Efficacy of transarterial embolisation in patients with life-threatening spontaneous retroperitoneal haematoma.

AIM: To evaluate the technical and clinical success of embolisation in patients with life-threatening spontaneous retroperitoneal haematoma (SRH) and to assess predictors of clinical outcome. MATERIALS AND METHODS: Thirty patients (mean age: 71.9±9.8 years) with SRH underwent digital subtraction angiography (DSA). All patients received anticoagulant or antiplatelet medication or a combination of both at the time the SRH occurred. RESULTS: Pre-interventional computed tomography angiography (CTA) revealed active retroperitoneal bleeding in 28 of 30 (93.3%) patients. DSA identified active haemorrhage in 22 of 30 patients (73.3%). Twenty-nine of 30 (96.7%) patients underwent embolisation. n-Butyl-2-cyanoacrylate (NBCA) was used in 15 patients (51.7%), coils were used in 10 patients (34.5%), and both embolic agents were used in four patients (13.8%). The technical success rate was 100%. Pre-interventional haemoglobin levels increased significantly after embolotherapy from 70.9±16.1 g/l to 87±11.3 g/l (p<0.001), whereas partial thromboplastin time decreased from 58±38 to 30±9 seconds (p<0.001) after embolotherapy. The need for transfusion of concentrated red cells decreased from 3±2.2 to 1±1.1 units (p<0.001) after the intervention. Clinical success was achieved in 19 of 29 (65.5%) patients. No major procedure-related complications occurred. Seven patients (24.1%) died within 30 days after the procedure. CONCLUSION: Embolotherapy in patients with life-threatening SRH leads to a high technical success rate and is a safe therapeutic option. The clinical success rate was acceptable and influenced by pre-interventional coagulation status and by the amount of transfused concentrated red cells.

Neurogenic heterotopic ossification: epidemiology and morphology on conventional radiographs in an early neurological rehabilitation population.

OBJECTIVE: To retrospectively evaluate neurogenic heterotopic ossification in an early neurological rehabilitation population (phases B and C) with respect to epidemiology and morphology on conventional radiographs. MATERIALS AND METHODS: Over a 4-year period, 1,463 patients treated at a clinic for early neurological rehabilitation were evaluated for clinical symptoms of neurogenic heterotopic ossification. In case of clinical suspicion, plain radiographs of the expected sites were obtained. If heterotopic ossification was detected, the initial and subsequent radiographs were retrospectively analyzed for sites, size, and morphology. Immature lesions were categorized as small (<10 mm) or large (10-100 mm). RESULTS: The prevalence rate of neurogenic heterotopic ossification was 2.05%. The condition was most common in young male adults. The hip was the most common site accounting for more than half of the cases. Two or more ossifications were seen in 56.7% of the affected patients with approximately two-thirds showing bilateral symmetric involvement of corresponding joint regions. The size of ossifications strongly varied interindividually. Small immature lesions demonstrated less progression in size than large lesions during maturation (P < 0.05). CONCLUSION: Standard radiographs, as a fast and inexpensive technique, allow the expected size progression of heterotopic ossifications during maturation to be estimated, which is relevant in terms of therapeutic decisions, patient mobilization, and neurological rehabilitation.

Treatment of refractory CMV-infection following hematopoietic stem cell transplantation with the combination of foscarnet and leflunomide.

BACKGROUND: Treatment of cytomegalovirus (CMV) disease after allogeneic hematopoietic stem cell transplantation (HSCT) is limited by toxicities of current antiviral drugs and the occurrence of drug resistant strains. Leflunomide, an immunosuppressive agent used for treatment of rheumatoid arthritis, also has activity against CMV by impairing viral assembly. Here we report the control of refractory CMV disease by the combined use of foscarnet and leflunomide. PATIENTS AND RESULTS: A 1S-year-old boy with juvenile myelo-monocytic leukemia (JMML) received an allogeneic HSCT with bone marrow stem cells from a mismatched, unrelated donor (MMUD, recipient and donor CMV-positive). CMV-reactivation two months post transplantation (Tx) could only be controlled by the use of cidofovir. Because of secondary graft failure, the boy received a second HSCT with peripheral blood stem cells (PBSC) of the same donor after overall 6 months. CMV-infection was noticed three weeks later, associated with a considerable rise of both CMV-copy number and pp65-antigen. Since reinduction with cidofovir was ineffective and ganciclovir not warranted due to the history of graft failure, the child then received a combination of foscarnet/leflunomide, leading to a rapid decline of his CMV-copy number and to an afebrile state. Hematological, hepatic or renal toxicities were not observed. CONCLUSION: This case report suggests that leflunomide may be of use in the management of transplant recipients with CMV-infection refractory or intolerant to conventional antiviral therapy.

[Problems of randomized studies in complementary medicine demonstrated in a study on mistletoe treatment of patients with breast cancer]. / Problematik randomisierter Studien in der Komplementärmedizin dargestellt am Beispiel der Misteltherapie bei Patientinnen mit Mammakarzinom.

BACKGROUND: Prospective randomized studies on mistletoe therapy repeatedly demonstrated that there is a basic problem in the matter of enrolling the appropriate number of patients within a reasonable amount of time. Most studies have to face this problem. However, recent experience suggests that this problem is more pronounced in the case of mistletoe treatment of cancer patients. OBJECTIVE: Possibility of recruitment and randomization of breast cancer patients for a mistletoe study. PATIENTS: During a period of 28 months every patient was registered who was admitted to the Gynecological Hospital of the University of Heidelberg because of suspected cancer. RESULTS: Out of 1,922 patients who were operated on for breast tumor, 521 first met the inclusion and exclusion criteria. 154 out of these 521 patients agreed to take part in the study. After availability of the final results on tumor staging and the therapy plan for conventional treatment, 80 out of the 154 women had to be excluded from the study. From the remaining 74 patients (48%), however, only 29 (39%) would have agreed to take part in a randomized mistletoe study. CONCLUSIONS: This confirms our suspicion that the difficulties of enrollment and randomization in the case of mistletoe studies exceed those of studies conducted in conventional oncology. The reasons for this dramatic effect and the possibility of alternative study designs are discussed.

Variability of filtration and food assimilation rates, respiratory activity and multixenobiotic resistance (MXR) mechanism in the mussel Perna perna under lead influence

The economic importance that myticulture is conquering in Santa Catarina State (South of Brazil) explains the crescent search for new coastal sites for farming. Physiological and biochemical studies of the mussel Perna perna are important to the establishment of methodologies for program assessment and environmental monitoring, allowing to infer about site quality and possible influences of xenobiotic agents on coastal areas. In order to evaluate effects caused by lead poisoning (1.21 mumol.L-1), the mussels were maintained at constant temperature (25ºC) and fed with Chaetoceros gracilis for 15 days. The control group was acclimatized in sea water 30ë. At the end of this period time, physiological measurements were carried out along with statistic analysis for filtration rates, lead assimilation and overall respiratory activity. The mechanism of multixenobiotic resistance (MXR) was particularly evaluated in standardized gill fragments using rhodamine B accumulation and its quantification under fluorescence optical microscopy. Regarding the control group, results had shown that the mussels maintenance in a lead-poisoned environment caused higher filtration rates (1.04 and 2.3 and L.h-1.g-1; p < 0.05) and lower assimilation rates (71.96 percent and 54.1 percent, respectively). Also it was confirmed a lesser rhodamine B accumulation in the assays under influence of lead, suggesting that this metal induces the MXR mechanism expression in mussel P. perna. These results indicate that such physiological and biochemical alterations in the mussels can modify the energy fluxes of its metabolism, resulting in possible problems on the coastal systems used as cultivating sites

Measurements of IL-6, soluble IL-6 receptor and soluble gp130 in sera of B-cell lymphoma patients. Does viscum album treatment affect these parameters?

Interleukin-6 (IL-6) can be involved in several diseases including lymphoid malignancies. This cytokine binds to soluble IL-6 receptor (sIL-6R) circulating in blood, leading to signal transduction via gp130. Soluble IL-6R shows agonistic activity for IL-6, and the soluble form of gp130 (sgp130) an antagonistic effect against the complex IL-6/sIL-6R. Viscum album extract (Iscador) as an immunomodulator is used in the treatment of malignant disorders. In this study we investigated the effect of this treatment on the serum levels of IL-6, sIL-6R and sgp130 in B-cell lymphoma patients (n = 27), in comparison to healthy controls (n = 28). Twenty-one of 27 patients had been treated previously with chemo/radiotherapy. The patients were divided into two groups; those with short-term (investigated before and during treatment) or those with long-term Viscum album (VA) therapy (investigated during therapy). The serum levels of the three parameters were determined by ELISA. In patients having short-term treatment IL-6 values were similar to those of controls. During long-term therapy the values were significantly lower (P<0.05). The values of sIL-6R were elevated only in long-term treated patients (P<0.05), the values of sgp130 in both short-term (P<0.05) and in long-term treated patients (P=0.001). There is a significant correlation (P<0.05) between levels of sIL-6R and sgp130 in both therapy groups at 24 hours after injection. This indicates that the potent effect of sIL-6R on the biological activity of IL-6 could be inhibited by sgp130 as antagonist. Clinical data show that half of the patients (6/12) with long-term treatment had a continuous complete remission, whereas only 2/15 patients with short-term treatment had a complete remission.

Variability of filtration and food assimilation rates, respiratory activity and multixenobiotic resistance (MXR) mechanism in the mussel Perna perna under lead influence.

The economic importance that multiculture is conquering in Santa Catarina State (South of Brazil) explains the crescent search for new coastal sites for farming. Physiological and biochemical studies of the mussel Perna perna are important to the establishment of methodologies for program assessment and environmental monitoring, allowing to infer about site quality and possible influences of xenobiotic agents on coastal areas. In order to evaluate effects caused by lead poisoning (1.21 mumol.L-1), the mussels were maintained at constant temperature (25 degrees C) and fed with Chaetoceros gracilis for 15 days. The control group was acclimatized in sea water 30@1000. At the end of this period time, physiological measurements were carried out along with statistic analysis for filtration rates, lead assimilation and overall respiratory activity. The mechanism of multixenobiotic resistance (MXR) was particularly evaluated in standardized gill fragments using rhodamine B accumulation and its quantification under fluorescence optical microscopy. Regarding the control group, results had shown that the mussels maintenance in a lead-poisoned environment caused higher filtration rates (1.04 and 2.3 and L.h-1.g-1; p < 0.05) and lower assimilation rates (71.96% and 54.1%, respectively). Also it was confirmed a lesser rhodamine B accumulation in the assays under influence of lead, suggesting that this metal induces the MXR mechanism expression in mussel P. perna. These results indicate that such physiological and biochemical alterations in the mussels can modify the energy fluxes of its metabolism, resulting in possible problems on the coastal systems used as cultivating sites.

Variability of filtration and food assimilation rates, respiratory activity and multixenobiotic resistance (MXR) mechanism in the mussel Perna perna under lead influence

The economic importance that myticulture is conquering in Santa Catarina State (South of Brazil) explains the crescent search for new coastal sites for farming. Physiological and biochemical studies of the mussel Perna perna are important to the establishment of methodologies for program assessment and environmental monitoring, allowing to infer about site quality and possible influences of xenobiotic agents on coastal areas. In order to evaluate effects caused by lead poisoning (1.21 mumol.L-1), the mussels were maintained at constant temperature (25ºC) and fed with Chaetoceros gracilis for 15 days. The control group was acclimatized in sea water 30‰. At the end of this period time, physiological measurements were carried out along with statistic analysis for filtration rates, lead assimilation and overall respiratory activity. The mechanism of multixenobiotic resistance (MXR) was particularly evaluated in standardized gill fragments using rhodamine B accumulation and its quantification under fluorescence optical microscopy. Regarding the control group, results had shown that the mussels maintenance in a lead-poisoned environment caused higher filtration rates (1.04 and 2.3 and L.h-1.g-1; p 0.05) and lower assimilation rates (71.96% and 54.1%, respectively). Also it was confirmed a lesser rhodamine B accumulation in the assays under influence of lead, suggesting that this metal induces the MXR mechanism expression in mussel P. perna. These results indicate that such physiological and biochemical alterations in the mussels can modify the energy fluxes of its metabolism, resulting in possible problems on the coastal systems used as cultivating sites.

A importância sócio-econômica que a mitilicultura conquistou no Estado de Santa Catarina explica a crescente procura por novos sítios costeiros para o seu uso. Estudos fisiológicos e bioquímicos do mexilhão Perna perna se apresentam como metodologias viáveis para programas de avaliação e monitoramento ambiental, permitindo inferir sobre a qualidade dos sítios e possíveis influências de agentes xenobióticos nas áreas costeiras. Com o objetivo de determinar a existência de variabilidade nesses parâmetros evocada pelo chumbo (1.21 mimol.L-1), mexilhões Perna perna foram mantidos à temperatura constante e alimentados com Chaetoceros gracilis por 15 dias. O grupo controle foi aclimatado em água do mar a 30‰. No final desse período foram realizados experimentos estáticos fisiológicos de filtração, respiração e assimilação, como também foi quantificada a atividade do mecanismo MXR em fragmentos de brânquias, pelo acúmulo de rodamina B, por microscopia óptica de fluorescência. Em relação ao grupo controle, a manutenção dos organismos em solução de chumbo causou maiores taxas de filtração (1,04 e 2,3 e L.h-1.g-1; p 0,05) e menores taxas de assimilação (71,96 e 54,1%, respectivamente). Também foi confirmado menor acúmulo de rodamina nos organismos sob influência do chumbo, sugerindo que este metal induz a expressão do mecanismo MXR no mexilhão Perna perna. Os resultados indicam que tais alterações fisiológicas e bioquímicas do mexilhão podem alterar os fluxos de energia no metabolismo, resultando em possíveis problemas nos sistemas costeiros utilizados como sítios de cultivos.

[Favorable long-term outcome with mistletoe therapy in a patient with centroblastic-centrocytic non-Hodgkin lymphoma]. / Langfristig guter Verlauf unter Misteltherapie bei einem Patienten mit einem zentroblastisch-zentrozytischen Non-Hodgkin-Lymphom.

HISTORY AND ADMISSION FINDINGS: Follicular non-Hodgkin lymphoma had been diagnosed in a 44-year-old man. Physical examination revealed several cervical, axillary, inguinal and infrainguinal lymphomas, maximally 1.5 x 1.2 cm in diameter. ADDITIONAL INVESTIGATIONS: Computed tomography showed multiple thoracic, abdominal and inguinal lymphoma, which--according to the Ann Arbor classification--were follicular non-Hodgkin stage IV (low grade) lymphoma with bone marrow infiltration. TREATMENT AND COURSE: Treatment with an extract of mistletoe (Iscador) was initiated and has been continued to-date (12 years). Quality of life throughout ths period has remained good. Phases of uninterrupted treatment resulted in lymphoma regression (regionally complete), while cessation of treatment led to progression. CONCLUSION: This case report demonstrates the efficacy of treating lymphoma with extract of mistletoe (Iscador). This therapeutic success confirms the result obtained in other patients with this disease. Thoughts of contraindication to mistletoe therapy belong to the realm of unfounded speculation.

Stopping a silent killer. Preventing heart disease in women.

It's true that, at any age, heart disease occurs more often in men than in women. While heart disease is widely recognized as an important cause of death and disability in men, we often fail to appreciate that it is the leading cause of death in women older than age 60.

Long-term persistence of immunoglobulin A (IgA) and IgM antibodies against human cytomegalovirus in solid-organ transplant recipients.

The retrospective analysis of 494 solid-organ transplant recipients revealed that during the follow-up period (mean duration, 3.2 years) 184 (88%) of 209 anti-human cytomegalovirus (HCMV) immunoglobulin A (IgA)-positive patients remained IgA positive, as did 128 (74.85%) of 171 anti-HCMV IgM-positive patients. We conclude that anti-HCMV IgA and IgM testing for management of clinically relevant HCMV infections in solid-organ transplant recipients is dispensable.

Biogenic amines and division of labor in honey bee colonies.

Brain levels of dopamine, serotonin, and octopamine were measured in relation to both age-related division of labor and inter-individual differences in task specialization independent of age in honey bee colonies. The only differences among similarly aged bees performing different tasks were significantly lower levels of dopamine in food storers than comb builders and significantly lower levels of octopamine in soldiers than foragers, but soldiers also were slightly younger than foragers. Differences associated with age-related division of labor were stronger. Older bees, notably foragers, had significantly higher levels of all three amines than did younger bees working in the hive. Using social manipulations to unlink chronological age and behavioral status, octopamine was found to exhibit the most robust association between behavior and amine level, independent of age. Octopamine levels were significantly lower in normal-age nurses versus precocious foragers and overage nurses versus normal-age foragers, but not different in reverted nurses versus reversion colony foragers. Dopamine levels were significantly lower in normal-age nurses versus precocious foragers, but higher in reverted nurses versus reversion colony foragers. Serotonin levels did not differ in any of these comparisons. These correlative results suggest that octopamine is involved in the regulation of age-related division of labor in honey bees.

A double-blind study comparing the safety, tolerability, and efficacy of ioversol 320 and iopamidol-300 in cerebral angiography.

Ioversol is a new nonionic, triiodinated, water-soluble contrast medium. In a controlled double-blind study, ioversol 320 versus iopamidol-300 was tested on 60 patients in cerebral angiography. The safety of the contrast medium, the general and local tolerance, as well as the contrast quality were tested. In this study, ioversol 320 displayed no differences from iopamidol-300 in terms of contrast quality, neurologic status, and liver and kidney tolerance. In the local tolerance test, patients receiving ioversol 320 perceived significantly less heat than patients receiving iopamidol-300 when all injections were considered.

End-user programs in medical school libraries: a survey.

A questionnaire was sent to all medical school libraries listed in the Annual Statistics of Medical School Libraries in the United States and Canada (1983-1984) asking librarians to describe their end-user programs. Of the 113 responding libraries, 78 had an end-user program. All provided some kind of formal instruction, 39 made equipment available to end users, and 22 provided and administered passwords. The reasons most cited for starting a program were staff interest and patron requests. The two most frequently taught systems were NLM/MEDLINE and BRS/Colleague. In general, respondents felt positive about the programs and planned to continue them. The most frequently mentioned problem was need for more equipment.

Conspiracy of silence: psychiatric counseling with students at high risk for academic failure.

The authors examined the academic records and counseling histories of 132 freshman students at a state university who sought psychiatric counseling. They found that most students with poor previous academic performance were not helped academically by brief (crisis intervention) psychiatric counseling. They also found that many couselors resisted confronting such students with their academic inadequacies.