[Histopathological degeneration score of fibrous cartilage. Low- and high-grade meniscal degeneration]. / Histopathologischer Degenerations-Score des Faserknorpels. Low-grade- und High-grade-Meniskusdegeneration.

Although histopathology of meniscal degeneration plays an important role, no criteria to assess severity of the degeneration are available to date. Our aim was to create a histopathological scoring system for meniscal degeneration with good interobserver variability, taking matrix degradation and cellularity in meniscal tissue into consideration. Degeneration is classified as follows: grade 1 (low), grade 2 (intermediate), grade 3 (high). The pattern of NITEGE deposits (G1 fragment of aggrecan) was assessed immunohistochemically (n=38) and compared with the grades of degeneration. In 48% of the patients with grade 2 or 3 degeneration extracellular NITEGE deposits (specificity 100%) were found, whereas grade 1 patients showed no deposits. Extracellular NITEGE deposits correlated positively with the grade of degeneration. In all, 30 cases (10 per grade) were assessed by three pathologists (A, B, C). Grading conformity was 70% for grade 1, 66% for grade 2 and 100% for grade 3. Cohen's Kappa coefficient was 0.6--0.7 between pairs of observers. Combining grade 1 and 2 to low-grade degeneration, compared to a grade-3 high-grade degeneration achieved Kappa coefficients of between 0.93 and 1.0. This reproducible degeneration score for fibrous cartilage could form the basis for the standardized assessment of meniscal degeneration.

[Brain-natriuretic-peptide (BNP) for improvement of the diagnostic determination in a conserving emergency room]. / Brain-natriuretic-peptide (BNP) zur Verbesserung der Diagnosefindung in einer konservativen Notaufnahme.

BACKGROUND: Dyspnea is one of the most common symptoms for presentation in an emergency department. Evaluation of this very unspecific symptom can be very time-consuming and costly. Thus, we investigated the value of a rapid bedside-test for BNP in discriminating dyspnea due to "cardiac" reasons from "non-cardiac" dyspnea in the emergency room. METHODS AND RESULTS: We studied 100 patients who presented to the emergency department with "severe dyspnoea" as the leading symptom. In all patients BNP was determined from blood samples drawn on admission. All patients had to complete a dyspnea score for severity of dyspnea. The treating physician was blinded to the results of BNP measurements. After discharge patients were divided into "cardiac" and "non-cardiac" dyspnea on the basis of all findings gathered during the hospital stay by a panel of 3 physicians blinded to the results of BNP measurements. The 2 groups were compared for difference in BNP levels and for differences in the dyspnea score. While the dyspnea score showed no significant difference, there was a significant difference in BNP measurements (p < 0.0001). CONCLUSIONS: With the TRIAGE BNP test a rapid discrimination between dyspnea due to ventricular failure and "non-cardiac" dyspnea can be obtained within 20 minutes after first presentation. This test can save time and resources in this critical group of patients.