[Signet ring cell infiltrate in the colon and gastric mucosa]. / Siegelringzellhaltiges Infiltrat in der Kolon- und Magenschleimhaut.

A 49-year-old female patient presented with anemia of unclear origin (hemoglobin level 6 µg/dl). During coloscopy a circular wall edema in the right flexure of the colon was observed and gastroduodenoscopy gave rise to the suspicion of fundic gland polyps (Elster's cysts) of the mucosa. In the lamina propria of the gastric mucosa, infiltration of a poorly differentiated carcinoma with signet ring cell morphology could be histologically identified resulting in the suspected diagnosis of a primary gastric signet ring carcinoma. Using immunohistochemistry it could be shown that the tumor cells expressed cytokeratin 7 (CK7), estrogen receptors and Gata 3 but not CK20 or Cdx2. The diagnosis of metastases of lobular breast cancer in the gastric and colon mucosa could be made.

Computed virtual chromoendoscopy versus standard colonoscopy with targeted indigocarmine chromoscopy: a randomised multicentre trial.

OBJECTIVE: Colonoscopy is the accepted gold standard for screening of neoplastic colorectal lesions, but the substantial miss rate remains a challenge. Computed virtual chromoendoscopy with the Fujinon intelligent colour enhancement (FICE) system is a new dyeless imaging technique that might allow higher rates of adenoma detection. METHODS: This is a prospective randomised five tertiary care centre trial of colonoscopy in the FICE mode versus standard colonoscopy with targeted indigocarmine chromoscopy (control group) in consecutive patients attending for routine colonoscopy. Histopathology of detected lesions was confirmed by evaluation of endoscopic resection or biopsy specimens. RESULTS: 871 patients were enrolled, and 764 patients (344 female, mean age 64 years) were subjected to final analysis (368 in the FICE group, 396 in the control group). In total, 236 adenomas (mean of 0.64 per case) were detected in the FICE group and 271 adenomas (mean of 0.68 per case) in the control group (p = 0.92). There was no statistically significant difference in the percentage of patients with >or=1 adenoma between the control group (35.4%) and the FICE group (35.6%) (p = 1.0). For the differential diagnosis of adenomas and non-neoplastic polyps, the sensitivity of FICE (92.7%) was comparable with that of indigocarmine (90.4%) (p = 0.44). CONCLUSIONS: At colonoscopy, adenoma detection rates are not improved by virtual chromoendoscopy with the FICE system compared with white light endoscopy with targeted indigocarmine spraying. However, FICE can effectively substitute for chromoscopy concerning the differentiation of neoplastic and non-neoplastic lesions.

Autoantibodies in Type 1 diabetes.

BACKGROUND: Autoimmune diseases are associated with autoantibodies which recognise specific antigens. METHODS: Autoantibodies can be detected by various methods including immunofluorescence and radioimmunoassays using disease-specific radiolabelled recombinant autoantigens As recombinant assay have high-throughput potential, it is now even possible to screen whole populations. RESULTS: Diabetes-associated autoantibodies including autoantibodies to glutamic acid decarboxylase are valuable in disease classification and disease prediction. Some autoantibodies are more predictive of diabetes than others. CONCLUSIONS: Autoantibodies, and the antigens they recognise, are potentially valuable in the prediction and prevention respectively of type 1 diabetes as well as in the classification of autoimmune diabetes. Screening the general population for type 1 diabetes susceptibility is now feasible. Trials to prevent type 1 diabetes using disease-associated autoantigens are now in progress.

Cancer rehabilitation services in a tertiary care center.

People with cancer often have functional limitations resulting from fatigue, deconditioning, pain, or metastasis to the musculoskeletal or nervous system, in addition to the psychosocial aspects of dealing with their disease. Their medical caregivers often focus on treating the disease and overlook these important aspects. The Department of Physical Medicine and Rehabilitation at the Mayo Clinic developed a Cancer Rehabilitation Service in 1979 to address these needs for hospitalized patients. Some of the challenges and successes of this service are briefly discussed in this article.

Evaluation of consultation-based rehabilitation for hospitalized cancer patients with functional impairment.

OBJECTIVE: To evaluate prospectively the effect of consultation-based interdisciplinary rehabilitation in hospitalized cancer patients. PATIENTS AND METHODS: Three hundred forty-one hospitalized patients with cancer were referred to the Cancer Adaptation Team (interdisciplinary rehabilitation services) over an 8-month period. Functional status at enrollment and dismissal was evaluated with a Barthel Mobility Index and Karnofsky Performance Status scale. Quality-of-life parameters were evaluated with specifically designed questionnaires. RESULTS: Two hundred ninety patients met the inclusion criteria. One hundred eighty-nine survived and completed the study. Significant functional improvement was observed between enrollment and dismissal on both functional indexes (P< or =.001). Quality-of-life questionnaires, while limited by low completion rate, showed significant improvement on multiple parameters. CONCLUSION: Significant functional gains were observed in hospitalized cancer patients who received interdisciplinary rehabilitation services on a consultation basis.

Differential genome analysis of bacteria by genomic subtractive hybridization and pulsed field gel electrophoresis.

A comprehensive analysis of the differences between the genomes of two closely related bacterial strains should give insight into the molecular basis of their individual phenotypic and genotypic characteristics. Here we present an integrative approach including two different strategies for the thorough investigation of genomic divergence. We have combined two techniques including genomic subtractive hybridization and comparative genome mapping by pulsed field gel electrophoresis (PFGE) techniques. The subtractive method for which a protocol is given herein results in the production of a library of specific DNA sequence tags present only in one strain, while the construction of macrorestriction maps of the bacterial chromosomes yields data about the overall genome organization and the arrangement and distance of gene loci. Comparison of the physical and genetic maps and determination of the map positions of the strain-specific DNA sequences reveals gross chromosomal modifications, insertions or deletions of additional genetic material, and transpositional events. The further investigation of the strain-specific regions yields information about the nature and origin of the acquired DNA and their influence on the evolution of the individual bacterial genome. The two methods were applied to differential genome analysis of clonal divergence in Pseudomonas aeruginosa choosing two clone C isolates from diverse habitats.

Paroxysmal sympathetic storms ("diencephalic seizures") after severe diffuse axonal head injury.

We describe a patient with a severe traumatic head injury who exhibited paroxysmal sympathetic storms, similar to those described in "diencephalic seizures." No epileptiform activity was evident on electroencephalography, and therapeutic levels of anticonvulsants failed to alter the spells; however, use of morphine sulfate abolished them. The features of this and several previously reported cases refute the primary roles of the diencephalon and seizures in this syndrome. Rather, in the setting of already compromised autonomic neuronal integrity, subtle fluctuations in intraventricular pressure or activation of reflexes triggered from muscle mechanoreceptors or chemoreceptors during episodes of hypertonia are more likely. "Paroxysmal sympathetic storms," a more appropriate descriptive term for these phenomena, should be recognized; thus, unnecessary diagnostic evaluations can be minimized, and appropriate therapy can be initiated.

Large genome rearrangements discovered by the detailed analysis of 21 Pseudomonas aeruginosa clone C isolates found in environment and disease habitats.

In order to determine primary genetic events which occur during the diversification of a Pseudomonas aeruginosa clone in natural habitats, comparative genome analysis of 21 isolates of a predominant clone, called clone C, derived mainly from patients with cystic fibrosis (CF) and the aquatic environment, was carried out. Physical chromosome maps were constructed for the restriction enzymes SpeI, PacI, SwaI and I-CeuI by one and two-dimensional pulsed-field gel electrophoresis and by comparison with the existing strain C map. The positioning of 26 genes generated the genetic maps. Chromosome size varied between 6345 and 6606 kilobase-pairs (kb). A plasmid of 95 kb was detected in the strains of non-CF origin and, in addition, was found to be integrated into the chromosome of all strains but one CF isolate. Four subgroups of clone C strains were discriminated by the acquisition and loss of large blocks of DNA that could cover more than 10% of the chromosome size. The exchange of DNA blocks which ranged in size from 1 kb to 214 kb occurred preferentially around the terminus of replication region which is poor in biosynthetic genes. Genetic material which was additionally introduced into strain C in comparison with strain PAO seems to be a target of mutational processes in clone C strains. Within and among subgroups CF isolates frequently exhibited large inversions affecting the whole chromosomal structure. We concluded that the exchange of DNA blocks by mechanisms of horizontal transfer and large chromosomal inversions are major factors leading to the divergence of a clone in the species P. aeruginosa.

Large chromosomal inversions occur in Pseudomonas aeruginosa clone C strains isolated from cystic fibrosis patients.

An analysis of the chromosomal structure of 21 Pseudomonas aeruginosa clone C genotypes of various origins was carried out. The circular chromosomes showed various insertions and deletions which did not alter the gene order in 6 environmental and one ear isolate in comparison with strain PAO and strain C. However, the chromosome structure differed by at least one large inversion in 50% of the genotypes (7/14) isolated from cystic fibrosis patients. Recombination endpoints were scattered throughout the chromosome. All but one inversion included the terminus of replication which was displaced by the recombination events. The rearrangements shifted the positions of the rrn operons with respect to the origin of replication, but the transcription of the rrn operons remained in the same direction as replication. The exclusive detection of inversions in isolates from cystic fibrosis lungs, which represent an atypical habitat for P. aeruginosa, supports the theory that peculiar features of this new ecological niche may select, cause or tolerate genomic changes.

Infections with Pseudomonas aeruginosa in patients with cystic fibrosis.

The lung infection with Pseudomonas aeruginosa is regarded as one of the major causes of health decline in patients with cystic fibrosis (CF). The CF host response to the persistent bacterial antigen load in the endobronchiolar lumen is characterized by a pronounced humoral response, local production of cytokines, influx of neutrophils into the lung and a protease-protease inhibitor imbalance predominantly sustained by released neutrophil elastase. CF is an autosomal recessive disease, and we could demonstrate for our local patient population that the age-dependent risk to become chronically colonized with P. aeruginosa can be differentiated by the disease-causing CFTR mutation genotype. The age-specific colonisation rates were significantly lower in pancreas sufficient than in pancreas insufficient patients. P. aeruginosa is occasionally detected in throat swabs already in infancy or early childhood in most patients although there is a lapse of several years amenable to preventive measures such as vaccination until onset of persistent colonization. The epidemiology of the infection with P. aeruginosa was investigated by quantitative macrorestriction fragment pattern analysis. The distribution and frequency of clones found in CF patients match that found in other clinical and environmental aquatic habitats, but the over-representation of specific clones at a CF clinic indicates a significant impact of nosocomial transmission for the prevalence of P. aeruginosa-positive patients at a particular center. Most patients remain colonized with the initially acquired P. aeruginosa clone. According to direct sputum analysis the majority of patients is carrying a single clonal variant at a concentration of 10(7)-10(9) CFU. Co-colonization with other species or other clones is infrequent. Independent of the underlying genotype, the CF lung habitat triggers a uniform, genetically fixed conversion of bacterial phenotype. Most CFP, aeruginosa strains become non-motile, mucoid, LPS-, pyocin- and phage-deficient, secrete less virulence determinants and shift the production of cytokines evoked in neutrophils. On the other hand, other properties such as antimicrobial susceptibility or adherence to bronchial mucins remain highly variable reflecting the capacity of P. aeruginosa to adapt to ongoing changes in the CF lung habitat.

Comparative genome mapping of Pseudomonas aeruginosa PAO with P. aeruginosa C, which belongs to a major clone in cystic fibrosis patients and aquatic habitats.

A physical and genetic map was constructed for Pseudomonas aeruginosa C. Mainly, two-dimensional methods were used to place 47 SpeI, 8 PacI, 5 SwaI, and 4 I-CeuI sites onto the 6.5-Mb circular chromosome. A total of 21 genes, including the rrn operons and the origin of replication, were located on the physical map. Comparison of the physical and genetic map of strain C with that of the almost 600-kb-smaller genome of P. aeruginosa reference strain PAO revealed conservation of gene order between the two strains. A large-scale mosaic structure which was due to insertions of blocks of new genetic elements which had sizes of 23 to 155 kb and contained new SpeI sites was detected in the strain C chromosome. Most of these insertions were concentrated in three locations: two are congruent with the ends of the region rich in biosynthetic genes, and the third is located in the proposed region of the replication terminus. In addition, three insertions were scattered in the region rich in biosynthetic genes. The arrangement of the rrn operons around the origin of replication was conserved in C, PAO, and nine other examined independent strains.

[Case studies of the effect of tyrosine administration in children with phenylketonuria on cognitive processes]. / Fallstudien zum Einfluss von Tyrosingaben bei phenylketonurischen Kindern auf kognitive Prozesse.

Eight patients with phenylketonuria and low protein nutrition were treated in a double blind crossover study for the time of 3 month with 150 mg tyrosine per kg body weight and day and placebo thereafter or vice versa. The concentration of phenylalanine in serum was not influenced by the administration of tyrosine whereas tyrosine in serum markedly increased. Psychological tests were 7 times repeated in monthly intervals. From the study it is to suggest that there is an improvement of the test results caused by an effect of training due to the repeated tests and an additional improvement caused by tyrosine.

Thermoregulation and fever in normal persons and in those with spinal cord injuries.

Thermoregulation and fever are primarily mediated through the hypothalamus and its effector mechanisms. In persons with complete spinal cord injuries above T-6, thermoregulation is substantially impaired because of the interruption of neuronal pathways to and from the hypothalamus. These same pathways are important in the production of fever in response to infections, and injury to these pathways in patients with high-level spinal cord injuries should diminish their ability to mount a febrile response. In clinical practice, however, measurements of body temperature are used to make decisions in patients with spinal cord injuries in a manner similar to that in patients without spinal cord injuries. In this article, we review the literature on thermoregulation and fever in normal persons and in those with complete spinal cord injuries and propose possible mechanisms for fever in persons with high-level spinal cord injuries.

[Differential choice of the procedure in the surgical treatment of fractures in the trochanteric area]. / Differenzierte Verfahrenswahl zur operativen Versorgung von Frakturen im trochanteren Bereich.

718 trochanteric fractures, surgically treated with nailing according to Ender, 130 degrees angled blades of AO, 95 degrees condyle blades of AO, valgisation blades of AO and the (DHS) dynamic hip screw of AO were followed up for anatomical reconstruction, early weight-bearing, complications and spectrum of indication. The best surgical method is the DHS-osteosynthesis, easy to perform, weight-bearing at once, low rate of complications and good results by a broad spectrum of indications. Subtrochanteric fractures should be treated with 95 degrees condyle blade and unstable fractures connected with destruction of Adam's bow with valigisation osteotomy and valgisation blade.

Viscosity and electrolyte concentrations in gastric juice from cystic fibrosis children compared to healthy children.

The viscosity of gastric juice and the concentrations of sodium, potassium, calcium, magnesium and chloride ions were measured before and after stimulation with pentagastrin in 10 children with cystic fibrosis and compared to those in 10 healthy children of corresponding ages. The viscosity values followed the same patterns as those for the sodium and calcium ion concentrations and were higher in the cystic fibrosis group. The electrolyte concentrations in the basal and different post-stimulation fractions of the gastric juice were higher in the cystic fibrosis group. Significant differences between both groups could only be found in the electrolyte concentrations. The total secretion of each of the electrolytes was the same in both groups because along with the increased electrolyte concentration in the cystic fibrosis group there was a reduced volume of gastric juice. The dependence of viscosity on the individual electrolyte concentration is discussed. The differences in the viscosity and the electrolyte concentrations in gastric juice from the cystic fibrosis children seems to be due to changes in the process of gastric secretion and not due to the influence of swallowed saliva.

Distribution of hypertrophic pulmonary osteoarthropathy.

Radionuclide bone scanning is a sensitive detector of new bone formation. It offers the possibility of more complete description of the distribution of hypertrophic pulmonary osteoarthropathy. The scintigraphic findings in 48 confirmed cases of hypertrophic pulmonary osteoarthropathy (HPO) are described. Several new observations about the involvement of bones and distribution pattern have been made: the skull (mandible and/or maxillae) was involved in 42% of cases, the scapulae in 67%, and the patellae in 50%. Clavicles were involved in 33% of cases. With the exception of the humerus, the proximal and distal portions of each long bone were involved with equal frequency. Involvement of the extremities was invariably present, and disease almost always appeared more active in the lower than in the upper extremities. Asymmetric involvement of the extremities was noted in 17% of cases, and there was irregular involvement in 15%. Differentiation of metastatic disease from HPO by bone scanning is generally not difficult, since the most frequent patterns of distribution of these two conditions are entirely different.

[Contamination of milk after teat redisinfection with iodophores]. / Zur Kontamination der Milch nach Zitzennachdesinfektion mit Jodophoren.

The passage of iodine to milk after drug redisinfection with iodophores developed in the GDR and the Polish People's Republic has been studied by labelling these preparations with iodine-131. The iodine contents found in the milk lay below the internationally indicated limits of tolerance. Therefore, from the hygienic-toxicological point of view, the use of these iodophore variants might be considered safe, provided that they were employed properly.