Clenbuterol - regional food contamination a possible source for inadvertent doping in sports.

The misuse of the sympathomimetic and anabolic agent clenbuterol has been frequently reported in professional sport and in the livestock industry. In 2010, a team of athletes returned from competition in China and regular doping control samples were taken within the next two days. All urine samples contained low amounts (pg/ml) of clenbuterol, drawing the attention to a well-known problem: the possibility of an unintended clenbuterol intake with food. A warning that Chinese meat is possibly contaminated with prohibited substances according to international anti-doping regulations was also given by Chinese officials just before the Bejing Olympic Games in 2008. To investigate if clenbuterol can be found in human urine, a study was initiated comprising 28 volunteers collecting urine samples after their return from China. For the quantification of clenbuterol at a low pg/ml level, a very sensitive and specific isotope dilution liquid chromatography-tandem mass spectrometry (LC-MS/MS) assay was developed using liquid/liquid re-extraction for clean-up with a limit of detection and quantification of 1 and 3 pg/ml, respectively. The method was validated demonstrating good precision (intra-day: 2.9-5.5 %; inter-day: 5.1-8.8%), accuracy (89.5-102.5%) and mean recovery (81.4%). Clenbuterol was detectable in 22 (79%) of the analyzed samples, indicating a general food contamination problem despite an official clenbuterol prohibition in China for livestock.

Declining chloroquine resistance of Plasmodium falciparum in Lambaréné, Gabon from 1992 to 1998.

Plasmodium falciparum malaria continues to threaten human populations in the tropics and travellers in endemic areas. Drug resistance of the parasite is a major problem in treating this devastating disease. In a prospective trial we investigated the in vitro sensitivity of Plasmodium falciparum to chloroquine, quinine and mefloquine in the Albert Schweitzer Hospital in Lambaréné, Gabon every second year from 1992 to 1998. We used the standard WHO in vitro sensitivity assay. Parasite sensitivity to quinine and mefloquine remained stable over the years. However, parasite resistance to chloroquine decreased highly significantly with the change in local malaria treatment policy. In 1992, 100% of parasite isolates showed resistance to chloroquine, whereas in 1998 only 45% were found resistant.

Mycotoxins in house dust - an underestimated problem?

People in developed countries spend up to 90% of their time indoors. This led to an increased awareness for problems regarding indoor environment in recent years. It is known that especially spores, mycelia and organic compounds released by the microbial colony e.g. mycotoxins and microbial volatile organic compounds (MVOCs) can be harmful to human health. The aim of a pilot program is to investigate mould-dependent health complaints in a burdened population of the city of Leipzig, Germany. Phase 1 of the investigation includes inspection of dwellings, determination of exposure and clinical examination of exposed persons. In phase 2 it is planned to analyse the influence of burdens with mould spores and their metabolites like mycotoxins on health complaints. House dust seems to be a representative sample medium for sedimented spores and mycelia which may contain mycotoxins. The analysis will be performed by LC-MS-MS after extraction of the crude dust samples by accelerated solvent extraction. The qualitative proof of mycotoxins in house dust was successful in a case study with a high burden.

[Osteochondrodysplasias. Prenatal diagnosis and pathological-anatomic findings]. / Osteochondrodysplasien. Pränatale Diagnostik und pathologisch-anatomische Befunde.

Prenatal sonographic investigations were applied for malformations to 7,194 foetuses, between October 1985 and April 1992, with 28 cases of osteochondrodysplasia (OCD) and one case of dysostosis being dissected. Included were 20 cases of lethal osteochondrodysplasia, among them two cases of lethal hypophosphatasia, five cases of thanatophoric dysplasia, one case each of Type II shortrib (polydactyly) syndrome (VERMA-NAUMOFF) and metatropic dysplasia, three cases of campomelic dysplasia and eight cases of Type II A imperfect osteogenesis. Also observed were eight cases of nonlethal OCD, among them three cases of diastrophic dysplasia and five of achondroplasia. Dysostosis was recorded from one case and was diagnosed as Type V acrocephalosyndactyly (Pfeiffer). Identification of a specific OCD proved to be difficult in the second or third trimenon. Hence, the form of OCD was prenatally diagnosed only in ten of all cases investigated. Tentative diagnosis was first established from the postmortem radiograph. Additional malformations and other abnormalities then were detected by complementary pathologico-anatomic processing of findings. The final diagnosis was derived from radiological, pathologico-anatomic and histological findings. Diagnosis of this constitutional osteopathy is quite difficult and calls for interdisciplinary cooperation between gynaecologists, neonatologists, paediatric surgeons, radiologists, geneticists and pathologists. More effective counselling of affected families is the major purpose of all the efforts involved.

[Usefulness of the cotton swab (Q-Tip) test in general practice]. / Zur Brauchbarkeit des Watup- (Q-Tip-) Tests in der Praxis.

Cotton swabs (Watup or Q-Tip) were transurethrally applied to 50 women with urinary incontinence of different classification and case history to check for pressing-related inclination of the urethra. Testing was supported by inspection of the anterior vaginal wall and urethrocystography. Speculum examination has been found to provide minimum information, primarily after vaginal operations. Watup testing, however, was in better agreement with X-ray findings. Deviating inspection findings were related solely to positive Watup tests, while deviating X-ray findings were obtained with equal frequency in cases of positive and negative Watup tests (with five each being falsely positive and falsely negative). Higher accuracy was obtained in cases in which Watup tests and inspection findings had been identical. In such cases, complementary X-ray procedures for additional assessment of ventral fixation of the urethra were not necessary, if several signs of increased urethral inclination had been clinically detected. On the other hand, insufficient fixation of the urethra to the symphysis must be considered probable by X-ray examination in about 40 per cent of all cases in which no abnormal mobility of the urethra had been suggested by inspection and Watup test. Hence, negative Watup test would not be sufficient for adequate surgical decision-making.

[Nephrosonography--findings in acute pyelonephritis gravidarum]. / Nephrosonographie--Ergebnisse bei akuter Pyelonephritis gravidarum.

Nephrosonographic checks were made on 25 women during pregnancy (prior to and after treatment) and after childbirth, in order to obtain morphological information on dynamics of upper urinary tract in cases of acute pyelonephritis gravidarum. Pyelectasia was recorded from 19 patients (76 per cent) on the right side, one patient (four per cent) on the left, two patients (eight per cent) on either side, and was not recorded at all from three women (twelve per cent). Moderate to severe dilatations had been more often recordable from patients with high temperature, but not as often from mild cases. Recurrence rates went up along with severity of ectasia. Physical treatment (lateral positioning and heat) yielded subjectively perceived improvement but failed to result in nephrosonographically recordable decline in dilatation. Pregnancies ended in premature births in 20 per cent of these cases. No dilatation of upper urinary tract was any detectable three months after parturition. While nephrosonography for routine still is disputed in the context of normal pregnancy, it should be used on all cases of acute pyelonephritis gravidarum.

[Temporary percutaneous nephrostomy in pregnancy]. / Die temporäre perkutane Nephrostomie in der Schwangerschaft.

Engorged kidneys in pregnancy call for relieving nephrostomy, if locally delimited or systemic effects threaten to be a risk to mother and/or child. Five women were treated over the past five years, with percutaneous nephrostomy being performed on them for acute pyelonephritis gravidarum (n = 4, among them two with one kidney) or asymptomatic collateral excessive ectasia of the pyelo-calyceal system (n = 1). The intervention was followed by antegrade splinting in two cases. Soon clinical but less sonographic improvement was recordable from four patients as a result of renal relief. Delivery was necessary in one case, six days after nephrostomy. Widening application of nephrosonography also in pregnancy should not become a temptation for percutaneous nephrostomy to be performed also on cases of symptomatic urinary stasis. A more generous approach should be taken only to functionally or anatomically solitary-kidney cases.

Percutaneous transluminal embolization for improved prognosis of renal cell carcinoma--dependence on tumor stages.

The effect of percutaneous transluminal embolization (PTE) on the prognosis of renal cell carcinoma, depending on tumor stage, was retrospectively investigated on 303 patients. The life-table method was used for statistical comparison of survival rates of preoperatively or palliatively embolized patients with those of patients who merely underwent nephrectomy or were symptomatically treated. Preoperative PTE in tumor stages T2 and T3 resulted in extended survival rates, which were statistically significant in T2 cases. Prognosis was also improved in patients who underwent palliative embolization as compared with those patients who were inoperable and received only symptomatic treatment. Prognosis following palliative PTE and delayed nephrectomy was not worse than that following preoperative PTE and immediate nephrectomy.

[Improvement in the prognosis of renal cell carcinoma by percutaneous transvascular embolization]. / Verbesserungen der Prognose des Nierenzellkarzinoms durch perkutane transvasale Embolisation.

In a retrospective study of 303 patients with renal cell carcinomas the prognostic influence of the percutaneous transvasal embolization of the renal artery was demonstrated. In form of the life-table-method we compared statistically the survival rates of preoperatively or palliatively embolized patients with such ones who were only nephrectomized or treated only symptomatically. In the tumour stages T2 and T3 the preoperative percutaneous transvasal embolization leads to a clearly higher survival rate; in stage T2 statistically significant. After palliative embolization the improvement of the prognosis is evident compared with the inoperable patients who were treated only symptomatically. The prognosis after palliative preoperative percutaneous transvasal embolization and retarded nephrectomy is not worse than after preoperative percutaneous transvasal embolization and immediate nephrectomy. The effect of the preoperative and palliative embolization improving the prognosis should incite all partners who up to now objected to this therapeutic method to reconsider their therapy concept.