Subject(s)
Brain Edema/diagnosis , Brain Ischemia/diagnosis , Diffusion Magnetic Resonance Imaging , Hypoglycemia/diagnosis , Image Processing, Computer-Assisted , Internal Capsule , Brain Damage, Chronic/prevention & control , Brain Edema/therapy , Brain Ischemia/therapy , Diagnosis, Differential , Dominance, Cerebral/physiology , Female , Glucose Solution, Hypertonic/administration & dosage , Humans , Hypoglycemia/complications , Infusions, Intravenous , Middle Aged , Remission, Spontaneous , Stroke/diagnosisABSTRACT
HISTORY AND ADMISSION FINDINGS: An 83-year old woman was admitted with pain in the left arm and on the left hemithorax. Subsequently, herpes zoster developed on the left arm. The next day, the patient got confused and was agitated. Furthermore, paresis of both legs and the left arm occurred. INVESTIGATIONS: Cranial computed tomography was negative for intracerebral haemorrhage or ischaemia. Examination of cerebrospinal fluid revealed lymphocytic pleocytosis and increased albumin and lactate concentrations. Polymerase chain reaction (PCR) confirmed presence of varicella zoster virus DNA in the cerebrospinal fluid. DIAGNOSIS, TREATMENT AND COURSE: After diagnosis of varicella zoster encephalitis, complicating herpes zoster on the left arm, intravenous treatment with aciclovir was initiated. Consequently, the patient's clinical status improved and the neurological signs declined. CONCLUSIONS: Herpes zoster is a rare differential diagnosis of pain on the left hemithorax and may manifest without skin rashes in the initial stadium. In older patients suffering from herpes zoster, disorientation is common. However, in the presence of focal neurological deficits, varicella zoster encephalitis should definitively be ruled out by spinal tap, even if cranial imaging studies are negative.
Subject(s)
Brachial Plexus Neuritis/diagnosis , Brachial Plexus Neuritis/etiology , Encephalitis, Varicella Zoster/complications , Encephalitis, Varicella Zoster/diagnosis , Rare Diseases/diagnosis , Adult , Diagnosis, Differential , Female , HumansABSTRACT
INTRODUCTION: In Germany, there are hardly any reliable data on patient care in the primary care setting which warrant the development and implementation of clinical guidelines. In this paper, data generated by a prospective observational study of patients with urinary tract symptoms are compared to the recommendations of an evidence-based clinical guideline. PATIENTS AND METHODOLOGY: Over a period of 6 months all patients consulting one of 6 General Practitioners in southern Germany with symptoms of dysuria have been documented on a standardised patient record. Data were compared to the recommendations of the guideline "Dysuria" by the German Society of General Practice and Family Medicine (DEGAM) to assess the relevance and feasibility of the guideline. In a scenario, compliance with the guideline is extrapolated to the realm of primary care. RESULTS: Basic demographic and epidemiological data agree with basic assumptions of the guideline. As far as diagnostic and therapeutic strategies are concerned there are significant discrepancies between the recommendations and the realm of primary care. Microbiologic cultures are ordered far less then recommended, second line drugs are prescribed far more often then recommended, macroscopic urinoscopy is performed widely but not covered by the guideline at all. If GPs complied completely with the guideline, many more diagnostic procedures would be performed and a different palette of antimicrobial drugs would be prescribed. CONCLUSION AND OUTLOOK: The "Dysuria-Guideline" of DEGAM was developed for a prevalent and relevant topic in primary care in Germany. There are significant discrepancies between the recommendations and the realm of primary care. Post-hoc-analysis is an informative and feasible tool to identify potential obstacles against implementation of guidelines.
Subject(s)
Family Practice/standards , Urination Disorders/therapy , Germany , Humans , Quality Assurance, Health CareABSTRACT
The immune system of swine is unique in that the expression of CD4 and CD8 antigens defines four subpopulations of resting extrathymic T lymphocytes. Beyond phenotypic differences to other species, porcine T lymphocytes, particularly when derived from infected animals, are known to show high non-specific cytolytic in vitro activity. Here we describe the putative porcine CD6 antigen (workshop CD6; wCD6) which enables a phenotypic separation of T lymphocytes responsible for major histocompatibility complex (MHC)-restricted and non-MHC-restricted cytotoxicity. The putative porcine CD6 analogue, wCD6, a protein with a molecular mass of 110,000, shows high specificity for T lymphocytes and is neither expressed on B lymphocytes nor on cells of the myeloid lineage. In the extrathymic T-lymphocyte compartment wCD6 characterizes two T-lymphocyte fractions: wCD6+ T lymphocytes including both CD4+ T-helper cell subpopulations (CD4+CD8- and CD4+CD8+) and within the CD4-CD8+ fraction cells with high CD8 antigen density. In contrast the CD4-CD8- gamma/delta T-cell receptor (TCR) subset and CD4-CD8+ cells with low CD8 antigen density are included in the wCD6- T-lymphocyte fraction. Functional studies with separated wCD6 fractions revealed that the wCD6- cells can be characterized by spontaneous and non-MHC restricted cytolytic activity, whereas the wCD6+ T lymphocytes are responsible for MHC-restricted T-cell functions. Thus, the porcine wCD6 is an important antigen to discriminate between MHC-restricted and non-MHC-restricted cytotoxicity.
