Umgang mit dem Prostatakarzinom bei über 75-jährigen Männern: Aktiv oder passiv?

Zusammenfassung: Die steigende Lebenserwartung und die zunehmende Zahl älterer Menschen in der Bevölkerung westlicher Industrienationen rücken das Prostatakarzinom (PCa) im höheren Lebensalter zunehmend in den Fokus des Interesses. Einigkeit besteht darin, dass >75-jährige Männer von einem PSA-Screening nicht profitieren. Ein höheres Alter allein sollte jedoch weder die Diagnostik noch die Behandlung eines Tumorleidens generell ausschließen. Zu berücksichtigen ist aber gerade beim Prostatakarzinom das Risiko von Überdiagnostik und Übertherapie. Die Mehrzahl der älteren Männer leidet an einer Vielzahl von Begleiterkrankungen, welche die Lebenserwartung einschränken, und das konkurrierende Mortalitätsrisiko übersteigt das der Tumorerkrankung um ein Vielfaches. Der behandelnde Urologe und der betroffene Patient sollten deshalb mögliche Auswirkungen einer Diagnosestellung und Therapie auf die Lebensqualität berücksichtigen. Alter, bestehende Komorbiditäten und die individuelle kognitive und körperliche Leistungsfähigkeit stellen neben spezifischen Tumorparametern gute Kriterien für eine individualisierte Behandlungssteuerung dar. Bei gesunden, aktiven >75-jährigen Männern mit "High-risk-PCa-Kriterien" und Patienten mit einer PSA-Verdoppelungszeit < 12Monate sollte eine Therapie in Erwägung gezogen werden. Alle anderen Patienten in diesem Alter profitieren vermutlich nicht von einer Behandlung des PC

Product Liability Law

While Virginia is not typically seen as progressive in the field of product liability law, the Commonwealth is nonetheless a forum in which these product liability battles take place. This article summarizes selected decisions of the United States Court of Appeals for the Fourth Circuit, federal district courts in Virginia, and courts of the Commonwealth issued between July 1, 2004 and May 15, 2005. This article also includes a discussion of the most relevant legislative changes made by the Virginia General Assembly over the same time period. While a complete analysis of every decision and statute affecting product liability is not possible, this article summarizes those which should be the most useful to practitioners in Virginia

Adaptive data acquisition multiplexing system and method

A reconfigurable telemetry multiplexer is described which includes a monitor-terminal and a plurality of remote terminals. The remote terminals each include signal conditioning for a plurality of sensors for measuring parameters which are converted by an analog to digital converter. CPU's in the remote terminals store instructions for prompting system configuration and reconfiguration commands. The measurements, instructions, and the terminal's present configuration and status data are transmitted to the monitor-terminal and displayed. In response to menu-driven prompts generated and displayed at the monitor-terminal, data generation request commands, status and health commands, and the like are input at the monitor-terminal and transmitted to the remote terminals. The CPU in each remote terminal receives the various commands, stores them in electrically alterable memory, and reacts in accordance with the commands to reconfigure a plurality of aspects of the system. The CPU in each terminal also generates parameter measurements, status and health signals, and transmits these signals of the respective terminals to the monitor-terminal for low data rate operator viewing and to higher rate external transmission/monitor equipment. Reconfiguration may be in real time during the general period of parameter measurement acquisition, and may include alteration of the gain, automatic gain rescaling, bias, and or sampling rates associated with one or more of the parameter measurements made by the remote terminals

In vitro factor XIII supplementation increases clot firmness in Rotation Thromboelastometry (ROTEM®)

Factor XIII (F XIII) is an essential parameter for final clot stability. The purpose of this study was to determine the impact of the addition of factor (F)XIII on clot stability as assessed by Rotation Thromboelastometry (ROTEM(R)). In 90 intensive care patients ROTEM(R) measurements were performed after in vitro addition of F XIII 0.32 IU, 0.63 IU, 1.25 IU and compared to diluent controls (DC; aqua injectabile) resulting in approximate F XIII concentrations of 150, 300 and 600%. Baseline measurements without any additions were also performed. The following ROTEM(R) parameters were measured in FIBTEM and EXTEM tests: clotting time (CT), clot formation time (CFT), maximum clot firmness (MCF), maximum lysis (ML), maximum clot elasticity (MCE) and a-angle (aA). Additionally, laboratory values for FXIII, fibrinogen (FBG), platelets and haematocrit were contemporaneously determined. In the perioperative patient population mean FBG concentration was elevated at 5.2 g/l and mean FXIII concentration was low at 62%. The addition of FXIII led to a FBG concentration-dependent increase in MCF both in FIBTEM and EXTEM. Mean increases in MCF (FXIII vs. DC) of approximately 7 mm and 6 mm were observed in FIBTEM and EXTEM, respectively. F XIII addition also led to decreased CFT, increased aA, and reduced ML in FIBTEM and EXTEM. In vitro supplementation of FXIII to supraphysiologic levels increases maximum clot firmness, accelerates clot formation and increases clot stability in EXTEM and FIBTEM as assayed by ROTEM(R) in perioperative patients with high fibrinogen and low FXIII levels

Effects on coagulation of balanced (130/0.42) and non-balanced (130/0.4) hydroxyethyl starch or gelatin compared with balanced Ringer's solution: an in vitro study using two different viscoelastic coagulation tests ROTEM™ and SONOCLOT™†

Background Hydroxyethyl starch (HES) solutions compromise blood coagulation. Low molecular weight, low-substituted HES products, and electrolyte-balanced solutions might reduce this effect. We compared the effects of in vitro haemodilution on blood coagulation with a balanced 6% HES 130/0.42 solution (HESBAL), a saline-based 6% HES 130/0.4 solution (HESSAL), a balanced lactated Ringer's solution (RL) and a saline-based 4% gelatin solution (GEL). Methods Blood was obtained from 10 healthy male volunteers and diluted with the test solutions by 33% and 66%. Quality of clot formation was measured using two viscoelastic coagulation tests: SONOCLOT™ and activated rotation thromboelastometry ROTEM™. Results Of 16 parameters measured by the viscoelastic devices, we found three statistically significant differences compared with baseline for RL, but 11 for GEL, 10 for HESSAL, and 11 for HESBAL in the 33% haemodilution group (P=0.01). Comparing the different solutions, we observed a significant difference between crystalloids and colloids but none between GEL and HES. In the 66% dilution group, effects on blood coagulation were increased when compared with the 33% dilution group. We found no differences in coagulation impairment between balanced and non-balanced HES products and no differences in the detection of impaired blood coagulation due to haemodilution between the two viscoelastic coagulation tests. Conclusions Both ROTEM™ and SONOCLOT™ are sensitive tests for the detection of impaired blood coagulation due to haemodilution. There are fewer effects on blood coagulation using crystalloids compared with colloids. The effects of GEL and HES are similar. There is no difference between balanced HES 130/0.42 and non-balanced HES 130/0.

Anaesthetics and cardiac preconditioning. Part II. Clinical implications

There is compelling evidence that preconditioning occurs in humans. Experimental studies with potential clinical implications as well as clinical studies evaluating ischaemic, pharmacological and anaesthetic cardiac preconditioning in the perioperative setting are reviewed. These studies reveal promising results. However, there are conflicting reports on the efficacy of preconditioning in the diseased and aged myocardium. In addition, many anaesthetics and a significant number of perioperatively administered drugs affect the activity of cardiac sarcolemmal and mitochondrial KATP channels, the end‐effectors of cardiac preconditioning, and thereby markedly modulate preconditioning effects in myocardial tissue. Although these modulatory effects on KATP channels have been investigated almost exclusively in laboratory investigations, they may have potential implications in clinical medicine. Important questions regarding the clinical utility and applicability of perioperative cardiac preconditioning remain unresolved and need more experimental work and randomized controlled clinical trials. Br J Anaesth 2003; 91: 566-7