclerotic nature. Further consequences of renal artery stenosis, such as left ventricle hypertrophy and hypertensive encephalopathy are topics of recent research. Due to progress in percutaneous techniques during the last decade interventional therapy has replaced surgery as the treatment method of choice for lesions located near the origin. The only randomized study comparing endovascular stent revascularization with best medical therapy (ASTRAL) failed to show a benefit of revascularization of renal artery stenoses.

Endovascular stent-graft implantation in acute traumatic aortic dissection with contained rupture and hemorrhagic shock.

BACKGROUND: Traumatic dissections of the thoracic aorta with consecutive organ ischemia are emergencies with an enormously high mortality despite immediate surgical therapy. Successful therapy of a thoracic aortic aneurysm by percutaneous implantation of a stent graft prosthesis was first reported in 1994. In recent years endovascular methods have been used increasingly for the treatment of acute aortic syndromes. CASE REPORT: After a traffic accident, a 33 year old motorcycle rider was admitted to our emergency unit conscious with clinical signs of hemorrhagic shock. His lower extremities were pulseless and paraplegia of the legs had already developed. An immediate angio-CT scan demonstrated a contained rupture of the aortic wall with mediastinal hematoma caused by a dissection beginning in the aortic arch. In the cathlab the right femoral artery was exposed and an angiography was performed showing a complete interruption of aortic blood flow caused by the transection. Under angiographic control an endovascular self-expanding nitinolstent (Talent Stent Graft, Medtronic) was implanted into the descending aorta. After moderate balloon inflation at the proximal entry, the rupture was completely closed and perfusion was restituted. The further clinical course was complicated by rhabdomyolysis necessitating additional subtotal arm amputation. Spinal ischemia resulted in persisting paraplegia of the legs. CONCLUSION: An urgent treatment of a contained rupture of the descending aorta with consecutive organ ischemia by endovascular implantation of stent graft prosthesis is technically possible. Advantages are a less invasive procedure and rapid restitution of blood flow.

Unchanged response to stimulation of pituitary hormone release after serial UV irradiation in men.

A group of 24 healthy young men were evaluated before and after serial suberythematous ultraviolet (UV) radiation: group I, control (no irradiation); groups II and III, 12 radiations in 4 weeks with two different spectra (both containing UV-B). Before the first and 2 days after the last exposure all the volunteers were given an intravenous injection of thyrotropin releasing hormone (TRH, protirelin 0.2 mg) and luteinizing hormone releasing hormone (LH-RH, gonadorelin 0.1 mg). The serum concentrations of TSH, follicle stimulating hormone, LH and prolactin were measured at 0, 20, 30, 45 and 60 min by radioimmunoassay. Neither basal nor stimulated levels of the pituitary hormones showed significant changes after UV radiation. The results showed that exposure to suberythematous doses of UV did not influence the regulation of pituitary hormones in these healthy individuals.

A Circadian Rhythm in the Number of Daughter Cells in Synchronous Chlorella fusca var vacuolata.

Chlorella fusca var vacuolata cells were transferred to continuous darkness or weak light (0.07 watts per square meter) (both were called waiting time, WT) after a 12-hour light and 12-hour dark schedule. A daily dilution is performed at the end of the light/dark schedule, resulting in always the same average production of 18 autospores per mother cell. After 12 and 24 hours of WT in darkness, the production of autospores in a subsequent light/dark schedule was 50 and 100%, respectively. If the WT was performed in weak light (0.07 watts per square meter) the lowest production was obtained, independently of the length of WT. However, an interruption of this weak light by dark pulses (3 hours) increased the autospore production by an amount that depends upon the phase of the circadian rhythm, and varied up to 70% of the control (WT in permanent darkness). If the WT (total darkness) was interrupted by light pulses of 0.5 hour (white, same as used for growth), a phase response curve of productivity resulted. Pulses between the 12th and 18th hour of WT in darkness gave a 3-hour delay of maximum; later on pulses shifted the maximum autospore production 3 hours ahead.

[Organization of a psychiatric department in the Hamburg-Eilbek general hospital--a description]. / Einrichtung einer Psychiatrischen Abteilung am Allgemein-Krankenhaus in Hamburg-Eilbek--Eine Beschreibung.

In January 1980 a Psychiatric Department was established at the General Hospital for decentralised psychiatric treatment of inpatients. The article describes the preparatory planning which went into the concept of the Department. First of all, the Hospital is scheduled to look after a district with a population of 110,000. If patients are in need of psychiatric inpatient treatment, they are not selected according to diagnostic or other criteria. In connection with the Federal German Government's "Psychiatric Key Plan" the hospital set up an outpatient department and--financed at its own cost and from own resources--a psychosocial contacting department, a temporary and permanent home, decentralised sociopsychiatric services located in the community itself, and other projects. The article then describes the treatment concept which includes, besides psychosomatic and sociopsychiatric elements, psychotherapeutic aspects as well, the latter having a point of emphasis in group therapy. Finally, the article underlines fundamental concepts regarding the problem of co-operation with a large psychiatric hospital. It is pointed out that it will be necessary to develop a comprehensive treatment concept so that it becomes possible to find out for each patient which type of treatment and care will be most appropriate in his particular case both as regards outpatient and hospital treatment.

Nitrate uptake and nitrate reduction in synchronous Chlorella.

Nitrate uptake was followed continuously in cultures of Chlorella sorokiniana using ionsensitive electrodes. During the lifecycle of the synchronous cell cultures, a drastic increase occurred in the first hour after the onset of the light. Nitrate uptake rate was shown to be dependent on illumination intensity, nitrate concentration, and temperature. These results point to an energy-linked uptake process. From the different timecourses of nitrate uptake rate and nitrate reductase activation, one can conclude that the increased nitrate reductase activity after light onset is regulated via nitrate uptake. Further evidence for a regulation in this direction is shown by the action of ammonium on nitrate uptake and nitrate reductase activity. The results are discussed in terms of the regulation of the nitrate consuming system.

Changes in pigment content, lipid pattern and ultrastructure of synchronous Chlorella after heat and cold shocks.

Completely synchronous Chlorella cultures were treated with heat (45°C) or cold shocks (4° C) of different lengths at the sixth hour of the 14:10 h lightdark-cycle. After the treatment the cells were grown under normal conditions. Analysis at the end of the cycle showed a direct connection between pigment bleaching, reduction of lipid content, loss of thylakoid stacking and a shift of the fluorescence emission maximuminto a region of shorter wavelength. The thylakoid stacking was completely loosened after a heat shock while two thylakoids remained in contact after cold treatment. This probably explains the different regeneration capacities in temperature shock treated cells. None of the described effects could be observed directly after the shocks. From the parallel decay of chlorophyll a, monogalactosyl diglyceride and carotenoids an intimate correlation with the photosystem II complex is suggested.

Synthesis of DNA during the cell cycle of synchronous Anacystis nidulans.

Cells of Anacystis nidulans strain 1402-1 incorporate [methyl-(3)H]thymidine or [8-(3)H]adenine into DNA; in synchronous cultures (21/2 h full light, 1/2 h weak light, 5 h dark), this incorporation occurs in the dark to different extents according to the labeled precursor offered or to its specific activity. The specific activity of in vivo, uniformly labeled DNA decreases to half the initial value when the cells are grown in the absence of radioactive DNA precursors during the light phase; it does not decrease during the following dark phase. If unlabeled thymidine is given during the dark phase, the specific activity of the DNA starts to decrease at the onset of the next light phase. The time course of the decrease supports the hypothesis that all cells start their DNA replication immediately after illumination and that the first cells have completed if after 1.25 h. The slowest cells then need 3.75 h for completion of DNA replication. It is discussed whether the incorporation during the dark might be due to pool size effects.

[Endogenous variations of productivity in Scenedesmus acutus and their relation to the nucleic acid metabolism]. / Endogene Produktivitätsschwankungen bei Scenedesmus acutus und ihre Beziehung zum Nucleinsäure-Stoffwechsel.

1. In Scenedesmus acutus Tomaselli, endogenous variations in cell progeny production and chlorophyll formation have been found which are very similar to those previously described in Chlorella by Hesse (Z. Pflanzenphysiol. 67, 58-77, 1972). When the dark phase of the light-dark-cycle is prolonged to a certain extent, cell productivity drops to a minimal value during the next normal light-dark-cycle. If the duration of the supplementary dark treatment comes near to 24 h, cell productivity is almost normal during the next cycle. 2. Nucleic acid labeling with radioactive precursors is very similar in Scenedesmus acutus and Chlorella pyrenoidosa. Short time labeling with uridine results in labeled chloroplastic RNA and DNA, the cytoplasmic RNA being almost unlabeled. With guanosine, both chloroplastic and cytoplasmic RNA as well as DNA are labelled. In nucleic acid separation on acrylamide gels special caution must be taken, since endocellular RNases are particularely active in some cell stages of Scenedesmus. Optimal results are obtained with ripe mother cells; during nucleic acid purification, cell homogenates have to be frozen together with the phenol-cresol mixture. 3. Large differences in guanosine incorporation are found after treatment of the cells with supplementary dark time. After the normal 10:12 h light-dark-cycle, and also after 24 h of supplementarry dark time, much more radioactive guanosine is incorporated into chloroplastic RNA than into cytoplasmic RNA. After 12 h of supplementary dark time, however, cytoplasmic RNA is more extensively labeled than chloroplastic RNA. 4. When the specific radioactivity of guanosine is diluted to one half, the incorporation into the rRNA of cytoplasm and chloroplast is strongly reduced. This is due to the filling up of the guanosine pool in the two compartments. In contrast, DNA labeling is hardly influenced by reduced specific radioactivity of the precursor. This may be interpreted as meaning that the radioactive labeling reflects the rate of DNA synthesis rather than the size of the guanosine pool in the nucleus. Differences found in the labeling of DNA after 12 and 24 h of supplementary dark time can than be interpreted as variations in DNA synthesis rate.