Einleitung: L-Carnitin spielt eine zentrale Rolle im Energiestoffwechsel. Da dieser in der Frühlaktation bei Hochleistungskühen besonders beansprucht und z.T. überlastet wird, ergibt sich die Frage, ob durch L-Carnitinsupplementation ein stabilerer Stoffwechsel und damit bessere Leistungen erreicht werden können. Zielstellung: Es wurde geprüft, ob bei Hochleistungskühen mit einer mittleren Milchleistung von 12000 kg/Jahr die orale Supplementation von L Carnitin im peripartalem Zeitraum bei zwei verschiedenen Applikationszeiträumen Stoffwechsel-, Leistungs- und Gesundheitsverbesserung erbringt. Versuchsanordnung: Aus einer Gesamtherde von 322 Kühen wurden 81 Tiere randomisiert auf vier Gruppen aufgeteilt. Zwei dieser Gruppen erhielten L-Carnitin (Supplementationsgruppen) und die anderen zwei Gruppen stellten die Kontrollgruppen (KG 1 n = 14/ KG 2 n = 11) dar. Von den supplementierten Gruppen erhielt Car. 1 (n = 26) von 3 Wochen (Wo.) ante partum (a.p.) bis zur Kalbung über das Futter täglich 5g L Carnitin (Carnipas®). Post partum bekamen die Tiere 1g L Carnitin von der Kalbung bis vier Wo. p.p. Parallel wurden einer zweiten supplementierten Gruppe, Car. 2 (n = 30), täglich 5g L Carnitin 3 Wochen a.p. bis zur Kalbung verabreicht. Klinische und Blutkontrollen erfolgten 28 Tage (d) a.p., drei d p.p, 28 d p.p. sowie 56 d p.p. Es wurden das Gesamtcarnitin (GC, n = 5), das freie Carnitin (FC, n = 5), Carnitinester (CE, n = 5), FFS, BHB, Bilirubin, Glucose, Cholesterol, Harnstoff, TTP, Albumin, CK, AST, Pi, Ca, Fe bei allen Tieren analysiert. Zusätzlich erfolgte die Erfassung der Laktationsleistung, der Milchinhaltsstoffe, der Rastzeit (RZ), der Zwischentragezeit (ZTZ) und der Morbidität. Ergebnisse: Das GC, FC und die CE besitzen in den supplementierten Gruppen Car 1 drei d p.p. höhere Konzentrationen als die Kontrollgruppen, die bei Car. 2 (p < 0,05) im GC und FC auch im weiteren Verlauf beobachtet wurden. Ein deutlicher Konzentrationsabfall aller L-Carnitinfraktionen vier Wo. p.p. wurde in den supplementierten Gruppen beobachtet. In den Kontrollgruppen stiegen sie zur gleichen Zeit nicht einheitlich an. Acht Wochen p.p. sanken die L-Carnitinkonzentrationen im Blut sowohl in den Kontrollgruppen, als auch in der supplementierten Gruppen weiter ab. In allen Gruppen stiegen drei d p.p. die FFS-Konzentrationen an (p < 0,05), das BHB auch in den supplementierten Gruppen, die Glucose- und Cholesterolkonzentration fielen ab (p < 0,05). Vier und 8 Wo. p.p. ließen sich ein Abfallen der FFS- (p < 0,05) und der BHB-Konzentrationen (p < 0,05) erkennen. Die Cholesterol- (p < 0,05) und verzögert auch die Glucosekonzentration stiegen an. Drei d p.p. stiegen die Bilirubinkonzentration (p < 0,05) und die AST-Aktivität (p < 0,05) an, dem ein ebensolcher Abfall (p < 0,05) folgte. Präpartal trat in der supplementierten Gruppen Car. 2 eine höhere Bilirubinkonzentration als in der Kontrollgruppe (p < 0,05) auf, was bei den AST-Aktivitäten zwischen den supplementierten Gruppen postpartal (p < 0,05) der Fall war. Drei d p.p waren niedrigere Konzentrationen des Proteins (p < 0,05), des Albumins (p < 0,05) in Car. 2 und in der Kontrollgruppe sowie des Harnstoffs (p < 0,05) in den Kontrollgruppen zu beobachten. Die CK-Aktivität nahm drei d p.p. zu (p < 0,05), um vier Wo. p.p. wieder abzufallen (p < 0,05). Gleichzeitig war einen Anstieg des Proteins (p < 0,05) und des Albumins in den Kontrollgruppen (p < 0,05), verzögert auch in den supplementierten Gruppen (p < 0,05), messbar. In allen Gruppen waren drei d p.p. niedrigere Ca- (p < 0,05), Fe- (p < 0,05) und Pi- Konzentrationen (p < 0,05) auffällig, die später wieder anstiegen. Im Verlauf war die Ca-Konzentration bei Car. 2 gegenüber der Kontrollgruppe höher (p < 0,05). Die Leistungsparameter differierten weder bei den Milchleistungs-, noch bei den Fruchtbarkeitskennzahlen gesichert. Bezüglich der Morbidität war auffällig, dass das GC und FC bei gesunden Kühen a.p. gegenüber den im Laktationsverlauf erkrankten gesichert höher war (p < 0,05). Schlussfolgerungen: Orale L Carnitinapplikation bei Kühen mit hohem Milchleistungsniveau erbrachte keine Stoffwechsel-, Leistungs- und Morbiditätsunterschiede gegenüber den Kontrollgruppen. Die Ergebnisse entsprechen aber der Hypothese einer gesteigerten ß-Oxidation durch die Carnitinsupplementation mit erhöhten BHB-Konzentrationen als Folge. Post partum gesunde Kühe hatten a.p. signifikant höhere L-Carnitinkonzentrationen als kranke.

No description available.

Transition zone biopsies have been found to increase the detection rates of cancer of the prostate in patients with negative digital rectal examination. There are however no data available whether the higher biopsy rate is associated with greater morbidity. The present study was therefore designed to evaluate the complication rate of extended sextant biopsy. In this prospective study, 162 consecutive patients who presented for prostatic evaluation were included. After starting prophylactic antibiotic treatment 48 h prior to the procedure, transrectal ultrasound-guided core biopsies were obtained from each lobe: three each from the peripheral zone (apex, mid-zone and base) and two from the transition zone of each prostatic lobe. In all patients a questionnaire was obtained 10–12 days after the procedure. Major complications occurred in 3 patients. In 2 of the 3 cases major macroscopic hematuria was treated by an indwelling catheter for 1 or 2 days and 1 patient developed fever >38.5°C for 1 day. Minor macroscopic hematuria was present in 68.5% of the patients. In 17.9% of these cases, the hematuria lasted for more than 3 days. Hematospermia was observed in 19.8% and minor rectal bleeding occurred in 4.9%. Ten-core biopsies did not lead to an increase in adverse effects or complications when compared to the results of sextant biopsies reported in the literature. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Background:There is controversial evidence with regard to the significance of peripheral arterial disease (PAD) as an indicator for future stroke risk. We aimed to quantify the risk increase for mortality and morbidity associated with PAD. Methods:In an open, prospective, noninterventional cohort study in the primary care setting, a total of 6,880 unselected patients ≧65 years were categorized according to the presence or absence of PAD and followed up for vascular events or deaths over 5 years. PAD was defined as ankle-brachial index (ABI) <0.9 or history of previous peripheral revascularization and/or limb amputation and/or intermittent claudication. Associations between known cardiovascular risk factors including PAD and cerebrovascular mortality/events were analyzed in a multivariate Cox regression model. Results:During the 5-year follow-up [29,915 patient-years (PY)], 183 patients had a stroke (incidence per 1,000 PY: 6.1 cases). In patients with PAD (n = 1,429) compared to those without PAD (n = 5,392), the incidence of all stroke types standardized per 1,000 PY, with the exception of hemorrhagic stroke, was about doubled (for fatal stroke tripled). The corresponding adjusted hazard ratios were 1.6 (95% confidence interval, CI, 1.1–2.2) for total stroke, 1.7 (95% CI 1.2–2.5) for ischemic stroke, 0.7 (95% CI 0.2–2.2) for hemorrhagic stroke, 2.5 (95% CI 1.2–5.2) for fatal stroke and 1.4 (95% CI 0.9–2.1) for nonfatal stroke. Lower ABI categories were associated with higher stroke rates. Besides high age, previous stroke and diabetes mellitus, PAD was a significant independent predictor for ischemic stroke. Conclusions:The risk of stroke is substantially increased in PAD patients, and PAD is a strong independent predictor for stroke. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

No description available.

Aims: Trends in morbidity and mortality, fully or partially attributable to alcohol, for adults aged 18–64 were assessed for Germany. Methods: The underestimation of population exposure was corrected by triangulating survey data with per capita consumption. Alcohol-attributable fractions by sex and two age groups were estimated for major disease categories causally linked to alcohol. Absolute numbers, population rates and proportions relative to all hospitalizations and deaths were calculated. Results: Trends of 100% alcohol-attributable morbidity and mortality over thirteen and eighteen years, respectively, show an increase in rates of hospitalizations and a decrease in mortality rates. Comparisons of alcohol-attributable morbidity including diseases partially caused by alcohol revealed an increase in hospitalization rates between 2006 and 2012. The proportion of alcohol-attributable hospitalizations remained constant. Rates of alcohol-attributable mortality and the proportion among all deaths decreased. Conclusions: The increasing trend in mortality due to alcohol until the mid-1990s has reversed. The constant proportion of all hospitalizations that were attributable to alcohol indicates that factors such as improved treatment and easier health care access may have influenced the general increase in all-cause morbidity. To further reduce alcohol-related mortality, efforts in reducing consumption and increasing treatment utilization are needed.

Transition zone biopsies have been found to increase the detection rates of cancer of the prostate in patients with negative digital rectal examination. There are however no data available whether the higher biopsy rate is associated with greater morbidity. The present study was therefore designed to evaluate the complication rate of extended sextant biopsy. In this prospective study, 162 consecutive patients who presented for prostatic evaluation were included. After starting prophylactic antibiotic treatment 48 h prior to the procedure, transrectal ultrasound-guided core biopsies were obtained from each lobe: three each from the peripheral zone (apex, mid-zone and base) and two from the transition zone of each prostatic lobe. In all patients a questionnaire was obtained 10–12 days after the procedure. Major complications occurred in 3 patients. In 2 of the 3 cases major macroscopic hematuria was treated by an indwelling catheter for 1 or 2 days and 1 patient developed fever >38.5°C for 1 day. Minor macroscopic hematuria was present in 68.5% of the patients. In 17.9% of these cases, the hematuria lasted for more than 3 days. Hematospermia was observed in 19.8% and minor rectal bleeding occurred in 4.9%. Ten-core biopsies did not lead to an increase in adverse effects or complications when compared to the results of sextant biopsies reported in the literature. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Background The number of liver resections is constantly rising over the last decades. Despite the reduction of overall mortality and morbidity in liver surgery, biliary leakage is still a relevant postoperative complication that can lead to a fatal postoperative course. Aim of this analysis is the identification of specific risk factors for postoperative biliary complications after liver resections and the development of a predictive biliary leakage risk score. Methods A single-center, retrospective analysis of 844 liver resections performed in the Department of Visceral, Thoracic and Vascular Surgery, Technische Universität Dresden, between 1/2013 and 12/2019 is conducted to identify risk factors for postoperative biliary leakage and a risk score for biliary leakage after hepatectomy is established based on multivariate regression. The score has been validated by an independent validation cohort consisting of 142 patients. Results Overall morbidity is 43.1% with 36% surgical complications and an overall mortality of 4.3%. Biliary leakage occurred in 15.8% of patients. A predictive score for postoperative biliary leakage based on age, major resection, pretreatment with FOLFOX/cetuximab and operating time is created. Patients are stratified to low (< 15%) and high (> 15%) risk with a sensitivity of 67.4% and a specificity of 70.7% in development cohort and a specificity of 68.2% and sensitivity of 75.8% in validation cohort. Conclusions The presented score is robust and has been validated in an independent patient cohort. Depending on the calculated risk, prevention or early treatment can be initiated to avoid bile leakage and to improve postoperative course.

No description available.

Background:There is controversial evidence with regard to the significance of peripheral arterial disease (PAD) as an indicator for future stroke risk. We aimed to quantify the risk increase for mortality and morbidity associated with PAD. Methods:In an open, prospective, noninterventional cohort study in the primary care setting, a total of 6,880 unselected patients ≧65 years were categorized according to the presence or absence of PAD and followed up for vascular events or deaths over 5 years. PAD was defined as ankle-brachial index (ABI) <0.9 or history of previous peripheral revascularization and/or limb amputation and/or intermittent claudication. Associations between known cardiovascular risk factors including PAD and cerebrovascular mortality/events were analyzed in a multivariate Cox regression model. Results:During the 5-year follow-up [29,915 patient-years (PY)], 183 patients had a stroke (incidence per 1,000 PY: 6.1 cases). In patients with PAD (n = 1,429) compared to those without PAD (n = 5,392), the incidence of all stroke types standardized per 1,000 PY, with the exception of hemorrhagic stroke, was about doubled (for fatal stroke tripled). The corresponding adjusted hazard ratios were 1.6 (95% confidence interval, CI, 1.1–2.2) for total stroke, 1.7 (95% CI 1.2–2.5) for ischemic stroke, 0.7 (95% CI 0.2–2.2) for hemorrhagic stroke, 2.5 (95% CI 1.2–5.2) for fatal stroke and 1.4 (95% CI 0.9–2.1) for nonfatal stroke. Lower ABI categories were associated with higher stroke rates. Besides high age, previous stroke and diabetes mellitus, PAD was a significant independent predictor for ischemic stroke. Conclusions:The risk of stroke is substantially increased in PAD patients, and PAD is a strong independent predictor for stroke. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.