[Are there benefits for catheter valves for catheter-associated quality of life? : Results of an investigation in 427 catheter wearers with life-long indication]. / Hat eine Ventilversorgung Vorteile bei der katheterassoziierten Lebensqualität? : Ergebnisse einer Untersuchung an 427 Katheterträgern in lebenslanger Indikation.

BACKGROUND: In urology, a subset of patients with lifelong urine drainage are fitted with a catheter valve. Data on catheter-related quality of life (crqol) in this subset of patients are missing. AIM: Clarification of the whether there are advantages for valve-aided catheters in comparison with continuous urine drainage in catheter wearers with a lifelong indication. METHODS: In all, 357 patients with a catheter with lifelong indication of continuous urine drainage from a previous study were compared with 70 valve-aided patients. The crqol was evaluated by a validated assessment with 25 items and five domains. RESULTS: There were statistically more patients with a suprapubic catheter than with a transurethral indwelling catheter (73.4 vs. 54.4%, p = 0.005), significantly more patients with bladder voiding dysfunction (73.5 vs. 52.6%, p = 0.003) and significantly more patients with small catheter sizes (p = 0.001). Crqol was altogether slightly impaired with a median score of 4.2 (no impairment indicated by 5 points) in valve-aided patients, but crqol was more impaired in valve-aided patients compared to patients with continuous drainage (4.4 points, n. s.). Some items demonstrated more problems dealing with urinary urge in valve-aided patients, but catheter-related pain was more often worse in patients with continuous drainage. CONCLUSION: There is no clear evidence for an advantage of a catheter valve over a continuous urine drainage system. Thus, the decision regarding a catheter-valve system must be made individually according to the indication and the preferences of the patient.

[Comparison of catheter-associated quality of life in external urinary diversion: nephrostomy vs. suprapubic catheter]. / Vergleich der katheterassoziierten Lebensqualität bei externen Harnableitungen: Nephrostomie vs. suprapubischer Katheter.

INTRODUCTION: A percutaneous nephrostomy (PCN) affects the integrity of the patient due to the requirement of an external drainage bag and regular changes. The catheter-associated quality of life (QOL) was evaluated using a validated assessment and compared to similar patients with suprapubic bladder drainage. METHODS: A validated assessment analyzing catheter-related QOL for 5 domains and 25 individual items (first published by Mary Wilde) was completed during a catheter change appointment by patients who had their unilateral or bilateral PCN for a minimum of 3 months in life-long indication. RESULTS: In 66 patients (unilateral PCN: 42 patients), a moderate impairment of their catheter-related QOL was shown. The overall QOL score was median 4.0 on a scale of 0-5. This was rated lower-indicating a stronger impairment of QOL-than in patients with a suprapubic bladder catheter, who had a median score of 4.3. Significant differences were found related to the catheter type in the items "feeling of humiliation due to the PCN", "conflicts with the medical or nursing staff", "fear of painful catheter changes", "feeling ill", "being handicapped in activities of daily living" and "concern of not being able to do what one wants to do" and "fear of catheter leakages". The indication for the PCN due to a malignant or benign underlying disease was not associated with the catheter-related QOL. CONCLUSION: For the first time, the catheter-related QOL was found to be moderately impaired in patients with a PCN using a validated assessment. Affected individuals report feeling "ill" and "limited/disabled" in activities of daily living; thus, the surgical indication should be strict. Fear of painful catheter changes and of catheter leakages indicates the need of technically correct catheter changes.

[Quality of life for wearers of a suprapubic or transurethral bladder catheter as lifelong permanent care]. / Lebensqualität bei Trägern eines suprapubischen oder transurethralen Harnblasenkatheters als lebenslange Dauerversorgung.

BACKGROUND: The insertion of a Foley catheter (FC) or a suprapubic catheter (SPC) in lifelong intent is an intervention with significant complications, comorbidities and impact on the further life that has not yet been analyzed. METHODOLOGY: The analysis was based on a validated assessment of catheter-related QoL with 25 items in 5 domains and applied to patients with a Foley or suprapubic catheter in lifelong indication and with the catheter in place for at least 3 months. Assessment data were enriched with information on the type and diameter of the catheter as well as demographic data. RESULTS: Questionnaires from 357 patients (260 male, 97 female, 193 with suprapubic catheter, 162 with Foley catheter, 2 no information) were included in the study. Patients with a Foley catheter were significantly older than patients with a suprapubic catheter (78.9 ± 11.1 years vs. 74.4. ± 12.6 years, p < 0.001). The average QoL score was 4.1 points on a scale from 1 (maximum impairment of QoL) to 5 (no impairment of QoL) indicating a moderately negative impact on QoL. Scores below the average were mainly driven and accompanied by a fear of urine leakage, urine odor, painful catheter changes and urinary infections increasing with age. Additionally, patients were worried about negative effects on their daily life activities due to the catheter. These worries seemed to be more pronounced in females with urinary incontinence, patients with a catheter size ≥ 18 Ch. and with an age of < 70 years. The type of catheter showed a greater impact on the QoL in females with suprapubic catheters when compared with males in contrast to patients with transurethral catheters. CONCLUSION: The results of the study provide further information for the medical clarification for patients and caregivers, having to decide between a lifelong catheter drainage or alternatives, such as provision of an aid or surgical recanalization.

H5N1 influenza virus and the safety of plasma products.

BACKGROUND: The ever-increasing number of human H5N1 influenza virus infections may enable these viruses to acquire the ability to spread effectively among humans and potentially to cause a pandemic. Recently, more systemic virus dissemination was reported during H5N1 virus infection of humans, resulting in significant virus concentrations also in the blood. The observation has raised concerns about the safety of labile blood products for transfusion and consequentially also for plasma derivatives. To confirm the safety margins of plasma products, dedicated virus inactivation processes used during their production were investigated for their effectiveness in inactivating this virus of recent concern. STUDY DESIGN AND METHODS: Virus inactivation by steps commonly used during the manufacture of plasma derivatives, such as pasteurization for human albumin, solvent/detergent treatment for intravenous immunoglobulin (IVIG), vapor heating for factor VIII inhibitor bypassing activity, and incubation at low pH for IVIG, were investigated with a reassortant strain of H5N1 influenza virus. RESULTS: The results show that H5N1 influenza behaves as expected for lipid-enveloped viruses; that is, the virus is effectively inactivated by all the commonly used virus inactivation procedures tested. CONCLUSION: The safety margins of plasma derivatives against the theoretical transmission of H5N1 influenza virus are very substantial.

Male aerial display and reversed sexual size dimorphism in the dunlin

Reversed sexual size dimorphism, with males smaller than females, is common in waders. The aerial display hypothesis suggests that sexual selection in males favours aerial agility, and hence small size, in species with male display flights. We tested this hypothesis in the dunlin, Calidris alpinaDisplay flights were uncommon in the early breeding season but increased markedly when females began laying. Male display areas were largely overlapping, and display flight seemed to be mainly an advertising signal to potential mates. Display rate, as well as proportion of time spent in aerial display, increased with decreasing male size. During aerial display, small males also performed costly hovering flights more often and for relatively longer than large males. These results support the aerial display hypothesis.Copyright 1997 The Association for the Study of Animal Behaviour1997The Association for the Study of Animal Behaviour

[Sexual activity in advanced age in the context of gender, family status and personality aspects--results of a representative survey]. / Sexuelle Aktivität im höheren Lebensalter im Kontext von Geschlecht, Familienstand und Persönlichkeitsaspekten--Ergebnisse einer repräsentativen Befragung.

In a representative study, 450 elderly men and women over the age of 60 years were--besides other questions--asked if they had any sexual activity within the last 12 months. Not regarding the gender of these persons, but rather just the marital status, i.e. if they still have a partner, two-thirds of the old people between 61-70 years and one-third of the group older than 70 years, who still have a partner, had sexual activity. We then looked for a relationship between sexual activity and special aspects of personality, measured by the Giessen Test. We found that older people who still have sexual activity describe themselves als less depressed, with more social contacts, and with a higher social potency than elderly people with no sexual activity.

[The specificity of so-called "smoker cells" in lung tissue]. / Zur Spezifität sogenannter "Raucherzellen" im Lungengewebe.

A simple test for demonstration of smoker cells was verified on bronchoalveolar lavage (BAL) and cytological smears of lung tissue. Alveolar macrophages exhibit in 81% (BAL) respectively 86% (surgical material) of the smokers with Fettrot 7B a red colouring of the cytoplasm. Only few non-smokers show a positive reaction for smoker cells. In ex-smokers this positive reaction disappears after 7 month. We conclude, that this method is very sensitive but not absolutely specific for detecting smokers with a simple cytological test.

[Determination of macrophage activity in bronchoalveolar lavage fluid in patients with lung diseases]. / Bestimmung der Makrophagenaktivität in der bronchoalveolären Lavageflüssigkeit bei Patienten mit Lungenkrankheiten.

In order to investigate the metabolic activity of alveolar macrophages in the bronchoalveolar lavage fluid from patients with extrinsic allergic alveolitis, pulmonary sarcoidosis, bronchogenic carcinoma, chronic bronchitis, tuberculosis, bronchial asthma and from sensitized asymptomatic persons, the quantitative and qualitative Nitroblue-tetrazolium test was used. There was observed a significant increase of the alveolar macrophage activity in patients with bronchogenic carcinoma, chronic bronchitis, sarcoidosis and extrinsic allergic alveolitis. The results of the investigation emphasize the central role of the alveolar macrophages in the triggering and regulation of the inflammatory reaction in the lung and consequently play an important role in the elucidation of pathogenic mechanisms in lung diseases.

[Chemiluminescent measurements of alveolar macrophages in sarcoidosis patients]. / Chemilumineszenz-Messungen an Alveolarmakrophagen bei Sarkoidose-Patienten.

The phagocytic activity of alveolar macrophages (AM) in a group of patients with stage I, stage II and stage III pulmonary sarcoidosis (gradation according to Wurm) has been investigated. Additionally a classification in different forms of the course of sarcoidosis was made (acute = Loefgren's syndrome, latent = primary-chronic, and relapses). Patients with other lung diseases and healthy subjects were recruited as control group. The phagocytic activity (stimulation with opsonized yeast cell wall particles) of AM, which were isolated by bronchoalveolar lavage, was determined by means of chemiluminescence (CL)-measuring using lucigenin and luminol, respectively, as amplifiers. The investigations showed that the lucigenin-dependent yeast cell wall-induced CL of AM in patients with sarcoidosis is significantly increased in comparison to the control group. No significant changes of the luminol-dependent CL of AM from sarcoidosis patients could be detected. The lucigenin-dependent CL-response of AM is obviously an indicator of the intensity of the alveolitis and thus of the activity of the pathological process in sarcoidosis. The results suggest that in pulmonary sarcoidosis there is a hyperreactive AM/lymphocytes-system.

[Effect of antioxidants on the production of reactive oxygen metabolites by stimulated alveolar macrophages]. / Einfluss von Antioxidanzien auf die Erzeugung von reaktiven Sauerstoffmetaboliten durch stimulierte Alveolarmakrophagen.

Reactive oxygen metabolites (ROM) (O2-, H2O2, 1O2, .OH, OX-) which are produced by stimulated alveolar macrophages (AM), neutrophils and eosinophils, play an important role in the pathogenesis of many acute and chronic lung diseases. With regard to a therapeutic application the influence of the antioxidants ascorbic acid (Vitamin C) and alpha-tocopheryl acetate (Vitamin E acetate) on the production of ROM by AM was investigated. The AM were isolated by bronchoalveolar lavage from patients with different lung disorders. The ROM were determined by means of chemiluminescence-measuring. alpha-Tocopheryl acetate solved in peanut oil causes a little increase of the yeast cell wall-induced chemiluminescence. Pure alpha-Tocopheryl acetate has no effect on the chemiluminescence. In contrast to alpha-Tocopheryl acetate the addition Vitamin C to the stimulated AM results in a strong diminution of the chemiluminescence signal. This result suggests that Vitamin C reduces the generation of ROM by AM. Therefore Vitamin C could be a suitable scavenger of radicals and oxidants in different lung diseases.

[Value of bronchoalveolar lavage in assessing the activity of sarcoidosis]. / Stellenwert der bronchoalveolären Lavage (BAL) in der Aktivittsbeurteilung der Sarkoidose.

BAL was performed in different courses of sarcoidosis in order to evaluate the importance of this examination. We found a higher degree of lymphocytosis in Löfgren's syndrome and in relapses than in the others. Probably there is a direct connection between high intensity alveolitis and reduction of diffusing capacity. There could not be found any correlation to other markers of activity (lung function, SACE, 67-Gallium-Scan).

[The effect of ambroxol and bromhexine on the "respiratory burst" of alveolar macrophages]. / Einfluss von Ambroxol und Bromhexin auf den "Respiratory Burst" von Alveolarmakrophagen.

The effect of ambroxol and bromhexine on the yeast cell wall- and arachidonic acid (AA)-induced luminol-respectively lucigenin-dependent chemiluminescence (CL) of alveolar macrophages (AM) of patients with lung diseases has been investigated. Both drugs cause a suppression of the induced CL. These results suggest that ambroxol and bromhexine reduce the generation of reactive oxygen metabolites (ROM) by AM. The mechanism of action is thought to involve the activation of the acyl-CoA: lysophosphatide acyltransferase. The increase of this enzyme activity lowers probably the intracellular concentration of free AA and consequently also the production of ROM. The investigations show a new possibility for the influence of biosynthesis of ROM and likely of eicosanoids, which play an important role as pathogenetic mediators in different lung diseases.

[Modulation of alveolar macrophage activity by ambroxol, bromhexine and exogenous arachidonic acid]. / Modulation der Alveolarmakrophagenaktivität durch Ambroxol, Bromhexin und exogene Arachidonsäure.

The increased generation of reactive oxygen metabolites (ROM) (O2-, H2O2, 1O2, X OH, OX-) by alveolar macrophages (AM) and neutrophils has been proposed as an important step in the pathogenesis of many acute and chronic lung disorders. With regard to a possible therapeutic application in this context the effect of bromhexine and ambroxol on the activity of AM of of guinea-pigs and of patients with lung diseases was investigated. The activity of AM, which were isolated by bronchoalveolar lavage, was determined by means of chemiluminescence (CL)-measuring. Ambroxol and bromhexine cause a depression of the spontaneous as well as of the induced CL [yeast cell walls, yeast glucan, exogenous arachidonic acid (AA)] of AM. AM from guinea-pigs and in some cases also from patients show primarily an increase of the CL-signal under the influence of bromhexine. These results suggest that ambroxol and bromhexine reduce the production of ROM by AM. The mechanism is possibly due to the activation of acyl-CoA-lysophosphatide acyltransferase. The increase of this enzyme activity lowers the intracellular concentration of the free AA, whereby the generation of ROM is diminished too. The investigations exhibit a new possibility of influence of respiratory burst and thus indirectly of AA-liberation from phospholipids. The probable reduction of AA-liberation by these drugs could also be of importance for other lung cells especially concerning the biosynthesis of eicosanoids (AA-metabolites), which play an important part as pathogenetic mediators in different lung diseases.

[Bronchoalveolar lavage]. / Bronchoalveolärre Lavage.

The incidence of interstitial lung diseases is increased during the last years. A possibility for improvement the diagnosis of these lung diseases is the bronchoalveolar lavage (BAL). In a critical review the performance of the BAL, same properties of the isolated macrophages and the determination of biochemical parameters in lavage fluid are described. In this context especially problems of diagnosis of sarcoidosis are discussed. There are new fields of application of BAL (diagnosis of occupational lung diseases, control of therapy). In order to improve the comparability of different results a standardization of BAL is necessary.

[Lymphocyte populations in bronchoalveolar lavage fluid in various interstitial lung diseases]. / Lymphozytenpopulationen in der broncho-alveolären Spülflüssigkeit bei einigen interstitiellen Lungenkrankheiten.

Differential cell counts, T-, Tactive-, Tstable-, and B-lymphocytes were studied in bronchoalveolar lavage (BAL) fluid and in peripheral blood from patients with thoracic sarcoidosis (S), extrinsic allergic alveolitis (EAA) and idiopathic pulmonary fibrosis (IPF). In patients with S and EAA the total number of lymphocytes, the percentage of T-, Tactive-, and Tstable-lymphocytes were increased in BAL-fluid, especially in cases of active S and of acute EAA. Contrary to the BAL-fluid the peripheral blood values for T-lymphocytes were decreased in S and in the range of the control group (healthy volunteers) in EAA. The BAL-fluid of patients with IPF is characterized by a high number of polymorphonuclear cells, especially neutrophils. Current concepts of pathogenesis of interstitial lung diseases are discussed and the possible key role of alveolitis in this process is elucidated.

[Malta fever in a brucellosis free region: analysis of a malta fever outbreak in the Göttingen area 1982]. / Maltafieber in einem brucellosefreien Areal: Analyse des Maltafieberausbruches im Raum Göttingen 1982.

During April/Mai 1982 15 patients were affected with acute Malta fever around Goettingen an area known the be brucellosis-free until then. The source of infections were local flocks of sheep. The infections were mainly acquired when assisting at lamb birth or abortions. Between onset and diagnosis of the disease intervals up to 3 month occurred. Diagnostically crucial were blood cultures and serological tests. Therapy with tetracyclines or co-trimoxazole were effective in all cases. In patients with status febrilis and anamnestic contact with brucellosis-prone animals brucellosis should be considered, even if the local area appears to be brucellosis-free.

[Results of studies on dogs after unilateral allogeneic lung transplantation without immunosuppression]. / Untersuchungsbefunde an Hunden nach unilateraler allogener Lungentransplantation ohne Immunsuppression.

The observations and the results after allogenic lung transplantation in 24 receivers were reported. The animals were not treated immuno-suppressively. They survived 6.2 days on an average and died in consequence of the rejection. The transplant is progressively threatened of bacterial infections after the beginning of the rejection even in case of an operation under sterile conditions. The investigations confirmed a narrow correlation between the leucocyte count and the course of the rejection. However, the condition of the transplant can be estimated approximately certainly by means of complex clinical methods of examination.