ACTH-Bestimmungen im Plasma aus dem Bulbus cranialis venae jugularis

Der Anstieg der Corticosteroninkretion in das Nebennierenvenenblut frisch hypophysektomierter Ratten diente zur Bestimmung von ACTH-Spiegeln in 1 ml nativen, menschlichen Plasma. Normale ACTH-Plasmaspiegel sind sowohl bei Punktion der Vena cubitalis als auch des Bulbus cranialis venae jugularis durch diese Methode nicht oder nur ungenau zu erfassen. Bei Patienten mit pathologisch erhöhten ACTH-Spiegeln in der Vena cubitalis sind die ACTH-Spiegel im Bulbus cranialis venae jugularis signifikant höher. Es ließ sich eine Beziehung zwischen ACTH-Spiegel in der Peripherie (Vena cubitalis), Differenz der ACTH-Spiegel zwischen Bulbus cranialis venae jugularis und Vena cubitalis und biologischer Halbwertszeit von endogenem ACTH aufstellen. Nach den Ergebnissen der Bestimmung von ACTH-Spiegeln bei Nebennierengesunden läßt sich folgern, daß die biologische Halbwertszeit von endogenem ACTH größer als 4 min sein muß. Bei Patienten mit erhöhten ACTH-Spiegeln ließ sich die biologische Halbwertszeit von endogenem ACTH größenordnungsmäßig mit ca. 40 min berechnen. Bei diesen Patienten betrug die mittlere tägliche ACTH-Inkretion ca. 100 E.ACTH-contents of 1 ml specimens of human plasma were assayed by measurement of increases of corticosterone output in the adrenal vein of acutely hypophysectomized rats. This procedure is not sensitive enough to measure normal ACTH-levels acurately, neither when blood was drawn from the bulbus cranialis venae jugularis, nor from the vena cubitalis. In patients having pathologically elevated ACTH-levels, the ACTH-content of plasma is significantly higher in the bulbus cranialis venae jugularis than in peripheral venous blood. An equation is presented formulating the relation of peripheral ACTH-levels, differences of ACTH-levels between bulbus cranialis venae jugularis and vena cubitalis, and of the biological halflife of endogenous ACTH. On the basis of the results of the determinations of socalled normal ACTH-levels it can be concluded, that the biological halflife of endogenous ACTH is longer than 4 min. From the data of patients with elevated ACTH-levels a halflife of approximately 40 min and a mean ACTH-secretion of approx. 100 units per day could be calculated

Book Reviews

J.H. Plumb, Frederic A. Youngs, Jr., Henry L. Snyder, E. A. Reitan, and David M. Fahey. The English Heritage. St. Louis: Forum Press, 1978. Pp. 419. Paper, $9.95. Review by Don M. Cregier of the University of Prince Edward Island. J. R. Hay. The Development of the British Welfare State, 1880-1975. New York: St. Martin's Press, 1978. Pp. x, 116. Cloth,$18.95; C. J. Bartlett. A History of Postwar Britain, 1945-1974. New York: Longman, Inc., 1977. Pp. v, 360. Cloth, $19.00; paper,$9.95. Review by Fred R. van Hartesveldt of Valley City State College. Donald Kagan, ed. The End of the Roman Empire: Decline or Transformation? Second edition. Lexington, Massachusetts: D.C. Heath and Co., 1978. Pp. xii, 188. Paper, $3.95. Review by Charles M. Flail of Harwood Union High School. Alexander J. DeGrand. The Italian Nationalist Association and .the Rise of Fascism in Italy. Lincoln: University of Nebraska, 1978.- pp. x, 238. Cloth,$12.50; Leon Poliakov. The Aryan Myth: A History of Racist and Nationalist Ideas in Europe. New York: Meridian, 1974. Pp. x, 388. Paper, $4.95; Esmonde M. Robertson. Mussolini as Empire Builder: Europe and Africa, 1932-36. New York: St. Martin's, 1978. Pp. 246. Cloth,$17.95. Review by Helmut J. Schmeller of Fort Hays State University. Peter N. Carroll and David W. Noble. The Free and the Unfree: A New History of the United States. New York: Penguin, 1977. Pp. 448. Paper, $4.95. Review by Larry A. Greene of Seton Hall University. Irwin Unger. These United States: The Questions of Our Past. Boston: Little, Brown, 1978. Pp. xxiv, 993, lxxix. Cloth,$15.95 (single-volume ed.); paper, $9.95 (two-volume ed.); H. L. Ingle and James A. Ward. American History: A Brief View. Boston: Little, Brown, 1978. Pp. xii, 500, ix. Paper,$9.95 (single-volume ed.); $5.95/volume (two-volume ed.). Review by Richard A. Diem of The University of Texas at San Antonio. Maxine Seller. To Seek America: A History of Ethnic Life in America. Englewood, New Jersey: Jerome S. Ozer, 1977. Pp. 328. Paper,$6.95. Review Larry Madaras of Howard Community College (Maryland). Willie Lee Rose, ed. A Documentary History of Slavery in North America. New York: Oxford University Press, 1977. Pp. xvi, 537. Cloth, $19.95; paper,$7.00. Review by Charles T. Haley of Colby College. Alice Marriott and Carol Rachlin. Plains Indian Mythology. New York: Mentor, 1975. Pp. xi, 180. Paper, $1.75. Review by Michael B. Husband of Morningside College. J. Frank Dobie. Apache Gold and Yaqui Silver. Albuquerque: University of New Mexico (c. 1967), 1976. Pp. xiii, 366. Paper,$4.95; James B. Gillett. Six Years with the Texas Rangers, 1875-1881. Lincoln: University of Nebraska (c. 1925), 1976. Pp. xxxvi, 259. Paper, $3.95; Robert Edgar Riegel. The Story of the Western Railroads: From 1852 Through the Reign of the Giants. Lincoln: University of Nebraska (c. 1926), 1964.Pp. xv, 345. Paper,$3.95. Review by Michael L. Tate of the University of Nebraska at Omaha. Emma Goldman. Living My Life. Edited by Richard and Anna Maria Drinnon. New York: The New American Library, 1977. Pp. 754. Paper, $6.95. Review by Sally Allen of Hampshire College. John Baskin. New Burlington: The Life and Death of an American Village. New York: Plume, 1977 . Pp. xii, 259. Paper,$2.95; Diana Klebanow, Franklin L. Jonas, and Ira M. Leonard. Urban Legacy: The Story of America's Cities. New York: Mentor, 1977. Pp. xix, 421. Paper, $2.95. Review Joseph M. McCarthy of Suffolk University. &nbsp

The risk of delirium after sedation with propofol or midazolam in intensive care unit patients

AIM: Knowledge of risk factors may provide strategies to reduce the high burden of delirium in intensive care unit (ICU) patients. We aimed to compare the risk of delirium after deep sedation with propofol versus midazolam in ICU patients. METHODS: In this prospective cohort study, ICU patients who were in an unarousable state for ≥24 h due to continuous sedation with propofol and/or midazolam were included. Patients admitted ≤24 h, those with an acute neurological disorder and those receiving palliative sedation were excluded. ICU patients were assessed daily for delirium during the 7 days following an unarousable state due to continuous sedation. RESULTS: Among 950 included patients, 605 (64%) subjects were delirious during the 7 days after awaking. The proportion of subsequent delirium was higher after midazolam sedation (152/207 [73%] patients) and after both propofol and midazolam sedation (257/377 [68%] patients), compared to propofol sedation only (196/366 [54%] patients). Midazolam sedation (adjusted cause-specific hazard ratio [adj. cause-specific HR] 1.32, 95% confidence interval [CI] 1.05-1.66) and propofol and midazolam sedation (adj. cause-specific HR 1.29, 95% CI 1.06-1.56) were associated with a higher risk of subsequent delirium compared to propofol sedation only. CONCLUSION: This study among sedated ICU patients suggests that, compared to propofol sedation, midazolam sedation is associated with a higher risk of subsequent delirium. This risk seems more apparent in patients with high cumulative midazolam intravenous doses. Our findings underpin the recommendations of the Society of Critical Care Medicine Pain, Agitation/sedation, Delirium, Immobility (rehabilitation/mobilization), and Sleep (disruption) guidelines to use propofol over benzodiazepines for sedation in ICU patients

Mycobacterium tuberculosis Transmission from Human to Canine

A 71-year-old woman from Tennessee, USA with a 3-week history of a productive, nonbloody cough was evaluated. Chest radiograph showed infiltrates and atelectasis in the upper lobe of the right lung. A tuberculosis (TB) skin test resulted in a 14-mm area of induration. Sputum stained positive for acid-fast bacilli (AFB) and was positive for Mycobacterium tuberculosis by DNA probe and culture. Treatment was initiated with isoniazid, rifampicin, and pyrazinamide. After 14 days of daily, directly observed therapy, the patient complained of nausea, vomiting and diarrhoea. Treatment adjustments were made, and therapy was completed 11 months later with complete recovery. Six months after the patient\u27s TB diagnosis, she took her three and a half-year-old male Yorkshire Terrier to a veterinary clinic with cough, weight loss, and vomiting of several months\u27 duration. Initial sputum sample was negative on AFB staining. Eight days after discharge from a referral veterinary teaching hospital with a presumptive diagnosis of TB, the dog was euthanized due to urethral obstruction. Liver and tracheobronchial lymph node specimens collected at necropsy were positive for M. tuberculosis complex by polymerase chain reaction. The M. tuberculosis isolates from the dog and its owner had an indistinguishable 10-band pattern by IS6110-based restriction fragment length polymorphism genotyping

Classification of substandard factors in perinatal care:development and multidisciplinary inter-rater agreement of the Groningen-system

Background: Perinatal audit is an established method for improving the quality of perinatal care. In audit meetings substandard factors (SSF) are identified in cases of perinatal mortality and morbidity. To our knowledge there is no classification system specifically designed for the classification of substandard factors. Such a classification may help to standardise allocation of substandard factors to categories. This will help to prioritise, guide and implement actions in quality improvement programs. Methods: A classification system of 284 substandard factors (SSF) identified in perinatal audit meetings between 2007 and 2011 was drawn up using the WHO Conceptual Framework for the International Classification for Patient Safety as a starting point. Discussions were held on inter-rater disagreements, inclusion of items, format and organisation and definitions of the main-and subcategories. A guideline was developed. An independent multidisciplinary group tested the classification. Independent of inter-rater agreement the allocations to categories were counted. For the counts in the subcategories one and two, we used the allocations in the main category as reference. The chance corrected agreement between classifiers was tested with Cohen's kappa statistic. Results: The classification consists of 9 main categories with one or two subcategories. The main categories are (1) Equipment and Materials, (2) Medication, (3) Additional tests/investigations, (4) Transportation, (5) Documentation, (6) Communication, (7) Medical practice, (8) Other and (9) non classifiable. Of 3663 allocations by 13 classifiers 1452 SSF's were allocated (40 %) to 'medical practice' and 1247 (34 %) to 'documentation'. 118 (3 %) times SSF's were not classifiable, mainly due to unclear phrasing of the SSF. The chance corrected agreement of 284 substandard factors in the main category was 0.68 (95 % CI 0.66-0.70) and 0.57 (95 % CI 0.54-0.59) for the CDG and the IGD respectively. Conclusions: Classifying substandard factors has given insight into problem area's in perinatal care and can give direction to medical, political and financial quality improvement measures. The Groningen-system has well defined categories and subcategories and the guidelines and examples are clear. The multidisciplinary inter-rater agreement is moderate to good. Improvement of the phrasing of the substandard factors is expected to improve inter-rater agreement

Comparing Pandemic to Seasonal Influenza Mortality: Moderate Impact Overall but High Mortality in Young Children

Background: We assessed the severity of the 2009 influenza pandemic by comparing pandemic mortality to seasonal influenza mortality. However, reported pandemic deaths were laboratory-confirmed - and thus an underestimation - whereas seasonal influenza mortality is often more inclusively estimated. For a valid comparison, our study used the same statistical methodology and data types to estimate pandemic and seasonal influenza mortality. Methods and Findings: We used data on all-cause mortality (1999-2010, 100% coverage, 16.5 million Dutch population) and influenza-like-illness (ILI) incidence (0.8% coverage). Data was aggregated by week and age category. Using generalized estimating equation regression models, we attributed mortality to influenza by associating mortality with ILI-incidence, while adjusting for annual shifts in association. We also adjusted for respiratory syncytial virus, hot/cold weather, other seasonal factors and autocorrelation. For the 2009 pandemic season, we estimated 612 (range 266-958) influenza-attributed deaths; for seasonal influen

Unprecedented staining of polar lipids by a luminescent rhenium complex revealed by FTIR microspectroscopy in adipocytes.

Fourier transform infrared (FTIR) microspectroscopy and confocal imaging have been used to demonstrate that the neutral rhenium(i) tricarbonyl 1,10-phenanthroline complex bound to 4-cyanophenyltetrazolate as the ancillary ligand is able to localise in regions with high concentrations of polar lipids such as phosphatidylethanolamine (PE), sphingomyelin, sphingosphine and lysophosphatidic acid (LPA) in mammalian adipocytes