Hantavirus disease in Germany due to infection with Dobrava-Belgrade virus genotype Kurkino.

Members of the Dobrava-Belgrade virus (DOBV) species are hantaviruses carried by different Apodemus mice as reservoir hosts and causing haemorrhagic fever with renal syndrome (HFRS) in humans. In Central Europe, the Kurkino genotype of DOBV, associated with the striped field mouse, Apodemus agrarius, is prevalent. This paper presents the first extensive study of the serological and molecular diagnostics, epidemiology and clinics of DOBV-Kurkino infections in Central Europe. Serum samples from 570 German patients living in the habitat of A. agrarius (north and northeast Germany) and exhibiting febrile disease, were analysed. All samples were tested by ELISA, subsets of samples were also analysed by immunoblot, neutralization assay, and RT-PCR. A group of 86 individuals was confirmed as DOBV-infected. The virus neutralization assay allowed a reliable identification of DOBV antibodies during both acute and convalescent phases of infection. However, differentiation of relevant DOBV genotypes was not possible by neutralization test but required molecular analysis. Whereas DOBV IgM antibodies tend to persist in the infected organism, RNAaemia seems to be short. Nucleotide sequences were amplified from four patients, and their analysis demonstrated infection by DOBV-Kurkino. With respect to the initial results, the high degree of identity of local patient-derived and A. agrarius-derived virus sequences may allow a closer allocation of the geographical place where the human infection occurred. In contrast to moderate/severe HFRS caused by the DOBV genotypes Dobrava or Sochi, all available data showed a mild clinical course of HFRS caused by DOBV-Kurkino infection without lethal outcomes.

Atypical severe Puumala hantavirus infection and virus sequence analysis of the patient and regional reservoir host.

Nephropathia epidemica (NE) caused by Puumala hantavirus (PUUV) is a mild variant of haemorrhagic fever with renal syndrome, which is endemic in Germany. We describe the case of a 67-year-old man initially presenting with acute bilateral angle-closure glaucoma, an atypical clinical presentation of PUUV infection. Subsequently, the patient developed a severe course of disease additionally complicated by profound hepatitis and interstitial nephritis, both phenomena which are rarely described in association with hantavirus infection. Serologic diagnosis was complicated by delayed antibody production until the 10th day of illness; however, PUUV RNA was detectable early in disease. To further analyse this unusual case, sequencing of the PUUV S segment was performed from the patient and regional reservoir host which showed a close relation.

Momentum conserving one-dimensional system with a finite thermal conductivity.

A one-dimensional system of particles is examined in which even numbered particles are bound to adjacent even particles by harmonic spring forces, while odd particles are free. Even and odd particles collide elastically. This is a momentum conserving modification of the famous "ding-a-ling" model. Molecular-dynamics simulations are carried out and the current power spectra are obtained. The energy current power spectrum has zero slope at low frequencies. This implies that the thermal conductivity κ is finite and independent of system length L , for L sufficiently large. Steady-state simulations provide further evidence that κ is independent of L at large values of L . The relevance of this result to the proof by Prosen and Campbell that momentum conservation with nonvanishing pressure implies an infinite thermal conductivity is discussed.

Acute cholecystitis: video-laparoscopic versus traditional treatment.

It has been shown that a video-laparoscopic approach is the preferred method for treatment of cholecystitis. However, when we consider acute cholecystitis, many questions must be answered. The aim of this study is to compare video-laparoscopic and conventional surgery in the management of acute cholecystitis.

Videolaparoscopic approach of the splenic cyst: a case report.

The authors report a case of an asymptomatic 30-year-old female patient with an extensive cystic lesion continuous with the splenic parenchyma. A review of the literature and use of a videolaparoscopic approach to the treatment of these lesions is presented.

Non-traumatic acute abdomen: videolaparoscopic approach.

BACKGROUND AND OBJECTIVE: Although videolaparoscopy has been considered a safe method for many elective procedures, its use in traumatic and non-traumatic acute abdomen needs to be evaluated. The aim of this article is to evaluate the role of videolaparoscopy in non-traumatic acute abdomen as a method of diagnosis and treatment. METHODS: Between January 1992 and December 1996, 462 patients' charts were reviewed, retrospectively. Patients were admitted to the emergency room of São Rafael Hospital with symptoms of non-traumatic acute abdomen. Routine investigation of abdominal pain was performed in all patients, followed by videolaparoscopy. The laparoscopic procedures were done with four main purposes: diagnosis (ie, enteritis); diagnosis and treatment (ie, appendicitis); treatment only, when the diagnosis was known (ie, acute cholecystitis); and in cases where the conversion to conventional laparotomy was necessary, indicating the best incision. RESULTS: The vast majority of patients had inflammatory causes of acute abdomen (82.03%); others causes were hemoperitoneum (11.03%), bowel obstruction (3.25%), perforation of a hollow viscera (1.74%), vascular occlusion (1.3%), and negative laparoscopy (0.65%). CONCLUSIONS: This study shows that laparotomy was necessary in only 7.14% of the patients. The videolaparoscopic approach was used for diagnosis (99.35%) and treatment (92.86%) of patients with acute abdomen.

Laparoscopic versus open appendicectomy: a comparative study.

There are many questions regarding the advantages and disadvantages a videolaparoscopic approach in the treatment of acute appendicitis. The authors present the results of a non-randomized, prospective study with 496 patients admitted between January 1992 and March 1998 by the General Surgery Service of São Rafael Hospital Salvador-BA-Brazil. The patients were submitted for appendicectomy by video laparoscopy or by the traditional open method, and variables such as surgery duration, morbidity, mortality, costs, and length of stay (LOS) were compared. The results demonstrate that laparoscopic appendicectomy is a safe alternative for treatment of acute appendicitis; however, there are several disadvantages that gradually must be overcome.

Videolaparocholecystectomy: casuistry of 1000 cases.

Despite the ongoing evolution in the medical treatment of biliary pathology, the standard of treatment for gallstones remains cholecystectomy. There are no alternative treatments that have shown the same efficacy as surgery. Current alternative treatments have shown high recurrence and failure rates. Cholecystectomy remains the gold standard for management of gallstones. The surgical access of laparoscopic cholecystectomy accomplished by Mouret in 1987 allows for a reduction in operative trauma, hospital stay, postoperative pain and convalescence. These factors permit a faster return to normal activities. Today, laparoscopic cholecystectomy is performed in almost all medical centers around the world; however, the procedure is not free of complications. The objective of this study was to analyze our first 1000 cases of laparoscopic cholecystectomy, giving emphasis to the morbidity and mortality of the procedure.

Pediatric priapism associated with Mycoplasma pneumoniae.

OBJECTIVES: Priapism in the pediatric population is rare and most commonly occurs secondary to sickle cell disease or hematologic malignancy. We present a case of a 12-year-old boy with priapism who required aggressive surgical therapy for adequate detumescence. This patient had a recent viral upper respiratory infection and titers for Mycoplasma pneumoniae were indicative of infection. We propose that a hypercoagulable state was induced by the M. pneumoniae infection, which resulted in the priapism. METHODS: A 12-year-old boy with a recent upper respiratory illness presented to his pediatrician with priapism. After failing conservative management, the patient ultimately required a surgical shunt for detumescence. Serum was sent to detect antibodies against M. pneumoniae. RESULTS: The child failed to respond to corporeal irrigations and bilateral Winter shunts. He underwent an El-Ghorab procedure the following morning, which resulted in a flaccid penis. Serum M. pneumoniae antibodies were detected and indicated moderate infection. CONCLUSIONS: We propose that this 12-year-old boy had priapism secondary to infection with M. pneumoniae. M. pneumoniae infection can produce a hypercoagulable state, especially in selected areas of the circulation. This is the first reported case of priapism associated with M. pneumoniae.

Beta-thalassemia major and sickle cell disease.

Beta-thalassemia major and sickle cell disease are genetic disorders of red blood cells, caused by abnormal hemoglobin. These hemoglobinopathies affect males and females equally. Both are chronic disorders requiring lifelong treatment for affected individuals and education and support for them and their families. Special nursing considerations for the care of women facing the unique challenges of these disorders will be discussed.

[Progressive multifocal leukoencephalopathy in Wegener's granulomatosis in relation to therapy with cyclosporin A]. / Progressive multifokale Leukoenzephalopathie bei Wegener'scher Granulomatose unter Therapie mit Cyclosporin A.

A female patient with Wegener's granulomatosis developed severe bone marrow depression after two years treatment with cyclophosphamide. Corticosteroids alone could not sufficiently suppress disease activity, therefore additive therapy with Cyclosporin A was started. Four weeks later the patient developed a central nervous system disorder with affective disturbances and progressive somnolence. However, inspite of intensive diagnostic procedures, no definite diagnosis could be established. After another two months she died. Post-mortem-examination showed progressive multifocal leukoencephalopathy. An association between immunosuppressive therapy and reactivation of JC-Virus is suggested.

[The syndrome of post-transfusion purpura]. / Das Syndrom der posttransfusionellen Purpura.

Thrombocytopenic purpura occurred in two women aged 67 and 77 years, who earlier on had been pregnant, six and twelve days after blood transfusions. The platelet deficient phase lasted 16 and more than 50 days. Differentiation from other causes of thrombocytopenic haemorrhage was based on immunohaematologic findings. Both patients were negative for the platelet specific antigen PlA1 (Zwa). The platelet specific antibody (anti-PlA1) responsible for the purpura could be demonstrated and characterised immunologically.