Clinical and aesthetic outcome analysis of a case series of trigonocephaly patients after early fronto-orbital advancement.

The timing of operation for trigonocephaly is recommended before the age of 1 year. To evaluate the outcome of a consecutive series operated in a single centre, the current study was performed. The study cohort comprised a retrospective single-centre series of 20 patients with trigonocephaly operated before the age of 12 months. Intra- and postoperative clinical data, as well as aesthetic outcome measured by two-dimensional asymmetry index (2D AI) and correction of the curvature on lateral and pictures from above were evaluated. Furthermore, to evaluate postoperative aesthetic outcome, a new classification (Grades I-IV) was proposed. The mean age of the cohort was 7.9 months. 2D AI changed from 0.049 pre- to 0.03 postoperatively (P=0.165). The correction of the curvature in lateral pictures yielded a significant change on postoperative pictures (P=0.002) as well as on pictures from above. Using the proposed classification, 16/20 (80%) patients had a postoperative outcome of Grade I, 4/20 (20%) Grade II. In patients operated before the age of 12 months an excellent (Grade I, AI <0.03) or good aesthetic (Grade II, adequate parents' or surgeon's opinion) result could be reached in all patients.

Physical recovery after laparoscopic vs. open liver resection - A prospective cohort study.

BACKGROUND: While the number of laparoscopic liver resections (LLRs) is increasing worldwide, its impact on physical recovery remains unclear. We hypothesized that LLR is associated with better physical recovery than open liver resection (OLR). To address this question, we investigated the impact of laparoscopic liver resection compared to open liver resection on physical recovery in a prospective trial. METHODS: Twenty-one patients who underwent LR were included in this study (11 OLR (52.4%) and 10 LLR (47.6%), respectively). Physical recovery was measured by bicycle stress testing at months 1 and 6 after surgery and compared to preoperative stress testing. Standardized performance for bicycle stress testing was calculated based on age, sex, height and weight. Physical recovery was compared between groups as change of performance (%). RESULTS: Median age was 58 years (Inter Quartile Range (IQR): 44-68), and the main indications for LR were colorectal liver metastases (n = 10; 45%) and hepatocellular carcinoma (n = 6; 27%). The one-month change of performance level was -8% (IQR: -12-1) compared to the preoperative level with no significant difference between open and laparoscopic LR (LLR: -8% (-11 - 1); OLR: -6% (-12 - 4), p = 0.833). Furthermore, 6 months postoperatively, patients in both groups had not reached back their preoperative performance level (LLR: -5.7% (-8.4 - 18.6); OLR -4. 8% (-12.6 - 1.9), p = 0.833). CONCLUSION: In this study, we report an impaired physical recovery after LR that was not fully restored 6 months after surgery. There was no significant difference between open and laparoscopic LR in terms of bicycle stress testing. Limitations of the study include the limited sample size and differences, albeit non-statistically significant, in the baseline characteristics of the two groups. To rule out a possible role of age or underlying indication for liver resection on physical recovery, future randomized controlled trials need to be performed.

Endostatin and physical exercise in young female and male athletes and controls.

It was suggested that endostatin, an angiogenic mediator, is influenced by physical exercise. We performed bicycle stress testing in 88 healthy non-smoking female and male individuals, divided into athlete and non-athlete groups. Serum endostatin and norepinephrine were measured at rest, after reaching maximum workload and after 20 min of recovery. At baseline, both female and male controls showed significant lower levels compared to female and male athletes (89.39±15.32 resp. 93.39±15.00 ng/ml; p<0.001 vs. 128.81±20.84 resp. 147.52±27.72; p<0.001). An increase in endostatin levels in both groups and sexes was associated with bicycle stress testing (p for all groups<0.001). The extent of endostatin increase was comparable in both groups and sexes and varied between 23-27%. Significance was obscured when the performance was entered as covariate. Acutely induced physical strain leads to an increase in endostatin levels in athletes and controls of both sexes, the extent of increase depending on the extent of workload. An athletic lifestyle with >3 h of endurance training/week seems to lead to higher long-term endostatin levels which might play a role in the connection between sports and cardiovascular prevention.

[Palliative care in respiratory medicine]. / Palliativmedizin in der Pneumologie.

Palliative care should be part of respiratory medicine for two reasons: first, many respiratory diseases--besides thoracic tumours--need palliative care in the late stages of the disease. Second, dyspnoea is a common symptom in advanced, primary extrapulmonary diseases and the knowledge of respiratory specialists can be beneficial in the treatment of this symptom. In this paper we describe frequent symptoms of advanced pulmonary diseases and their treatment. Moreover, we focus on the structure of palliative care in Germany.

Automation of urine sediment examination: a comparison of the Sysmex UF-100 automated flow cytometer with routine manual diagnosis (microscopy, test strips, and bacterial culture).

Urine specimens from 438 patients were examined with the UF-100 flow cytometer (Sysmex TOA Medical Electronics (Europe) GmbH, Hamburg, Germany) and by manual microscopy and test strips. One hundred and forty-two of these were also examined bacteriologically. The measurements with the UF-100 were performed on native urine without prior centrifugation. Intraassay imprecision, CV of 1.3% (547/microliter) to 8.5% (24/microliter) for erythrocytes and CV of 2.4% (218/microliter) to 5.6% (10/microliter) for leukocytes, are similar to those usual in clinical chemistry, and are very much better than those seen in manual microscopy of sediment. In routine use, overloading the flow cytometer by an excessive concentration of particles was observed in 9% of specimens. Such specimens should be checked visually. The UF-100 is distinctly more sensitive than manual microscopy for determining leukocytes, erythrocytes, epithelial cells and bacteria. Reference ranges were estimated from the results obtained. These enabled the UF-100 to replace routine manual diagnostic methods. Although the sensitivity is improved over manual microscopy of sediment, it is always necessary to perform parallel test strip examination when determining erythrocytes in order to detect haemolysis. In our opinion the Sysmex UF-100 is a suitable replacement for manual microscopy of urine sediment. In addition it offers an opportunity to improve standardization of basic urinalysis.

Intravenous N-acetylcysteine and lung glutathione of patients with pulmonary fibrosis and normals.

Idiopathic pulmonary fibrosis (IPF) is characterized by a huge alveolar oxidant burden and a deficiency of glutathione, a major antioxidant, in the pulmonary epithelial lining fluid (ELF). Therefore, a rational therapeutic strategy is to increase lung glutathione to augment the pulmonary antioxidant protective screen. To evaluate this concept, different doses of N-acetylcysteine (NAC), a glutathione precursor, were administered intravenously to eight patients with pulmonary fibrosis and six control subjects. In patients, bronchoalveolar lavage fluid (BALF) total glutathione increased significantly from 0.99 +/- 0.25 microM to 1.79 +/- 0.37 microM within 3 h following 1.8 g NAC, whereas 4.8 g NAC had no additional effect (1.47 +/- 0.34 microM). In the control subjects, NAC did not significantly alter BALF total glutathione (baseline: 0.79 +/- 0.17 microM, 600 mg NAC: 0.92 +/- 0.33 microM, 1.8 g NAC: 1.39 +/- 0.41 microM, 4.8 g NAC: 1.33 +/- 0.46 microM). The same was true in ELF, 1.8 g NAC significantly raised ELF total glutathione in patients from 186 +/- 47 microM to near normal levels (373 +/- 103 microM), with no further increase following 4.8 g NAC (293 +/- 62 microM). In the control subjects, ELF total glutathione remained unchanged independent of the NAC dose (baseline: 342 +/- 91 microM, 600 mg NAC: 385 +/- 135 microM, 1.8 g NAC: 633 +/- 220 microM, 4.8 g NAC: 646 +/- 263 microM). The increases in total glutathione were almost entirely due to increased levels of reduced glutathione, the form functional as an antioxidant. No adverse effects were noted.(ABSTRACT TRUNCATED AT 250 WORDS)