ABSTRACT
Calciphylaxis is a potentially life-threatening disease that occurs up to 4% of patients with chronic terminal renal failure and secondary hyperparathyroidism. Clinical symptoms are painful skin erythema and ischemic necrosis as a result of calcification of the small and medium-sized arteries of the subcutaneous tissues. The mortality of the disease is as high as 87% mainly due to sepsis from superinfection. We report on a 59-year-old patient with chronic renal failure and normal calcium-phosphate-product with leg ulcers as a rare manifestation of a calciphylaxis. In spite of an early parathyroidectomy and a temporary complete wound-healing the death because of calciphylaxis could not be prevented.
Subject(s)
Calciphylaxis/diagnosis , Calciphylaxis/etiology , Kidney Failure, Chronic/diagnosis , Kidney Failure, Chronic/etiology , Leg Ulcer/complications , Leg Ulcer/diagnosis , Calciphylaxis/surgery , Fatal Outcome , Female , Humans , Kidney Failure, Chronic/surgery , Leg Ulcer/surgery , Middle Aged , Rare Diseases/diagnosis , Rare Diseases/etiology , Rare Diseases/surgeryABSTRACT
BACKGROUND: Based on sporadic reports of microbial contamination of mineral waters, it has been recommended that, for safety reasons, particularly immunocompromised patients should drink tap water rather than bottled mineral water. However, in terms of safety, evidence of the clinical consequences may allow a better estimate than a positive in vitro test for contamination. Therefore, we reviewed the literature on documented disease outbreaks due to contaminated mineral and tap waters. MATERIAL AND METHODS: We performed a systematic search of the literature using the database MEDLINE. In order to identify evidence relevant for Germany, we restricted our search to the years 1985-1997 (i.e. legal force of the mineral and table waters act in Germany) and the countries of Central and Northwestern Europe as well as the USA and Canada. RESULTS: Cases of contamination of tap water were documented in nearly all countries included. In 35 communications we found reports on a total of 423,000 cases of disease outbreaks due to contaminated tap water, in some cases even with lethal outcome. Main diagnosis was gastroenteritis, and main species of microorganism was crytosporidium. In contrast, there was no documented case of disease outbreak due to contaminated bottled mineral water. CONCLUSION: Tap water as well as bottled water are both supremely safe components of nutrition. The recommendation that tap water is better than mineral water, particularly for high-risk patients, is not supported by the literature.
Subject(s)
Disease Outbreaks , Mineral Waters/standards , Safety , Water Microbiology , Water Supply/standards , Global Health , HumansABSTRACT
The relevance of calcium (Ca2+), an essential bone mineral, to the prevention and treatment of osteoporosis is well established. However, a good deal of evidence casts doubt on the validity of current RDAs (recommended daily allowance), i.e., 800-1000 mg/day. New guidelines consistently advocate higher daily intakes (up to 1500 mg/day), a goal that may be difficult to achieve for many patients. Environmental as well as individual behavioral factors may limit the consumption of dairy products, whereas calcium supplements require a high level of compliance and cause additional costs. Calcium-rich mineral waters may offer a promising alternative. A systematic literature search was performed (Medline, years 1966-1998) to identify experimental studies on the bioavailability of calcium-rich mineral waters. First, all publications on calcium absorption from mineral waters were identified, and, in a second step, studies comparing calcium absorption from mineral waters with that from dairy products. Four studies fulfilled all inclusion criteria. A meta-analysis based on published p values indicated calcium absorption from mineral waters was significantly higher (p = 0.03) than that from dairy products. Although only few studies with a relatively small number of subjects are available to date, the bioavailability of calcium from calcium-rich mineral waters thus seems to be at least comparable to, and possibly better than, that from dairy products. These results are in keeping with the assumption that calcium-rich mineral water is a useful calcium source to achieve new, higher recommended daily allowances of calcium.
Subject(s)
Calcium/pharmacokinetics , Dietary Supplements , Mineral Waters , Biological Availability , Calcium/administration & dosage , Dairy Products , Female , Humans , Intestinal Absorption/physiology , Male , Nutrition Policy , Osteoporosis/prevention & controlABSTRACT
A special caliper was designed to determine the stretching capacity of a circular capsulorhexis allowing measurements in 0.02 mm increments. A small capsulorhexis 4.5-6.0 mm in diameter could be stretched 2.7 times; a large capsulorhexis 6.5-8.0 mm in diameter was stretched 2.6 times the original diameter. A smooth circular capsulorhexis is very strong and stabile but also has significant stretching capacity. In a small capsulorhexis, there is the danger that zonular fiber defects or posterior capsular rupture may occur during manual expression, of the nucleus. A large capsulorhexis is more suitable for manual nucleus delivery.
Subject(s)
Cataract Extraction/instrumentation , Lens Capsule, Crystalline/surgery , Lenses, Intraocular , Animals , Elasticity , Lens Capsule, Crystalline/physiopathology , Swine , Tensile StrengthABSTRACT
The prognostic value of three DNA cytometric parameters--stemline ploidy (STL), stemline shoulder fraction (SSF) and "proliferative" fraction (PRF)--for the prediction of disease transformation and survival was examined for 20 patients with chronic myelogenous leukemia (CML) during the course of their disease and compared with two commonly used hematologic parameters (degree of leukocytosis and percentage of circulating leukemic progenitor cells). With disease progression, STL and SSF increased significantly, whereas PRF showed a steady decrease from diagnosis to blast crisis. The most significant part of these changes took place during the chronic phase, before the clinical onset of disease transformation. Hematologic parameters, in comparison, revealed significant changes later, shortly before blast crisis. The remaining duration of the chronic phase diminished from 25.5 months at the time of diagnosis, when the median STL was 2.0c, to 19.6 months for patients showing an STL of 2.1c, to 15.0 months with an STL of 2.2c and to 1.0 months for those with an STL of greater than or equal to 2.3c. Prognostically relevant limits for SSF and PRF were at 20%. When the SSF passed this limit or the PRF fell below it, the mean remaining chronic phase of these patients amounted to only 14.1 and 10.1 months. Interactive cytometry allows analysis of the DNA cytometric equivalent of changes in leukemic progenitor cells, which are well known from cytogenetic and cell kinetic studies. These three DNA cytometric parameters reflect the "natural history" of CML with the development of a cytogenetically hyperdiploid clone during disease progression in most patients and a simultaneous loss of proliferative potential on the level of myelobasts.(ABSTRACT TRUNCATED AT 250 WORDS)
Subject(s)
Blast Crisis/pathology , DNA, Neoplasm/analysis , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics , Stem Cells/chemistry , Histocytochemistry , Humans , Ploidies , Predictive Value of Tests , Risk Factors , Survival RateABSTRACT
Due to the specific anatomy at the toe of the claw, inflammation of the corium at this site is characterised by a rapid spread to the distal phalanx. Radiography is important for the diagnosis and essential for determining the prognosis. In the early stage of the condition, therapy consists of correct wound care and relieving the affected claw from weight-bearing by applying an orthopaedic shoe to the partner claw. Resection of the claw toe is indicated if there is evidence of osteolysis. The postoperative healing period frequently lasts more than two months; there is a tendency to hypergranulation. Deformation of the claw due to irregular horn growth following surgery may occur. Compared to the treatment by amputation, the economic life of the patient is longer following resection and there are no restrictions on use.
Subject(s)
Cattle Diseases/therapy , Hoof and Claw , Animals , Cattle , Cattle Diseases/surgery , Female , Foot Diseases/surgery , Foot Diseases/therapy , Foot Diseases/veterinary , Hoof and Claw/surgery , Male , Retrospective StudiesABSTRACT
The Doppler ultrasound is a proper method to diagnose pathologic venous flow in the pelvic and and femoral regions. It is possible to differentiate deep vein thrombosis and chronic venous insufficiency of the typical kind of disturbance. This method permits only functional but not morphological findings; it offers the chance of preselection to other invasive methods.
Subject(s)
Thrombophlebitis/diagnosis , Ultrasonography , Venous Insufficiency/diagnosis , Doppler Effect , Femoral Vein , Humans , Leg , Varicose Veins/diagnosisABSTRACT
Most important in vascular surgery is the exact preoperative diagnosis. The Doppler-ultrasonography is an exact and simple method to estimate localization and different changes in the peripheral arteries; the results allow a dependable preselection for necessary preoperative angiography. Advantages and results of Doppler-ultrasonography are described. Two cases are demonstrated.
