[Quality management during postoperative pain therapy]. / Qualitätsmanagement der postoperativen Schmerztherapie.

BACKGROUND: A main target of surgical treatment is to minimize postoperative pain. The aim of this study was to evaluate the benefit of quality management on postoperative pain and to improve pain therapy. METHODS: In a prospective study, postoperative pain was recorded in a total of 700 patients in a general and visceral surgical ward in 2000, 2001, and 2002. Pain was measured on a ten-point visual analogue scale (0 no pain, 10 most severe pain). RESULTS: Applying the principles of quality management (plan, do, check, act), we analyzed the reasons for high pain scores in detail. After study of the results in 2000, additional recommendations and guidelines for perioperative pain therapy were provided to all the physicians, and the mean visual analogue pain scores decreased by 15% in 2001 and more than 30% in 2002. At baseline, 12% of patients had pain above the threshold of 3 at rest and 5 in motion. These scores could be reduced to 6% and 3% in the two successive years, respectively. CONCLUSION: A simple pain management system in a general surgical ward led to considerable improvement in postoperative pain scores as assessed by visual analogue scale.

[Long-term course of reflux symptoms following Helicobacter pylori eradication]. / Langzeitverlauf von Refluxbeschwerden nach Helicobacter pylori-Eradikation.

BACKGROUND AND OBJECTIVE: Conflicting data regarding new onset or deterioration of gastroesophageal reflux disease (GORD) following eradication of Helicobacter pylori infection have been reported. Successful eradication therapy may influence gastric acid output. The study aimed to to investigate whether patients with pre-existing GORD or peptic ulcer disease may experience deterioration of GORD. PATIENTS AND METHODS: 75 consecutive patients of a prospective longitudinal study (median age 66 years, n = 45 males) had received successful H. pylori eradication therapy because of the following main diagnosis: peptic ulcer (n = 37), GORD (n = 16), functional dyspepsia (n = 22). Two to three years later, they had an interview regarding the course of their dyspeptic and reflux symptoms. Negative H. pylori status at present was confirmed by (13)C-urea breath test in all patients. Ten patients were excluded because of proton pump inhibitor treatment. RESULTS: Patients with deterioration of GORD (new onset or increasing reflux symptoms) were found significantly more frequently in the group with functional dyspepsia (36 %) compared to pre-existing GORD (16 %) or peptic ulcer disease (5 %). Improvement of pre-existing reflux complaints were reported mostly by patients with peptic ulcer disease. There was no significant impact of initial reflux manifestations like reflux symptoms or reflux oesophagitis on the course. CONCLUSIONS: During long-term follow-up after H. pylori eradication, patients experience improvement as frequently as deterioration of reflux symptoms. There is a tendency towards improvement of reflux symptoms if peptic ulcer disease had been the indication for eradication, but towards deterioration in patients with initial functional dyspepsia. A clinical relevant prediction, however, is not feasible.

Transpositional behaviour of an Ac/Ds system for reverse genetics in rice.

A collection of transposon Ac/ Ds enhancer trap lines is being developed in rice that will contribute to the development of a rice mutation machine for the functional analysis of rice genes. Molecular analyses revealed high transpositional activity in early generations, with 62% of the T0 primary transformants and more than 90% of their T1 progeny lines showing ongoing active transposition. About 10% of the lines displayed amplification of the Ds copy number. However, inactivation of Ds seemed to occur in about 70% of the T2 families and in the T3 generation. Southern blot analyses revealed a high frequency of germinal insertions inherited in the T1 progeny plants, and transmitted preferentially over the many other somatic inserts to later generations. The sequencing of Ds flanking sites in subsets of T1 plants indicated the independence of insertions in different T1 families originating from the same T0 line. Almost 80% of the insertion sites isolated showing homology to the sequenced genome, resided in genes or within a range at which neighbouring genes could be revealed by enhancer trapping. A strategy involving the propagation of a large number of T0 and T1 independent lines is being pursued to ensure the recovery of a maximum number of independent insertions in later generations. The inactive T2 and T3 lines produced will then provide a collection of stable insertions to be used in reverse genetics experiments. The preferential insertion of Ds in gene-rich regions and the use of lines containing multiple Ds transposons will enable the production of a large population of inserts in a smaller number of plants. Additional features provided by the presence of lox sites for site-specific recombination, or the use of different transposase sources and selectable markers, are discussed.

Intensified treatment of type 1 diabetes: prospective evaluation at one year of a therapeutic patient education programme.

BACKGROUND: Type 1 diabetes treatment requires not only an intensive insulin regimen, but also intensive management, which daily involves participation of the patient. Our aim was to prospectively evaluate the efficacy on patient skills and metabolic control of our routine 5-day in-patient education programme. METHODS: Over one year, each type 1 diabetic patient undertaking the programme for the first time, and able to complete a 2, 6, and 12 month follow-up, participated in the study (n=76). At baseline (T0), 61 patients had intensified insulin treatment and 15 increased from 2 to 3 daily insulin injections during the hospital stay. Using questionnaires and analysis of a glycaemia logbook, we evaluated at T0, T2, T6 and T12 patient skills related to diet, physical exercise, self-monitoring of blood glucose (SMBG), adjustment of insulin doses, and treatment of hypoglycaemia. Metabolic control was evaluated at the same time. RESULTS: At one year, the following skills improved: Intake of carbohydrates (T0: 59%, T12: 90% of patients, p<0.001) and snacks (p<0.001), appropriate physical exercise (p<0.001), frequency of SMBG (T0: 3.3 +/- 1.5/day, T12: 4.5 +/- 1/day, p<0.001), frequency of post-prandial tests (p<0.001) and adjustment of insulin doses (T0: 18%, T12: 53% of patients, p<0.001). More patients always carried sugar (T0: 61%, T12: 97%, p<0.001) and appropriately treated hypoglycaemia (T0: 48%, T12: 79%, p<0.001). Concurrently, HbA(1c) decreased (T0: 8.6 +/- 1.5%, T12: 7.7 +/- 0.9%, p<0.001), and the frequency of hypoglycaemia was reduced (p<0.001). There was a correlation between the decrease of HbA(1c) and the frequency of SMBG (p<0.001, r2=0,24). CONCLUSIONS: Education led to positive changes in patient skills, which were maintained over one year and were associated with improved metabolic control.

[Surgical decompression of cervical arthrotic myelopathies: comparison of surgical anterior and posterior approaches]. / Décompression chirurgicale des myélopathies cervicarthrosiques: comparaison des abords antérieur et postérieur.

PURPOSE OF THE STUDY: Operative treatment of cervical myelopathy has focused on decompression of the spinal cord to avoid neurological deterioration. Anterior or posterior operative techniques have been used to decompress the canal with variable success. The purpose of this study was to compare surgical results after subtotal corporectomy or discectomy with an anterior approach and laminectomy or laminoplasty with a posterior approach. MATERIAL AND METHODS: We reviewed 30 patients with cervical spondylolitic myelopathy who had undergone surgery between 1989 and 1998. Mean age was 55.8 years (range 28 to 82). There were 23 men and 7 women. An anterior approach was used for 14 patients to achieve subtotal corporectomy or anterior discectomy with strut grafting. A posterior approach was used in another 14 patients to achieve laminectomy or laminoplasty. Both anterior and posterior approaches were used for two patients. The severity of the pre- and postoperative neurological deficits was assessed with the Nurick scale. RESULTS: Average follow-up was 35.7 months (range 8 to 120). Neurological status improved in 83% of the patients. Improvement was better for those operated with the anterior approach for pain or brachialgia. The duration of the posterior procedures was, however, shorter with less blood loss. There was no statistical difference between the anterior or posterior approaches for motor function, sensory function, gait anomalies, or complications. CONCLUSION: Surgical treatment is effective in cervical spondylolitic myelopathy. The anterior approach is preferred in case of pain or brachialgia; the posterior approach is indicated in case of poor health status or for bedridden patients.

Mate recognition in the two-spot ladybird beetle, Adalia bipunctata: role of chemical and behavioural cues.

On encountering a mature female, a male of the two-spot ladybird, Adalia bipunctata (L.), first palpated her elytra with his maxillary palps, then mounted her, extruded his penis and mated. Copulation never occurred between active males but males copulated with dummies bearing male elytra as frequently as with dummies with female elytra of their own species. Similarly, males attempted mating with immobilised conspecifics of both sexes. However elytra washed in chloroform failed to stimulate mating. Analysis of the chloroform extracts of the elytra revealed that male and female ladybirds are coated by the same blend of hydrocarbons among which 9- and 7-methyl tricosane are dominant. Our results are consistent with a role of these cuticulars hydrocarbons in species recognition and show that behaviour, in particular movement, is necessary for discrimination between males and females.

Long-term reduction of cold hardiness following ingestion of ice-nucleating bacteria in the Colorado potato beetle, Leptinotarsa decemlineata.

We investigated the effect of ingestion of ice-nucleating bacteria on the supercooling capacity and cold hardiness of the Colorado potato beetle (Leptinotarsa decemlineata Say), a freeze-intolerant species that overwinters as adults in shallow, terrestrial burrows. Ingestion of ice-nucleating bacteria (Enterobacter agglomerans, Pseudomonas fluorescens, Pseudomonas putida, Pseudomonas syringae), fed on slices of potato tuber, caused an abrupt decrease in supercooling capacity. No change occurred in the supercooling capacity of beetles fed Escherichia coli, as this species lacks ice-nucleating activity. Ingestion rates showed that tubers treated with different species were equally palatable. During diapause induction beetles evacuated food from their guts, but nevertheless retained sufficient ice-nucleating bacteria to diminish supercooling. Beetles fed P. fluorescens and P. putida exhibited reduced supercooling even after an 8-wk exposure to simulated winter conditions. Furthermore, P. fluorescens was isolated 10-wk post-ingestion from diapausing beetles. Our data suggest that ingested bacteria may be retained by insects during entry into diapause and that the cold hardiness of candidate crop pests, such as L. decemlineata, may be reduced by feeding them ice-nucleating bacteria prior to winter diapause.

Class II HLA antigens in multiple sclerosis.

HLA typing in Wellington revealed a stronger association of multiple sclerosis with DR2 than with DQw1. The association with DQw1 appeared to be due to linkage disequilibrium of this antigen with DR2. These results, when considered in conjunction with other studies, are most easily explained by the hypothesis that susceptibility to multiple sclerosis is influenced by multiple risk factors, with DR2 being an important risk factor in Caucasoid populations.

Psoriatic arthritis: clinical subgroups and histocompatibility antigens.

Histocompatibility antigens were determined in 60 patients with psoriatic arthritis. The patients were divided into clinical subgroups according to axial or peripheral joint involvement, disease severity based on number of peripheral joints involved, and the presence or absence of bone erosions. The total group showed a significant increase in frequency of HLA-A1, B17, B27, and DR7 when compared with a control population. The subgroup with spondylitis had a significant increase in frequency of HLA-B27 when compared with patients with peripheral arthritis (p less than 0.001). The subgroup with peripheral arthritis alone had a higher frequency of HLA-DR7 than the control group (p less than 0.001). There were also significant associations between HLA-DR7 and chronic severe disease (p less than 0.001) and between HLA-DR4 and the presence of erosions (p less than 0.05).

Ethnic and HLA patterns related to multiple sclerosis in Wellington, New Zealand.

A recent survey revealed 237 cases of multiple sclerosis in Wellington, New Zealand, giving an overall prevalence of 69 cases per 100,000. Two hundred and thirty-five were European with one Asian and only one Maori, confirming the rarity of the disease in Maoris. HLA A3, B7 and DR2 antigens were more frequent in multiple sclerosis patients compared with European controls. The same antigens were much less common in the Maori population. The results suggest that Maoris have a low susceptibility to multiple sclerosis despite living in a high risk area, and that genetic susceptibility may be related to the HLA system.