[Interventional bronchoscopy-an overview]. / Interventionelle Bronchoskopie ­ ein Überblick.

In addition to lung function testing and radiological imaging, bronchoscopy is the most important diagnostic tool in patients with bronchial and pulmonary diseases. Through the combined use of flexible and rigid bronchoscopes, nowadays bronchoscopy can be increasingly used as an endoscopic treatment procedure for pulmonary diseases. In cases of thoracic tumors interventional bronchoscopy provides palliative and curative treatment modalities. Apart from bronchoscopic tumor treatment, techniques for endoscopic lung volume reduction have increasingly come into focus in recent years. Furthermore, treatment options for asthma and chronic bronchitis as well as airway stenosis and fistulas are available.

[Recommendations for Performing Bronchoscopy in Times of the COVID-19 Pandemic - Update 12/2020]. / Empfehlungen zur Durchführung einer Bronchoskopie in Zeiten der COVID-19-Pandemie: Update 12/2020.

The SARS-CoV-19 pandemic continues to be globally related with significant morbidity and mortality, making protective measures to prevent transmission of the virus still necessary. Healthcare employees are exposed to a higher risk of infection and this is particularly true when performing aerosol-generating procedures such as bronchoscopy.Since the publication of recommendations for performing a bronchoscopy in the times of COVID-19 more than six months ago, the risk situation has not changed significantly, but due to the considerable gain in knowledge in the meantime, an update of the recommendations was necessary.The updated recommendations include the reduction of aerosol formation, the personal protection of the people involved in the procedure, as well as measures to better organize the processes in the endoscopy suite in order to perform bronchoscopic procedures securely even in times of COVID-19.

[Recommendations for Performing Bronchoscopy in Times of the COVID-19 Pandemic]. / Empfehlungen zur Durchführung einer Bronchoskopie in Zeiten der COVID-19-Pandemie.

COVID-19, caused by coronavirus SARS-CoV-2 is a new and ongoing infectious disease affecting healthcare systems worldwide. Healthcare worker are at high risk for COIVD-19 and many have been infected or even died in countries severely affected by COVID-19 like China or Italy. Bronchoscopy causes cough and aerosol production and has to be considered a significant risk for the staff to get infected. Particular recommendations should guide to prevent spreading COVID-19 and to protect healthcare worker when performing a bronchoscopy.

5'- vs. 3'-end sugar conformational control in shaping up dinucleotides.

The 5'-end N-sugar puckering is currently believed to govern the intramolecular dinucleotide stacking. We demonstrate that if this 5'-conformation is indeed important in shaping up dinucleotide structures, the 3'-end sugar conformation can either potentiate or cancel the stacking capacity induced by the 5'-end N-sugar conformation.

Cryobiopsy increases the diagnostic yield of endobronchial biopsy: a multicentre trial.

Forceps, brushes or needles are currently the standard tools used during flexible bronchoscopy when diagnosing endobronchial malignancies. The new biopsy technique of cryobiopsy appears to provide better diagnostic samples. The aim of this study was to evaluate cryobiopsy over conventional endobronchial sampling. A total of 600 patients in eight centres with suspected endobronchial tumours were included in a prospective, randomised, single-blinded multicentre study. Patients were randomised to either sampling using forceps or the cryoprobe. After obtaining biopsy samples, a blinded histological evaluation was performed. According to the definitive clinical diagnosis, the diagnostic yield for malignancy was evaluated by a Chi-squared test. A total of 593 patients were randomised, of whom 563 had a final diagnosis of cancer. 281 patients were randomised to receive endobronchial biopsies using forceps and 282 had biopsies performed using a flexible cryoprobe. A definitive diagnosis was achieved in 85.1% of patients randomised to conventional forceps biopsy and 95.0% of patients who underwent cryobiopsy (p<0.001). Importantly, there was no difference in the incidence of significant bleeding. Endobronchial cryobiopsy is a safe technique with superior diagnostic yield in comparison with conventional forceps biopsy.

Tratamento com nifedipina, um bloqueador de canais de calcio, melhora o conteudo muscular de glicogenio de membro imobilizado de ratos / Treatment with calcium channel blocker (nifedipine) improves muscle glycogen content in immobilized hindlimb of rats

Avaliar se o tratamento com nifedipina interfere nas reservas musculares de gliucogenio que sao alteradas pela imobilizacao (IM) de membro posterior de ratos. Metodo: 24 ratos Wistar machos foram divididos em 4 gruos: controle, controle tratado com nifedipina (NI, via oral, sonda orogastica 1 mg/Kg), imobilizado (posicao neutra do tornozelo) e imobilizado tratado com nifedipina, durante 7 dias. Apos o periodo experimental, o conteudo de glicogenio muscular (GLI) dos musculos soleo(S), gastrocnemios branco (GB) e vermelho (GV), extensor longo dos dedos (ELD) e tibial anterior (TA) foi avaliado pelo metodo do fenol sulfurico, alemdo peso do S e ELD. Os dados foram analisados com o ANOVA (two way) seguido do teste de `t`(p<0,05). Resultados: A IM promoveu reducao no GLI(31,6 no S; 56,6 no GB; 39 no GV; 41,7 no ELD e 45,2 no TA, por cento). No grupo-controle, a NI promoveu elevacao do GLI somente no S (31 por cento), por outro lado, no grupo imobilizado a elevacao foi significativa no GLI dos musculos S(119 por cento), GB(70 por cento), GV (84 por cento) e TA(41 por cento). Cabe ressaltar que o tratamento nao impediu a perda de peso induzida pela IM. Conclusao: o tratamento com nifedipina propiciou melhora nas reservas energeticas do musculo imobilizado, sugerindo interferencia nas alteracoes calcemicas desebcadeadas concomitantemente com o processo de atrofia

Constituents of the trunk bark of Maquira coriacea.

The isolation of 14 known triterpenoids and phytosterols from the trunk bark of Maquira coriacea, and complete spectral data of a cardenolide, k-strophanthin-beta (1), are reported.

Relapsing pneumonia due to a migrating intrathoracic foreign body in a World War II veteran shot 53 years ago.

In the great majority of cases of long-standing intrathoracic foreign bodies, patients are asymptomatic. However, symptoms may occur years later from the migration of the foreign body. We report on a 70-year-old patient who developed relapsing pneumonia due to obstruction of a bronchial branch of the left apical group by a migrating infantry bullet impacting 53 years ago. This was not diagnosed until the second attack of pneumonia in 1998. The bullet remains were removed bronchoscopically and the pneumonia resolved completely without further complications.

[Long-term experiences with mechanical patient-controlled analgesia pumps for therapy of postoperative pain in general surgery]. / Langzeiterfahrungen in der Anwendung mechanischer PCA-Pumpen zur Therapie postoperativer Schmerzen in der Allgemeinchirurgie.

The efficiency and safety of patient-controlled analgesia (PCA) in the treatment of postoperative pain is well documented. An alternative to electrical systems is the disposable pump, which is cost effective. The aim of this study was to prove the efficiency and safety of PCA disposable pumps. Eighty patients (45 men, 35 women, mean age 50 +/- 16 years) were included and received single-use PCA pumps (Vygon Medical Products, Aachen, Germany) for postoperative pain control. A sufficient reduction in pain levels, measured by the Verbal Rating scale (VRS), was achieved in nearly all patients. For the first application, a single bolus of 7.0 +/- 2 mg piritramide (Dipidolor) was needed, the mean of treatment time was 56 +/- 31 h. We had two dropouts because of non-compliance, two patients felt dizzy, and one patient felt nauseous. Further side-effects were observed during treatment. Our study led us concluded that PCA therapy with mechanical, disposable pumps is a safe and efficient treatment for postoperative pain. Such a concept can be introduced without an "Acute Pain Service" if the staff are well trained.

[Inflammatory pseudotumor of the spleen as an incidental asymptomatic finding in a 44-year-old patient]. / Inflammatorischer Pseudotumor der Milz als akzidenteller asymptomatischer Befund bei einer 44jährigen Patientin.

In the era of routinely used ultrasound techniques intrasplenic tumors are diagnosed more frequently. Usually these findings are not combined with specific symptoms. However, large cysts can lead to malfunctions of nearly located organs by displacing. Etiopathogenetic findings in our region are mainly non parasitic, epithelial and traumatic cysts or tumors of the spleen. We describe a large splenic mass of a 44 years old female patient. Pathological dignity remained unclear after using sonographic, radiological and clinical techniques. After uncomplicated total splenectomy the histopathological diagnosis revealed a benign, pseudoinflammatory tumor of the spleen. Inflammatory pseudotumors are a benign response to an unknown cause. It must be a main objective of preoperative diagnostics to distinguish them from malignant processes.

Alkaloids from Aspidosperma species from Bolivia.

Two Bolivian Aspidosperma species were investigated. The seed and stem bark of Aspidosperma macrocarpon Mart. contain six known alkaloids: (-)-vincadifformine, ervinceine, kopsanone, kopsinine, kopsanol in the seed, and kopsanone, kopsinine, kopsanol, 18-epikopsanol in the stem bark. The stem bark of Aspidosperma pyrifolium Mart. contains eleven known alkaloids: (-)-vincadifformine, O-demethylpalosine, haplocine, N-formylaspidospermidine, vallesine, demethoxyaspidospermine, palosine, (-)-aspidospermine, aspidospermidine, akuammicine, tubotaiwine, beside the two new bases dehydroxyhaplocidine and 10-methoxyaspidospermidine.

[Diagnostic and therapeutic problems of acute lower gastrointestinal hemorrhage]. / Diagnostische und therapeutische Probleme der akuten unteren gastrointestinalen Blutung.

In a four year period (1990-93) 75 patients were treated in our hospital for acute lower gastrointestinal bleeding. In the course of diagnostic procedures an upper gastrointestinal bleeding was excluded routinely and further 126 endoscopic measures were performed. All patients underwent rectoscopy and additional partial or total coloscopy. In addition to that, 16 scintigrams and 7 angiograms were taken. The validity of the endoscopic measures was 0.73, scintigraphy and angiography were less valid with 0.53 and 0.34. Therefore endoscopic diagnostic procedures are of more value. 32 of these 75 patients underwent operative treatment. Recurrent bleeding after operative treatment was seen in 6.25%. Overall mortality was 5.33%. Because prognosis of a recurrent bleeding after operative treatment is poor, primary subtotal colectomy is indicated when the source of bleeding can not be localized.

A proposed architecture for ambulatory systems development.

We have developed an architecture and application framework known as the Ambulatory Services Architecture (ASA) for computerized management of patient records for ambulatory care. Our primary design goals included the development of an architecture that will be readily adaptable to advances in technology needed to enhance computerized patient record systems (e.g., multimedia, human-computer interfaces such as voice-to-text, and a fully distributed objects, etc.) and a data model and database implementation capable of providing the flexibility and extensibility needed to support a broad spectrum of specialty medical practices. This report describes the data model, access control, and the client/server components of the Ambulatory Services Architecture.

Collaborative social and medical service application.

Baylor College of Medicine has five Teen Health Clinics (THC) dispersed throughout Harris county. The population served by the clinics includes inner-city adolescent boys and girls 19 years of age and under. Patients receive services such as family planning, sexually transmitted disease screening and treatment, perinatal care, counseling, and support services. Adolescents may receive services at any one of the clinics at no cost to the adolescent or their dependents. Given the geographical distribution of the clinics and the reliance on paper-based records, client services cannot be provided efficiently or expeditiously. According to the statistics developed by Clinic staff, ineffective coordination of service needs and client schedules undermine the follow-up needed for effective care. For example, a counselor will often need to balance a school schedule, clinic visits, well baby follow-up, and the Best Friends Program for a new mother. In addition, the lack of ready access to patient information impairs the ability of clinical and social service staff to provide continuity of care. In fact, some cases of client dropout are attributable to these difficulties. We have developed the Collaborative Social and Medical Service Application (CSMSA) to facilitate the provision of social and medical services to this population. The CSMSA is a domain-specific application based on a robust infrastructure known as the Ambulatory Services Architecture (ASA). This system is designed to support integrated social and ambulatory care. The ASA is a Baylor developed application framework and architecture for the computerization of the patient medical record in the ambulatory care setting. The working environment for the CSMSA user is an integrated desktop which provides an operating environment for both third-party applications and the CSMSA, as well as a fundamental set of services. The integrated desktop services include a mechanism for object organization or grouping, a facility for the management of desktop objects including disposal and storage, and an embedded search utility to assist in the location of desktop objects as well as other application objects. The access control mechanism will provide the security for the desktop environment by requiring the user to log into and out of the environment. This security mechanism will also enable/disable CSMSA tools based on the user's role at the clinic. The CSMSA is designed to provide work process, functionality and data access appropriate to the responsibilities of the user, e.g., a THC clerk may have permission to view a patient's orders but does not have the facility to create an order. Patient context is defined through a patient browser containing the master patient index or a user defined patient list. Patient encounters are managed using forms based on the process for each encounter type (e.g., initial visit). Forms are used for data entry and for queries. Data entry forms are only committed to the patient database (i.e., making the patient data available to other users who have permission to access the data) when the user approves the data. The CSMSA provides a means to suspend an entry into a chart by saving incomplete or non-committed data entry forms as part of the desktop state which is restored when the user logs into the system. CSMSA was designed to provide a robust, expandable application capable of accommodating the changes in health care and social services delivery while encompassing evolving software standards and new technology. This goal was achieved using object-oriented methodologies and technologies, combined with an object-oriented database management system as the foundation of our server to facilitate the evolution of our data model.

Analysis, requirements and development of a collaborative social and medical services data model.

In any medical and social service setting, patient data must be readily shared among multiple providers for delivery of expeditious, quality care. This paper describes the development and implementation of a generalized social and medical services data model for an ambulatory population. The model, part of the Collaborative Social and Medical Services System Project, is based on the data needs of the Baylor College of Medicine Teen Health Clinics and follows the guidelines of the ANSI HISPP/MSDS JWG for a Common Data Model. Design details were determined by informal staff interviews, operational observations, and examination of clinic guidelines and forms. The social and medical services data model is implemented using object-oriented data modeling techniques and will be implemented in C++ using an Object-Oriented Database Management System.

The development of a data security model for the Collaborative Social and Medical Services System.

This paper presents the development of the Collaborative Social and Medical Services System's (CSMSS) data security mechanism. This mechanism was synthesized from an analysis of the CSMSS problem domain, and from a study of the methods used by modern operating systems and database management systems. The resulting mechanism is more flexible and expressive than traditional access control methods and is generally applicable to the management of privacy and multi-provider access.

The development of a client application for the collaborative social and medical services system.

This paper describes the design and implementation of a client application for the Baylor College of Medicine Teen Health Clinics. The application is the front end to the Collaborative Social and Medical Services System (CSMSS) under development by Baylor's Medical Informatics and Computing Research Program [8]. The application provides distributed access to an underlying object oriented database system. A process driven and patient centered design will provide staff members with a complete set of services, including forms for data entry and viewing, query, and access management to facilitate efficient and effective delivery of services. Role-specific interfaces will be supplied for clerks, nurses, nurse practitioners, physicians, and social workers. The client application is being designed using object oriented methodologies and technologies with the C++ programming language, and will operate within a Microsoft Windows operating environment utilizing Object Linking and Embedding for application interoperability.