[Verumontanum mucosal hyperplasia as a differential diagnosis of a local recurrence following radical prostatectomy]. / Verumontanum-Mukosahyperplasie als Differenzialdiagnose eines Lokalrezidivs nach radikaler Prostatektomie.

Verumontanum mucosal gland hyperplasia (VMGH) is a benign microacinar proliferative lesion, which occurs exclusively in the verumontanum and the posterior urethra and is one of the lesions that may be confused with a low-risk adenocarcinoma of the prostate gland.We present the case of a 72-year-old male patient who underwent radical prostatectomy due to an adenocarcinoma of the prostate gland (pT2c pN0 cM0 R0, Gleason Score: 3 + 3 = 6). Five years after the operation, we sonographically detected a 3x2 cm large tumour in the prostate bed. While our first assumption was a PSA-negative local recurrence following radical prostatectomy, a comprehensive histological examination along with the clinical evaluation led us to the diagnosis of a VMGH. VMGH is a less well-known differential diagnosis of PSA-negative local recurrence following radical prostatectomy, whose clinical manifestation should be presented.

Linkage between growth retardation and pituitary cell morphology in a dystrophin-deficient pig model of Duchenne muscular dystrophy.

OBJECTIVE: Human patients with Duchenne muscular dystrophy (DMD) commonly exhibit a short stature, but the pathogenesis of this growth retardation is not completely understood. Due to the suspected involvement of the growth hormone/insulin-like growth factor 1 (GH/IGF1) system, controversial therapeutic approaches have been developed, including both GH- administration, as well as GH-inhibition. In the present study, we examined relevant histomorphological and ultrastructural features of adenohypophyseal GH-producing somatotroph cells in a porcine DMD model. METHODS: The numbers and volumes of immunohistochemically labelled somatotroph cells were determined in consecutive semi-thin sections of plastic resin embedded adenohypophyseal tissue samples using unbiased state-of-the-art quantitative stereological analysis methods. RESULTS: DMD pigs displayed a significant growth retardation, accounting for a 55% reduction of body weight, accompanied by a significant 50% reduction of the number of somatotroph cells, as compared to controls. However, the mean volumes of somatotroph cells and the volume of GH-granules per cell were not altered. Western blot analyses of the adenohypophyseal protein samples showed no differences in the relative adenohypophyseal GH-abundance between DMD pigs and controls. CONCLUSION: The findings of this study do not provide evidence for involvement of somatotroph cells in the pathogenesis of growth retardation of DMD pigs. These results are in contrast with previous findings in other dystrophin-deficient animal models, such as the golden retriever model of Duchenne muscular dystrophy, where increased mean somatotroph cell volumes and elevated volumes of intracellular GH-granules were reported and associated with DMD-related growth retardation. Possible reasons for the differences of somatotroph morphology observed in different DMD models are discussed.

Dispersion-Induced Beam Instability in Circular Accelerators.

The envelope instability near the 90° phase advance in periodically focused space charge dominated beams is a well-known phenomenon in linear transport sections or linacs. The corresponding stop band is usually avoided because of the resulting strong mismatch oscillations and beam loss. We show that in circular accelerators or transport sections including bending magnets the instability is modified due to the effect of dispersion. Using the two-dimensional envelope equations extended by the dispersion equation we identify an additional stop band above 120°. For periodic focusing the stop band results from the confluence of an envelope mode with the newly identified coherent dispersion mode. Results from perturbation theory are compared with the full envelope model and particle-in-cell simulation, which all show good agreement. The newly identified mode has several implications and applications for the characterization of intense beams in circular machines.

PFO closure: rational, procedure and devices.

Patent foramen ovale (PFO) is a common anatomical variant occurring in 20-25% of the population. In most cases, a PFO remains asymptomatic. However it allows for any venous particle such as thrombus, air or vasoactive substances to bypass the lung and enter the arterial circulation. Accordingly, PFO's have been linked to cryptogenic stroke, migraine and decompression illness. While the number of device closures have been increasing the therapy remains controversial as ­ until recently ­ data supporting PFO closure came from non randomized studies only. In this review we will discuss the existing data on PFO closure including results of the three randomized controlled trials comparing device closure with medical therapy in patients with cryptogenic stroke. We will also focus on the implantation technique, the complications and the different devices that are used for this procedure.

Complications during carotid artery stenting.

Carotid stenting has become a commonly used procedure for the treatment of carotid artery stenosis. Though equipment and techniques have improved tremendously over the recent 3 decades, complications do occur. It is important for carotid operators to be familiar with potential complications and adverse events. In this article complications and adverse events of carotid stenting including those that are related to the vascular access site, vessel spasm, dissection, perforation, thrombotic occlusion and hemodynamic instability and arrhythmias are reviewed. In addition, management strategies are discussed.

[The role of caregivers in health care. Historical backgrounds and current conflict situations]. / Die Rolle der Pflege im Gesundheitswesen. Historische Hintergründe und heutige Konfliktkonstellationen.

As a result of recent demographic developments, there has been an increased demand for high-quality health care. Among the various health professions, caregiving represents the largest professional group, numbering approximately 820,000 caregivers. Despite its size, this group is failing to meet basic conditions in line with international standards that secure adequate care. This failing is primarily due to the special path that Germany took regarding healthcare at the end of the nineteenth century and on which it continues to this day. It manifests itself in a heteronomy to which the professional group is permanently subjected by lobbies and policies that view health care from a perspective whose primary aim is to reduce unemployment. The present lack of organization of caregivers has frustrated their political assertiveness; and not least because of this, many caregivers leave the profession early. The profession itself is grappling with its professional identity. The development of expert standards, research into care, ethical reflections, as well as the struggle for common professional training are positive signs in this ongoing debate and are reflected in the positive feedback received from patients. The interdisciplinary dialogue between caregivers and physicians is in need of improvement. The first signs of progress are evident within the framework of health care ethics committees. This dialogue would certainly benefit both the professional group as well as the patients.

[Secondary malignancies in urinary diversions]. / Sekundärmalignome in Harnableitungen.

In contrast to ureterosigmoidostomy no reliable clinical data exist for tumor risk in different forms of urinary diversion using isolated intestinal segments.In 44 German urological departments, operation frequencies, indications, patient age, and operation dates of the different forms of urinary diversion, operated between 1970 and 2007, could be registered. The secondary tumors up to 2009 were registered as well and related to the numbers of the different forms of urinary diversions resulting in tumor prevalences.In 17,758 urinary diversions 32 secondary tumors occurred. The tumor risk in ureterosigmoidostomy (22-fold) and cystoplasty (13-fold) is significantly higher than in other continent forms of urinary diversion such as neobladders or pouches (p<0.0001). The difference between ureterosigmoidostomy and cystoplasty is not significant, nor is the difference between ileocecal pouches (0.14%) and ileal neobladders (0.05%) (p=0.46). The tumor risk in ileocecal (1.26%) and colonic neobladders (1.43%) is significantly higher (p=0.0001) than in ileal neobladders (0.5%). Of the 16 tumors that occurred following ureterosigmoidostomy, 16 (94%) developed directly at the ureterocolonic borderline in contrast to only 50% following urinary diversions via isolated intestinal segments.From postoperative year 5 regular endoscopic controls of ureterosigmoidostomies, cystoplasties, and orthotopic (ileo-)colonic neobladders are necessary. In ileocecal pouches, regular endoscopy is necessary at least in the presence of symptoms or should be performed routinely at greater intervals. Following neobladders or conduits, only urethroscopies for urethral recurrence are necessary.

[Tumors following urinary diversions. Results of a multicenter study]. / Tumorentstehung nach Harnableitung. Ergebnisse einer Multicenterstudie.

BACKGROUND: The risk estimation of secondary tumors after different types of urinary diversion with intestinal segments has as yet been possible only for ureterosigmoidostomy. METHOD: We analyzed the operative records of 44 German clinics for urinary diversions performed from 1970 to 2007 and registered all reported secondary tumors up to 2009. RESULTS: In 17,758 urinary diversions 32 secondary tumors occurred. The tumor risk in ureterosigmoidostomy (2.58%) and cystoplasty (1.58%) is significantly higher than in other continent forms of urinary diversion (p<0.0001). The risk in orthotopic (ileo)colonic neobladders (1.29%) is significantly higher (p=0.0001) than in ileal neobladders (0.05%). The difference between ileocecal pouches (0.14%) and ileal neobladders is not significant (p=0.46). CONCLUSION: Ureterosigmoidostomies, cystoplasties, and orthotopic (ileo)colonic neobladders necessitate regular endoscopic evaluation from at least the fifth postoperative year. After ileal neobladders, conduits, and catheterizable ileocecal pouches regular routine endoscopy is not imperative.

Experimental evidence of the 90 degrees stop band in the GSI UNILAC.

In a particle accelerator with a periodic structure beam space charge force may excite resonant beam emittance growth if the particle's transverse phase advance approaches 90 degrees . A recent simulation study with the PARMILA code [D. Jeon, Phys. Rev. ST Accel. Beams 12, 054204 (2009)]10.1103/PhysRevSTAB.12.054204 has shown the feasibility of measuring the stop band of this fourth order resonance in the GSI Universal Linear Accelerator UNILAC and proposed its experimental verification, which is reported here. Measurements of transverse phase space distributions behind a periodically focusing structure reveal a fourfold symmetry characteristic of fourth order resonances as well as a resonance stop band above sigma_{0}=90 degrees per focusing cell. These experimental findings agree with results from three different beam dynamics simulation codes, i.e., DYNAMION, PARMILA, and TRACEWIN.

Experimental evidence of space charge driven emittance coupling in high intensity linear accelerators.

In high intensity linacs emittance exchange driven by space charge coupling may lead to the well-known "equipartitioning" phenomenon if the stop band at sigma(parallel) = sigma(perpendicular) is crossed at sufficiently slow rate. This Letter is the first experimental evidence of this phenomenon in a high intensity linear accelerator, here the UNILAC at GSI. Measurements of emittances at the entrance and exit of one drift tube linac tank comprising 15 lattice cells are taken for a set of transverse and longitudinal tunes. The onset of exchange on the stop band of previously derived "stability charts" confirms theoretical predictions. The measured transverse emittance growth also compares well with results from the beam dynamics simulation codes DYNAMION and TRACEWIN.

Collective emittance exchange with linear space charge forces and linear coupling.

We show that pronounced collective nonlinear behavior is present in a beam with linear coupling and space charge as described by the complete second order moment equations. The collective effects result in a shifted and broadened resonance condition as well as saturation effects in the emittance transfer. For slow stop-band crossing either the beam evolves along a skewed matched solution with full emittance exchange or the exchange is hindered by collective space charge effects, depending on the emittance ratio and direction of crossing.

[Percutaneous endovascular aneurysm repair without arteriotomy (Perclose system)]. / Perkutane endoprothetische Therapie des Aortenaneurysmas ohne Arteriotomie.

BACKGROUND AND OBJECTIVE: It is common clinical practice to perform an arteriotomy for the endovascular treatment of infrarenal and thoracic aortic aneurysms. Instead we used the percutaneous endovascular Perclose device to perform the aneurysm repair without arterial cut-down. PATIENTS AND METHODS: The Perclose device contains four needles with two suture loops for closing the femoral artery access site. The sutures were deployed after the arterial puncture, before introduction of sheaths (diameter 12 - 27 F = 4 - 9 mm). After the procedure the sutures were used to close the puncture site. We attempted to achieve hemostasis with the Perclose system in 104 femoral arteries in 60 patients (7 females, mean age 69 +/- 12 years). The mean vessel diameter was 10 +/- 2 mm. RESULTS: The percutaneous graft implantation was successfully achieved in 58 of 60 patients. The graft could not be forwarded into the aorta in two cases because of calcified iliac arteries. The Perclose suture technique was successfully used in 97 femoral arteries. In one case a false aneurysm developed and in another case a secondary hemorrhage occurred. Seven patients needed additional manual compression to achieve complete hemostasis. A surgical repair was not necessary. The time to hospital discharge ranged from 4.5 hours to 32 days (median: 18 hours). 20 patients stayed longer than 24 h in the hospital, only 2 of them for reasons related to the puncture site. CONCLUSION: Closing the access site with the Perclose system is technically feasible and effective, even with large sheaths up to 27 F = 9 mm. This technique reduces the invasiveness of the endovascular repair of aortic aneurysms and decreases the length of hospital stay, i. e. it allows treatment in outpatients.

Anisotropic free-energy limit of halos in high-intensity accelerators.

We study halo emittance growth in anisotropic beams and show that the rms emittance growth resulting from mismatch is highly anisotropic, depending on the tune ratio. We find that the free-energy limit calculated by Reiser [J. Appl. Phys. 70, 1919 (1991)] for an axisymmetric 1D halo can be extended to 2D if understood as an upper bound to the rms emittance growth averaged per degree of freedom. The thus-obtained "free-energy limit" of an ideal transport system is compared with the halo rms emittance growth in simulations of the Spallation Neutron Source linac.

[Acute peripheral vestibular lesions. Monocular subjective visual vertical and cyclodeviation]. / Akute periphere vestibuläre Läsionen. Monokulare subjektive visuelle Vertikale und Zykloduktionsstellung.

BACKGROUND: A deviation of the subjective visual vertical (svv) is often found in patients with unilateral peripheral vestibular lesions and in most cases the deviation is transitory and easy to compensate. The purpose of the study was to find out if there is a correlation between deviation of the svv and objective cyclodeviation of the retina. PATIENTS AND METHODS: A total of 20 patients (10 females and 10 males aged between 16 and 78 years) with acute vestibular disease were enrolled. Only patients with a binocular deviation of the svv of more than 2 degrees and/or a difference between the monocular deviation of more than 1.5 degrees were included. The svv was examined monocular in a darkened room and after pupil dilatation, fundus photography was performed on each eye. The angle between papilla and macula was measured manually. RESULTS: We found a good qualitative correlation between svv (mean 7.9 degrees) and objective cyclodeviation (mean 10.6 degrees). CONCLUSION: In contrast to the binocular measurement of the svv, we found good correlation between the monocular svv and the objective cyclorotation measured with fundus photography. It is not yet clear which part of the vestibular system is responsible for cyclodeviation. Because of our results we recommend monocular measurement of the svv in clinical examinations.

New synthetic siderophores and their beta-lactam conjugates based on diamino acids and dipeptides.

Linking of siderophores to antibiotics improves the penetration and therefore increases the antibacterial activity of the antibiotics. We synthesized the acylated catecholates and hydroxamates as siderophore components for antibiotic conjugates to reduce side effects of unprotected catecholate and hydroxamate moieties. In this paper, we report on bis- and tris-catecholates and mixed catecholate hydroxamates based on diamino acids or dipeptides. These compounds were active as siderophores in a growth promotion assay under iron limitation. Most of the conjugates with beta-lactams showed high in vitro activity against Gram-negative bacteria especially Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumoniae, Serratia marcescens and Stenotrophomonas maltophilia. The compounds with enhanced antibacterial activity use active iron uptake routes to penetrate the bacterial outer membrane barrier, demonstrated by assays with mutants deficient in components of the iron transport system. Correlation between chemical structure and biological activity was studied.

Antibodies anti-Chlamydia pneumoniae and anti-Mycoplasma pneumoniae in patients with negative serology for hantavirus. Retrospective study

The seroprevalence of Chlamydia pneumoniae and Mycoplasma pneumoniae in hantavirus seronegative patients, who had symptoms and signs compatible with pneumonia was established. For this purpose we used the indirect fluorescent antibody test. Titers > or =1:16 for C. pneumoniae and M. pneumoniae were found in 8.6 percent and 17.1 percent of the serum, respectively, showing evidence of recent or current infection

Drebrin particles: components in the ensemble of proteins regulating actin dynamics of lamellipodia and filopodia.

Drebrin, an actin-binding 70-kDa protein with an unusually slow SDS-PAGE mobility corresponding to approximately 120 kDa, containing a proline-rich, profilin-binding motif, had originally been reported from neuronal cells, but recently has also been found in diverse other kinds of tissues and cell lines. In biochemical analyses of various cells and tissues, employing gel filtration, sucrose gradient centrifugation, immunoprecipitation and -blotting, we have identified distinct states of soluble drebrin: a approximately 4S monomer, an 8S, ca. 217-kDa putative trimer, a 13S and a > 20S oligomer. In the 8S particles only [35S]methionine-labelled drebrin but no other actin-binding protein has been detected in stoichiometric amounts. By immunofluorescence and immunoelectron microscopy, drebrin-positive material often appeared as "granules" up to 400 nm in diameter, in some cell types clustered near the Golgi apparatus or in lamellipodia, particularly at leading edges, or in dense-packed submembranous masses at tips (acropodia) or ruffles of leading edges, in filopodia and at plaques of adhering junctions. We conclude that these drebrin complexes and drebrin-rich structures allow the build-up and maintenance of high local drebrin concentrations in strategic positions for the regulation of actin filament assembly, thereby contributing to cell motility and morphology, in particular local changes of plasticity and the formation of protrusions.

Resonant emittance transfer driven by space charge.

Space charge can lead to emittance and/or energy exchange known as "equipartitioning issue" in linacs, or space-charge coupling in high-current synchrotrons. It is described here as an internal resonance driven by the self-consistent space-charge potential of coherent eigenmodes. By a detailed comparison of analytical theory with 2D particle-in-cell simulation for Kapchinskij-Vladimirskij (KV) and waterbag distributions, we discuss characteristic features of this resonance mechanism in the vicinity of the symmetric focusing resonance band--for practical purposes, the most important case--and discuss the applicability of the linearized KV theory.

Nuclear particles containing RNA polymerase III complexes associated with the junctional plaque protein plakophilin 2.

Plakophilin 2, a member of the arm-repeat protein family, is a dual location protein that occurs both in the cytoplasmic plaques of desmosomes as an architectural component and in an extractable form in the nucleoplasm. Here we report the existence of two nuclear particles containing plakophilin 2 and the largest subunit of RNA polymerase (pol) III (RPC155), both of which colocalize and are coimmunoselected with other pol III subunits and with the transcription factor TFIIIB. We also show that plakophilin 2 is present in the pol III holoenzyme, but not the core complex, and that it binds specifically to RPC155 in vitro. We propose the existence of diverse nuclear particles in which proteins known as plaque proteins of intercellular junctions are complexed with specific nuclear proteins.

Analytical calculation of the longitudinal space charge and resistive wall impedances in a smooth cylindrical pipe.

The longitudinal space charge and resistive wall impedances have been investigated in a smooth cylindrical beam pipe. At any point from the beam axis, we obtained an expression for the total impedance, which at the beam surface r=a for infinite pipe wall conductivity gives the expression for the total impedance that was derived by Zotter and Kheifets in studying the impedance of uniform beams in concentric cylindrical wall chambers, when a single cylindrical chamber is considered [B. W. Zotter and S. A. Kheifets, Impedances and Wakes in High-Energy Particle Accelerators (World Scientific, Singapore, 1998), Chap. 6]. A fitting formula for the space-charge impedance at the beam surface (r=a), which is valid for arbitrary wavelengths, is given. Rather than calculating the impedance with the field on the axis [Joseph J. Bisognano, Fifth European Particle Accelerator Conference (EPAC96), edited by S. Myers, A. Pacheco, R. Pascual, Ch. Petit-Jean-Genaz, and J. Poole (Institute of Physics, Bristol, 1996), Vol. 1, p. 328], the fitting formula is obtained by averaging over the transverse beam distribution. We also give another approach for the calculation of the resistive wall impedance using the flux of the Poynting vector at the pipe wall and then compare it with the expression obtained from the volume integral over the beam distribution.