[Long-term oxygen therapy--impact on the quality of life in persons with chronic obstructive lung disease]. / L'oxygénotherapie de longue durée--impact sur la qualité de vie des personnes souffrant de broncho-pneumopathie chronique obstructive.

Chronic bronchopenumopathies are today a real public health problem. They are mainly due to tobacco, and during their development, they generate a heavy handicap. At an advanced stage, the patient develops a respiratory insufficiency and then requires a substitution treatment: long lasting oxygen therapy. The study we have just carried out shows that such a treatment enabling to prolong life is not totally justified as an improvement of life quality. Indeed, it seems to aggravate the constraints engendered by the disease itself. A training on the place of prescription, the development of hospital-home care service networks and patients associations, would perhaps allow a better acceptance and adaptation to the treatment (these suggestions could be the subject of future research). Likewise, it might be interesting to ponder over the impact of making the general public and the smokers sensitive to such a condition and to the handicap it generates.

Drug metabolizing capacity of cryopreserved human, rat, and mouse liver parenchymal cells in suspension.

The phase I and phase II drug-metabolizing capacity of freshly isolated and cryopreserved parenchymal cells (PC) from human, rat, and mouse liver held in suspension at 37 degrees C for up to 120 min after thawing was compared. Although 7-ethoxycoumarin-O-deethylase activity was strongly reduced in freshly isolated as well as in cryopreserved PC from human, rat, and mouse liver after 120 min, 7-ethoxyresorufin-O-deethylase activity as well as the profile and formation rates of hydroxylated testosterone metabolites in general remained constant throughout the 2-h incubation period in cryopreserved PC from all three species and was similar to that measured in freshly isolated PC. The activity of glutathione S-transferase (GST) and that of UDP-glucuronosyltransferase (UDP-GT) toward 4-methylumbelliferone significantly decreased, whereas the activities of UDP-GT activity toward 4-hydroxybiphenyl and sulfotransferase in cryopreserved human PC were similar to those measured in freshly isolated PC. The activities of GST, UDP-GT toward 4-methylumbelliferone, and sulfotransferase in cryopreserved rat PC showed a significant decrease when compared with the activities in freshly isolated PC. The phase II enzyme activities in cryopreserved mouse PC proved to be far more stable, being similar to the activities of freshly isolated mouse PC at all four time points measured with the exception of GST, which showed a decay from t = 60 min onward. In conclusion, phase I drug-metabolizing enzyme activities in cryopreserved human, rat, and mouse PC are very similar to those of freshly isolated PC, whereas phase II enzyme activities are affected by cryopreservation.

Meropenem monotherapy versus cefotaxime plus metronidazole combination treatment for serious intra-abdominal infections.

In an open, randomised, multicentre trial, the efficacy and tolerability of empirical meropenem monotherapy (1 g intravenously every 8 hours) and cefotaxime (2 g every 8 hours) plus metronidazole (0.5 g intravenously every 8 hours) for 5 to 10 days was compared in 94 patients with serious intra-abdominal infection who required surgery. Eighty-three patients had an evaluable clinical response. Significantly more patients in the meropenem group had a satisfactory clinical response at the end of treatment (41/43 [95.3%] vs 30/40 [75.0%]; p = 0.008). The bacteriological response was also higher in the meropenem group (31/33 vs 26/32). In the bacteriologically evaluable population, a satisfactory clinical response was observed in 31/33 of those who received meropenem compared to 24/32 of the cefotaxime/metronidazole recipients (p = 0.03). Empirical meropenem monotherapy should prove a useful alternative to the currently standard combination treatment for serious intraabdominal infections.

Human Kupffer cells secrete IL-10 in response to lipopolysaccharide (LPS) challenge.

BACKGROUND/AIMS: Kupffer cells are involved in local immunoregulation in the liver by secretion of cytokines and direct cellular contact. They are able to influence the function of other liver cells, i.e. sinusoidal endothelial cells, Ito cells and hepatocytes. The three known major functions of Kupffer cells are clearance of endotoxin from the portal circulation, release of soluble mediators and presentation of antigen. METHODS: Human Kupffer cells were isolated by collagenase perfusion followed by centrifugal elutriation and analyzed for cytokine secretion after 3 days in culture. RESULTS: We found that freshly isolated human Kupffer cells secreted the anti-inflammatory cytokine interleukin-10 in response to stimulation with lipopolysaccharide. The release of interleukin-10 was maximal 12-24 h after lipopolysaccharide challenge. Furthermore, we could show that exogenous interleukin-10 downregulated the release of the proinflammatory cytokines interleukin-6 and tumor necrosis factor alpha by Kupffer cells after lipopolysaccharide stimulation. The release of interleukin-6 was maximal 24 h after stimulation and interleukin-10 inhibited interleukin-6 release after 6 h. Tumor necrosis factor alpha showed maximal secretion 6 h after stimulation and exogenous interleukin-10 also downregulated the tumor necrosis factor alpha release after 6 h. CONCLUSIONS: Kupffer cells are exposed physiologically to lipopolysaccharide present in portal venous blood. Given the known anti-inflammatory effect of interleukin-10, our findings of secretion of interleukin-10 by Kupffer cells in response to lipopolysaccharide and suppression of interleukin-6 and tumor necrosis factor alpha release by Kupffer cells in vitro through exogenous interleukin-10 suggest an important role for interleukin-10 in the regulation of the local immune response in the liver sinusoid.

[Ambulatory monitoring of frequency of apnea in patients with suspected sleep apnea syndrome. Comparative studies using a thermistor sensor]. / Ambulantes Monitoring der Apnoefrequenz bei Patienten mit Verdacht auf Schlafapnoesyndrom. Vergleichende Untersuchungen mit einem Thermistorsensor.

To record and evaluate the number and duration of nocturnal apneas, and easy method is needed in an outpatient setting. New methods such as recording the tracheal sounds, heart frequency, and O2 saturation, are now available. Recording of thermal convection by Thermistor has not been performed on an outpatient basis so far. Hence, we developed a method by which a thermistor was placed on a mask to record the nasal and oral flow. A specially developed computer hardware evaluates date, time, period, number and mean values of the apneas. The parameters were compared with the conventional methods of recording apneas (thoracic and abdominal movement. O2 saturation, heart frequency and 3 thermistors at mouth and nose). 20 patients, mean age 53.1 +/- 1.6 years, were examined. In 12 patients the apnea frequency was between 0 and 50 apneas per night, in 8 between 50 and 550. Patients with an apnea frequency of more than 50 per night (polygraphy) could be identified with the thermistor method. Our results show that the method is sensitive in respect of the oral and nasal flow. The method seems valid to differentiate between normal persons and patients with increased risk of apnea syndrome.

[Comparative studies on the effect of nasal CPAP, theophylline and oxygen in patients with sleep apnea syndrome]. / Vergleichsuntersuchungen zur Wirkung von nCPAP, Theophyllin und Sauerstoff bei Patienten mit Schlafapnoesyndrom.

In patients with sleep apnea-syndrome nasal CPAP-therapy is the method of choice. The apnea phases are practically completely eliminated. However some patients with SAS don't accept CPAP-therapy. In this group Theophylline or O2-therapy respectively is discussed. We examined therefore 21 patients (55.8 +/- 9 years) with sleep-apnea syndrome and an apnea-index of 39 +/- 19.9 during 4 consecutive nights (diagnosis, nCPAP-therapy, O2-therapy by 21/min, by nasal prongs and Theophylline 375-400 mg in the evening and calculated apnea-index, the longest apnea and the lowest O2-saturation. On CPAP the number of apneas was practically reduced to 0. On Theophylline there was a relevant reduction of the apnea frequency. On O2-therapy only few patients with non-compliance Theophylline-therapy can be of some benefit in patients with moderate sleep-apnea syndrome. However the apnea-index cannot be normalized.

Monitoring at home.

To reduce time committment and expense in the diagnosis of sleep apnea it is necessary to develop simplified monitoring techniques. The monitoring systems to detect apneas should have high sensitivity, good reproducibility, be inexpensive and practical to use. The following methods have been suggested: inductance plethysmography, capnography, flow measurements by thermistors, tracheal sound recording, static charge sensitivity bed, oximetry, activity monitoring, detection of snoring. Some devices to registrate breathing have been combined with oximetry and other methods. The results have been validated by polysomnography and show rather good correlations. However, there exists no information on the time and cost savings of a step wise diagnosis of sleep apnea.

Clinical efficacy and safety of teicoplanin in the treatment of gram-positive infections.

This study was an open efficacy and safety study of teicoplanin in hospitalized patients with gram-positive infections. 26 patients entered the study. Teicoplanin was administered by intravenous bolus injection at a dose of 200 mg or 400 mg every 24 h, and in all cases an initial loading dose of 400 mg was given. The mean duration of treatment was 9.4 days (range four to 20 days). The infections included 18 skin/soft tissue, four lower respiratory tract, two urinary tract and two joint/bone. Clinical cure and improvement occurred in 20 of the 26 patients. Only two adverse events (moderate diarrhoea and mild pain at injection site) related to teicoplanin occurred in one patient. It was concluded that teicoplanin was effective and well tolerated in the treatment of gram-positive infections.

Preoperative radiotherapy as adjuvant treatment in rectal cancer. Final results of a randomized study of the European Organization for Research and Treatment of Cancer (EORTC).

A randomized clinical trial was conducted by the European Organization for Research and Treatment for Cancer (EORTC) Gastrointestinal Cancer Cooperative Group to study the effectiveness of irradiation therapy administered in a dosage of 34.5 Gy, divided into 15 daily doses of 2.3 Gy each before radical surgery for rectal cancer (T2, T3, T4, NX, MO). Four hundred sixty-six patients were entered in the clinical trial between June 1976 and September 1981. Tolerance and side effects of preoperative irradiation were acceptable. The overall 5-year survival rates were similar in both groups. When considering only the 341 patients treated by surgery with a curative aim, the 5-year survival rates were 59.1% and 69.1% in the control group and in the combined modality group, respectively (p = 0.08). The local recurrence rates at 5 years were 30% and 15% in the control group and the adjuvant radiotherapy group, respectively (p = 0.003). Although this study did not show preoperative radiotherapy to have a statistically significant benefit on overall survival, it does have a clear effect on local control of rectal cancer. Therefore, before performing radical surgery, this adjuvant therapy should be administered to patients who have locally extended rectal cancer.

[Distal radius fracture--indications for conservative, partial surgical and surgical therapy]. / Distale Radiusfraktur--Behandlungsergebnisse, Indikationen zur konservativen, halboperativen und operativen Therapie.

460 fractures of the distal radius including 91 which are treated surgically are investigated in a retrospective study. There were 260 fractures of the left and only 200 of the right radius. 66% of the patients were female, especially striking is the superior number of women older than 45 years. The evaluation of the final radiological results referring to anatomical joint angles and normal radius length shows a high correlation to the evaluation of the final functional results. 70% of the latter are valued as excellent or good, 19% as tolerable and 11% as poor. The classification according to Frykman shows a significantly better result for cases without violation of the distal ulna. The comparison between operative and non-operative treatment of dislocated fractures without infraction of the radiocarpal joint demonstrates good results of percutaneous wire fixation in those cases. The therapy of fractures with infraction of radiocarpal and radioulnar joint is difficult. In this group we could not find a superiority of operative against conservative treatment. Wire fixation lead to 19% poor results and cannot be recommended for all cases. Six patients treated by external fixation and five treated by osteosynthesis using metal plates had good or tolerable results. The indication for using these methods has to be considered.

Dynamics of mode-locked laser diodes employing a repetitive short pulse drive current.

A novel noniterative modeling technique is described and used to simulate the characteristics of a laser diode source which is mode-locked by a train of short current pulses produced by a comb generator. The basic experimental setup is described, as are the modeling process and a comparison of model predictions and experimental observations. It is shown that the predictions of the numerical model which uses only a single fitting parameter, the coupling efficiency of the laser diode to an external grating, are in good agreement with the measured mode-locking characteristics.

Influence of diode facet reflectivity on the dynamics of actively mode-locked semiconductor lasers.

The majority of models developed to describe the actively mode-locked operation of diode generated lasers have been for diodes having one antireflection coated facet. The basic starting point of such models is the assumption that the residual facet reflectivity can be ignored. In the present paper, we employ a model developed specifically to deal with mode-locked operation for diodes with a significant facet reflectivity. Experimental observation of mode-locked operation for different facet reflectivities shows that the model provides a good description of this mode of operation. It is to be emphasized that the comparison between model predictions and experimental observations is basically exact; no fitting parameters are used, and the significant diode parameters are independently measured. This model, thus validated, is used to explore how low the residual facet reflectivity needs to be to be treated as negligible. It is shown that, even for very low values, this facet reflectivity has a strong influence on the dynamical behavior of the mode-locked diode laser.

[Clinical incidence of subclavian thromboses following pacemaker implantation]. / Klinische Inzidenz von Subclaviathrombosen nach Schrittmacherimplantation.

Although pacemaker (PM) implantation has developed into a standard therapy in appropriate rhythm disorders the procedure is not free of complications. One of the most common problems is thrombotic alteration in the region of the entry of the pacemaker electrode into the venous system. To obtain more details of the incidence and extent of these complications, we investigated a total of 97 patients in two groups, clinically, phlebographically and by Doppler-ultrasound technique. 56 (30 males, 26 females, mean age 73 years) were examined 1 week, and 41 (18 males, 23 females, mean age 72 years) 1 year after PM implantation. The thrombotic changes were quantified and correlated to various anamnestic and clinical parameters with the following results: 1 week after implantation 25% of patients show thrombi with collaterals, in 15% shorter than, and in 10% longer than 3 cm. One complete obturation of the implantation vessel was recognized. Thrombotic changes without collaterals were found in 36%, in 25% shorter than, and in 11% longer than 3 cm. One year after PM implantation there are organized thrombi in 71%, 41% of these patients show collaterals phlebographically. The others had no hemodynamic changes. Of all the anamnestic and clinical parameters, a significant correlation was found only between development of thrombi and material of electrodes. Polyurethane electrodes have a significantly higher rate of thrombosis than silicone electrodes (p less than or equal to 0.0066).(ABSTRACT TRUNCATED AT 250 WORDS)

[Preoperative radiotherapy in rectal cancer]. / Präoperative Strahlentherapie beim Rektumkarzinom.

A combined therapy of the rectum carcinoma was performed from 1973 to 1980; a randomization was made between preoperative irradiation with 34.5 Gy and operation. The irradiation was performed with Co-60 with opposing fields, including the small pelvis as well as the para-aortal region of the 2nd lumbar vertebra. The evaluation of March 1983 showed a significantly higher number of deaths caused by the tumor in the only operated patients. With respect to side effects, there are no essential differences between the preirradiated and the only operated group.

Improved quality of life with an implantable pump for liver perfusion.

In spite of the current discussion on whether liver perfusion is effective (Grage et al. 1979; Ansfield et al. 1975), the implantable perfusion pump offers the possibility of combining the still questionable therapeutic success with a high quality of life during the time remaining to such patients.

[The value of computer tomography in the diagnosis of local recurrences of carcinoma of the rectum (author's transl)]. / Stellenwert der Computertomographie in der Diagnostik des lokalen Rektumkarzinomrezidivs.

The tendency of rectal carcinomas to recur makes it necessary to reexamine these patients repeatedly. The tissues remaining following resection of the rectum can only be examined directly by computer tomography. The value of this procedure in the diagnosis of local recurrences has so far not been established. The results of computer tomography must therefore be correlated with already established methods, particularly clinical examination and CEA measurements.

Comparison of ftorafur with 5-fluorouracil in combination chemotherapy of advanced gastrointestinal carcinoma.

The aim of the study was to compare the combination 5-FU-carmustine with ftorafur-carmustine in the treatment of advanced gastrointestinal cancer. To this end, a prospective, multicenter, randomized trial was initiated. Part I of this trial showed that similar response rates can be obtained with 5-FU-carmustine and ftorafur-carmustine in 109 patients (32.7% versus 26.3%). However, median survival was better in patients treated with 5-FU-carmustine (307 days versus 163 days). Part II of the trial revealed that neither a higher dosage of ftorafur (2 g/m2/day X 5 days) nor the addition of vincristine to both regimens changed the previously obtained results significantly. Again, median survival was found to be better in patients treated with 5-FU combination chemotherapy (304 days versus 144 days). Both the 5-FU and the ftorafur combination were tolerated reasonably well. The results suggest that combination chemotherapy including 5-FU is superior to ftorafur at the applied dosages in terms of survival.