[Clinical and sonographic examination findings in patients with carotid-cavernous sinus fistulas]. / Klinische und echographische Untersuchungsbefunde bei Patienten mit Carotis-Sinus-cavernosus-Fisteln.

BACKGROUND: Symptoms and clinical findings in patients with carotid-cavernous fistulas are specific. Nevertheless, they can be very mildly expressed. This study aims to point out the potential diagnostic value of ultrasound of the orbit. METHODS: A total of 25 patients with a reliable angiographic diagnosis of a fistula were reviewed retrospectively. We analyzed the symptoms, clinical findings and demonstrability in ultrasound of the orbit. RESULTS: The most common clinical findings were nerve palsy, dilation of episcleral vessels and exophthalmos. If an ultrasound had been part of the examination a dilation of the superior ophthalmic vein could be demonstrated in all cases. CONCLUSION: The expeditious ultrasound investigation provides valuable information for the diagnosis of red eyes which are resistant to treatment. The examiner has to consider a fistula and perform an ultrasound especially when diplopia has newly occurred. Finally, the expedient neuroimaging can be arranged.

[Contact lens-associated superficial stromal keratitis caused by Paecilomyces lilacinus]. / Kontaktlinsenassoziierte oberflächliche stromale Keratitis durch Paecilomyces lilacinus.

This article presents two cases of contact lens wearers with keratitis caused by Paecilomyces lilacinus. The special feature of these cases was the superficial manifestation of the infection in the upper stromal layer without infiltration into deeper layers. The pathogen was identified following epithelial debridement and corneal scraping. In both cases the fungal keratitis could be successfully managed by intensive topical treatment with voriconazole. Except for an epithelial debridement with EDTA chelation and an amniotic membrane transplantation in one case, no further surgical interventions were necessary.

Regular participation in leisure time activities and high cardiovascular fitness improve motor sequence learning in older adults.

INTRODUCTION: Older adults show higher interindividual performance variability during the learning of new motor sequences than younger adults. It is largely unknown what factors contribute to this variability. This study aimed to, first, characterize age differences in motor sequence learning and, second, examine influencing factors for interindividual performance differences. METHOD: 30 young adults (age M = 21.89, SD = 2.08, 20 female) and 29 older adults (age M = 69.55, SD = 3.03, 18 female) participated in the study. Motor sequence learning was assessed with a discrete sequence production (DSP) task, requiring key presses to a sequence of visual stimuli. Three DSP practice phases (á 8 blocks × 16 sequences, two six-element sequences) and two transfer blocks (new untrained sequences) were performed. Older participants conducted the Mini-Mental Status Examination and a visuospatial working-memory task. All participants finished a questionnaire on everyday leisure activities and a cardiovascular fitness test. RESULTS: Performance speed increased with practice in both groups, but young improved more than older adults (significant Group × Time effect for response time, F(1,5) = 4.353, p = 0.004, [Formula: see text] = 0.071). Accuracy did not change in any age group (non-significant Group × Time effect for error rates, F(1,5) = 2.130, p = 0.091, [Formula: see text] = 0.036). Older adults revealed lower transfer costs for performance speed (significant Time × Group effect, e.g., simple sequence, F(1,2) = 10.511, p = 0.002, [Formula: see text] = 0.156). High participation in leisure time activities (ß = - 0.58, p = 0.010, R2 = 0.45) and high cardiovascular fitness (ß = - 0.49, p = 0.011, R2 = 0.45) predicted successful motor sequence learning in older adults. DISCUSSION: Results confirmed impaired motor learning in older adults. Younger adults seem to show a better implicit knowledge of the practiced sequences compared to older adults. Regular participation in leisure time activities and cardiovascular fitness seem to prevent age-related decline and to facilitate motor sequence performance and motor sequence learning in older adults.

[Self-Medication, Health and Online Orders: An Online Survey]. / Selbstmedikation, Gesundheit und Internetbestellung: Eine Online-Befragung.

Background: The intensive use of Internet as health guide is proved by a current representative survey. Online orders of OTC pharmaceuticals and prescription medicine represent a special way of utillisation. Intention: The aim of the following study is to investigate motives and backgrounds of self-medication in coherency of health and ordering of OTC pharmaceuticals via Internet. Method: With an online questionnaire developed in particular for this thesis N=104 internet users (mean age M=32,7; SD=11,1 consisting of 73 female and 31 male participants) were questioned concerning the relevant topics. Furthermore, the subjects were interviewed with regard to identification of their quality of life (with the German version of the EUROHIS-QOL 8 item index), their well-being (by using the German version of the WHO-5 well-being index, version II). Results: The wish for (especially temporal) independence from a physicians treatment and the idea of a faster convalescence or prevention of worse ailment could be identified as motives for self-medication. The most frequently selected advantages of ordering drugs via internet were the lower price, organisational aspects such as direct home delivery or saving time without a consultation. In contrast, the lack of advice was often mentioned as a possible disadvantage, just like the risk of undetected and undiagnosed diseases. Compared to participants who did not do any Internet orders, participants who ordered their non-prescription drugs on the Internet were less aware of possible risks and they also used painkillers available without prescription more frequently. However, there were no differences in the total amount of applied OTC medications, which made a drug abuse less likely. Overall, self-medication of the users of Internet forums interviewed within this thesis seemed to be quantitatively and qualitatively appropriate. Conclusion: Self-medication by Internet users in this study seems to be reasonable in a quantitative and qualitative way.

Herpetogramma bipunctalis (Lepidoptera: Crambidae) biology and techniques for rearing on leaves of the blackberry (Rubus spp., Rosaceae).

The larvae of the southern beet webworm Herpetogramma bipunctalis (Fabricius, 1794) damage the leaves of species in the plant genus Rubus. The present study investigated the biology of H. bipunctalis and developed a protocol for raising H. bipunctalis under laboratory conditions. On the basis of the biological data, we devised a life table. In order to develop the rearing procedures, we determined which oviposition substrate and blackberry cultivar were the most appropriate for larval development. The mean durations of the egg, larval, and pupal stages were 5.59 days, 26.37 days, and 13.37 days, respectively, and the corresponding survival rates were 80.83%, 49.07%, and 83.23%. The mean pupal weight was 0.0491 g for males and 0.0536 g for females. The mean life cycle (egg-to-adult) period was 45.33 days, and overall survival to adulthood was 33.01%. H. bipunctalis females laid a mean of 252.63 eggs over a mean of 13.60 days of oviposition; the mean pre-oviposition period was 2.67 days. Mean female and male life spans were 17.51 and 19.25 days, respectively, and the sex ratio was 0.51. The life-table data indicated that H. bipunctalis can reproduce 57.9 times per generation. Each cage contained one blackberry leaf placed on a paper towel. This method allowed us to obtain the greatest number of eggs. The larval stage was shorter for insects reared on leaves of the Guarani cultivar than for those reared on leaves of the Xavante cultivar (22.63 vs. 26.37 days). These basic data can aid in establishing strategies for the management of H. bipunctalis on blackberry farms.

Cytokines in mycobacterial infections: in vitro and ex vivo studies.

Different species of mycobacteria differ in their capacity to induce the production of tumor necrosis factor-alpha (TNF-alpha) by human monocytes in vitro. Whereas M. tuberculosis is a potent inducer of TNF-alpha, M. leprae is much less potent. TNF-alpha production is found to be associated with the availability of H2O2 generated by activated monocytes, as superoxide enhancing H2O2 concentration increases and catalase degrading H2O2 decreases TNF-alpha production. Furthermore, M. kansasii with high intrinsic catalase induce less TNF-alpha than mycobacteria with low intrinsic catalase. In vitro infection of monocytes with M. tuberculosis leads to an impairment of the antigen-presenting capacity, as determined by a reduction of antigen-induced T cell proliferation and interferon gamma (IFN-gamma) production. Of crucial importance is this impairment is the M. tuberculosis-induced down-modulation of MHC class II antigens. The role of TNF-alpha in vivo is reflected in patients with various forms of leprosy. In skin lesions of lepromatous leprosy patients TNF-alpha, interleukin 1 beta (IL-1 beta), and INF-gamma production are found to be rare, whereas these cytokines are well expressed in skin lesions of patients with tuberculoid leprosy. After multidrug chemotherapy an increase of local cytokine production is found. Taken together, these findings suggest that components of mycobacteria may interfere with local cell-mediated immune reactions in vivo. The molecular mechanisms involved in these local responses need to be defined.

Species-specific assessment of Mycobacterium leprae in skin biopsies by in situ hybridization and polymerase chain reaction.

Conventional histopathologic diagnosis of mycobacterial infections are limited to the determination of "acid-fast bacilli". A species-specific diagnosis is thus far impossible. In addition, routine microbiologic assessments of mycobacteria suffer from the major drawback that a species-specific diagnosis is extremely time-consuming and in several cases even impossible. As Mycobacterium leprae cannot be cultured in vitro, we tried to specifically target this obligate intracellular parasite by in situ hybridization and polymerase chain reaction (PCR) techniques. For this purpose we used a 22 mer oligonucleotide probe recognizing a species-specific sequence of the 16S rRNA of Mycobacterium leprae. Using an immunoenzymatic detection method for in situ hybridization we were able to specifically assess Mycobacterium leprae (a) in long-term cultured macrophages in vitro infected with different mycobacteria species and (b) in frozen sections of skin biopsies obtained from patients suffering from lepromatous leprosy. These results could be confirmed and extended by PCR experiments in which we used conserved oligonucleotide primers for 16S rRNA to amplify bacterial DNA isolated from different eubacterial species and from fresh-frozen as well as from formalin-fixed, paraffin-embedded and routinely processed mycobacteria-infected tissues. Upon Southern blot analysis, the Mycobacterium leprae-specific oligonucleotide probe exclusively hybridized with PCR products obtained from Mycobacterium leprae-containing samples (including paraffin sections), but not with PCR products obtained from samples containing other mycobacterial species. As species-specific oligonucleotide probes targeted at rRNA are described for a variety of mycobacterial species, these methods may be generally applied for a rapid species-specific assessment of mycobacteria in histologic material.

Enhancement of monocyte antimycobacterial activity by diethyldithiocarbamate (DTC).

Diethyldithiocarbamate (DTC) has been recently reported to significantly reduce the incidence of opportunistic infections in HIV-infected patients. The present study addresses the question whether DTC is capable of stimulating antimycobacterial activity of mononuclear phagocytes. We found that peripheral blood mononuclear cells (PBMC) of healthy subjects preincubated in vitro with 100-1000 ng/ml of DTC and thereafter infected with Mycobacterium tuberculosis H37Rv or Mycobacterium avium-intracellulare complex exhibited an enhanced antimycobacterial activity compared with control-incubated cells as assessed by the determination of mycobacterial colony-forming units. In subsequent experiments monocytes from healthy volunteers injected with 5 mg/kg body weight of DTC were tested ex vivo for antimycobacterial activity at various periods of time after injection. Injection of DTC resulted in a significant enhancement of antimycobacterial activity which was most evident 24 h after DTC injection. We conclude that DTC stimulates the antimicrobial function of mononuclear phagocytes both in vitro and in vivo. These results may explain the favourable clinical course observed in HIV-infected patients treated with DTC and may serve as a basis for treatment with DTC in patients with drug-resistant atypical mycobacteriosis.