The best way to assess oedema using T1, T2 mapping or three-dimensional T2-weighted fast-spin-echo triple inversion recovery sequences via cardiovascular MRI in outpatients with suspected myocarditis.

AIM: To evaluated T1-, T2 mapping, and a three-dimensional (3D) T2-weighted fast-spin-echo triple inversion recovery sequences (3D STIR) for diagnosing myocardial oedema in patients with suspected early myocarditis and at follow-up. MATERIALS AND METHODS: Sixteen patients with suspected myocarditis and 15 controls matched for gender and age were examined prospectively. To evaluate oedema, an electrocardiogram-triggered T1 and T2 mapping with a gradient spin echo technique and 3D STIR sequences were used to cover the entire left ventricle. The signal intensity ratio (heart muscle in relation to skeletal muscle) was calculated (3D STIR ratio). All patients underwent repeat examinations at follow-up. RESULTS: The mean 3D-STIR ratio was 2.14±0.45 at the patients' initial examination as compared to the control patients' 1.54±0.18 in (p=0.0001) and 1.75±0.16 in patients at follow-up (p=0.002 versus first visit). The 3D STIR ratio of the septum, anterior, lateral, and inferior wall also differed significantly between patients and controls. No significant difference was observed in T1 and T2 mapping between patients and controls at baseline and patients at follow-up. CONCLUSIONS: A significantly higher global signal intensity ratio with 3D-STIR was identified in patients with suspected myocarditis compared to controls, and a significant change during follow-up. No significant difference was detected in T1-, T2 mapping between patients and controls, or between the initial examination and follow-up of patients. The global 3D-STIR ratio may therefore be useful for the diagnosis of myocarditis and should be explored further.

[Efficacy of a ketogenic diet in urological cancers patients : A systematic review]. / Wirksamkeit der ketogenen Diät bei urologischen Tumorerkrankungen : Ein systematischer Review.

BACKGROUND: Beside the classical anticancer treatment tumor patients try to find proactive alternative therapies to fight their disease. Lifestyle changes such as introducing a ketogenic diet is one of the most popular among them. The German Association of Urological Oncology (AUO, Arbeitsgemeinschaft Urologische Onkologie) presents a systematic review investigating the evidence of ketogenic diet in cancer patients. MATERIALS AND METHODS: A systematic literature research was conducted in the databases Medline, Livivo, and the Cochrane Library. Only clinical studies of tumor patients receiving chemotherapy while on a ketogenic diet were included. The assessment of the results was performed according to the predefined primary endpoints overall survival and progression-free survival and secondary endpoints quality of life and reduction of adverse effects induced by cytostatics. RESULTS: Nine studies met the inclusion criteria: eight prospective and one retrospective study case series respectively cohort-studies, with a total of 107 patients. Currently there is no evidence of a therapeutic effect of a ketogenic diet in patients with malignant tumors regarding the clinical outcome or quality of life. CONCLUSION: Based on the current data, a ketogenic diet can not be recommended to cancer patients because prospective, randomized trials are missing.

[Side effects of chemotherapy]. / Nebenwirkungen der Chemotherapie.

Urologic tumors are frequently treated by multimodal therapeutic strategies with the consequence of an increasing number of adverse events. The most common chemotherapy-induced side effects are neutropenia, stomatitis, mucositis, diarrhea, and emesis. The efficacy of tumor therapy can be improved by good prophylaxis and standardized management of side effects.

[Short version of the German S3 guideline for bladder cancer]. / Kurzform der S3-Leitlinie Harnblasenkarzinom.

Urinary bladder cancer is the second most common cancer of the urogenital system. The Guideline Program in Oncology (Leitlinienprogramm Onkologie) of the Association of the Scientific Medical Societies in Germany (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften, AWMF), the German Cancer Society (Deutsche Krebsgesellschaft) and the German Cancer Aid (Deutsche Krebshilfe) as well as 31 different medical societies have developed the first interdisciplinary, evidence-based German guideline for bladder cancer. This short version presents the resulting series of diagnostic and therapeutic recommendations which were based on a systematic literature search and approved by a team of bladder cancer experts. The full version is available under http://leitlinienprogramm-onkologie.de/ .

Role of surface mannan in the adherence of Candida albicans to fibrin-platelet clots formed in vitro.

An alkali-soluble extract from a cell wall preparation of Candida albicans was conjugated to sheep erythrocytes (SRBC) by using periodate oxidation or concanavalin A. Conjugated SRBC readily attached to a fibrin-platelet matrix, whereas nonconjugated SRBC did not. To determine the active component which promoted attachment of SRBC, the alkali-soluble fraction was treated with alpha-mannosidase, pronase, or glusulase or chemically degraded by acetolysis. The treated extract was then reconjugated with SRBC, and attachment was measured. When treated with alpha-mannosidase or degraded by acetolysis, the alkali-soluble extract failed to promote the adherence of SRBC to the fibrin-platelet matrix. Pronase- or glusulase-digested extract promoted attachment equally as well as untreated controls. In addition, when preabsorbed with antiserum to whole cells of C. albicans, the alkali extract abrogated the inhibition of adherence by antiserum, thus indicating its antigenicity. The extract consisted primarily of polysaccharide (72%) and contained a small amount of protein (less than 1%). Mannose and glucose (ratio, 3:1) were detected by gas-liquid chromatography. These data indicate that cell surface mannan may play an important role in the adherence of C. albicans to the fibrin-platelet matrices which form in vivo on the endocardium of heart valves.

Adherence of Candida albicans to a fibrin-platelet matrix formed in vitro.

The adherence of Candida albicans to a fibrin-platelet matrix formed in vitro was studied. Platelet-rich plasma obtained from rabbits was incubated with thrombin and CaCl2 to form a clot in tissue culture dishes. Such clots were then infected with 3 x 10(7) C. albicans cells per 0.3 ml prelabeled with [U14C]-glucose, and the percent adherence was measured after 30 min of incubation by counting the radioactivity in saline washes of the clot as well as a streptokinase-streptodornase digest of the corresponding clot. Heat- and formaldehyde-killed cells did not adhere as well as viable cells. Pretreatment of C. albicans with trypsin, chymotrypsin, and pronase reduced adherence to the clots. Normal rabbit serum and anti-Candida antiserum also inhibited adherence 40 and 100%, respectively, Diethylaminoethyl-purified anti-Candida gamma globulin (1:8) completely inhibited adherence, whereas purified normal serum gamma globulin did not. Several Candida spp. and Saccharomyces cerevisiae showed differences in their ability to adhere to clots. C. albicans and C. stellatoidea presented the highest adherence, whereas C. krusei, C. guilliermondii, and S. cerevisiae adhered less readily. Other species were intermediate in their ability to adhere.