Genetic Diversity of in Germany and Global Relations of Its Genetic Background.

This is the first study to explore the genetic diversity and population structure of domestic water buffalo () in Germany and their potential relations to herds in other parts of Europe or worldwide. To this end, animals from different herds in Germany, Bulgaria, Romania, and Hungary were genotyped and compared to genotypes from other populations with worldwide distribution and open to the public. The pilot study analyzed population structure, phylogenetic tree, and inbreeding events in our samples.

[Delayed Takotsubo syndrome - A critical perioperative incident].

Introduction: The term Takotsubo syndrome (TTS) describes a transient ventricular dysfunction. Symptoms and complication rate are similar to those of a myocardial infarction.

Medical History: An 81-year-old female patient was admitted for thrombendarterectomy of the left femoral artery.

Effects of theophylline on anesthetized malignant hyperthermia-susceptible pigs.

Background: Theophylline was shown to induce contracture development in porcine malignant hyperthermia (MH) susceptible (MHS) skeletal muscles in vitro. The purpose of the current study was to investigate the in vivo effects of theophylline in MHS and MH normal (MHN) swine.

Methods: MH-trigger-free general anesthesia was performed in MHS and MHN swine.

[Further education in anesthesiology. Implementation at the University Hospital Hamburg-Eppendorf].

Due to the lack of physicians and the changing demands of junior staff more attractive curricula are needed in anesthesiology in Germany. In the German Society of Anesthesiology and Intensive Care Medicine as well as the Association of German Anesthesiologists discussions on the optimization of training have a long tradition. The following article gives a description of the concept and the practical approach to the training curricular at the University Hospital Hamburg-Eppendorf and is designed to stimulate discussion on possible concepts for training in anesthesiology.

Magnetic coupling in enantiomerically pure trinuclear helicate-type complexes formed by hierarchical self-assembly.

Based on chiral, enantiomerically pure 7-[(S)-phenylethylurea]-8-hydroxyquinoline (1-H), trinuclear helicate-type complexes 2-5 are formed with divalent transition-metal cations. X-ray structural analyses reveal the connection of two monomeric complex units [M(1)(3)](-) (M=Zn, Mn, Co, Ni) by a central metal ion to form a "dimer". Due to the enantiopurity of the ligand, the complexes are obtained as pure enantiomers, resulting in pronounced circular dichroism (CD) spectra.

Duration of mission time in prehospital emergency medicine: effects of emergency severity and physicians level of education.

Background: Prehospital emergency care is provided in many European countries by specialised emergency physicians. However, little is known about the impact of experience and educational level of emergency physicians on providing prehospital care.

Methods: During a 6-month period all deployments of an emergency physician-staffed ambulance in a metropolitan area were studied according to possible predictors of prehospital mission times.

Influence of resident training on anaesthesia induction times.

Background: The effect of resident training in anaesthesiology on operating room (OR) economics is an issue of debate. Comparisons of anaesthesia process times between residents and consultants might be systematically skewed by interactions of anaesthesia technique and patient factors.

Methods: In this prospective, observational study, we analysed anaesthesia process times in 599 cases performed for four different surgical services in a University hospital.

[Utilization rates and turnover times as indicators of OR workflow efficiency].

Background: In many hospitals operating room (OR) utilization rates and turnover times (the time from the end of the previous surgical procedure to the beginning of the next) are used as indicators of OR workflow inefficiency. However, there have been no detailed studies to determine whether these indicators really provide an adequate picture of avoidable wasting of time in the OR.

Methods: All relevant OR processes in a busy surgical suite with nine ORs were studied in detail over an 8-week period.

[The new regulations for the licence to practice medicine. Implementation for the faculty of anesthesiology at the University Clinic Hamburg-Eppendorf].

After the amendments to the regulations for the licence to practice medicine, the rating of the faculty of anesthesiology has clearly increased. In the following article a concept will be described whereby these standards were implemented at the University of Hamburg. The basic principle, especially the training in the practical proficiencies, is to achieve a continuous learning process from students through to specialists for anesthesiology.

[Key performance indicators of OR efficiency. Myths and evidence of key performance indicators in OR management].

A variety of different key performance indicators, both for process and financial performance, are used to evaluate OR efficiency. Certain indicators like OR utilization and turnover times seem to become common standard in many hospitals to evaluate OR process performance. Despite the general use and availability of these indicators in OR management, the scientific evidence behind these data is relatively low.

Cumulative and bolus in vitro contracture testing with 4-chloro-3-ethylphenol in malignant hyperthermia positive and negative human skeletal muscles.

In this study we evaluated the in vitro effects of 4-chloro-3-ethylphenol (CEP) using cumulative (12.5-200 micromol/L) or bolus (75 and 100 micromol/L) administrations, on muscle specimens from malignant hyperthermia (MH) susceptible and MH nonsusceptible patients, respectively. In the cumulative CEP in vitro contracture test, contractures were significantly greater in the MH susceptible compared with the MH nonsusceptible muscles in all concentrations between 25 and 100 micromol/L.

Phosphodiesterase-III-inhibition with amrinone leads to contracture development in skeletal muscle preparations of malignant hyperthermia susceptible swine.

Background And Objective: The phosphodiesterase-III (PDE-III) inhibitor enoximone-induced marked contractures in skeletal muscle specimens of malignant hyperthermia (MH) susceptible (MHS) human beings and swine. Whether this is a substance specific effect of enoximone or caused by inhibition of PDE-III remained unclear. Therefore, the effects of the PDE-III inhibitor amrinone in porcine MH normal (MHN) and MHS skeletal muscles were investigated.

Ryanodine contracture threshold times for diagnosis of malignant hyperthermia susceptibility: an experimental approach from a single laboratory.

Study Objectives: To define threshold times for ryanodine contracture testing (RCT) using skeletal muscle specimens from malignant hyperthermia-susceptible (MHS) and control individuals.

Design: Prospective study.

Setting: Malignant hyperthermia (MH) laboratory at a university hospital.

Histomorphologic examination of skeletal muscle preparations does not differentiate between malignant hyperthermia-susceptible and -normal patients.

Background: It has been suggested that malignant hyperthermia (MH) can be diagnosed by specific myopathologic alterations. The purpose of this study was to investigate whether there are characteristic myopathologic changes in skeletal muscles of MH-susceptible (MHS) compared with MH-normal (MHN) patients.

Methods: Four hundred forty patients with clinical suspicion of MH were classified as MHN, MH equivocal (MHE), or MHS by the in vitro contracture test with halothane and caffeine.

[Theophylline induces contractures in porcine skeletal muscle preparations with the disposition to malignant hyperthermia].

Objective: Theophylline, a methylxanthine, leads to an increase of the cytoplasmic Ca(2+)-concentration in the muscle cell. Since the in-vitro contracture test (IVCT) with halothane and caffeine does not distinguish a 100% between malignant hyperthermia susceptible (MHS) and non-susceptible (MHN), we examined the in-vitro effects of theophylline in porcine skeletal muscle preparations.

Methods: After approval by the local animal care committee ten MHS- and nine MHN-swine were anaesthetized and muscle biopsies taken.

Dantrolene--a review of its pharmacology, therapeutic use and new developments.

Human malignant hyperthermia is a life-threatening genetic sensitivity of skeletal muscles to volatile anaesthetics and depolarizing neuromuscular blocking drugs occurring during or after anaesthesia. The skeletal muscle relaxant dantrolene is the only currently available drug for specific and effective therapy of this syndrome in man. After its introduction, the mortality of malignant hyperthermia decreased from 80% in the 1960s to < 10% today.

[Is a presymptomatic malignant hyperthermia in-vitro diagnosis with 4-chloro-3-ethyl phenol possible? A study using porcine skeletal preparations].

Objective: The diagnosis of malignant hyperthermia is currently performed with the in-vitro contracture test (IVCT) with halothane and caffeine. This test has a sensitivity of 99.0 % but only a specificity of 93.

Induction of malignant hyperthermia in susceptible swine by 3,4-methylenedioxymethamphetamine ("ecstasy").

Background: 3,4-Methylenedioxymethamphetamine (MDMA, "ecstasy") can mediate acute toxic effects such as muscle rigidity, metabolic acidosis, and hyperthermia. Because of close clinical similarities, an association between MDMA intoxication and malignant hyperthermia (MH) was suggested. The aim of this study was to investigate whether MDMA is a trigger of MH in susceptible swine.

Multicentre evaluation of in vitro contracture testing with bolus administration of 4-chloro-m-cresol for diagnosis of malignant hyperthermia susceptibility.

Background And Objective: The in vitro contracture test with halothane and caffeine is the gold standard for the diagnosis of susceptibility to malignant hyperthermia (MH). However, the sensitivity of the in vitro contracture test is between 97 and 99% and its specificity is 78-94% with the consequence that false-negative as well as false-positive test results are possible. 4-Chloro-m-cresol is potentially a more specific test drug for the in vitro contracture test than halothane or caffeine.

Effects of a 5HT(2) receptor agonist on anaesthetized pigs susceptible to malignant hyperthermia.

Background: The pathophysiology of the serotoninergic system in malignant hyperthermia (MH) is not completely understood. The serotonin-2 (5HT(2A)) receptor agonist 1-(2,5-dimethoxy-4-iodophenyl)-2-aminopropane hydrochloride (DOI) induces typical MH symptoms, including skeletal muscle rigidity, an increase in body temperature, hyperventilation and acidosis in conscious MH-susceptible (MHS) pigs. Whether these symptoms are directly generated in skeletal muscle, result from central serotonergic overstimulation or from a porcine stress syndrome remains unresolved.

[Dantrolene. Pharmacological and therapeutic aspects].

Malignant hyperthermia (MH) is a genetic, potentially life-threatening disorder of the skeletal muscle presenting during or following general anaesthesia. Trigger agents are volatile anaesthetics and depolarising muscle relaxants. Dantrolene is the only available drug for effective and specific MH therapy, which reduces significantly the mortality rate.

In vitro and in vivo effects of the phosphodiesterase-III inhibitor enoximone on malignant hyperthermia-susceptible swine.

Background: In human skeletal muscles, the phosphodiesterase-III inhibitor enoximone induces in vitro contracture development, and it has been suggested that enoximone could trigger malignant hyperthermia (MH). In this study, the in vitro and in vivo effects of enoximone in MH-normal (MHN) and MH-susceptible (MHS) swine were investigated.

Methods: Malignant hyperthermia trigger-free general anesthesia was performed in MHS and MHN swine.