Early diagnosis of colorectal cancer: a preventive task in occupational health.

Morbidity of colorectal cancer is still accreting; therefore in 2003 a total of 57000 patients fell ill and about 28000 died due to colorectal carcinoma. According to the etiology, many different factors are currently in discussion. However, as in about 25-30% of the cases familial clustering can be observed one of the most probable might be the genetic predisposition. Nevertheless only in 3% of all cases this predisposition is also scientifically assured. The high average age of manifestation raised the question if there might be also an occupational relationship for colorectal carcinoma in tense of an occupational disease. Therefore there is sight for occupational health to contribute to early diagnosis of colorectal carcinoma within the scope of routine check-up, health management and research of occupational diseases.

[Iatrogenic lesion of the radial nerve--disability in domestic work concerning liability]. / Iatrogene Radialisschädigung--die konkrete Behinderung der Hausfrau in der Haftpflichtversicherung.

In liability cases caused by accidents, the actual compensation for consecutive sustained damage to the patients' health and pain is not sufficient. Moreover, besides payments for a loss of earning capacity, the compensation for loss of efficiency in daily life such as for domestic work might be necessary. Therefore, distinct indications for the expert's appraisal exist.

Determination of azithromycin in gastric biopsy samples.

OBJECTIVES: To measure the concentration of azithromycin in gastric biopsy samples of gastritis patients undergoing Heliobacter pylori eradication treatment with azithromycin as one antibiotic constituent of the medication. PATIENTS: Seven male outpatients, non-smokers, non-alcoholics, aged 25-40 years (mean 32 years), suffering from gastritis with involvement of H. pylori. METHODS: The patients received a 5-day treatment with azithromycin (1 x 500 mg on day 1 and 1 x 250 mg on days 2-5), 40 mg pantoprazole once daily and 2 x 400 mg metronidazole once daily. Samples of gastric tissue were obtained from 5 patients and of gastric juice from 2 patients, at the occasion of gastroscopic interventions. The gastric samples were subject to analysis of azithromycin, using a highly sensitive and specific HPLC method with electrochemical detection. RESULTS: The median concentrations of azithromycin in gastric tissue amounted to 7.5 microg/g on day 2 and to 9.7 microg/g on day 5 of the treatment. Four days after the end of treatment, median concentrations were still at 3.9 microg/g. In all tissue samples, azithromycin concentrations were well above the MIC for H. pylori (0.25 microg/ml). The well-known tissue affinity of azithromycin was underlined by the lack of detectable levels in gastricjuice. CONCLUSION: The high concentrations of azithromycin observed in gastric tissue of patients with gastritis on a 5-day dosage regimen point to a favorable pharmacokinetic basis for a role of azithromycin as a component of the eradication therapy of Heliobacter pylori.

Left bronchial intubation by a single-lumen tube in adults: effects of bevel and curvature.

This study was designed to determine whether left bronchial intubation could be accomplished by reversal of the direction of the bevel or by changing the direction of curvature of a normal tracheal tube. The 60 study patients were divided into three groups. In group 1, the patients were intubated in the usual manner, with bevel to the left and the tube concave anteriorly. In group 2, the normal tracheal tube was rotated 90 degrees counterclockwise during insertion. In group 3, the bevel of the tracheal tube was altered to face the right, with the tube still concave anteriorly. In group 1, all 20 tracheal tubes entered the right primary bronchus. In group 2, 14 tracheal tubes (70%) entered the left primary bronchus. In group 3, 18 tubes entered the right primary bronchus and 2 entered the left. The position of the bevel did not influence the positioning of the tracheal tube in the right or left bronchus. In summary, 90 degrees counterclockwise rotation from the usual position and altering the concavity of the tube to face the left significantly increased the likelihood of intubation of the left primary bronchus.

Pneumothorax during laparoscopic Nissen fundoplication.

We present a case of 100% pneumothorax in a 41-yr-old man with a history of gastritis and gastroesophageal reflux scheduled for Nissen fundoplication. The patient was anaesthetized, and insufflation of the abdominal cavity with carbon dioxide was performed uneventfully. There was an increase in the peak inspiratory pressure and wheezing was noted with a decrease in the arterial oxygen saturation to 91%. An obstructive pattern was noted on the end tidal carbon dioxide monitor. The patient also had decreased breath sounds in the left lung field. The endotracheal tube was withdrawn 1.5 cm with equal breath sounds noted in both lung fields, but the wheezing persisted. At the end of the case the trocars were removed and the abdomen was deflated. The arterial oxygen saturation increased to 94% while breathing F1O2 of 1.0. A chest roentgenogram showed a 100% left pneumothorax. A left chest tube was placed with immediate improvement of the arterial oxygen saturation to 100%. We recommend monitoring of arterial oxygen saturation, peak inspiratory pressures, and excursion of the chest for early diagnosis and prompt treatment of pneumothorax during laparoscopic procedures.

Increase in choleresis by means of artichoke extract.

The choleretic action of artichoke extract [main ingredient: cynarin (1.5-di-caffeoyl-D-quinc acid)] was investigated in a randomised placebo-controlled double-blind cross-over study (pilot study) [n = 20]. The effect of the standardized, artichoke extract: Hepar SL forte (administered as a single dose: 1.92 g, by the intraduodenal route in a solution of 50 ml of water) was studied by measuring intra-duodenal bile secretion using multi-channel probes. Thirty minutes after the test-substance was administered, a 127.3% increase in bile secretion was recorded, after 60 minutes, 151.5%, and after another 60 minutes, 94.3%, each in relation to the initial value. The relevant differences for the placebo were significant to the extent of p < 0.01 and were clinically relevant. The highest increase in the case of the placebo (139.5%) was seen after 30 minutes. At 120 and 150 minutes the volume of bile secreted under the active treatment was also significantly higher than under the placebo (p < 0.05). In the placebo group, bile secretion fell below the initial level after 3 hours. An effective period of about 120-150 minutes was regarded as satisfactory to influence enzymatic digestion and the motor function of the intestine when the test substance was given postprandially. No side effects nor changes in the laboratory parameters in connection with the experiment were observed. Results indicate that artichoke extract can be recommended for the treatment of dyspepsia, especially when the cause may be attributed to dyskinesia of the bile ducts or disorder in the assimilation of fat.

Divalent ions and myocardial function during cardiopulmonary by-pass (CPB). Changes of total calcium, ionized calcium, and magnesium in plasma.

In 17 patients who underwent openheart surgery with cardiopulmonary bypass using heparinized fresh blood for priming the heart-lung machine the following investigations were done: Blood samples taken at different periods of surgery were assayed for total calcium (Catot), ionized calcium (Ca++), magnesium (Mg), hemoglobin, total pasma proteins, and the acid-base-status. Considering the different kinds of cardiopulmonary bypass the patients were divided into three groups: In the first group the results ofsurgical procedure with and without hemodilution perfusion were compared. During hemodilution perfusion Catot decreased markedly whereas Ca++ remained nearly constant. In the second group the influence of different calcium concentrations of the prime solution on Catot and Ca was tested. A low calcium content of 2.8 mEq/1 lowered Catot and Ca++ to subnormal levels. In the third group results of Mg-induced cardioplegia were compared with findings during surgical procedure with anoxic cardiac arrest. A remarkable increase of magnesium at the perfusion onset could be observed. Magnesium remained within the upper level of normal range until surgery end and decreased to normal values in the postoperative stage. Since energy requirements of the arrested heart and thus the velocity of ATP-breakdown during ischemia are closely related to the Ca++ concentration of the extracellular space low plasma calcium levels are considered to be advantageous during cardiopulmonary bypass. Only at the end of partial bypass before the heart fully takes over circulating work a sufficient calcium substitution is recommended.