Efficiency of cold passover and heated humidification under continuous positive airway pressure.

Cold passover and heated humidifiers are employed for the prevention of side-effects associated with continuous positive airway pressure (CPAP) treatment. However, to date, it has not been possible to separately measure the humidity of inspired and expired air. The aim of this study was to compare the relative humidity of the inspired air and the water loss during respiration between cold passover and heated humidifiers under CPAP. Humidity and temperature were determined separately for the respiratory phases, without humidification, with cold passover and heated humidifiers in 10 healthy subjects. Humidity was measured with a capacitive hygrometer, temperature with a "Type K" thermosensor, and impedance of the total respiratory system with impulse oscillometry. The relative humidity (rH) of the inspired air (mean+/-SD) increased significantly from 24.0+/-9.1%, rH (34.8+/-1.0 degrees C, no humidifier) to 34.5+/-10.1%, rH (34.6+/-1.0 degrees C) under cold humidification, and to 53.9+/-13.2% rH (35.0+/-1.1 degrees C) under heated humidification. With heated humidification, water loss was reduced by 38% compared to cold humidification. The impedance increased from 5.7+/-1.8 cmH2O x L x s(-1) (no humidifier) to 6.7+/-1.8 cmH2O x L x s(-1) (heated humidifier). The authors conclude that the use of a heated humidifier during continuous positive airway pressure appreciably increases the relative humidity of the inspired air and reduces the water loss during respiration.

Pregnancy-related changes of carnitine and acylcarnitine concentrations of plasma and erythrocytes.

Total-, free-, and acylcarnitine concentrations were determined in whole blood, plasma, and red blood cells of 88 women during pregnancy. Already in the 12th week of gestation the mean whole blood carnitine level was significantly (p < 0.01) lower than those of the controls. From the 12th gestational week up to parturition there was a further significant (p < 0.01) decrease. This reduction of total carnitine in whole bloods was mainly caused by a significant (p < 0.01) decrease of free carnitine levels, since no marked changes of short chain acylcarnitine values were found throughout pregnancy. The contribution of red blood cell L-carnitine to whole blood carnitine increased significantly (p < 0.05) to 61% at delivery versus 39% (controls). In umbilical cord blood free and total carnitine levels were significantly (p < 0.05) higher than the corresponding maternal levels. The contribution of red blood cell L-carnitine to whole blood carnitine was higher in cord blood than in maternal blood. The results of the present study demonstrate that during pregnancy whole blood and plasma carnitine levels decrease to those levels found in patients with carnitine deficiency. Also the percentage of acylcarnitine on total carnitine, found in the present study, is characteristic for a secondary carnitine deficiency. Thus L-carnitine substitution in pregnant women, especially in risk pregnancies, may be advantageous.

[The value of surgical staging in the early stages of ovarian carcinoma]. / Die Bedeutung der Staging-Operation bei den Frühstadien des Ovarialkarzinoms.

The value of surgery in early ovarian cancer was assessed in a retrospective analysis of prognostic factors in all 222 patients with primary stage I epithelial ovarian carcinoma treated in this department between 1975 and 1987. Only cellular differentiation grade (p less than 0.03) and surgical procedure - total abdominal hysterectomy, bilateral salpingo-oophorectomy +/- omentectomy vs. unilateral salpingo-oophorectomy - (p less than 0.02) were of significant influence on estimated survival (Cox model). All other factors (age, FIGO stage, integrity of the capsule, uni-vs. bilaterality, histology) were of no prognostic importance. Unilateral salpingo-oophorectomy without any additional staging reduces the 5-year survival probability (62% vs. 84%). Future prospective studies on adjuvant therapy must be based on exact staging during surgical management before randomisation. Determination of cellular differentiation is also essential.

[The value of cytoreductive second-look surgery in advanced epithelial ovarian carcinoma]. / Die Wertigkeit der zytoreduktiven Second-look-Operation beim forgeschrittenen epithelialen Ovarialkarzinom.

40 patients with advanced epithelial ovarian carcinoma were investigated to evaluate the influence of further cytoreduction during second-look surgery on survival after termination of first-line polychemotherapy containing cisplatinum. Radical tumorectomy with no macroscopic residual tumor mass was achieved in 27.5% of cases; in 52.5% the residual tumour mass was less than 2 cm and in 20% it was more than 2 cm in diameter after cytoreductive second-look surgery. Median survival time after second-look within these three groups of patients was 15.2 months, 16.9 months and 15.3 months, respectively (Mantel test, p = 0.74). In contrast to the situation at the diagnostic operation, further cytoreduction during second-look surgery has no positive influence on survival. We therefore abandoned this operation in clinically tumour-positive patients.

[Ambroxol versus betamethasone for the promotion of antepartum lung maturity in pathological pregnancies]. / Ambroxol versus Betamethason zur Förderung der antepartalen Lungenreife bei pathologischen Schwangerschaften.

Although glucocorticoids have been universally implemented to stimulate fetal lung maturity, their effectiveness and side effects are still widely contested. In search of alternative drugs a double-blind study was conducted between June 1981 and June 1984 comparing betamethasone, a conventional corticoid, and ambroxol, a bromhexine metabolite for efficacy and tolerance in prenatal prevention of the respiratory distress syndrome (RDS) in premature infants and full-term neonates. The therapeutic efficacies of betamethasone and ambroxol for this indication proved to be comparable. Since the possible risks of corticoid therapy in abnormal pregnancies are repeatedly discussed in the literature and in daily clinical practice. 137 patients with EPH gestosis, placental insufficiency, diabetes mellitus, and premature rupture of the membranes were selected from the original group of 308 patients. Only minor side effects (e.g. nausea) were present in a few of the 137 cases undergoing treatment with the 2 test substances. No side effects were observed in the neonates. The incidence of fetal RDS was comparable in both groups (2.9% with ambroxol, 2.2% with betamethasone). Transient and mild RDS cases were slightly more frequent in the ambroxol group than in the betamethasone group. To date, contraindications to ambroxol treatment in abnormal pregnancies are unknown and since generally the rate of potential side effects is considered to be lower in comparison with corticoid treatment, the use of ambroxol especially in abnormal pregnancies corresponding indication can be recommended.

[Side effects of adjuvant therapies of breast cancer: their significance for the patient]. / Nebenwirkungen adjuvanter Therapien beim Mammakarzinom: Ihre Bedeutung für die Patientin.

In a retrospective survey we interviewed 53 patients with respect to side effects of adjuvant therapy for breast cancer. All of them had undergone modified mastectomy and were randomly assigned to either chemotherapy, irradiation or a combination of both. Standardized questionnaires concerning the side effects and semi-structured, focusing counseling talks were the methods used in questioning the patients. Patients named significantly more side effects of severe and extreme intensity with chemotherapy, and especially in the group given combination therapy, where chemo- and radiotherapy could be directly compared by the patient. The experience was particularly threatening when several side effects occurred simultaneously. Different psychological aspects and visualisation of systemic and local side effects are discussed with respect to the patient's ability to cope with adjuvant therapy. Consequences for routine care are: continuous explanatory talks about side effects throughout the whole process, muscle relaxation and interdisciplinary cooperation.

[Prognostic significance of the onset of infection in newborn infants]. / Prognostische Bedeutung des Beginnes einer Sepsis beim Neugeborenen.

Between September 86 and May 87 we reviewed the case histories of 25 newborns (gestational age: 33-41 weeks, birth weight: 1280-3600 g) with septicaemia proved by positive blood cultures. Two groups are formed: Group A: onset of sepsis within the first 48 hours of life (10 newborns), group B: onset of sepsis after 48 hours of life (15 newborns). No differences in gestational age and birth weight were found between the groups. Amnionitis was found in 8 mothers (80%) of group A, however, we found only 2 (13%) mothers with amnionitis in group B. All patients in group A had signs of the respiratory distress syndrome and their clinical condition was poor. Only the CRP was helpful in the laboratory diagnosis of septicaemia. In group B sepsis was diagnosed in 11 (73%) patients by means of a raised CRP and an increased immature neutrophil count. Only 4 patients of this group showed clinical deterioration. The following bacteria were cultured: Group A: E. coli 4, b-streptococci 3, Klebsiella 3. Group B: Staph, aureus 8, Strept. faecalis 5, Pseudomonas 2. In group A 3 patients died and 3 patients developed meningitis with neurological sequelae. In group B non of the patients died, but 2 patients developed osteomyelitis.

[Carnitine in therapy of placental insufficiency--initial experiences]. / Carnitin als Therapie der Plazentainsuffizienz--erste Erfahrungen.

Carnitine (3-hydroxy and 4-trimethylaminobutyrate) present in all living cells, plays an important role in the oxidation of fatty acids. It is known that high dose carnitine activates surfactant synthesis. Given to women with imminent premature delivery, its benefit on the post natal period is proved. Own studies showed an increased need of carnitine during pregnancy. Therefore the questions rose if carnitine substitution improves placental insufficiency. 15 pregnant women were treated with 2 x 1 g carnitine orally for one week and with 1 x 1 g carnitine during the following 7 days when their fetus showed a retardation of 1-3 weeks. The control group were 15 untreated patients with the same problems of retardation. The placental insufficiency was diagnosed by fetometry, by blood parameters and the doppler ultrasound flow measurement. In the group of the treated patients 11 out of 15 showed an improvement, in 4 patients no effect of carnitine was seen and in 1 patient the retardation increased. In the control group 8 out of 15 patients showed a spontaneous improvement of fetal growth, 2 women did not have a change in their retardation and 5 patients had to be hospitalized because of increasing placental insufficiency. Inspite of the small number of patients a tendency towards a profit in carnitine treatment for placental insufficiency seems to be real.

[Carnitine levels in pregnancy]. / Carnitinspiegel während der Schwangerschaft.

Carnitine (trimethylamino-hydroxy butyric acid) is present in all living cells. It is necessary for the transport of fatty acids into mitochondria and for other metabolic functions of the cell. Studies in various animal species have demonstrated a transfer of carnitine from the mother to the fetus during pregnancy. Recent studies reported decreased carnitine levels at term, but little is known on carnitine levels during various stages of human gestation. Therefore it was interesting to measure the blood carnitine status during normal human pregnancy from early stages up to term, including analyses of umbilical cord blood of the newborn. The results show a gradually decreasing carnitine level in maternal plasma, a sharp decline within the 1st trimester was followed by a much slower but highly significant decrease in the 2nd and 3rd trimester. In whole blood carnitine levels are decreasing, too. The continuous decrease of the portion of plasma carnitine in whole blood is correlated with a higher carnitine concentration in the blood cells. Together these results might indicate an increased need of carnitine during pregnancy. Therefore the clinical application of carnitine not only to provide a respiratory distress syndrome should be examined.

Abortion risk in chorionic villus sampling. Evaluation in elective termination of pregnancy.

100 patients were examined to evaluate the risk of abortion of chorionic villus sampling. In the 8th-10th week of pregnancy a catheter with a mandrin was introduced into the chorion frondosum under ultrasound guidance. The mandrin was then removed and trophoblast tissue obtained by aspiration. The patients agreed to postpone elective termination of pregnancy for 2 weeks. Another ultrasound was performed before suction curettage. With increasing experience, the abortion rate dropped to 4%, whereas the rate of successful biopsies and analyses rose to more than 90%. Based on these results, chorionic villi sampling was made available at the 1st Department of Obstetrics and Gynecology, University of Vienna, as an alternative method to amniocentesis. Out of 38 biopsies, 25 karyotypes were normal, two biopsies revealed pathological results (trisomy 21, 22), 11 samples showed no results (insufficient tissue or no mitoses). One patient had a spontaneous abortion (trisomy 22) and one an abortion due to infection. Chorionic villus sampling could replace amniocentesis because chromosomal anomalies may be detected already in the 1st trimester of pregnancy.

C-reactive protein: an early marker for neonatal bacterial infection due to prolonged rupture of amniotic membranes and/or amnionitis.

The C-reactive protein (CRP) concentration was determined in 25 infants whose mothers had presented with prolonged rupture of amniotic membranes (PROM) and/or amnionitis. CRP was positive (i.e. greater than or equal to 6 mg/l) within the first 6 hrs of life in 10 and negative in 15 infants. Clinically, all infants with positive CRP developed symptoms suggesting bacterial infection and both the absolute immature neutrophil counts as well as the ratio immature/total neutrophils were significantly higher in them on day 2 of life than in infants with negative CRP. Blood cultures were only positive in infants with positive CRP. Thus CRP can be regarded as an early marker for neonatal bacterial infection due to PROM and/or amnionitis.

[Value of postoperative irradiation of cases of cervix cancer of histologic stage I/b with extensive infiltration (stage I/c)]. / Zur Wertigkeit der postoperativen Bestrahlung von Zervixkarzinomfällen des histologischen Stadiums I/b mit ausgedehnter Infiltration (Stadium I/c).

The separation of FIGO stage I b cervical carcinoma into a new histological stage I b1 and a stage I c (deep infiltration confined to the cervix) leads to an essential difference in therapeutic results. 5-year survival of 152 cases consigned to the new stage I b1 was 92%, whereas that of 95 cases of the new stage I c was only 77%. Hence, 5-year survival of stage I c patients is lower than of FIGO stage II a (83%). Contrary to our earlier practice, since 1976 all stage I c cases have received postoperative irradiation (Cobalt60). 5-year survival of 75 stage I c cases without lymph node metastasis was 83% when treated by surgery alone; 5-year survival of 22 similar cases treated by surgery and postoperative irradiation was 82%. There is no benefit of postoperative irradiation in cases of stage I c cervical carcinoma when the lymph nodes are not affected.