Reversal of UVA skin photosensitivity and DNA damage in kidney transplant recipients by replacing azathioprine.

Azathioprine is associated with enhanced skin photosensitivity to ultraviolet A (UVA) and leads to incorporation of 6-thioguanine (6-TG) into DNA of dividing cells. Unlike canonical DNA, 6-TG DNA is damaged by UVA, which comprises more than 90% of the ultraviolet reaching earth. Skin photosensitivity to UVA and UVB was measured in 48 kidney transplant patients immunosuppressed either by azathioprine (n = 32) or mycophenolate (n = 16). In 23 patients, azathioprine was subsequently replaced by mycophenolate and skin photosensitivity, DNA 6-TG content in peripheral blood mononuclear cells, and susceptibility to UVA-induced DNA damage were monitored for up to 2 years. The mean minimal erythema dose to UVA on azathioprine was twofold lower than on mycophenolate. Three months after replacing azathioprine by mycophenolate mofetil, the minimal erythema dose to UVA had increased from 15 to 25 J/cm(2) (p < 0.001) accompanied by reduced DNA 6-TG content. P53 protein expression in irradiated skin indicated reduced susceptibility to UVA-induced DNA damage. 6-TG DNA in peripheral blood mononuclear cells remained measurable for over 2 years. Replacing azathioprine selectively reduced the skin photosensitivity to UVA, attenuated UVA-induced skin DNA damage, and is likely based on incorporated 6-TG in DNA.

[Computer assistance to improve therapy planning for head neck oncology]. / Computergestützte Assistenz zur Verbesserung der Therapie-Planung in der Kopf-Hals-Onkologie.

The ongoing development in therapies of head and neck malignomas has led to a further differentiation of treatment options. Complex surgical procedures, a wide variety of multi modal therapy options, changing radiation technologies (IMRT - Intensity-modulated radiation therapy) and numerous "targeted therapies" emphasize the need for a precise treatment plan. Beside this, imaging has seen significant improvements beyond the technical ones, e. g. with the implementation of PET/CT scanners. This increase in pre-therapeutic data volume, together with a diversification of treatment options calls for a further discussion of the basics of therapeutic decisions. Planning relevant data processing by computer assisted systems can aid in these decisions. This work describes the current status of relevant computer assisted systems undergoing first testing for head and neck cancer therapy planning. Here, the integration of 3-dimensional patient data plays a central role. This planning tool forms the integrated base for a further development in the areas of radiation planning, documentation and study management.

[Musculoskeletal problems in rock climbing--a review]. / Probleme des Bewegungsapparates bei Sportkletterern--eine Ubersicht.

The popularity of rock climbing and the increasing number of high-level performing athletes have raised during the last years the incidence of musculoskeletal problems involving most frequently the upper extremities. This paper gives a survey on literature, diagnosis and treatment.

DIZE (dexamethasone, idarubicin, and continuous infusion of ifosfamide and etoposide): an effective and well-tolerated new regimen for patients with relapsed lymphoma.

We performed a phase II study of dexamethasone, ifosfamide, idarubicin and etoposide (DIZE) in patients with relapsed or refractory Hodgkin's (HL) and non-Hodgkin's lymphoma (NHL). The regimen consisted of dexamethasone (20 mg i.v. days 1-4), idarubicin (8 mg/m2 i.v. days 1+2), continuous infusion (c.i.) of ifosfamide (1,000 mg/m2 days 1-4), and c.i. etoposide (60 mg/m2 days 1-4). G-CSF (5 microg/kg) was used to support neutrophil recovery from day 5. In older patients (> 60 years) the dosage of idarubicin and ifosfamide was reduced to 75% in the initial cycle. Fourty six patients (pts) were treated with a total of 131 cycles. Sixteen pts were primary resistant and 30 were relapsed. Median age was 54.3 years (range 22-75). The median number of different prior chemotherapies was 1.7 (range 1 to 5). 31/46 (67.4%) pts had advanced disease (stage III or IV); 19/46 had B symptoms. Of 43 evaluable pts the response rate was 58.1% including 11 complete remissions (CR) and 14 partial remissions (PR). Mean duration of response was 8 months (1-30+). DIZE was more effective in relapsed than in refractory high-grade NHL (74 % vs 16.6%; p < 0.001). Of four heavily pretreated pts with HL, one obtained CR and two PR (response rate 75%). Myelosuppression was generally moderate with a mean duration of leukocytopenia < 1,000/microl of 2.5 days (range 0-18) and of thrombocytopenia < 25,000/microl 1.5 days (range 0-17). One patient died of uncontrollable infection in treatment related neutropenia. No other serious toxicities apart from alopecia were observed. We conclude that DIZE is safe and effective in heavily pretreated pts with relapsed lymphoma. The continuous infusion of cytostatic drugs such as that used in the new DIZE protocol might reduce hematotoxicity.

[Bilateral supracondylar process of the humeri with unilateral median nerve compression in an 8-year-old child. A case report]. / Beiderseitiger Processus supracondylaris humeri mit einseitiger Medianuskompression bei einer Achtjährigen. Ein Fallbericht.

We report a case of an eight-year-old girl with bilateral supracondylar process of the humerus and compression of the median nerve on the left side. A typical ligament of Struthers was found. After resection of bone and ligament, complete recovery was achieved.

[Conservative treatment of stable finger joint dislocations using the Stack splint]. / Die konservative Behandlung stabiler Mittelgelenkluxationen mit der Stack'schen Schiene.

Stable dislocations of PIP-joints should be treated by early motion. It is important to gain full extension from the very beginning of treatment. The anatomy and biomechanics as well as the use of a Stack button-hole splint is reported. 28 patients with 32 dislocations have been treated for two to four weeks with excellent results.

[Recurrent fracture of the pediatric forearm]. / Die Refraktur des kindlichen Unterarms.

In a retrospective multicenter study 28 relapse fractures of the forearm in children were reviewed. The male to female ratio was 23:5. Six children were younger than 6 years, 12 were between 6 and 10 years, and 10 were between 10 and 14 years old. The primary fracture was treated by cast fixation of 3-7 weeks duration. The refracture occurred on a average 14 weeks (4-32 weeks) after the primary fracture by a simple fall (n = 14) or a fall from height (n = 4), or during school (n = 6) or leisure-time (n = 3) sporting activities. In 84% of the patients partial consolidation, i.e. incomplete healing of one cortex of one or both forearm bones, preceded the refracture. In the majority of patients this was observed after a green stick fracture due to permanent angulation. Six patients were operated upon for irreducibility of the relapse fracture; the others were treated by conservative means. In two patients a second refracture occurred. Fifteen patients were available for a 2 year result. Definitive angulation of more than 10 degrees caused a clinically relevant limitation of pro-supination in five of six patients. To prevent relapse fractures of the forearm in children, complete circular consolidation of the original fracture has to be guaranteed. It remains unclear whether this is best achieved by special plaster techniques or by converting a greenstick fracture into a complete, unstable fracture.

[Transitory lesion of the radial nerve after fall onto the outstretched arm]. / Passagere Läsion des N. radialis durch Sturz auf den gestreckten Arm. Ein Fallbericht.

A patient presented with a bony avulsion of the radial collateral ligament of the elbow combined with a partial lesion of the radial nerve after a fall onto the outstretched arm. Probably the nerve was compressed at its penetration through the lateral intermuscular septum by a sudden contraction of the triceps tendon. Conservative treatment led to complete recovery.

Ulnar collateral ligament: differentiation of displaced and nondisplaced tears with US.

PURPOSE: To determine the usefulness of ultrasound (US) in the differentiation of displaced and nondisplaced tears of the ulnar collateral ligament (UCL). MATERIALS AND METHODS: A 7.5-10-MHz linear-array transducer was used to examine 69 patients in whom a UCL tear was suspected, 43 of whom also underwent surgery. The US findings were compared with those obtained at surgery. RESULTS: Results of US corresponded to results of surgery in 37 of 43 patients. Findings were false-positive in six patients. Twenty-six patients were treated conservatively with thumb casts. These patients showed stability and free range of motion at the first metacarpophalangeal joint at clinical follow-up (9-13 months). CONCLUSION: Sonography is useful for evaluating nondisplaced and retracted tears of the UCL and determining the need for surgery.

[Double stomach rupture as isolated injury]. / Doppelte Magenruptur als isolierte Verletzung.

A 19-year old female patient was admitted after a motorbike accident. The only injury was a double gastric rupture, which was probably caused by gastric dilatation owing to an over-consumption of carbonic acid fluids immediately prior to the accident.

[Two cases of complex carpometacarpal dislocation]. / Zwei Fälle komplexer karpometakarpaler Verrenkung.

Dislocations and fracture dislocations of the carpometacarpal joints are rare. In most cases they are caused by sudden forces, e.g. the crash of a motorcyclist against an obstacle while holding the handlebars or direct compression of the hand by a machine. The majority of patients are male. The literature contains reports of dorsal, palmar and divergent dislocations involving anything from one to all five carpometacarpal joints. Since the numbers of cases published by the various authors are rather small and different methods of treatment are proposed, we would like to describe two more carpometacarpal dislocations and compare them with previous reports.

[Bilateral subcutaneous rupture of the quadriceps tendon caused by minor trauma. A case report]. / Beidseitige subkutane Ruptur der Quadrizepssehne durch Bagatelltrauma. Ein Fallbericht.

A case of bilateral simultaneous rupture of the quadriceps tendons resulting from minor trauma is reported. The etiology, diagnosis and therapy are discussed.

[Posterior interosseous nerve paralysis after overexertion. A case report]. / Nervus interosseus posterior-Parese nach Uberanstrengung. Ein Fallbericht.

Entrapment neuropathies in the upper extremity are common. Spontaneous paralysis of the posterior intersosseous nerve may occur by compression at the arcade of Frohse, where the nerve enters the plane between the superficial and deep muscle bellies of the supinator. Benign soft tissue tumors, minor trauma, and local inflammation have led to paralysis of the posterior interosseous nerve in several cases. An additional report on paralysis of this nerve a few days after overexertion with later spontaneous recovery is presented.

Identification of human megakaryocytes derived from pure megakaryocytic colonies (CFU-M), megakaryocytic-erythroid colonies (CFU-M/E), and mixed hemopoietic colonies (CFU-GEMM) by antibodies against platelet associated antigens.

Pure megakaryocytic colonies, megakaryocytic-erythroid colonies and mixed hemopoietic colonies can be cultured from human bone marrow under appropriate culture conditions. Human plasma and mercaptoethanol support the growth for these different types of hemopoietic colonies. However, the addition of medium conditioned by leucocytes in the presence of phytohemagglutinin (PHA-LCM), as a source of thrombopoietin, is required for the formation of megakaryocytic colonies or megakaryocytes within mixed colonies. Megakaryocytes were identified by their typical morphological appearance in culture. Pure megakaryocytic colonies, megakaryocytic-erythroid colonies and mixed colonies were plucked by micropipette and analysed by the PAP-slide technique using antibodies to human factor VIII-related protein or serum derived from a patient with posttransfusion purpura; this particular serum demonstrated anti-P1A1 antibody activity. These antibodies might provide an excellent probe to identify megakaryocytic progeny from committed and non-committed hemopoietic progenitors, facilitating studies of early events in megakaryopoiesis.