[Acne inversa: A rare disease with far-reaching consequences for those affected : Experiences and wishes of patients]. / Acne inversa: eine seltene Erkrankung mit weitreichenden Auswirkungen für Betroffene : Erfahrungen und Wünsche von Patienten.

Patients affected by acne inversa (hidradenitis suppurativa) initially notice skin changes in atypical areas of the skin. These changes can include purulent inflammation, painfully filled and red-discolored bumps or oozing and strongly smelling, small to larger openings. In order to be able to receive medical help, patients must present to the general practitioner, report their complaints and also show the lesions. This represents an enormous inhibition threshold for those affected. However, the disease is usually recognized too late. This less known skin condition is often confused with other skin diseases. Even after diagnosis, adequate treatment is not always guaranteed. On the patient side, too, fear and feelings of shame prevent the patient from visiting the doctor, long-term therapies without success create a feeling of hopelessness, and fear of losing one's job are reasons for seeking therapy too late. The quality of life is lowest compared to individuals with other dermatoses. In addition to interdisciplinary treatment, the diverse situations experienced by those who are affected need to be acknowledged in social and medical settings.

Enterovirus 71 outbreak in Northern Sydney, 2013: case series and initial response.

AIM: Enteroviruses are a common cause of childhood disease which may manifest in a variety of ways. Enterovirus 71 (EV71) is a subtype of enterovirus which can cause meningoencephalomyelitis resulting in neurological sequelae including lethargy, weakness, ataxia, sleep myoclonus, urinary retention and, in severe cases, cardiorespiratory collapse due to neurogenic pulmonary oedema. EV71 was responsible for outbreaks in South East Asia in 1997-1998, in Western Australia in 1999 and in Sydney in 2000-2001. In 2013, we are experiencing another EV71 outbreak in Sydney. This study describes the discovery of a new outbreak in Sydney's Northern Beaches, the clinical findings as well as the public health response. METHODS: Thirty-seven children in total presented with presumed EV71 to the Northern Beaches Health Service from December 2012 to April 2013. Most children presented with a prodrome lasting 2-7 days prior to seeking medical attention. Sleep myoclonus was a common presenting sign occurring in 65%. Neurological signs were subtle in the majority of children and were at times missed by clinicians on a child's first presentation. Forty-six per cent of children who presented to Northern Beaches Health Service during this outbreak required a transfer to a tertiary paediatric centre for more intensive care. RESULTS: The public health investigation was important in establishing that the disease was widespread throughout the community and not as a result to exposure to a single child care setting. Identification of risk factors enabled more targeted communication to medical practitioners, child care centres and parents within the local community. CONCLUSIONS: EV71 is in Australia and all clinicians seeing children in primary, secondary and tertiary care centres need to be aware of the disease, the subtle nature of initial symptoms and the potentially devastating consequences.

Reduction of the complication rate in Liechtenstein hernia repair.

BACKGROUND: Inguinal hernia is one of the most common pathologies in the surgical setting. The introduction of the Lichtenstein technique in 1989 (tension-free hernioplasty with polypropylene mesh) represented one of the most significant breakthroughs in the treatment of this condition since Bassini's hernia repair. The aim of this study was to know the most significant predictive variables of complications in Lichtenstein hernioplasty and if some changes introduced in the technique could reduce these complications. STUDY DESIGN: A prospective study of 2002 inguinal hernias in 1592 patients, operated on during 17 years, using the Lichtenstein tension-free technique for hernia repair with a heavy polypropylene mesh. The early and late complications and the outcome of modifications introduced in the technique over the study period have all been studied. RESULTS: The modification in the type of closure reduced the complications rate from 14.4% down to 2.7%. The introduction of antibiotic prophylaxis reduced the infection rate from 1.2% down to 0.2%. CONCLUSIONS: The most significant predictive variables of complications in Lichtenstein hernioplasty are the type of closure, antibiotic prophylaxis, ASA risk and the presence of previous recurrence.

The genome of the social amoeba Dictyostelium discoideum.

The social amoebae are exceptional in their ability to alternate between unicellular and multicellular forms. Here we describe the genome of the best-studied member of this group, Dictyostelium discoideum. The gene-dense chromosomes of this organism encode approximately 12,500 predicted proteins, a high proportion of which have long, repetitive amino acid tracts. There are many genes for polyketide synthases and ABC transporters, suggesting an extensive secondary metabolism for producing and exporting small molecules. The genome is rich in complex repeats, one class of which is clustered and may serve as centromeres. Partial copies of the extrachromosomal ribosomal DNA (rDNA) element are found at the ends of each chromosome, suggesting a novel telomere structure and the use of a common mechanism to maintain both the rDNA and chromosomal termini. A proteome-based phylogeny shows that the amoebozoa diverged from the animal-fungal lineage after the plant-animal split, but Dictyostelium seems to have retained more of the diversity of the ancestral genome than have plants, animals or fungi.

Improving access to liver transplantation: the University of Puerto Rico experience

Liver transplantation is the only treatment for end-stage liver disease. It is costly, difficult, and not performed in Puerto Rico. For these reasons, it has been a limited option for Puerto Ricans with advanced cirrhosis, especially for those with no medical insurance to cover for the procedure. In an effort to improve access to the procedure and offer this chance of life to more Puerto Ricans facing death from complications of advanced liver disease, the Gastroenterology and Liver Diseases Division of the University of Puerto Rico, in collaboration with LifeLink Transplant Institute in Tampa, Florida and the Office of Catastrophic Funds of the Commonwealth of Puerto Rico, opened a clinic for liver transplant evaluation at the Medical Sciences Campus. The purpose of this clinic is to coordinate the pre-transplant evaluation of candidates for this therapy, provide the evaluation by the transplant surgeon in Puerto Rico, expedite the process in seriously ill patients, and offer post-transplant follow-up upon the patient's return to Puerto Rico. The purpose of this article is to describe the experience in this clinic from 1999 to 2003. One hundred ninety-three patients were seen from September 1999 to January 2003. The most common causes for liver disease were hepatitis C and alcohol, alone or in combination. One hundred thirty four were accepted as candidates for evaluation. Of these, 63 had completed the process, 33 were listed for transplantation and 21 had been transplanted by January 2003. Neither education level, marital status, health insurance nor Child score were associated with successful outcome. This clinic offers Puerto Ricans, especially those with limited resources, with a viable access to liver transplantation.

Prevalence of inflammatory bowel disease in an insured population in Puerto Rico during 1996

OBJECTIVES: Limited data exists about Inflammatory Bowel Disease (IBD) in Hispanic populations. The aims of the present study were to estimate overall and specific prevalence of IBD (Crohn's disease and ulcerative colitis) and to describe the characteristics of a group of patients from the University of Puerto Rico's IBD Registry. METHODS: To estimate the prevalence of IBD, computerized records of all physician billing and hospital discharges from a major health insurer in Puerto Rico and classified with ICD-9-CM codes 555.0-555.9 (Crohn's disease) and 556.0-556.9 (ulcerative colitis) during 1996 were searched. Prevalence was estimated by age group, sex, and type of insurance. To describe demographic and selected clinical information from patients with IBD, data gathered in the University of Puerto Rico's IBD Registry from 1995 through 2000 was analyzed. RESULTS: Out of 802,726 insured individuals, 332 had a diagnosis of Crohn's disease, 499 of ulcerative colitis and 21 had both diagnoses. The estimated prevalence per 100,000 was 41.4 for Crohn's disease, 62.2 for ulcerative colitis, and 106.1 cases per 100,000 for IBD. Peak prevalence of Crohn's disease occurred among the age groups 50-59 years and > or = 60 years, and the overall female:male prevalence ratio of Crohn's disease was 1.13 (95 per cent CI: 0.91-1.42). Ulcerative colitis was most prevalent among insured individuals aged 50-59 years and 40-49 years. The prevalence of ulcerative colitis was significantly higher among females than among males, with an overall prevalence ratio of 1.42 (95 per cent CI: 1.18-1.71). Of 342 patients participating in the IBD Registry, 155 (45.3 per cent) had Crohn's disease and 187 (54.7 per cent) had ulcerative colitis. Among patients diagnosed with Crohn's disease, 51.6 per cent were females, the mean age was 35.2 +/- 18.3 years, and 18.1 per cent had a family history of IBD. More than half (57.8 per cent) of patients with ulcerative colitis were females, the mean age was 42.6 +/- 17 years, and 17.1 per cent had a family history of IBD. CONCLUSIONS: The estimated prevalence of IBD in this insured population in Puerto Rico places it among the middle-range of that reported for other countries. Additional studies must be conducted in Puerto Rico in order to confirm the observed findings. Population-based epidemiologic studies aimed at estimating the burden of IBD in Hispanic populations in the United States and Latin America are essential for health care planning.

Competitive-kinesthetic interaction therapy.

The competitive-kinesthetic interaction therapy is based on several clinical observations of patients who are treated with the Brügger therapy in the "Murnau approach" and who are suffering from different pain syndromes in their movement system. These patients reported definite lessening of their tinnitus, including (in some cases) a complete cessation of their subjective ear noise, as a result of our therapy on the movement system. Our goal is to modulate and automate the civilizatory unforable engraved individual global movement patterns. This success, which accompanied the therapeutic removal of movement imbalance and related posture and motion disorders, suggests the possibility of influencing the balance-surveying organs of the complex equilibrium system, summarizing the information from the equilibrium tetrad within a central space-oriented data processing system, via the muscles of the entire locomotor system. A very important point is that the subjective improvements can be objectified in brain electrical activity mapping of vestibular evoked potentials. Two-hundred patients were treated with this therapy and were examined between April 1998 and April 1999.

Gingko biloba (Rökan) therapy in tinnitus patients and measurable interactions between tinnitus and vestibular disturbances.

Tinnitus is one of the most important symptoms in neurootology after vertigo, nausea, and hearing loss. In most cases, the origin of the tinnitus remains inexplicable. Well-known, however, is that tinnitus may arise in any part of the hearing pathway (i.e., both within the cochlea receptor and in the temporal lobe and projections). Tinnitus also is associated frequently with vertigo, nausea and hearing loss. An age predominance exists, with tinnitus more common among those older than 40 years. From this starting point, a great demand exists today for new ideas and developments in the diagnosis and treatment of tinnitus.

[Cardiac effects of Cordemcura in vitro]. / Herzwirkungen von Cordemcura in vitro.

Cordemcura has a dose-dependent inotropic effect in the Langendorff-perfused guinea pig heart, in the isolated spontaneously active atria of the guinea pig as well as in the isolated electrically stimulated rabbit papillary muscle. Tachyphylaxy symptoms and arrhythmogene side-effects have not been observed. The dose-dependent coronardilatory effect caused by Cordemcura as observed at the isolated heart of a guinea-pig appears intensely. The positive inotropic effect by Cordemcura on an isolated electrically stimulated papillary muscle of a rabbit is linked with a significant decrease of the relaxation time t2, whereas there is no change in the time to peak force t1. Both mean velocity of force development S1 as well as the mean velocity of relaxation S2 are increased by Cordemcura.