Opioid use prior to admission for chemotherapy induced febrile neutropenia is associated with increased documented infection, sepsis, and death.

PURPOSE: Cancer patients on chemotherapy are at risk for developing febrile neutropenia and infections. Opioids have been associated with immune suppression and risk of infection. We aimed to investigate opioid use associated with infections and death among cancer patients admitted with febrile neutropenia. METHODS: A total of 481 patients admitted for chemotherapy-induced febrile neutropenia were reviewed. There were 274 patients with opioid prescriptions (OP) within 10 days of hospitalization and 207 patients without opioid prescriptions (NOP) for >1 year of hospitalization. The primary outcomes were microbiologically and clinically documented infection as defined by the International Immunocompromised Host Society (IHS), sepsis by clinician, systemic inflammatory response syndrome (SIRS) criteria, and sequential organ failure assessment (SOFA) score. RESULTS: Documented infection occurred in 192 (70%) of patients with opioids compared to 99 (48%) with non-opioids, p < 0.001. Similar results were observed in sepsis by SOFA score with 173 (63%) opioids versus 92 (44%) non-opioids, p < 0.001, and sepsis by SIRS with 225 (82%) and 115 (56%) respectively, p < 0.001. Multivariable analysis showed opioid use has an increased adjusted odds of documented infection by 7.13 fold (95% CI 3.97-12.78), Sepsis by SOFA by 2.39 fold (95% CI 1.33-4.29), and Sepsis by SIRS by 1.87 fold (95% CI 1.13-3.10). Multivariable analysis for death/hospice showed that opioids had 2.30 fold (95% CI 1.16-4.57) increase in adjusted odds of death/hospice within 30 days of discharge. CONCLUSION: The data supports that patients with prior opioid use is associated with increased odds for infection, sepsis and death than non-opioid users admitted with febrile neutropenia.

[Secondary malignancies in urinary diversions]. / Sekundärmalignome in Harnableitungen.

In contrast to ureterosigmoidostomy no reliable clinical data exist for tumor risk in different forms of urinary diversion using isolated intestinal segments.In 44 German urological departments, operation frequencies, indications, patient age, and operation dates of the different forms of urinary diversion, operated between 1970 and 2007, could be registered. The secondary tumors up to 2009 were registered as well and related to the numbers of the different forms of urinary diversions resulting in tumor prevalences.In 17,758 urinary diversions 32 secondary tumors occurred. The tumor risk in ureterosigmoidostomy (22-fold) and cystoplasty (13-fold) is significantly higher than in other continent forms of urinary diversion such as neobladders or pouches (p<0.0001). The difference between ureterosigmoidostomy and cystoplasty is not significant, nor is the difference between ileocecal pouches (0.14%) and ileal neobladders (0.05%) (p=0.46). The tumor risk in ileocecal (1.26%) and colonic neobladders (1.43%) is significantly higher (p=0.0001) than in ileal neobladders (0.5%). Of the 16 tumors that occurred following ureterosigmoidostomy, 16 (94%) developed directly at the ureterocolonic borderline in contrast to only 50% following urinary diversions via isolated intestinal segments.From postoperative year 5 regular endoscopic controls of ureterosigmoidostomies, cystoplasties, and orthotopic (ileo-)colonic neobladders are necessary. In ileocecal pouches, regular endoscopy is necessary at least in the presence of symptoms or should be performed routinely at greater intervals. Following neobladders or conduits, only urethroscopies for urethral recurrence are necessary.

The effect of different doses of methisoprinol on the percentage of CD4+ and CD8+ T lymphocyte subpopulation and the antibody titers in pigeons immunised against PPMV-1.

As immunosuppression in pigeons is common and results in reduced post-vaccination immunity and lower health status of the birds, studies have been taken up aimed at evaluation of the effect of three doses of methisoprinol on the percentage of CD4+ and CD8+ T lymphocyte subpopulation in peripheral blood and in the spleen and the titre of anti-NDV antibodies in the serum of pigeons in four groups (A, B, C, D), with 20 birds each. Pigeons in each group were immunised against paramyxovirosis at week 6 and 9 of life. Water for injection (group A - control) or methisoprinol at 100 mg/kg of body weight (group B), 200 mg/kg of body weight (group C) and 600 mg/kg of body weight (group D) was administered intramuscularly for 3 days before each vaccination. The immunological analyses were carried out by flow cytometry and the ELISA test. The findings indicate that methisoprinol administered intramuscularly at 100 and 200 mg/kg of body weight for 3 successive days before vaccination against paramyxovirosis mainly stimulates the mechanisms of non-specific humoral and cellular immunity, which is indicated by a higher percentage of the subpopulation of CD4+ T lymphocytes in peripheral blood and in the spleen and a higher titre of anti-NDV antibodies.

[Free and pedicled muscle transfer as a therapy option in urological surgery]. / Der freie und gestielte Muskeltransfer als Therapieoption in der urologischen Chirurgie.

Various demands of reconstruction define restoration technique. The basic principle involves optimal anatomical and functional reconstruction with concurrent minimal donor-site morbidity. Dependent on the aetiology of the defect, there are various reconstructive possibilities available for obtaining an optimal result. An immediate single stage reconstruction, with the best possible result for the individual patient as the primary consideration, can be carried out by interdisciplinary teams. In this overview, the most common indications and principles of flap choice are presented in relation to the reconstructive requirements necessary for early rehabilitation of the patient or the earlier start of necessary adjuvant therapy.

"Low-risk" and "high-risk" HPV-infection and K-ras gene point mutations in human cervical cancer: a study of 31 cases.

To analyze the coexistence of human papilloma virus (HPV) infection and K-ras gene activation in cervical neoplasia, we investigated 31 (seven pre-invasive and 24 invasive) cervical carcinomas for "low-risk" (types 6 and 11) and "high-risk" (types 16 and 18) HPVs and K-ras point mutations using PCR-based technology. "Low-risk" HPVs were not detected in the group investigated; however, 20 of 31 (64%) cases were HPV 16 positive, while HPV 18 was found in only three (9.7%) samples (HPV 6/11 v. HPV 16/18, p < 0.0001; HPV 16 v. HPV 18, p < 0.0001; Fisher's exact test). There was a K-ras codon 12 point mutation in two of 31 (6.4%) neoplasms, with none of the cases showing a K-ras codon 13 point mutation. Two moderately differentiated squamous carcinomas showed K-ras exon 2 gene alterations. Interestingly, none of the pre-invasive cervical carcinomas displayed K-ras gene point mutations. The mean patient age did not differ significantly in the number of HPV-positive and -negative cases. A coexistence of "high-risk" human papillomavirus DNA with K-ras gene alterations was observed in three of 31 (9.7%) neoplasms (one IIA and two IB moderately differentiated cervical carcinomas). Our results suggest that "high-risk" HPVs coexist with K-ras gene alterations in a subset of moderately differentiated carcinomas of the cervix uteri.

[Detection of human papillomavirus type 16 and 18 in laryngeal cancer using PCR methods]. / Wykrywanie obecnosci wirusa brodawczaka ludzkiego HPV 16 i 18 w raku krtani z zastosowaniem metody PCR.

Human papillomavirus (HPV) is a small DNA virus. HPV is can be divided into two groups: mucosal and cutaneous. HPV have various oncogenic potential. The correlation between presence of high oncogenic type of HPV and carcinogenesis was confirmed in human anogenital tract and cervical carcinoma. The latest studies suggest HPV infection involvement in benign and malignant lesions of aerodigestive tract. The aim of our study was to determine the presence of the HPV genes E6/E7. The specimens were taken after total laryngectomy from 20 patients with squamous cell carcinoma. The fresh tissue specimens were frozen at -70 degrees C until DNA extraction and HPV detection. The presence of HPV DNA was assessed by polymerase chain reaction using specific primers for HPV 16 and 18 E6/E7. There were 7 (35%) HPV positive specimens in our group. 5 (25%) specimens were HPV 16 positive, 4 (20%) specimens were HPV-18 positive. In two cases HPV 16 and HPV 18 was present. The results suggest that high oncogenic types of HPV may play a role in pathogenesis of laryngeal carcinoma.

Detection of human papillomavirus types 16 and 18 in human neoplastic endometrium: lack of correlation with established prognostic factors.

HPV (types 16 and 18) DNA sequences are present in the majority of precancerous and cancerous lesions of the human uterine cervix. However, data concerning the involvement of HPVs infection in the pathogenesis of endometrial cancer are controversial. In the current study we investigated the frequency of the HPV types 16 and 18, detected by PCR amplification using the type 16- and 18-specific primers within the E7 Open Reading Frame (ORF) sequence, in 54 human endometrial carcinomas obtained from women of Polish origin. Moreover, we assessed the possible association of the HPV with the clinicopathological features of the cancer, patients' outcome as well as with the K-ras codon 12 gene point mutations. HPV type 16 was present in eleven out of 54 (20%) endometrial tumors, while HPV type 18 was detected only in three out of 54 (4%) neoplasms analyzed. HPV infection was not related either to the patients' age (r=0.11; p=0.428, Spearman correlation test) or to the clinicopathological parameters and patients' prognosis. A higher incidence of HPV 16/18 was detected in well (G1) differentiated than in moderately (G2) and poorly (G3) differentiated endometrial adenocarcinomas, but the difference was not statistically significant. Moreover, none of HPV-positive endometrial carcinomas harbored K-ras codon 12 gene point mutations. Our results suggest that some of the endometrial carcinomas are associated with HPV infection but the presence of the human papillamovirus types 16/18 is not related to the clinicopathological or prognostical features of the neoplasm.

[Neurofibromatosis type 1 --Recklinghausen's disease; pathogenesis and clinical symptoms]. / Nerwiakowlókniakowatosc typu 1--choroba Recklinghausena; patogeneza i klinika.

Neurofibromatosis type 1 (NF1) or von Recklinghausen neurofibromatosis is a common autosomal dominant disorder affecting 1 in 3000 individuals. The gene for NF1 is localized on chromosome 17q11.2. The gene mutations or the inactivation its protein product--neurofibromin are responsible for the manifestation of the disease. NF1 demonstrates a wide variability of clinical symptoms classified by NIH Consensus Conference in 1987.

[Use of polymerase chain reaction for pediatric diagnosis]. / Zastosowanie reakcji PCR w diagnostyce pediatrycznej.

Basic principles of main molecular biology techniques: polymerase chain reaction (PCR) and its variants; asymmetric PCR, ARMS, nested PCR, multiplex PCR and competitive PCR are discussed. Nucleic acids techniques are making increasing progress in molecular diagnostics. Sequence analysis of amplified DNA allows better identification of the pathogen, detection of mutant genes and more accurate prognosis and therapy of certain diseases.

Some unusual members of the family Pasteurellaceae isolated from human sources--phenotypic features and genomic relationships.

Twelve human isolates exhibiting the properties of the family Pasteurellaceae but phenotypically deviating from established species, or resembling species of animal origin that are only rarely reported to occur in human materials, were checked for their identities by DNA-DNA hybridization. The collection consisted of one strain of Actinobacillus lignieresii, two strains of Actinobacillus hominis (mannose-positive), two hitherto undescribed Actinobacillus or Actinobacillus-like species, [Pasteurella] haemolytica biovar T, CDC group HB-5 (initially oxidase and indole-negative), a new species in the [Haemophilus] aphrophilus [Haemophilus] segnis group, a new sucrose-negative and gas-producing Pasteurella-like species, and three strains of Bisgaard's Pasteurella-like taxon 16. Some diagnostically useful features of these unusual human Pasteurellaceae are described.

Reclassification of German, British and Dutch isolates of so-called Pasteurella multocida obtained from pneumonic calf lungs.

The taxonomic relationship of 131 strains previously identified as Pasteurella multocida obtained from calf pneumonia in West Germany, United Kingdom and Netherlands was investigated by extended phenotypic and limited genotypic characterization. Twenty-four strains were classified as P. multocida ssp. multocida, 15 strains as P. avium biovar 2 and 13 strains as P. canis biovar 2. Sixty-five and five strains were tentatively classified as ornithine negative P. multocida ssp. multocida and P. multocida ssp. septica, respectively. Genetic investigations showed that ornithine negative strains of P. multocida were related on species level. Less genomic binding was found between an ornithine negative strain of P. multocida ssp. septica and the type strains of the three subspecies of P. multocida. The taxonomic position of ornithine negative strains of P. multocida is still under investigation. The taxonomic position of the remaining nine strains is uncertain underlining the need for genotypic characterization within the genus Pasteurella to aid in defining single species by phenotypic tests.

Irradiation of free vascularized tissue transplants in rats.

The aim of this experimental investigation was to show whether immediate irradiation of a free flap or an island flap is dangerous or not. The free epigastric flap of the rat was used as a model for this investigation. The patency of the epigastric vessels of the rat was not influenced by the irradiation and the histological findings showed no early reaction to the irradiation of the vessels of the transplanted tissue. The vessels of this experiment indicate that a free tissue transplantation is possible even if a combined radio-surgical treatment is planned.