Recent Arctic warming vertical structure contested.

The vertical structure of the recent Arctic warming contains information about the processes governing Arctic climate trends. Graversen et al. argue, on the basis of ERA-40 reanalysis data, that a distinct maximum in 1979-2001 warm-season (April-October) Arctic temperature trends appears around 3 km above ground. Here we show that this is due to the heterogeneous nature of the data source, which incorporates information from satellites and radiosondes. Radiosonde data alone suggest the warming was strongest near ground.

Extreme climate of the global troposphere and stratosphere in 1940-42 related to El Niño.

Although the El Niño/Southern Oscillation phenomenon is the most prominent mode of climate variability and affects weather and climate in large parts of the world, its effects on Europe and the high-latitude stratosphere are controversial. Using historical observations and reconstruction techniques, we analyse the anomalous state of the troposphere and stratosphere in the Northern Hemisphere from 1940 to 1942 that occurred during a strong and long-lasting El Niño event. Exceptionally low surface temperatures in Europe and the north Pacific Ocean coincided with high temperatures in Alaska. In the lower stratosphere, our reconstructions show high temperatures over northern Eurasia and the north Pacific Ocean, and a weak polar vortex. In addition, there is observational evidence for frequent stratospheric warmings and high column ozone at Arctic and mid-latitude sites. We compare our historical data for the period 1940-42 with more recent data and a 650-year climate model simulation. We conclude that the observed anomalies constitute a recurring extreme state of the global troposphere-stratosphere system in northern winter that is related to strong El Niño events.

Listeria monocytogenes causing solitary liver abscess. Case report and review of the literature.

The authors report on a case of a solitary liver abscess due to Listeria monocytogenes in a 53-year-old diabetic white male and review all published cases of solitary listerial abscesses of the liver. L. monocytogenes is a rare cause of solitary liver abscess which occurs in elderly patients with diabetes mellitus. The clinical signs are variable and often mimic malignancy, with epigastric pain, night sweats and weight loss. Prevalent features are poor control of glycemia, temperature up to 38.5 degrees C and elevated alkaline phosphatase. Optimal treatment includes percutaneous drainage of the hepatic abscess and antibiotic therapy with an aminopenicillin or trimethoprim/sulfamethoxazole. Outcome of the reviewed patients was favourable with no mortality and no relapse of the disease.

[Early postoperative nutrition after elective colonic surgery]. / Frühpostoperative Ernährung nach elektiver Kolonchirurgie.

UNLABELLED: Our intent was to show that immediate postoperative oral feeding of a regular diet after elective open colorectal surgery is safe, feasible and can be tolerated by the patients. Our prospective study included 96 consecutive patients, and their results were compared with those of the literature. CONCLUSION: Early oral feeding after elective colorectal surgery is safe (morbidity: 12.5%; mortality: 2%); it can be tolerated without symptoms by a majority of patients (85%); it is easy, feasible, and shortens the postoperative length of hospital stay (10.6 days).

[Diffuse bile duct papillomatosis: high rate of recurrence and risk of malignant transformation]. / Die diffuse Gallengangpapillomatose: Hohe Rezidivrate und grosses Entartungspotential.

Bile duct papillomatosis is a rare disease. It is characterised by multicentric papillary lesions of the intra- and/or extrahepatic biliary epithelium. Because of its slow progression, its high rate of recurrence and significant risk of malignant transformation, it is an important cause of obstructive neoplastic bile duct diseases. We report one of these rare cases with the typical clinical signs and exceptional long survival time of eight years: After a history of fifteen years of recurrent epigastric pains the diagnosis of a diffuse biliary papillomatosis was made after surgery. Five years postoperatively a bile duct carcinoma has developed. After a R1-resection of the tumor, the patient was again free of complaints up to the appearances of multiple metastases two years later. He died a year later of metastasizing disease. We discuss the pathological and clinical aspects of this disease and review the literature.

Asthmatic risk factors and bronchial reactivity in non-diagnosed asthmatic adults.

Specific respiratory signs and symptoms are thought to occur prior to diagnoses of asthma as part of the natural history. These signs and symptoms include: high IgE, a history of wheezing symptoms, and/or excessive declines in lung function. The first two are thought to distinguish asthma from other airway obstructive diseases (AOD). To predict subsequent AOD, twelve years of follow-up (1972-84) data from the Tucson longitudinal epidemiological study of AOD in a community population were evaluated on 687 subjects aged 19-70 years on entry. To determine the likelihood that non-asthmatics that have these specific risk factors would have marked or intermediate bronchial reactivity to methacholine, an experimental study was performed. This was done in 1984-85 in a robust, efficient post-hoc stratified sample of male subjects ages 30-55 from the population followed from 1972. They were subsequently followed through 1991. Persistent symptoms best predicted final pulmonary function and new diagnosed AOD in subjects in the population. Previously diagnosed AOD also predicted lower pulmonary function. The experimental results indicate that predisposition to reactivity appears likely without the presence of diagnosed asthma. Further, the experimental subjects with high risk had increased symptomatology and decreased lung function when tested at follow-up; not all of the reactivity was explained by these factors. An attempt to predict reactivity by physician evaluation and special questionnaire was not fruitful. In addition, wheeze per se often disappeared without later evidence of asthma (or AOD) diagnosis, questioning some international tendencies to label all wheeze as asthma. Thus, high IgE significantly predicted bronchial responsiveness, but high IgE and symptoms are neither necessary nor sufficient. Also, both preclinical and clinical asthma predict eventual low lung function.

A prospective study of the natural history of asthma. Remission and relapse rates.

In this longitudinal study of a general population sample, remissions of asthma were common only during the second decade of life and were especially unusual in subjects ages 30 to 60 years on enrollment. Asthmatic subjects with severe symptoms, with reduced ventilatory function, or with a concomitant diagnosis of chronic bronchitis or emphysema on entry to the study were very unlikely to be in remission nine years later. Relapses of disease were common in subjects with a past history of asthma who were considered to be quiescent on enrollment to the study. Relapse rates tended to increase with age, at least up to the age of 70. Relapses were especially frequent among those "ex-asthmatics" who had persisting respiratory symptomatology on entry to the study.