Univariate and multivariate analysis of risk factors for severe Clostridium difficile-associated diarrhoea: importance of co-morbidity and serum C-reactive protein.

Aim: To investigate risk factors for severe clostridium difficile associated diarrhoea (CDAD) in hospitalised patients.

Methods: We analysed risk factors for severe CDAD (associated with systemic signs of hypovolemia) in 124 hospitalised patients by retrospective chart review.

Results: Severe CDAD was present in 27 patients (22%).

[Influence of processing and sterilization on the mechanical properties of pins made from bovine cortical bone].

In a biomechanical study pins made of xenogenous cortical bone were tested in vitro. Forty pins of 3 mm diameter and 60 mm length were made of eight different cattle tibiae and allocated to five different treatment groups. Freeze-dried pins served as control group.

[Strength testing of pins made of human femur cortical bone].

For biomechanical evaluation of cortical bone as a potential source for internal fixation devices, pins of 2 and 3 mm in diameter were made from fresh human femora and subjected to bending loads. Some of the pins were tested without further treatment; others were defatted and dried in acetone solution. Of the acetone-treated pins, some were autoclaved either at 121 degrees C for 20 min or at 134 degrees C for 8 min.

[Clinical anatomy as an integrating element in teaching surgical subjects].

Different conceptions to revise the licensing regulations for physicians (Approbationsordnung für Arzte) aim to interlock preclinical and clinical subjects. Therefore a more practice-oriented anatomy has to be taught in basic and postgraduate medical education. At the Westfalian Wilhelms University of Münster we established an interdisciplinary anatomical education, executed by clinical lecturers in cooperation with the educational staff of the Department of Anatomy.

[Prognostic differences in primary malignancies of the small intestine].

Malignant small bowel tumours are rare, with about 320 deaths every year due to metastases. Tumours of differing histologic entitites (adenocarcinomas, leimyosarcomas, non-Hodgkin, lymphomas, carcinoids) are detected at late stages of the disease because of non-specific symptoms. Valuable diagnostic means are small bowel enema, intestinoscopy and abdominal CT/ultrasound.

[Clinical anatomy in surgical education and graduate education].

On the basis of the experience that knowledge of anatomy is not as sound in clinical education as it should be and with a view to the new licensing regulations for physicians, at the Westfälische Wilhelms-Universität Münster, Germany, we established an interdisciplinary anatomical education. Clinical practitioners from 14 different specialties together with anatomists give lessons in applied anatomy accompanying the dissection course, and clinical experienced anatomists guide senior medical students in parallel to the practical courses to refresh their anatomical knowledge. Conjointly clinical practitioners and anatomists initiate, organize and establish meetings in postgraduate surgical education and experimental surgery.

Animal model of experimentally induced ectopic enchondral ossification in nude mice with xenograft of porcine epiphyseal cartilage.

In a specific animal model the induction of heterologous enchondral ossification was examined in long term follow-up. Physiologically normal and devitalized frozen porcine epiphyseal cartilage as a control group were transplanted as s.c.

SPIO-enhanced 2D-TOF MR angiography of the portal venous system: results of an intraindividual comparison.

The purpose of this study was to investigate whether MR angiography (MRA) of the portal venous system may be improved by means of superparamagnetic iron oxides (SPIOs) during accumulation phase imaging and to study the underlying contrast mechanisms. MRA of the portal venous system was performed on 48 patients before and after intravenous injection of a new SPIO (Resovist, Schering AG, Berlin, Germany). Resovist, as a predominantly liver parenchymal darkening agent on T2-weighted MR images with uptake into the reticuloendothelial cell system, was administered intravenously by bolus injection of 8 to 12 micromol Fe/kg body weight.

Modulation of 5-fluorouracil with methotrexate and low-dose N-(phosphonacetyl)-L-aspartate (PALA) is inactive in advanced pancreatic carcinoma.

Purpose: To evaluate the effect of biochemical modulation by PALA and methotrexate on the therapeutic activity of 5-fluorouracil (5-FU) in patients with advanced pancreatic adenocarcinoma.

Patients And Methods: The treatment protocol consisted of phosphonacetyl-L-aspartate (PALA) 250 mg/m2 i.v.

Effect of CYP2D1 inhibition on the behavioural effects of d-amphetamine.

In rats, amphetamine (AMP) conversion to 4-OH-AMP is metabolized by CYP2D1, the rat equivalent of the human enzyme CYP2D6. To determine the impact of impaired AMP metabolism on its behavioural effects, AMP-induced hyperactivity, AMP discrimination and AMP self-administration were examined in male Wistar rats with or without pretreatment with the CYP2D1 inhibitors quinine and budipine. In vivo, quinine (20 mg/kg) and budipine (10 mg/kg) increased the plasma area under the curve of AMP 4-fold and 3.

Combined modality treatment with accelerated radiotherapy and chemotherapy in patients with locally advanced inoperable carcinoma of the pancreas: results of a feasibility study.

Between July 1990 and September 1993, 32 patients with locally advanced irresectable adenocarcinoma of the pancreas, histologically proven by laparotomy, were involved in our study. Patients were treated with hyperfractionated, accelerated radiotherapy and simultaneous application of 5-fluorouracil and folinic acid. Chemotherapy was given on days 1,2 and 3.

Results and prognostic factors of splenectomy in idiopathic thrombocytopenic purpura.

Background: Splenectomy is the therapy of choice after relapse following different immunosuppressive treatments for idiopathic thrombocytopenic purpura, which is still the most frequent cause of thrombocytopenia.

Study Design: A prospective clinical study was undertaken to evaluate the rate of complete remission in idiopathic thrombocytopenic purpura after splenectomy, to reveal the influence of preoperative immunosuppression on the postoperative course in groups of patients with different responses to treatment, and to describe possible prognostic factors predicting the postoperative course of idiopathic thrombocytopenic purpura. Difino's classification of remission was used.

[The value of 3-phase spiral CT and magnetic resonance tomography in preoperative diagnosis of pancreatic carcinoma].

Unlabelled: The purpose of this study was to assess the role of spiral computed tomography (SCT) and magnetic resonance imaging (MRI) in the preoperative work-up of patients with pancreatic carcinoma, regarding local resectability and vascular involvement.

Methods And Materials: A total of 28 patients (19 men and 9 women; mean age 58 years) with known or highly suspected carcinoma of the pancreas were included in this study. All patients prospectively underwent MRI ( +/- gadolinium-DTPA ) and SCT (3-phase examination) as preoperative diagnostic imaging studies, and laparotomy was carried out within 7 days, irrespective of the MRI or SCT findings.

Phase II clinical evaluation of Gd-EOB-DTPA: dose, safety aspects, and pulse sequence.

Purpose: To investigate the efficacy of gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid (Gd-EOB-DTPA) in the detection of focal liver lesions with respect to dose, side effects, and pulse sequence.

Materials And Methods: A randomized double-blinded trial was performed in 33 patients with focal solid liver lesions. A bolus of Gd-EOB-DTPA, a liver-specific contrast agent, was intravenously administered at three different doses (12.

[New MR contrast media in liver diagnosis. Initial clinical results with hepatobiliary Eovist (gadolinium-EOB-DTPA) and RES-specific Resovist (SH U 555 A)].

The purpose of this work is to describe our initial clinical experience (in 66 patients) with Resovist and Eovist, two new liver-specific MR contrast agents. We focus our report on safety aspects, dose finding, and optimization and technical parameters. Both contrast agents were well tolerated and improved the detectability of focal liver lesions.

[New super-paramagnetic iron particles for MRI. Phase II study of malignant liver tumors].

The clinical tolerability and diagnostic value of Resovist as a new superparamagnetic iron oxide contrast medium was studied in 30 patients with malignant focal liver lesions (28 metastases, 2 HCC) within a phase II multicenter study. Magnetic resonance imaging (MRI) was performed at 1.0 Tesla with T1-weighted FLASH- and T2-weighted spin echo sequences before and following intravenous injection of Resovist at three different dose groups (4, 8 and 16 mumol Fe/kg).

Clinical results with Resovist: a phase 2 clinical trial.

Purpose: To investigate the superparamagnetic iron oxide (Resovist) designed for contrast material-enhanced magnetic resonance imaging of the liver.

Materials And Methods: A phase 2 trial was performed in 33 patients with no more than five known focal solid liver lesions. Resovist was administered intravenously at doses of 4, 8, and 16 mumol of iron per kilogram of body weight.

5-Fluorouracil, folinic acid, etoposide and cisplatin chemotherapy for locally advanced or metastatic carcinoma of the oesophagus.

38 patients with advanced oesophageal carcinoma were treated with intravenous (i.v.) folinic acid (300 mg/m2), 5-fluorouracil (500 mg/m2), etoposide (100 mg/m2), and cisplatin (30 mg/m2) (FLEP), on days 1, 2 and 3, every 22-28 days.

[Therapeutic problems of cancers of the gallbladder].

Data of 32 patients who were operated for gallbladder carcinoma were evaluated in a retrospective meta-analysis. Results were compared with endoscopic retrograde cholangio-drainage (ERCP) using large size 12/14-French gauge endo-prostheses with side flaps to prevent migration. According to the TNM classification 84% of patients were classified as stage IV, 12.

Clinical and functional results of abdominal rectopexy with absorbable mesh-graft for treatment of complete rectal prolapse.

Objective: To report the long term results of abdominal rectopexy in patients with complete rectal prolapse.

Design: Ongoing prospective randomised study.

Setting: Department of Surgery, Westfälische Wilhelms-University, Münster.

The complete apallic syndrome--a case report.

In six patients with apallic syndrome the EEG was isoelectric, although the patients were breathing spontaneously and vegetative functions remained stable for a long period of time. No cortical somatosensory evoked potentials could be recorded in four of the patients examined. Cranial CT performed in three patients revealed extensive hypodensity of the cortex, whereas the brain stem showed no major damage.

Total stabilization of the cervical spine in patients with cervical spondylotic myelopathy.

Certain patients with cervical spondylotic myelopathy demonstrate instability in the upper cervical vertebral column associated with marked narrowing of the vertebral canal in the neighboring lower cervical segments. This combination of causative mechanisms creates difficulty in using routine surgical procedures, especially in elderly and severely debilitated patients. We present three cases that typify this situation and illustrate marked resolution of debilitating myelopathy through total posterior fusion of the cervical spine usually incorporating the occiput.