Improving Outcome After Major Surgery: Pathophysiological Considerations

Surgical and anesthesia-related techniques may reduce physical stress for patients undergoing high-risk surgery, but major surgery is increasingly performed in patients with substantial comorbidities. Strategies for improving the outcome for such patients include approaches that both increase tissue oxygen delivery and reduce metabolic demand. However, these strategies have produced conflicting results. To understand the success and failure of attempts to improve postoperative outcome, the pathophysiology of perioperative hemodynamic, metabolic, and immunological alterations should be analyzed. Our aim in this review is to provide a survey of fields of opportunities for improving outcome after major surgery. The issues are approached from 3 different angles: the view of the patient, the view of the surgical intervention, and the view of the anesthesia. Special attention is also given to what could be considered the result of the interaction among the 3: perioperative inflammation and immune response.

Iatrogenic left main coronary artery dissection: incidence, classification, management, and long-term follow-up

Although rare, iatrogenic left main coronary artery (LM) dissection is a feared complication of coronary catheterization. Its incidence, optimal therapeutic management, and prognosis remain largely unknown. The aim of the present study was to estimate the incidence, characterize the population at risk, depict the initial management, and evaluate the long-term prognosis of iatrogenic LM dissection.

Age and gender differences in health-related quality of life of children and adolescents in Europe: a multilevel analysis

OBJECTIVES: To determine age and gender differences in health-related quality of life (HRQOL) in children and adolescents across 12 European countries using a newly developed HRQOL measure (KIDSCREEN). METHODS: The KIDSCREEN-52 questionnaire was filled in by 21,590 children and adolescents aged 8-18 from 12 countries. We used multilevel regression analyses to model the hierarchical structure of the data. In addition, effect sizes were computed to test for gender differences within each age group. RESULTS: Children generally showed better HRQOL than adolescents (P < 0.001). While boys and girls had similar HRQOL at young age, girls' HRQOL declined more than boys' (P < 0.001) with increasing age, depending on the HRQOL scale. There was significant variation between countries both at the youngest age and for age trajectories. CONCLUSIONS: For the first time, gender and age differences in children's and adolescents' HRQOL across Europe were assessed using a comprehensive and standardised instrument. Gender and age differences exist for most HRQOL scales. Differences in HRQOL across Europe point to the importance of national contexts for youth's well-being.

Nocardial brain abscess: observation of treatment strategies and outcome in Switzerland from 1992 to 1999

BACKGROUND Brain abscesses caused by Nocardia spp. are rare, but life-threatening infections that are notoriously difficult to diagnose and treat and which occur mainly in immunocompromised patients. Standard treatment guidelines are not available. METHODS A systematic search for nocardial brain abscesses from 1992 to 1999 was conducted in Switzerland for the comparison of clinical presentation, treatment strategies and outcome. RESULTS Seven cases were found, for which data of six were available. In 4/6 patients antimicrobial therapy led to a decrease in the size of abscesses. Four of six patients died. The cause of death was likely due to underlying co-morbidities, rather than the nocardial infection. CONCLUSION The finding that treatment was different in each case underscores the lack of therapeutic guidelines.

Der nacheiszeitliche Bergsturz im Kandertal (Schweiz): Alter und Auswirkungen auf die damalige Umwelt

Beim Bau des neuen AlpTransit Lötschberg Basistunnels wurden unter murgangartig verschwemmten Ablagerungen der alten Bergsturzmasse des Kandertals Stillwasserablagerungen mit zahlreichen organischen Resten und Torflagen gefunden. Die 14C-datierten Resultate der Pollen, Makrorest-, Holz- und Holzkohleanalysen ermöglichten eine Rekonstruktion der lokalen bis regionalen Umweltgeschichte. Ein Gewässer, vermutlich ein kleiner See, begann beim Tellenfeld in Frutigen um 8800 kal. Jahre v. Chr. zu verlanden. In der näheren Umgebung wuchs von 8800 v. Chr. bis 8000 v. Chr. ein Föhrenwald (Pinus silvestris), der reichlich mit Hasel (Corylus avellana) und anderen wärmeliebenden Gehölzen (Ulmen, Linden, Eichen; Ulmus, Tilia, Quercus) und Birken (Betula) durchsetzt war. Diese für die Nordalpen sehr frühe Bedeutung der Hasel ist durch 14C-datierte Corylus-Nussfragmente (9310±50 14C BP, 8722–8337 v. Chr.) belegt. Nach 8500 v. Chr. drängte die Hasel die Waldföhre allmählich zurück. Auf Grund der paläoökologischen Resultate muss angenommen werden, dass die Wälder um 7600 v. Chr. durch ein katastrophales Ereignis stark gestört wurden. Als Reaktion darauf kam es zu einer starken Zunahme der Waldbrände und es breiteten sich zuerst Farne und Gräser sowie wenig später Waldföhren aus. Das Gewässer wurde um 7100 v. Chr. durch verschwemmtes Bergsturzmaterial zerstört. Der geomorphologische Befund deutet darauf hin, dass diese Ereignisse in engem Zusammenhang mit dem Hauptbergsturz im Kandertal stehen, der aussergewöhnliche Ausmasse hatte (ca. 800 Millionen m3). Die Zerstörung der lokalen ökosysteme als Folge des Bergsturzes um 7600–7100 v. Chr. fiel in ein frühes holozänes Wärme- und Sonneneinstrahlungsmaximum, in dem es, wie vorgängige Untersuchungen in den Alpen und in anderen Gebirgen belegen, zu überdurchschnittlich vielen Hanginstabilitäten kam.

Increasing the Glutathione Content in a Chilling-Sensitive Maize Genotype Using Safeners Increased Protection against Chilling-Induced Injury

With the aim of analyzing their protective function against chilling-induced injury, the pools of glutathione and its precursors, cysteine (Cys) and gamma -glutamyl-Cys, were increased in the chilling-sensitive maize (Zea mays) inbred line Penjalinan using a combination of two herbicide safeners. Compared with the controls, the greatest increase in the pool size of the three thiols was detected in the shoots and roots when both safeners were applied at a concentration of 5 muM. This combination increased the relative protection from chilling from 50% to 75%. It is interesting that this increase in the total glutathione (TG) level was accompanied by a rise in glutathione reductase (GR; EC 1.6.4.2) activity. When the most effective safener combination was applied simultaneously with increasing concentrations of buthionine sulfoximine, a specific inhibitor of glutathione synthesis, the total gamma -glutamyl-Cys and TG contents and GR activity were decreased to very low levels and relative protection was lowered from 75% to 44%. During chilling, the ratio of reduced to oxidized thiols first decreased independently of the treatments, but increased again to the initial value in safener-treated seedlings after 7 d at 5 degreesC. Taking all results together resulted in a linear relationship between TG and GR and a biphasic relationship between relative protection and GR or TG, thus demonstrating the relevance of the glutathione levels in protecting maize against chilling-induced injury.