[Initial results of perineal MRI/ultrasound fusion biopsies under local anesthesia without standard perioperative antibiotic prophylaxis]. / Etablierung der perinealen MRT­/Ultraschallfusionsbiopsien in Lokalanästhesie ohne standardmäßige, perioperative Antibiotikaprophylaxe.

The perineal approach for prostate biopsy (PB) is a sterile alternative to conventional transrectal PB. Targeted local anesthesia allows perineal prostate biopsy (pPB) to be performed without general anesthesia. This paper presents the first results after establishing perineal MRI/ultrasound fusion biopsy (pFB) under local anesthesia without standard perioperative antibiotic prophylaxis. For this purpose, 144 patients were included in the study after pFB at the Vivantes Klinikum am Urban. No peri-interventional antibiotic prophylaxis was applied. Peri- and postoperatively, the pain sensation, measured using an analogue pain scale from 0-10, and complications were recorded. The median patient age was 68 and the median prostate-specific antigen (PSA) value 7.07 ng/ml. In all, 49% of the patients received primary PB. The overall detection rate for prostate cancer (PCa) was 71% and for PI-RADS 3, 4 and 5 was 44, 71 and 92%, respectively. The median pain sensation during biopsy was 2. Furthermore, 63% of patients with a transrectal prebiopsy considered this to be more painful and another 20% expressed similar pain levels. Only 1 patient developed a febrile urinary tract infection. The pFB of the prostate under local anesthesia without antibiotic, perioperative prophylaxis is a suitable alternative to the transrectal PB with regard to the detection rate of PCa, the side effect profile and the subjective pain perception of the patients during the intervention.

Baroreflex sensitivity predicts the induction of ventricular arrhythmias by cesium chloride in rabbits.

Previous studies have shown that the autonomic nervous system plays an important role in the genesis of ventricular tachycardia (VT) in patients with long QT syndrome, and in cesium chloride (Cs)-induced VT in animals. The present study investigated whether baroreflex sensitivity predicts the induction of VT by Cs in the rabbit in vivo. Monophasic action potentials (MAPs) of the left ventricular endocardium were recorded simultaneously with the surface ECG in 27 rabbits. Rabbits were divided into 4 groups based on the Cs-induced ventricular arrhythmias: (1) no ventricular premature contractions (No-VPC group), (2) single or paired VPC (VPC group), (3) monomorphic VT (MVT group), and (4) polymorphic VT (PVT group). Baroreflex sensitivity was significantly lower in the MVT and PVT groups than in the No-VPC and VPC groups. The plasma norepinephrine concentration before Cs injection was significantly higher in the MVT group than in the other 3 groups, and the norepinephrine concentration after Cs injection was significantly higher in the MVT and PVT groups than in the No-VPC and VPC groups. Baroreflex sensitivity was negatively correlated with the norepinephrine concentration before Cs injection. These results suggest that autonomic nervous system dysfunction, as defined by reduced baroreflex sensitivity, and elevated plasma norepinephrine concentrations predict increased susceptibility to Cs-induced VT.

[Pesticide immunotoxicity]. / Immunotossicità da pesticidi.

Pesticides have been reported as altering immune functions in animals and man. The authors review published data from which it emerges that pesticide exposure is often associated with depressed humoral and cellular responses in mammals. The immunomodulating effects are affected by the route of administration and can also occur without general toxic effects, with a clear dose-effect correlation and for different dose levels. Immunotoxicity has also been investigated in workers occupationally exposed to pesticides: many kinds of effects are described, since many immunotoxicants have multiple effects on immune functions but the authors emphasize the importance of further studies carried out in workplace situations where exposure levels can be more accurately measured.