Showing papers in "Wiener Klinische Wochenschrift in 2004"

Hydroxyethyl starch--can the safety problems be ignored?

Abstract: Hydroxyethyl starch (HES) has come into widespread use for fluid management of acutely ill patients Certain characteristic complications of HES, notably renal impairment, hemorrhage and pruritus, have been well documented with all types of HES solutions The use of HES solutions with lower molecular weight and substitution has been claimed to minimize these safety risks In particular, solutions of 200 kDa molecular weight and 05 substitution (HES 200/05) and of 130 kDa molecular weight and 04 substitution (HES 130/04) have been advocated for their superior safety profile A critical appraisal of the available evidence does not provide reassurance that these or other HES solutions are risk free Most evidence indicates the equivalence of HES 200/05 and HES 130/04 with respect to effectiveness for volume expansion Since HES 130/04 is newer, its safety profile is less well characterized; however, it appears to share the same complication risks as those of HES 200/05 In randomized clinical trials employing sensitive markers, both HES 200/05 and HES 130/04 have been shown to impair renal function Both coagulopathy and clinical bleeding have been documented after administration of either HES 200/05 or HES 130/04, and the magnitude of negative effects on hemostasis has been similar for these two HES solutions Pruritus is a common side effect of all HES solutions, including HES 200/05 and HES 130/04, and can occur in diverse clinical settings in some cases after only small HES doses Typically presenting as pruritic crises of delayed onset, this complication is often severe, protracted and refractory to treatment An additional risk of HES infusion is the occurrence of potentially life-threatening anaphylactoid reactions, which are 45 times as frequent after HES as albumin exposure Limiting the dose and duration of HES therapy may be helpful in lessening the risk of undesired side effects; at present however, reliance on particular HES solutions does not appear sufficient to ensure safety

Procalcitonin in patients with acute and chronic renal insufficiency

Abstract: BACKGROUND: Bacterial infections are associated with a high morbidity and mortality rate in patients with acute and chronic renal failure. Because C-reactive-protein (CRP) is elevated in many patients with renal failure, even in the absence of infection, procalcitonin (PCT) might be useful for the detection of systemic bacterial infections. This cross-sectional observation study measured PCT and CRP in several groups of patients with various types, degrees and treatments of kidney diseases, including patients with sepsis treated with renal replacement therapy. PATIENTS AND METHODS: We determined PCT and CRP in 85 renal patients with different stages and treatments of renal insufficiency – chronic renal failure (CRF), n = 23; patients undergoing continuous ambulatory peritoneal dialysis (CAPD), n = 20; patients undergoing hemodialysis therapy (HD), n = 42 – and in a group of 40 patients with septic conditions, including 20 patients with acute renal failure (ARF). The infectious status of the patients was monitored. RESULTS: PCT in serum (reference value in healthy controls, 1 year) (median of 0.25 μg/l and 0.61 μg/l). However, PCT was elevated in patients on CAPD (median of 1.18 μg/l). In patients with sepsis, PCT was massively elevated in both the presence and absence of ARF. In contrast, CRP (reference value, <5mg/l) was markedly increased in patients undergoing short- and long-term HD (medians of 14.5 and 51.1 mg/l) but not in patients on CAPD. In patients with CRF and systemic bacterial infections, both PCT and CRP were markedly elevated (median: PCT, 63 μg/l; CRP, 130 mg/l) but, in contrast to PCT, CRP values overlapped in infected and noninfected patients. There was no relevant decrease in plasma concentrations of PCT by hemofiltration or hemodialysis in patients with sepsis. CONCLUSION: With the exception of CAPD patients, PCT levels were not significantly affected by renal diseases or treatments but were markedly elevated in the presence of infections. Thus, PCT is a valuable marker for early diagnosis of systemic bacterial infections in patients with CRF or patients undergoing HD. In contrast, CRP is elevated in several groups with renal diseases and has low specificity for the diagnosis of bacterial infections.

Estimation of seasonal variations in risk factor profiles and mortality from coronary heart disease.

Abstract: OBJECTIVE: Seasonal variations in coronary heart disease (CHD) and related risk factors have been reported previously However, no studies to date quantify the contribution of seasonal variations in risk factors to actual mortality in both men and women using a single database of sufficient size and follow-up METHODS: We investigated the database from the Western Austrian Vorarlberg Health Monitoring and Promotion Programme (VHM&PP) including over 450,000 repeated measurements of 149,650 individuals between 1985 and 1999 RESULTS: Of a total of 1266 deaths from CHD (ICD-9 410–414), 353 deaths occurred between December and February (279%), in contrast to 275 (217%) between June and August While the frequency of deaths through acute myocardial infarction (ICD-9 410) was similar over the seasons, chronic forms of CHD (ICD-9 414) occurred significantly (p < 0001) more frequently in winter Total cholesterol, blood pressure and body mass index showed pronounced seasonal variations with average levels significantly higher during the winter months in all age groups and both sexes, giving an estimated increase in SCORE risk of 68% in men and 36% in women However by contrast, use of single time point risk factor data tended to overestimate subsequent 10-year mortality if measured in winter and the converse in summer CONCLUSION: For the first time, this study quantifies the contribution of seasonal risk factor variation to CHD mortality The consistent effect across demographic groups suggests that this is a real physiological phenomenon and not an artefact of living conditions Interpretation of standard risk scores should take account of this seasonal fluctuation in subsequent investigation and follow-up

Endurance performance of the elderly mountaineer: Requirements, limitations, testing, and training

Abstract: Life expectancy has markedly increased during recent decades, resulting in a growing number of older individuals. Many of these elderly are turning to mountain sports activities in search of fun and new challenges. Although the scientific community has taken broad interest in the ageing process and how it affects physical and mental performance, little attention has focused on the elderly mountaineer. Mountain sports demand a relatively high degree of physical fitness and, because fitness and health decline with age, the risk of injury and death during mountain sports will increase. However, little information is available on fitness requirements for elderly mountaineers. This article mainly focuses on such requirements, and on performance limitations, assessment of individual performance, and training recommendations. A normal ascent rate of 300 meters per hour (up to 3500 m) requires an altitude-dependent relative oxygen consumption of 18-22 ml x min(-1) x kg(-1) or an ergometric performance of 1.2-1.5 watt x kg(-1) below the individual anaerobic threshold. Mild cardiopulmonary and musculoskeletal diseases are not contraindications for mountain sports activities, provided the proposed fitness requirements are attained. A regular exercise-training program under medical and sports expert advice will help the elderly to achieve these fitness standards, enjoy the mountain environment, and prevent injuries and fatalities.

Human albumin and starch administration in critically ill patients: a prospective randomized clinical trial.

Abstract: To determine whether intravenous infusion of either human albumin or hydroxyethylstarch (HES) in hypo-albuminemic critically ill may lead to an increase in colloid osmotic pressure and to a better clinical outcome, i.e. lower mortality and fewer complications, compared to fluid replacement with normal saline Prospective, randomized controlled clinical trial during 72 hours in 61 consecutively admitted severely ill patients. Randomisation took place by sealed envelope, kept outside of the hospital. Intensive care unit of the Twenteborg Hospital, Almelo, The Netherlands. Sixty-three severely ill, hypo-albuminemic patients were selected; 27 patients had severe sepsis and 36 were post-surgical patients with SIRS. Two patients died shortly after randomization, 15 patients received human albumin, 15 HES 500 and 15 HES 1000 ml, and 16 saline. The patients were randomized to receive 300 ml human albumin (20%) per day, or 1000 ml normal saline per day, or 500 ml or 1000 ml HES per day, all for 72 hours. The primary outcome was plasma colloid osmotic pressure (COP). Secondary end-points were fluid balance and the development of pulmonary edema. Administration of human albumin was effective in raising COP (P<0.001 on day 2 and day 3, compared to saline and HES). Neither fluid balances nor the development of peripheral or pulmonary edema were different between the groups. Mortality as well as length of stay at ICU were slightly higher in the group receiving human albumin although not statistically significant. Raising colloid osmotic pressure with human albumin in hypoalbuminemic patients is not associated with improvement of the clinical outcome

Prognostic markers in breast cancer: the reliability of HER2/neu status in core needle biopsy of 325 patients with primary breast cancer.

Abstract: Introduction The assessment of HER2/neu overexpression in tissue provides information about one of the most relevant prognostic and predictive markers in breast cancer: overexpression of HER2/neu is associated with worse prognosis in primary breast cancer. Since core needle biopsy is increasingly used for the diagnosis of breast cancer, the purpose of this study was to assess the reliability of HER2/neu evaluation using this technique in patients with primary breast cancer.

Extracorporeal shockwave treatment is effective in calcific tendonitis of the shoulder. A randomized controlled trial

Abstract: Background Calcific tendonitis of the shoulder is often associated with chronic pain and impairment of function. Extracorporeal Shockwave therapy (ESWT) is considered to be a treatment option. We compared the effects of two different ESWT regimens.

Austrian medical students' attitudes towards male and female homosexuality: a comparative survey.

Abstract: BACKGROUND: The attitudes of health-care professionals and medical students towards male and female homosexuality are of practical relevance and have increasingly become a topic of scientific research Comparative investigations between medical students and other student groups have not yet been conducted OBJECTIVES: To assess the attitudes of Austrian medical students towards homosexuality and to compare these with the attitudes of students of politics and veterinary medicine METHODS: Students of medicine (122), politics (145), and veterinary medicine (153) completed a questionnaire consisting of validated instruments assessing anti-homosexual attitudes, items assessing knowledge on homosexual issues, and basic demographic information RESULTS: Participants’ attitudes were predominantly positive For all instruments, two-way analyses of covariance revealed significant influences of participants’ sex and study major: students of medicine and veterinary medicine held more negative attitudes than students of politics, and males were more prejudiced than females Overall, attitudes towards male and female homosexuality were balanced, but male students of politics and veterinary medicine were more prejudiced towards male than female homosexuality A significant influence of participants’ sex (favoring females) was observed in knowledge of homosexual issues CONCLUSIONS: Although neutrality and empathy are considered vital in the doctor–patient relationship, medical students revealed more negative attitudes than students of politics did, the latter’s attitudes being similar to those of students of veterinary medicine These findings suggest that educational and correcting interventions are required in medical training

Prevalence and clinical manifestations of eating disorders in Austrian adolescents with type-1 diabetes

Abstract: Objectives To investigate prevalence and clinical manifestations of DSM-IV clinical eating disorders and subsyndromal eating problems among adolescents with type-1 diabetes

Incidence and outcome of rupture of the Achilles tendon

Abstract: We determined the incidence of complete rupture of the Achilles tendon in the Maribor region (273,609 inhabitants) between 1991 and 1996. During this period, 116 ruptures were treated at Maribor Teaching Hospital. The average incidence was 7 ruptures per 100,000 inhabitants, with a peak incidence of almost 9 per 100,000. Most injuries (65%) occurred during sports activities, with soccer as the major cause of rupture. The average age of patients was 37 years with a male-to-female ratio of 18:1. All patients underwent open surgical repair of the ruptured Achilles tendon, with a minimum follow-up of two years. 19.8% of cases developed complications and in 10.4% of these the complications were major. 1.9% of patients sustained a re-rupture. The mean AOFAS score was 96 points. The patients were subjectively very satisfied with their treatment in 88% of cases. Good functional results with a return to the usual pre-injury activities were achieved in 96% of patients.

Thrombophilic polymorphisms – factor V Leiden, prothrombin G20210A, and methylenetetrahydrofolate reductase C677T mutations – and preterm birth

Abstract: AIM OF THE STUDY: To evaluate the influence of three common thrombophilic polymorphisms, factor V Leiden (FV), prothrombin G20210A (PT), and methylenetetrahydrofolate reductase (MTHFR) C677T mutations, on preterm birth of unknown cause. PATIENTS AND METHODS: A single-centre case-control study of women with preterm infants of ≤35 weeks of gestation, in whom obvious maternal, uterine, and fetal causes responsible for preterm birth were excluded (n = 35). The controls were 54 women with term infants hospitalised in the same ward. RESULTS: There were no significant differences between the groups of mothers in history of fetal loss, venous or familial thrombosis, or previous preterm birth. FV was found in 8.6% of the cases, PT in 5.7%, and MTHFR mutation (homozygous) in 4.8% compared with 5.4% (p = 0.292; OR, 1.594; CI 95%, 0.303–8.384), 7.4% (p = 0.379; OR, 0.758; CI 95%, 0.131–4.374), and 4.5% (p = 0.485; OR, 1.050; CI 95%, 0.090–12.276), respectively, in the controls. Differences in the three thrombophilic polymorphisms in the two groups of infants were also not significant. CONCLUSION: We could not demonstrate a distinct association between these thrombophilic polymorphisms and preterm birth.

Clinical and epidemiological features of Lyme borreliosis in Bulgaria

Abstract: Data on disease expression and epidemiological characteristics of Lyme borreliosis in south-eastern Europe are scarce To reveal features of Lyme borreliosis in Bulgaria, clinical data and epidemiological characteristics of 1257 patients reported between 1999 and 2002 were analysed The most affected age group was 5–9 years, followed by 45–49 years, 50–54 years, and 10–14 years Most of the patients (68%) lived in a rural area or were attacked by ticks during activities in a rural area Lyme borreliosis cases occurred throughout the year with two peaks — one in June and second smaller one in September The most common clinical manifestation was erythema migrans (EM), diagnosed in 868 (691%) of the patients Rashes had a median diameter of 11 cm and were predominantly located on lower extremities Forty-four per cent of the rashes consisted of homogenous erythema and 56% had central clearing Multiple EM was detected in 43% of the EM cases Neuroborreliosis was the second most common presentation of Lyme borreliosis, diagnosed in 19% of the patients Lyme arthritis was found in 8% of the patients Heart and ocular manifestations were recorded in 11% and 09% of the patients, respectively Borrelial lymphocytoma and acrodermatitis chronica atrophicans were very rare (03%) Twenty-seven patients (21%) had multiple organ involvement The results of the study show that the epidemiology and clinical manifestations of Lyme borreliosis in Bulgaria are similar to those in the majority European countries but possess some distinguishing characteristics

Refractory Wegener's granulomatosis responds to tumor necrosis factor blockade.

Abstract: Wegener’s granulomatosis is a systemic necrotising vasculitis of small vessels that leads to severe impairment of affected organ systems. Conventional treatment is based on immunosuppression with a combination of steroids, cyclophosphamide, azathioprine or methotrexate over a prolonged time course. Early recurrence or disease refractory to therapy often results in a fatal outcome. As in other inflammatory disorders, tumor necrosis factor (TNF) plays an early and crucial role in progression of disease activity. We report on a patient with severe orbital Wegener’s granulomatosis who developed acute renal failure despite intense conventional immunosuppression with cyclophosphamide and steroids. To stop vasculitic activity, by disrupting the autoimmune inflammatory cascade, a TNF-blocking antibody (Infliximabŗ) was administered six times in a six-month period at 3 mg/kg body weight. Conventional immunosuppressive therapy with steroids and cyclophosphamide was continued, the latter being changed to azathioprine after three months. The first infusion of TNF antibody induced improvement of renal function, which continued throughout the course of therapy. The modification of diet in renal disease-glomerular filtration rate (MDRD-GFR) increased from 15.3 ml/min/1.73m2 before the start of TNF-blockade to 55.5ml/min/1.73m2 after six months of therapy. Serum creatinine levels, proteinuria and cANCA titer decreased concomitantly. Clinical remission of Wegener’s granulomatosis was induced without any major adverse events. A slight flare of orbital inflammation was successfully treated with an increased dose of azathioprine. Thus, in this case of refractory Wegener’s granulomatosis TNF-blockade by monoclonal chimeric TNF-antibody (Infliximabŗ) served as an effective tool to rescue kidney function and induce clinical remission.

Acute poisoning with autumn crocus (Colchicum autumnale L.)

Abstract: Introduction Colchicum autumnale, commonly known as the autumn crocus or meadow saffron, contains the antimitotic colchicine, which binds to tubulin and prevents it forming microtubules that are part of the cytoskeleton in all cells

Influence of the birth attendant on maternal and neonatal outcomes during normal vaginal delivery: a comparison between midwife and physician management.

Abstract: Background The purpose of this study was to compare the obstetric outcome of low-risk maternity patients attended by certified midwives with that of low-risk maternity patients attended by obstetricians.

The importance of preoperative localisation procedures in organic hyperinsulinism — Experience in 67 patients

Abstract: Preoperative localisation of insulinomas has been regarded unnecessary, given the significantly higher detection rates of intraoperative ultrasonography and bidigital palpation. These are mandatory before endoscopic surgery. 67 patients operated on for organic hyperinsulinism were retrospectively analysed regarding tumour localisation within the pancreas, tumour size, histological findings, sensitivities of preoperative imaging methods, and surgical techniques. 59 patients (88%) had solitary insulinomas, four patients (6%) multiple insulinomas and four adult patients (6%) nesidioblastosis. Well-differentiated neuroendocrine tumours with benign behaviour (including four patients with nesidioblastosis) were diagnosed in 53 patients (79%), tumours with uncertain behaviour in nine patients (13%) and well-differentiated neuroendocrine carcinomas in five (8%). Tumours were evenly distributed throughout the pancreas. Endoscopic ultrasound localised tumorus in 15 out of 21 patients (71%), conventional computed tomography (CT) in 7 out of 21 (33%), signleslice helical CT in 7 out of 12 (58%), multidetector CT in 5 out of 5 (100%), magnetic resonance imaging in 11 out of 13 (85%) and angiography in 15 out of 23 (65%). Various combinations of available methods achieved a sensitivity of 88% (49 patients true positive, 4 true negative, 7 false negative). Of 59 patients, solitary insulinomas were enucleated in 47 (80%), 11 patients underwent conventional open resection and one patient endoscopic distal pancreatic resection. Patients with nesidioblastosis or multiple tumours underwent pancreatic resections alone or in combination with enucleations. After biochemical diagnosis of organic hyperinsulinism, preoperative localisation is necessary for planning endoscopic pancreatic surgery, because of the possibility of multiple insulinomas, malignancy or nesidioblastosis in adults.

Comparison of different scoring methods for assessing the nutritional status of hospitalised patients

Abstract: OBJECTIVE: Despite intense clinical research, no commonly accepted diagnostic tool for assessment of nutritional status is yet available. In this study a comparison of four different methods for diagnosis of the nutritional status of patients admitted to a university hospital in Austria is presented. PATIENTS AND METHODS: Clinical data of 640 hospitalised patients were analysed in a prospective-descriptive study design. Four recommended methods, the Innsbruck nutrition score (INS), the Prideaux nutritional risk assessment (PNRA), the well established nutrition risk index (NRI), and the body mass index (BMI) were used to analyse nutritional status. RESULTS: The BMI showed 90.2% of the patients evaluated to have normal nutritional status, whereas the PNRA identified 48.9%, the NRI 40% and the INS 58.6% as well nourished. Patients were variously diagnosed with moderate malnutrition: 9% (BMI), 42% (PNRA), 54.8% (NRI) and 30% (INS). Severe malnutrition was detected in 0.5% (BMI), 9.1% (PNRA), 5.2% (NRI) and 11.4% (INS) of the patients evaluated. Cancer patients had the worst nutritional status. CONCLUSION: Malnutrition seems to be a common diagnosis among hospitalised patients in Austria. Screening and assessment of nutritional status should be integrated into clinical routine. The methods tested scored malnutrition at different frequencies. BMI seemed to underestimate the prevalence of malnutrition. The PNRA provided some information on clinical outcome, whereas the NRI had the best relationship between the degree of malnutrition and length of stay. Calculation of the INS may give correct diagnosis of severe malnutrition. Further prospective clinical studies are needed to validate the scoring systems used in this study and to provide accurate clinical diagnosis of malnutrition.

Immunoadsorption (IAS) as a rescue therapy in SLE: considerations on safety and efficacy.

Abstract: OBJECTIVE: In systemic lupus erythematosus (SLE), extracorporeal procedures aiming at reduction of immunoglobulin (Ig) and immune complexes (IC) are used as a rescue therapy. Plasma exchange (PE) has not been proven overall effective in SLE, and long-term treatment in particular has been associated with severe bacterial and viral infections. Immunoadsorption (IAS), in contrast, selectively removes Ig and IC and may thus be safer. We therefore investigated the rate of infections in SLE patients who were undergoing long-term IAS. METHODS: 16 SLE patients were treated with ≥10 courses of IAS, and nine patients with highly active disease received pulse cyclophosphamide (IVCP) therapy in parallel. We retrospectively analysed the records of all these patients for the occurrence of infections. Patients receiving IAS therapy plus IVCP were compared with 25 patients with similarly active disease treated with standard IVCP therapy within the same observation period. Patients receiving IAS without additional IVCP were compared with patients with similarly moderate disease activity receiving neither IAS nor IVCP. RESULTS: No potentially life-threatening viral infection occurred in IAS-treated patients and episodes of herpes zoster were equally distributed. No severe infection was observed during IAS without concomitant cyclophosphamide. As expected, more patients with highly active disease receiving IVCP experienced infections than those with less active disease (16 of 34 [47%] vs. 2 of 22 [9%], p < 0.04). On comparing the two groups with highly active disease, infections were similar (IAS plus IVCP, 3 of 9 patients [33%]; IVCP only, 5 of 25 [20%]), but one patient receiving IAS plus IVCP died of septicaemia. Disease activity significantly decreased in both groups treated with IAS. CONCLUSION: IAS has an acceptable safety profile with regard to severe infections and appears safe with regard to severe viral disease. Highly active disease and IVCP therapy increase the risk of severe infections in SLE.

Severe thrombocytopenia as a complication of acute Epstein-Barr virus infection.

Abstract: Severe thrombocytopenia is an extremely rare complication of acute Epstein-Barr virus (EBV) infection. EBV infection usually causes hematological abnormalities, mainly atypical lymphocytosis, which is a feature of infectious mononucleosis, and uncomplicated cases often present with mild decreases in platelet counts. Our otherwise healthy, 21-year-old male Caucasian patient had thrombocytopenia and bleeding diathesis with platelet counts of 8 x 10(9)/L without other signs and symptoms of infectious mononucleosis. We commenced treatment with intravenous methylprednisolone before the acute EBV infection was serologically confirmed. Platelet counts initially rose and then fell after we stopped administrating corticosteroids. Repeated administration of methylprednisolone was followed by full recovery of the platelet count and normalization of formerly elevated transaminases. EBV infection may happen in children, adolescents and adults and this differential diagnosis should be considered in every patient presenting with acute thrombocytopenia.

Active warming of critically ill trauma patients during intrahospital transfer: a prospective, randomized trial.

Abstract: Hypothermia in trauma victims is a frequently observed phenomenon in acute care. Known complications of hypothermia are impaired wound healing, cardiac complications, hemodynamic instability, impaired immune function and increased blood loss. We compared active warming versus passive warming in hypothermia in critical-care patients undergoing intrahospital transfer from ICU to computer tomography (CT). Thirty critically ill patients were randomized either to an actively warmed group, covered with a carbon-fiber heating blanket (set to 42°C) during the entire transport including the time spent in the CT, or to a passively warmed group, covered with a carbon-fiber heating blanket (switched off) during the entire transport and in the CT. The carbon-fiber blanket was covered with a conventional wool blanket in both groups. Vital parameters and core temperatures were recorded. Patients’ characteristics and vital parameters were similar in each treatment group. Initial average core temperature in group A was 36.4°C±0.2°C and remained stable at 36.4°C±0.1°C; core temperature in group B started at 36.4°C±0.2°C but decreased to 34.7°C±0.6°C. Hypothermia is common when critically ill trauma patients require intrahospital transport for diagnostic procedures. Resistive heating during intrahospital transport kept the core temperature stable and assured normothermia in all actively warmed patients. We therefore recommend active warming for critically ill trauma patients during intrahospital transport.

[Dietary fibre: more than a matter of dietetics. I. Compounds, properties, physiological effects].

Abstract: Dietary fibre is a heterogeneous group of substances which have only one common characteristic: the non-digestability in the small bowel. With one exception all fibres are carbohydrates (poly- or disaccharides). Some fibres are water-soluble, others are unsoluble. This property is associated with physiological effects. Soluble (viscous) fibres can bind water and thus form hydrocolloids or gels, unsoluble ones cannot. Dietary fibres play an essential role in the physiology of the gastrointestinal tract. They modify the absorption of nutrients (particularly carbohydrates and lipids) in the small bowel. They accelerate the gut transit time and determine stool composition and quantity. They are the main nutritional source for the colonic microflora. During the bacterial fermentation short-chain fatty acids are formed which are essential for nutrition and integrity of the colonocytes and for colonic function. Moreover gases, detoxicating enzymes, antioxidants and carcinogen-inactivating compounds arise. The most important fibres are cellulose, hemicellulose, pectin, guar, psyllium, beta-glucan, Klason lignin and digestion-resistant starch; they are present in varying amounts in plant foods and in fibre preparations. The usual daily intake of dietary fibre in Europe and the USA amounts to only 15-20 g, while health authorities and nutrition societies recommend a reference value of at least 30 g. Dietary fibres are applied as food-integrated, as supplement and as purified substances.

Increase of Serum Triiodothyronine Concentration in Soldiers With Combat-Related Chronic Post-Traumatic Stress Disorder With or Without Alcohol Dependence

Abstract: Post-traumatic stress disorder (PTSD) is a relatively new psychiatric disorder with three clusters of symptoms: trauma re-experiencing, avoidance, and increased arousal. The condition develops after a person sees, is involved in, or hears of an extreme traumatic stressor such as war, torture, natural catastrophe, assault, rape, or serious accident. PTSD is also often comorbid with other psychiatric disorders, especially with alcohol dependence. Several hormonal alterations have been reported in veterans with combatrelated PTSD, including elevations in certain thyroid hormones, e.g., total T3; however, previous studies have not controlled for alcohol dependence, a common comorbid psychiatric disorder in this population. The first aim of our study was to assess possible differences in basal serum levels of free triiodothyronine (FT3), total triiodothyronine (TT3), free thyroxine (FT4), total thyroxine (TT4), and thyroid stimulating hormone (TSH) in Croatian soldiers with combat-related chronic PTSD alone or comorbid with alcohol dependence and in healthy controls. The second purpose of the study was to determine any correlation between duration of combat activities, number of combat traumas, intensity and duration of PTSD symptoms, and serum levels of TT3, FT3, TT4, FT4, and TSH in this sample. We analyzed basal serum FT3, TT3, FT4, TT4, and TSH concentrations in soldiers with combat-related chronic PTSD (N=43), combat-related chronic PTSD comorbid with alcohol dependence (N=41), and in healthy controls (N=39) using a luminoimmunochemical assay. Soldiers with chronic combat-related PTSD with or without comorbid alcohol addiction had significantly higher values of TT3 than the control group (F=19.556, p<0.01). There was a significant correlation between TT3 levels and number of traumatic events in both the PTSD group (r=0.663, p<0.01) and those with PTSD comorbid with alcohol dependence (r=0.836, p<0.01). There was also a significant correlation between TT3 levels and symptoms of increased arousal in both PTSD (r=0.419, p<0.01) and PTSD comorbid with alcohol dependence (r=0.516, p<0.01). Elevated concentrations of serum TT3 are associated with combat-related PTSD, regardless of its comorbidity with alcohol dependence, and also with the number of traumatic events and symptoms of increased arousal. Given that current pharmacotherapy for PTSD is inadequate, reduction of TT3 may be a new strategy for pharmacologic intervention that could contribute to more effective treatment of this disorder.

The European Competence Network on Mastocytosis (ECNM).

Abstract: The European Competence Network on Mastocytosis (ECNM) is a Europe-wide, multinational cooperative approach attempting to improve recognition, diagnosis, and therapy of mastocytosis. The network is composed of local centers, physicians, and scientists who have dedicated their work to patients with mastocytosis. However, because of the rarity and complexity of the disease, each single component in the network alone would fail to meet important demands and to reach solid conclusions in this field of applied medicine. The ECNM represents an attempt to overcome this restriction as a cooperative multicenter platform that should serve as an important basis for the development of new therapeutic strategies and diagnostic concepts, and for the standardization of techniques used to determine diagnostic and prognostic parameters. Moreover, using future central databases and registries, a suitable infrastructure for the development of co-operative multicenter clinical trials will be established. In addition, the ECNM is dedicated to provide the best available information about the disease to patients and physicians.

High seroprevalence of granulocytic ehrlichiosis distinguishes sheep that were the source of an alimentary epidemic of tick-borne encephalitis.

Abstract: A sheep herd from which contaminated cheese was produced, causing 21 cases of alimentary tick-borne encephalitis (TBE) in human beings, was tested serologically for the presence of specific antibodies against both the TBE virus (TBEV) and Anaplasma phagocytophilum, the cause of tick-borne fever (TBF) in ruminants, and compared with three other herds variously exposed to tick bites but without any TBE history. Virus-neutralisation (VN) with the TBEV strain Hypr and CV-1 cells was used in TBE tests, and indirect immunofluorescence assay (IFA) with neutrophils from goats experimentally infected with A. phagocytophilum was used for TBF testing. In 13 sheep from the incriminated herd (N =41), VN titres ranging from 1/4 to 1/128 traced previous TBE infection and all sheep had elevated titres of A. phagocytophilum antibodies ranging from 1/80 to 1/5120 in IFA, whereas two other herds (N = 8 and 9) were seronegative for TBEV and had significantly lower levels of A. phagocytophilum antibodies, corresponding to a lesser challenge from TBF. A control herd (N = 10) that was grazed on tick-free meadows in north Norway was completely seronegative. The respective distributions of positive titres of A. phagocytophilum and TBEV antibodies in the incriminated herd were not mutually random; the animals with higher anti-A. phagocytophilum titres tended to have lower anti-TBEV titres and vice versa (Spearman correlation coeff. =-0.86, p< or =0.01). The authors hypothesize that the immunosuppressive effect of TBF co-infection in sheep could be a contributory cause of TBE-virus contamination of milk, an aspect of TBE epidemiology that has not been considered thus far.

Cancer mortality in Austria: 1970-2002.

Abstract: PURPOSE: The aim of this study is to assess the overall progress against cancer in Austria by analyzing changes in age-adjusted mortality rates from 1970 to 2002 METHODS: For the years 1970 through 2002, age-adjusted rates for all malignant neoplasms together and for selected cancers individually were calculated for men and women according to year and age The data were obtained from Statistik Austria RESULTS: Age-adjusted mortality rates of all cancers decreased in men by 22% and in women by 27% The annual decrease of cancer mortality was 08% per year in the time period analyzed and 17% per year from 1993 to 2002 in both sexes Among older persons (≥55 years) the mortality decreased by 21% in men and by 25% in women; among younger persons (≤54 years) by 25% and 40%, respectively In individual cancer sites, the highest mortality rates are observed before the year 1995 in both sexes, except for liver and brain cancer in men (with the most recent peaks in the year 2001) and lung and brain cancer in women (with the most recent peaks in the year 2002) CONCLUSIONS: The observed changes in cancer mortality are primarily related to changes in incidence and, in the last decade, to improved treatment and early detection, but neither of these contributions can be quantified The strengthening of prevention research (primary and secondary prevention) and further implementation of preventive knowledge is urgently needed

Successful switch from inhalative iloprost to oral bosentan in portopulmonary hypertension associated with liver cirrhosis

Abstract: Portopulmonary hypertension (PPHTN) is a rare complication of liver cirrhosis. Prostanoids have been shown to be effective in the treatment of PPHTN and have been used as a bridge to orthotopic liver transplantation. However, inhibition of platelet aggregation might be a limitation of prostacyclin therapy in patients with end-stage liver disease having an increased risk of bleeding from esophageal varices. The effect of oral bosentan, a dual endothelin-receptor antagonist in the reversal of PPHTN, is still unclear. We report a case of PPHTN (mean pulmonary artery pressure [mPAP] of 51 mmHg) that was successfully switched from inhalative iloprost to oral bosentan therapy. Hemodynamic and symptomatic improvements were maintained after a 12-month long-term treatment with inhalative iloprost as well as after single oral bosentan therapy. This is the first reported case of a successful switch from therapy with an inhalative prostacyclin analogue to oral bosentan in a patient suffering from PPHTN. Thus, oral bosentan therapy might be a promising new option for patients suffering from PPHTN.

Quantification of recent smoking behaviour using proton transfer reaction-mass spectrometry (PTR-MS).

Abstract: Smoking is the most important single risk factor in current public health. Surveillance of exposure to tobacco smoke may be accomplished using environmental monitoring or in-vivo tests for smoking biomarkers. Acetonitrile exhaled in human breath has been described as a potential marker mirroring recent smoking behavior. The aim of this study was to determine exhaled acetonitrile levels in a sample of 268 volunteers (48 smokers, 220 non-smokers) attending a local health fair. Breath specimens were collected into inert sample bags, with parallel collection of ambient air. Subsequently, all samples were analysed using proton transfer reaction-mass spectrometry (PTR-MS). Smokers had elevated levels of exhaled acetonitrile compared with non-smokers (p<0.001). Analysis using the receiver-operating-characteristic curve demonstrated that smoking can be predicted with a sensitivity of 79% and a specificity of 91%, using a cut-off concentration of 20.31 parts per billion of acetonitrile. This first field survey of exhaled acetonitrile in a large group of test persons demonstrates the feasibility of a rapid and non-invasive test for recent exposure to tobacco. We conclude that analysis of exhaled-breath acetonitrile may serve as a method of determining recent active smoking behaviour.