Solid phase extraction coupled to liquid chromatography-tandem mass spectrometry analysis of sulfonamides, tetracyclines, analgesics and hormones in surface water and wastewater in Luxembourg.

In the early 1990s different studies highlighted the relationship between pharmaceuticals, human health and the environment. Among the emerging contaminants, antibiotics are obviously of high concern, because of their potential for inducing antibiotic resistance. In addition, natural and synthetic hormones are relevant because of their potential endocrine-disrupting effects on wildlife. This investigation focuses on the analysis of four classes of veterinary and human pharmaceuticals (sulfonamides, tetracyclines, analgesics and hormones) in surface water and wastewater in Luxembourg. The selected eleven pharmaceuticals include four sulfonamides (sulfathiazole, sulfamethoxazole, sulfadimethoxine and sulfamethazine), two tetracyclines (tetracycline and oxytetracycline), two analgesics (ibuprofen and diclofenac), and three hormones (2 naturals, estrone and beta-estradiol, and a synthetic one, 17-alpha-ethinyl estradiol). The most innovative parts of this study are the simultaneous extraction of the above-mentioned pharmaceuticals as well as tracking their behaviour during flood events in a small river catchment. The method includes pre-concentration by solid phase extraction using Oasis HLB (Hydrophilic Lipophilic Balance) which gave superior results compared to Chromabond C-18EC, Chromabond(R) EASY and Bond Elut PLEXA cartridges, also evaluated in this investigation. The analysis of the investigated pharmaceutical compounds is carried out by high performance liquid chromatography coupled to a triple quadrupole mass spectrometer. The limits of quantification were 1 ng L(-1), except for beta-estradiol (2 ng L(-1)) and 17-alpha-ethinyl estradiol (6 ng L(-1)). Recovery rates range from 70 to 94%, with relative standard deviations between 4 and 19%. Application of this method to river concentration and flood events revealed high concentrations of ibuprofen (10-4000 ng L(-1)), with highest levels during flood events, while concentrations of estrogens (1-240 ng L(-1)) and sulfonamides (1-20 ng L(-1)) were comparatively low.

[Deep neck infections and mediastinitis]. / Tiefe Halsinfektionen und Mediastinitis. Eine schwerwiegende Komplikation nach schwieriger endotrachealer Intubation.

Deep neck infections and subsequent mediastinitis can occur as lethal complications after endotracheal intubation. A 53 year old female patient developed a neck abscess and mediastinitis due to esophageal perforation after endotracheal intubation. Neck and mediastinal exploration were performed as primary surgical treatment in cooperation with thoracic surgeons. Drainage tubes for neck and mediastinum were inserted and irrigated frequently. The abscess cavity was re-examined twice after primary surgery. Microbiological tests were performed at regular intervals to guarantee appropriate antibiotic therapy. This case demonstrates the importance of early and extensive surgical intervention and the necessity of interdisciplinary cooperation in treating such infections.

Effective monitoring of small river basins.

As the transport of many pollutants occurs during high floods monitoring programs must focus on these intermittent events. In small rivers the pollutants start their travel as short pulses often associated with fine particles, but disperse on their way downstreams. Therefore the chemical data of a flood event are only representative of a small part of the basin adjacent to the monitoring station. This is usually not taken into account by evaluating water quality data.

Recurrent genetic aberrations in thymoma and thymic carcinoma.

Apart from single reported aberrant karyotypes, genetic alterations in thymic epithelial neoplasms have not been investigated so far. In this study, 12 World Health Organization classification type A thymomas (medullary thymomas), 16 type B3 thymomas (well-differentiated thymic carcinomas), and nine type C thymomas, all of them primary thymic squamous cell carcinomas, were analyzed by comparative genomic hybridization and fluorescence in situ hybridization. With the exception of one single case, type A thymomas did not reveal chromosomal gains or losses in comparative genomic hybridization. In contrast, all type B3 thymomas showed chromosomal imbalances, with gain of 1q, loss of chromosome 6, and loss of 13q occurring in 11 (69%), six (38%), and five (31%) of 16 cases, respectively. In primary thymic squamous cell carcinoma, the most frequent chromosomal losses were observed for 16q (six of nine cases, 67%), 6 (4 of 9, 44%), and 3p and 17p (three of nine each, 33%), whereas recurrent gains of chromosomal material were gains of 1q (5 of 9, 56%), 17q, and 18 (three of nine each, 33%). This study shows that the distinct histological thymoma types A and B3 exhibit distinct genetic phenotypes, whereas type B3 thymoma and primary thymic squamous cell carcinoma partially share genetic aberrations. In addition to the possible tumorigenic role, the deletion in type B3 thymoma of chromosome 6, harboring the HLA locus, might play a role in the pathogenesis of paraneoplastic autoimmunity characteristic of thymoma.

[Prophylaxis and therapy of infectious complications of lung surgery]. / Prophylaxe und Therapie von infektiösen Komplikationen in der Lungenchirurgie.

Postoperative infections are a dreaded complication in pulmonal surgery. Besides the optimal preparation of the patients and careful operative technique, perioperative antibiotic prophylaxis represents an important factor in avoiding infectious consequences. Owing particularly to the high proportion of patients with malignant, consumptious illnesses in thorax surgery, immune deficiencies must be reckoned with in this group of patients. The spectrum of germs to be expected within the framework of pulmonal surgery determines to some extent which antibiotic shall be used. We have investigated the efficacy of a standardized antibiotic prophylaxis using cefotaxime (Claforan) in 200 pulmonal patients. Pleural empyema is a rare, but nonetheless important infectious illness, as a consequence of pulmonal operations, or also following pneumonia. Whilst the early stages of an empyema can often be successfully treated using only drainage treatment, chronic empyema usually requires a thoracotomy with empyema dissection and excortication, as well as subsequent irrigation-suction drainage treatment. In spite of specific surgical sanitation and irrigation-suction drainage treatment, therapy is often complicated by persistent germs in the thoracic cavity. Instillation therapy with taurolidine can lead to faster healing of the infection in such cases. Purulent mediastinitis is an extremely rare illness, but dreaded owing to its high mortality. The causes of the illness lie in injuries of the trachea, of the bronchial tubes, and of the oesophagus. With the introduction of medial sternotomy as operative entry, mediastinitis as a postoperative complication has increased noticeably in frequency. Mediastinitis occurs as a descending infection as a consequence of odontogenic affections. Owing to frequently late diagnosis, infection is usually advanced, so that simple drainage treatment of the mediastinum no longer suffices in many cases. We introduce our concept of treatment using our own patient collective.

Peak endocardial acceleration-based clinical testing of the "BEST" DDDR pacemaker. European PEA Clinical Investigation Group.

The peak endocardial acceleration (PEA, unit g) shows a near correlation with myocardial contractility during the isometric systolic contraction of the heart (dP/dtmax), with sympathetic activity and, thus, with physiological heart rate modulation. The (Biomechanical Endocardial Sorin Transducer (BEST) sensor is incorporated in the tip of a pacing lead and measures PEA directly near the myocardium. In an international study, the lead was implanted with the dual chamber pacemaker Living-1 (Sorin) in 105 patients. The behavior of the PEA signal was tested under conditions of physical and mental stress and during daily life activities by 24-hour recordings of PEA (PEA Holter) at 1 to 2 months and approximately 1 year after implantation. Implantation of the BEST lead was performed without complications in all patients. The sensor functioned properly in the short- and long-term in 98% of patients. Although PEA values differed from patient to patient, the values closely reflected the variations in sympathetic activity due to physical and mental stress in each patient. During exercise and during daily life activities a close correlation between PEA and heart rate was observed among patients with normal sinus rhythm. Peak endocardial acceleration allows a nearly physiological control of the pacing rate.

[Implantation of a transvenous defibrillation system in isolated persistent left superior vena cava]. / Implantation eines transvenösen Defibrillationssystems bei isoliert persistierender linker oberer Hohlvene.

HISTORY AND CLINICAL FINDINGS: A 49-year-old man, an alcoholic for the past 7 years, complained of dizziness, palpitations and exertional dyspnoea (NYHA stage III). Physical examination revealed peripheral cyanosis, slightly raised jugular venous pressure, râles in the lung bases, a loud systolic murmur, maximal over the apex, and an enlarged palpable liver. INVESTIGATIONS: Results of biochemical tests were unremarkable. The ECG showed sinus rhythm, 1 degree AV block and signs of left ventricular hypertrophy. Chest radiogram demonstrated cardiac dilatation and probably absent right superior vena cava (SVC). Long-term ECG monitoring during episodes of dizziness and one syncope revealed self-limited periods of unifocal ventricular tachycardia. Echocardiography and angiography showed bilateral ventricular dilatation with an ejection fraction reduced to 20%, as well as mild mitral and moderate tricuspid regurgitation but normal cardiac valves, suggesting a dilated cardiomyopathy. Coronary angiography was normal. No myocarditis was revealed on myocardial biopsy. The patient declined electrophysiological investigation. TREATMENT AND COURSE: Amiodarone caused higher degree AV block. A temporary pacemaker lead was inserted via the persistent left SVC, amiodarone discontinued and later a pacemaker-defibrillator system (ICD) implanted, previous digital subtraction angiography having demonstrated a left SVC and absent right SVC. The transvenous electrode had been placed via the left subclavian vein, left SVC (anode), coronary sinus, right atrium into the right ventricle (cathode), and the pacemaker-defibrillator implanted subpectorally. Stable electrode position and correct ICD function has been documented over 2 years. 4 months after implantation bursts of ventricular tachycardia recurred every few minutes that responded to renewed amiodarone administration. CONCLUSION: Good long-term results can be obtained with ICD electrodes implanted via a persistent LSVC.

[Current intra- and early postoperative results of transvenous pacemaker implantation]. / Aktuelle intra- und frühpostoperative Ergebnisse der transvenösen Schrittmacherimplantation.

UNLABELLED: Between 1986 and 1989 295 pacemaker (PM)-implantations were performed (mean age: 69.9 +/- 14.5 years; 54.9% male, 45.1% female). INDICATIONS: AV-Block II+III (36.6%), sick-sinus-syndrome (26.4%), bradyarrhythmia (18.0%). Concomitant disease: hypertension (40.6%), diabetes mellitus (19.3%), coronary artery disease (11.5%), malignant tumors (10.8%), renal failure (7.5%). We implanted in 72.9% VVI-PM, in 23.7% DDD-PM and in 3.4% AAI-PM. The median fluoroscopy-time as a measure for time of surgery was 6.2 minutes (DDD: 6.7; VVI: 5.4; AAI: 9.9). In 6.5% there were intraoperative complications: arrhythmias (3.4%), skeletal muscular stimulation (M.pect.; 1.4%), lead dislodgment (0.7%), missed puncture (A.subcl.; 0.7%). The early postoperative (14 days) complications rate was 9.5% (lead dislodgment 3.7%, development of high threshold 1.7%, bleeding 1.4%, bacteriaemia 1.0%, skeletal muscular stimulation 0.7%). The complication rate of AAI-PM (70.0%) was significantly higher compared to DDD-PM (29.8%; p less than 0.01) and VVI-PM (12.1%; p = 0.00025). In 17 patients (5.8%) reoperation was necessary (lead dislodgment n = 11, development of high threshold n = 3, arrhythmias n = 2, postoperative bleeding n = 1). The highest dislodgment rate was seen in atrial leads with active fixation (5.0%). In 2.6% of active fixation leads there was a development of high thresholds (passive fixation leads 0.5%). The selection of the PM-system to be implanted has to be considered in respect to the increased complication rate of DDD- and AAI-PM, especially in elderly patients.

[Perioperative complications in pacemaker surgeries]. / Perioperative Komplikationen bei Schrittmacheroperationen.

In the years 1979 to 1985 (period I) 717 (102 per annum), in 1986 to 1989 (period II) 295 (73 per annum) pacemaker procedures had been performed at the cardiothoracic surgery division of Würzburg University. Indications for pacemaker therapy were in 35.4% vs. 36.6% (period I vs. period II) an atrioventricular block grade II or III, in 18.1% vs. 26.4% sick sinus syndrome, in 15.3% vs. 18.0% bradycardic rhythm disturbances, in 9.5% vs. 6.1% a sinuatrial block, in 6.5% vs. 2.4% a bradycardic sinus rhythm, in 12.4% vs. 3.7% others. While 41% of the procedures were performed under general anesthesia during the first period of observation, local anesthesia was predominant later on. Preferred venous access (79% vs. 74%) was the right cephalic vein followed by the subclavian vein (12% vs. 14%). The amount of the two chamber systems rose form 11% (period I) to 24% (period II). Intraoperative complications occurred in 2.5% vs. 5.8% and postoperative (within 14 days) complications occurred in 4% vs. 5.8%, respectively. No death was to be registered. The reasons for the increase of intra- and postoperative complications are discussed.

[Peripheral round lesion of the lung: diagnosis, therapy, prognosis]. / Der periphere Lungenrundherd: Diagnostik, Therapie, Prognose.

A total of 407 patients were hospitalized on account of a peripheral round lesion in the lungs (PR); 176 of these patients were inoperable for a wide range of different reasons. In 32.9% of the cases, a peripheral bronchial carcinoma presented, in 26.9%, the lesions were metastases, and in 2% malignant growths that were not further classified. All the remaining PR were benign. The following surgical procedures were performed: 39.8% lobectomies, 19.2% wedge resections, 20.6% enucleations, 6.4% segmental resections, 5.1% bilobectomies, 2.2% pneumonectomies, 6.7% various other procedures. The surgical mortality rate was 1.7% (0% in the case of the benign lesions); the re-thoracotomy rate for complications was 4.5%. The five-year survival probability for all bronchial carcinoma patients was 36%, and for all meta patients 47%. The poorest prognosis was seen in patients with PR when a small cell carcinoma or adenocarcinoma presented, and also in T3 tumours.