[War trauma and PTSD among German war survivors. A comparison of former soldiers and women of World War II]. / Kriegstraumata und PTBS bei deutschen Kriegsüberlebenden. Ein Vergleich ehemaliger Soldaten und Frauen des Zweiten Weltkriegs.

Stressful war experiences can cause posttraumatic stress disorder (PTSD) in survivors. To what extent were the soldiers and young women of World War II affected by PTSD symptoms over the course of their lives? Do these men and women differ in the traumatic experiences and PTSD symptom severity? To investigate these questions 52 male and 20 female Germans aged 81-95 years were recruited through newspaper advertisements and notices and interviewed regarding war experiences and PTSD symptoms. Of the men 2% and 7% met the criteria for current and lifetime PTSD diagnoses, respectively, as compared to 10% and 30% of the women, respectively. Using multiple linear regression a dose-response relationship between the number of trauma types experienced and PTSD symptom severity could be demonstrated. The slope of the regression curve was steeper for women than for men. When controlling for the number of different traumatic experiences women reported a significantly higher severity of PTSD symptoms than men. It is presumed that this difference in severity of symptoms can be attributed to qualitative differences in the type of traumatic stress factors during the war. The present study provides evidence that even today people continue to be affected by PTSD symptoms due to events which occurred during World War II; therefore, during patient contact with this age group the war experiences specific to each individual need to be considered as potential moderators of symptoms.

Risk stratification scores for predicting mortality in coronary artery bypass surgery.

BACKGROUND: Four risk-stratification scores (RSSs - Euro, French, CCS/Higgins, Parsonnet) were tested as predictors of mortality in coronary artery bypass grafting (CABG) surgery. METHODS: From March to April 2000, the perioperative courses of 245 consecutive CABG patients were compared to the predictions according to the RSSs. Sensitivity and specificity were determined with receiver operating characteristics (ROC) curves. RESULTS: CCS/Higgins uses the most easily acquired patient data, and rates emergency conditions as high-risk. Euro focuses on advanced age and septal rupture. French uses the smallest number of patient parameters and rates rare critical situations as high-risk. Parsonnet is partially based on the physician's subjective assessment of a "catastrophic state," making the scoring arbitrary. All RSSs gave similar (not significant) areas under the ROC curves regarding mortality (Euro 0.826 +/- 0.080, French 0.783 +/- 0.094, CCS/Higgins 0.820 +/- 0.060, Parsonnet 0.831 +/- 0.042). Predicted risk levels for the 11 patients who died differed between the RSSs--Higgins placed these patients in 3 of 5 risk levels with ascending distribution. The other RSSs placed these patients in the highest risk level except for one and two patients, respectively, who were placed in the lowest Euro and French risk level. Euro and Parsonnet placed about half of all patients with non-lethal outcome in the highest risk level. CONCLUSIONS: All RSSs satisfactorily estimated the group risk for mortality. No RSS expressed sufficient validity to predict individuals with lethal outcome. In clinical use, CCS/Higgins proved the most practicable.

Risk scores currently used in German heart surgery.

BACKGROUND: Risk scores (RS) in heart surgery assess mortality and morbidity and mirror the degree of severity of disease of the patients when presented for surgery. We examined the use and dissemination of RS in Germany. MATERIAL AND METHODS: Our survey included 79 German heart surgery institutes in Fall 1999 and Winter 2000. RESULTS: Four institutes did not respond. Out of 75 (ad 100 %) responders 56 (75 %) institutes did not use RS, 17 (22 %) institutes used one RS method and 2 (3 %) institutes used two RS methods. The most frequently applied RS methods were the Cleveland Clinic Score and the Euro Score (n = 7, each) followed by institution-specific, internally developed RS methods (n = 5), Parsonnet's RS (n = 1) and the RS from the STS database (n = 1). Fourteen institutes used RS for internal quality control. Of these, 2 institutes publish their RS data for external quality control. The patient-related individual procedure risk was used in 6 institutes. CONCLUSIONS: A quarter of the German heart surgery institutes use one or more RS methods. The most commonly used were the Cleveland Clinic Score and the Euro Score, followed by internally developed RS methods. RS methods were most frequently used for internal quality control. The degree of the severity of disease of the patients who presented for surgery could only be compared between a small number of institutes using the same RS.

Characterization of enzymes involved in biotransformation of polycyclic aromatic hydrocarbons in terrestrial isopods.

Little is known about the capacity of terrestrial invertebrates to transform organic soil pollutants such as polycyclic aromatic hydrocarbons (PAHs). Studies were designed to characterize microsomal mixed function oxygenase and accompanying conjugation enzymes from the hepatopancreas of the terrestrial isopods Porcellio scaber and Oniscus asellus using pyrene and 1-hydroxypyrene as model substrates. The hydroxylation of pyrene and the formation of pyreneglucoside and pyrenesulfate appeared to be sensitive measures for the activity of cytochrome P450 aryl hydrocarbon hydroxylase (AHH), uridinediphosphateglucosyltransferase (UDPGT), and aryl sulfotransferase (ST), respectively. Treatment with the antibiotic riphampicine demonstrated that the enzyme activities originate from the animals themselves and not from symbiotic microflora present in the hepatopancreas and the gut. In both species, ST has a very high affinity for 1-hydroxypyrene with Km values two orders of magnitude lower than that of UDPGT. The Vmax values of UDPGT, however, are 10- to 20-fold higher than that of ST. Taking the P450 activities into consideration, both species are expected to transform PAHs in an equally effective way. When the isopods were fed with food containing benz[a]pyrene and 3-methyl-cholanthrene, none of the enzyme activities appeared to be inducible except for a small enhancement of UDPGT in O. asellus. Our findings indicate that terrestrial isopods have a high, noninducible capacity for biotransformation of PAHs and that the sulfate conjugation pathway is as important as the carbohydrate conjugation pathway. This conclusion is consistent with the low body residues of parent PAHs found in the field.

'He is too young to die ... and you too, doctor'.

Sometimes caregiving can be a matter of fear rather than of love.

Effects of i.v. anaesthetic agents on the chemotaxis of eosinophils in vitro.

Polymorphonuclear eosinophilic leucocytes (PME) participate in wound healing processes, the inflammatory response, bronchial asthma, allergies and defence against invading parasites. We have examined the effects of thiopental, methohexital, propofol, etomidate and ketamine on PME chemotaxis in vitro. PME were isolated from venous blood samples of 10 healthy volunteers using multi-stage Percoll gradient centrifugation. Eosinophilic chemotaxis was determined using a 48-well microchemotaxis chamber. Thiopental 150 micrograms ml-1 and etomidate 0.32 microgram ml-1 caused significant (P < or = 0.05) inhibition of PME chemotaxis. We conclude that thiopental and etomidate may have an adverse influence on wound healing processes and parasitic diseases. Further studies are recommended.

The effects of midazolam, droperidol, fentanyl, and alfentanil on phagocytosis and killing of bacteria by polymorphonuclear leukocytes in vitro.

Polymorphonuclear leukocytes (PMNL) make an outstanding contribution to the defence against invading bacteria. We studied the effects of midazolam, droperidol, fentanyl, and alfentanil on phagocytosis and killing of Staphylococcus aureus and Escherichia coli by PMNL in vitro. Using a method described by Eggleton et al., PMNL were isolated from venous blood samples obtained from ten volunteers. The fluorescence microscopic method mentioned by Bellinati-Pires et al. was used to examine phagocytosis and killing. Whereas both midazolam and droperidol caused a significant inhibition of phagocytosis as well as bactericidal activity, fentanyl and alfentanil did not influence these PMNL functions. In order to find out whether midazolam and droperidol are able to intensify perioperative bacterial infections in vivo as well, additional clinical studies should be conducted.

The effects of thiopentone, etomidate, ketamine and midazolam on several bactericidal functions of polymorphonuclear leucocytes in vitro.

Polymorphonuclear leucocytes (PMNL) are an essential component of the defence system against invading bacteria. There is evidence that some anaesthetics are able to suppress PMNL functions, promoting, perhaps, perioperative infection. We studied the effects of thiopentone, etomidate, ketamine, and midazolam on the generation of bactericidal agents (superoxide anion, hydrogen peroxide, and myeloperoxidase) by PMNL in vitro. Thiopentone inhibited superoxide anion (P < or = 0.01) as well as hydrogen peroxide production (P < or = 0.001). However, there was no statistically significant effect on myeloperoxidase release. Neither etomidate nor ketamine influenced the PMNL functions tested to any extent. Midazolam suppressed superoxide anion generation (P < or = 0.01) but only if a concentration far beyond clinical relevance was used.

Laparoscopy-guided drainage of hepatic abscess.

Hepatic abscess is a serious surgical condition with a mortality rate of up to 63% reported if not adequately treated. Laparotomy and computed tomographic (CT) guidance have been used to drain these collections, each with their own problems. Herein we describe a method of draining laparoscopically a hepatic abscess. A 45-year-old Haitian man presented with night sweats and fevers to 103 degrees F; he was diagnosed by CT to have a large (7 cm) abscess in the posterosuperior portion of the right hepatic lobe. The CT-guided drainage yielded only 8 cc fluid. The patient underwent laparoscopy-guided drainage of the abscess with placement of intra-hepatic and perihepatic drains. The patient had dramatic clinical improvement with no morbidity from the procedure. A follow-up CT of the abdomen revealed near-complete disappearance of the abscess cavity within 48 h. A straightforward method of laparoscopic drainage of hepatic abscesses is presented in detail. It provides a simple alternative for drainage with excellent results and minimal morbidity.

Phytochelatins in Cadmium-Sensitive and Cadmium-Tolerant Silene vulgaris (Chain Length Distribution and Sulfide Incorporation).

In response to a range of Cd concentrations, the root tips of Cd-tolerant plants of Silene vulgaris exhibit a lower rate of PC production accompanied by a lower rate of longer chain PC synthesis than those of Cd-sensitive plants. At the same Cd exposure level, stable PC-Cd complexes are more rapidly formed in the roots of Cd-sensitive plants than in those of tolerant plants. At an equal PC concentration in the roots, the PC composition and the amount of sulfide incorporated per unit of PC-thiol is the same in both populations. Although these compounds might play some role in mechanisms that contribute to Cd detoxification, the ability to produce these compounds in greater amounts is not, itself, the mechanism that produces increased Cd tolerance in tolerant S. vulgaris plants.

General surgery: is there a future?

General surgery may not survive in an age of superspecialization unless the emphasis of general surgical training shifts from broad competence to defined areas of expertise. The author presents suggestions for restructuring general surgery residency requirements.

Angiosarcoma after tylectomy and radiation therapy for carcinoma of the breast.

BACKGROUND: Angiosarcoma (AS) is an uncommon tumor that rarely develops after external beam radiation therapy (EBRT). Thirty-six cases have been reported in the literature. METHODS: The authors present two additional cases. Each of these patients received breast-conserving treatment for breast carcinoma that consisted of tylectomy and EBRT. In each case, AS developed in the field of prior irradiation. RESULTS: Currently, seven cases of AS after radiation therapy for breast-conserving treatment of breast carcinoma have been reported. The average time interval between the administration of radiation therapy and the development of AS is 8.6 years. CONCLUSIONS: This complication is rare and should not influence the decision to offer breast-conserving therapy to patients. However, patients should be informed that AS may develop as a result of radiation therapy.

Cancer in inguinal hernias.

Cancer in inguinal hernias is rare. The author reports the first case of thymoma metastatic to an inguinal hernia sac (saccular) and the 13th case of colon cancer in an inguinal hernia (intrasaccular); both cases presented clinically as incarcerated hernias.

[Argyria. A clinical, chemical analytic and micromorphologic study]. / Zur Frage der Argyrie. Eine klinische, analytisch-chemische und mikromorphologische Untersuchung.

A 62-year-old male patient developed generalized argyria following the intake of silver-proteinacetyltannate (Targesin; approx. 60 g in 10 years) as treatment for gastric discomfort. On histological and ultrastructural examination of the skin, silver particles were found not only in the usual locations but also in the Schwann cell, the mast cell, and in smooth muscle cells. This corresponded to chemical analysis, proving the presence of this metal in the skin. In the blood, a level of 0.26 +/- 0.04 ppm silver was found. By means of an equation, attempts were made to demonstrate the reaction process involved in the formation of Ag2S as subjected to the photochemical effect of sunlight.

Polydactyly of the foot.

Various types of the more common forms of polydactyly are discussed regarding both genetic background and surgical treatment. Two cases involving three different forms of polydactyly are presented. Surgical treatment of the condition is presented on an individual basis as to the type of polydactyly and the overall health status of the patient. Primary goals of surgery are discussed, including relief of symptoms, future shoe wear consideration, cosmesis and avoidance of growth center damage in children.