Knowledge, actual and potential use of HIV self-sampling testing kits among MSM recruited in eight European countries.

AIM: To describe the knowledge as well as current and potential use of self-sampling kits among men who have sex with men (MSM) and to analyse their preferred biological sample and result communication method. METHODS: We analyse data of MSM of HIV negative or unknown serostatus from an online survey conducted in eight countries (Belgium, Denmark, Germany, Greece, Portugal, Romania, Slovenia and Spain) between April and December 2016. It was advertised mainly in gay dating websites. We conduct a descriptive analysis of the main characteristics of the participants, and present data on indicators of knowledge, use and potential use of HIV self-sampling as well as their preferences regarding blood or saliva sample and face or non-face-to-face result communication by country of residence. RESULTS: A total of 8.226 participants of HIV negative or unknown serostatus were included in the analysis. Overall, 25.5% of participants knew about self-sampling (range: 18.8-47.2%) and 1.1% had used it in the past (range: 0.3-8.9%). Potential use was high, with 66.6% of all participants reporting that they would have already used it if available in the past (range: 62.1-82.1%). Most (78.6%) reported that they would prefer using a blood-based kit, and receiving the result of the test through a non-face-to-face-method (70.8%), even in the case of receiving a reactive result. CONCLUSION: The high potential use reported by MSM recruited in eight different European countries suggests that self-sampling kits are a highly acceptable testing methodology that could contribute to the promotion of HIV testing in this population.

Hemangioendothelioma of the mandible in a newborn infant - diagnostic and treatment approach of a rare vascular tumor.

Infantile hemangioendotheliomas are rare vascular tumors with predominant involvement of the soft tissues of the extremities. The occurence in the head and neck region and in particular intraoral occurence is extremely rare. The tumor is believed to be a neoplasm of borderline malignancy. We report a case of a 5-months old infant presenting with a hemangioendothelioma with extensive bony destruction of the mandible. Following surgical resection of the tumor with segmental mandibular resection primary mandibular reconstruction was performed using a rib graft being a useful compromise solution for primary mandibular reconstruction in young infants.

Metastatic malignant ameloblastoma responding to chemotherapy with paclitaxel and carboplatin.

We report an unusual case of metastatic ameloblastoma, involving lung and pleura. that repeatedly responded to systemic treatment with paclitaxel and carboplatin. suggesting principle chemosensitivity of this rare disease.

Expression of leptin and leptin receptor isoforms in the human stomach.

BACKGROUND: Leptin is an important regulator of food intake and energy expenditure. Initially it was thought to be expressed exclusively in and secreted by adipocytes. Recently, leptin expression was also noted in other tissues, including rat gastric mucosa. Information on leptin and leptin receptor expression in the human stomach is lacking. AIM: To investigate expression of leptin and its corresponding receptors in human gastric epithelial cells. METHODS: Fundic and antral gastric mucosal biopsies, primary cultures of human gastric epithelial cells, and the human gastric cancer cell line AGS were screened for expression of leptin and different leptin receptor isoform mRNA by reverse transcriptase-polymerase chain reaction. Immunohistochemistry was performed for localisation of leptin and leptin receptor proteins in gastric mucosa. RESULTS: mRNA of leptin and its four receptor isoforms (huOB-R, long receptor isoform; huB219.1-3, short receptor isoforms) was detected in gastric mucosal biopsies, cultured human gastric epithelial cells, and gastric cancer cells. Immunohistochemistry demonstrated that chief as well as parietal cells were reactive to leptin and leptin receptors. CONCLUSIONS: Leptin and leptin receptors are expressed in human gastric mucosa. These findings suggest a paracrine and/or autocrine effect of leptin on gastric epithelial cell function.

[Oral manifestations of Lpngerhans' cell histiocytosis. Therapeutic strategies involving oral and maxillofacial surgery]. / Langerhans-Zell-Histiozytose mit oraler Manifestation. Therapiestrategien mit Beteiligung der Mund-, Kiefer- und Gesichtschirurgie.

The definition of Langerhans' cell histiocytosis (formerly known as histiocytosis X) includes the clinical syndromes Hand-Schüller-Christian syndrome, Abt-Letterer-Siwe syndrome and eosinophilic granuloma, which in the past were considered separate entities. The prognosis of this disease varies between "favorable" and "infaust", depending on the age of the patient at first manifestation and the number of the organs involved. With the aid of various prospective clinical studies, suitable therapeutic schemes are currently being sought for. In the course of this search chemotherapy is gaining in significance and radiation therapy is merely playing a minor role. The surgical status has not changed inasmuch as it concerns solitary "operable" lesions. Based on three case reports from our clinic, different courses of illness are described. Oral manifestations of a Langerhans' cell histiocytosis have to be considered, especially with regard to therapy-resistant parodontopathies or with radiologically conspicuous, unexplained osteolysis. The immunohistological and electronic microscopic examinations confirm the diagnosis. The etiology of the disease has still not been clarified.

[The demonstration of microcalcification in breast core biopsies: DIMA specimen radiography (7x) compared to the histopathological findings]. / Mikrokalknachweis in Mammabiopsiezylindern: DIMA-Präparateradiographie 7fach im Vergleich zum histopathologischen Befund.

PURPOSE: Comparing the sensitivity in detecting microcalcifications in stereotactically guided core biopsy specimen of the breast of direct magnification (DIMA) specimen radiography (x7) with the histological examination. MATERIALS AND METHODS: In 52 patients 509 stereotactically obtained core biopsy (14-gauge) specimens of the breast were radiographed by direct magnification (DIMA) specimen radiography (x7) and examined histologically. RESULTS: In 188 specimen microcalcifications were detected by magnification radiography compared to 98 by histological examination. Only 3% of the specimen microcalcifications were seen exclusively in the histological examination. In core biopsies with malignancy the relative proportion of biopsies with radiologically detected microcalcifications was increased (59% versus 32%). CONCLUSION: Concerning the detection of microcalcifications in core biopsy specimen of the breast, the direct magnification (DIMA) radiography (x7) was superior compared to the histological examination. Due to the high relative proportion of biopsies with radiologically detected microcalcification and malignancy, we recommend a comprehensive histological examination of these specimen. Confirmation of microcalcifications in core biopsies should be achieved by magnification radiography to prove that the suspicious area in the breast was truly sampled. Specimen radiography simultaneously with the biopsy procedure can reduce the number of punctures in the process of documenting the presence of calcifications early in the biopsy procedure.

[Death caused by neglect?]. / Tod durch Vernachlässigung?

Over a period of several months a 23-year-old bedridden woman suffered from increasing cachexia with numerous decubital ulcera in the parental house. The parents induced the hospitalization not before the patient reached the agonal phase. The reported case was especially spectacular because the left arm had fallen off and lay beside the woman showing maggot infestation, mummification and skeletonization. Against the parents a preliminary investigation for manslaughter by negligence was instituted. This case report describes the unusual course of disease and the striking familiar situation.

Progress in developing animal models for biliary atresia.

Animal models for extrahepatic biliary atresia (EHBA) have failed to simulate the course of the disease. Until now only a few aspects of the entity could be investigated and no model was helpful in discovering the etiology of EHBA. Following the suspicion of a viral and hepatotropic infection, investigations in an infectious mouse model were continued. The results of previous and topical studies are summarized here. Infection of newborn Balb/c-mice with rhesus rotavirus (RRV) leads to cholestasis in 85% of the animals followed by a lethality of 90%. Preparation and histomorphological investigation of liver and ligamentum duodenale reveal EHBA of varying extent. Clinical course and morphological findings in mice are very similar to EHBA in newborn children and the results are presented in a chronological table. Hepatobiliary morbidity and lethality after RRV infection is higher in Balb/c-mice than in other mouse strains. This observation supports the suspicion that immunocompetence might be a determining factor in the etiology of EHBA. Initial therapeutic trials were made using this model by treating infected newborn mice with interferon-alpha (IFN). The prophylactic application of IFN protects the infected mice from cholestatic symptoms and appears to induce partial immunity. Their descendants are protected against the hepatotropic effect of RRV infection. Infected animals presenting with clinical signs of cholestasis can be treated successfully by IFN-therapy for one week. In the presented animal model. EHBA can be better induced and simulated than by any other method. As a first trial, a non-surgical and more etiologically orientated therapeutic method is tested in this model.

Treatment of extrahepatic biliary atresia with interferon-alpha in a murine infectious model.

The etiology of extrahepatic biliary atresia (EHBA) in newborns remains unknown, although a first infectious animal model with complete obstruction of the common bile duct could be established. Intraperitoneal inoculation of newborn Balb/c mice with rhesus rotavirus induced cholestasis, leading, in most cases, to biliary atresia with lethal outcome, similar to EHBA in human newborns. The influence of interferon-alpha (IFN-alpha) on the hepatotropism of rotavirus infection was investigated in this animal model. Single-dose therapy with 10000 IU of IFN-alpha protected all rhesus rotavirus-infected pups from cholestatic disease. The same dose, injected 5 d after infection, had no protective effect. Starting with onset of cholestatic symptoms, the treatment with 10000 IU of IFN-alpha daily showed good results in 29 mice. Seventy-six percent of the mice recovered after 1 wk of therapy. Histologic investigation revealed normal findings in the hepatobiliary tract of clinically normal mice. Twenty-one percent of the descendants of infected and prophylactic IFN-alpha-treated mice showed cholestatic symptoms after infection with rhesus rotavirus (79% in an untreated control group) and a milder form of the illness. In conclusion, we found that prophylactic treatment with IFN-alpha prevented the hepatobiliary system of newborn Balb/c mice from severe damage by rhesus rotavirus in this artificially designed infectious model for EHBA. Infected and icteric mice, treated for 1 wk with IFN-alpha, had good prospects for recovery and prevention of complete and irreversible occlusion of the extrahepatic bile ducts. Infected and prophylactic IFN-alpha-treated dams gave good protection to their descendants. This means that EHBA in this model could probably be averted by maternal antibodies against rotavirus.

New aspects in a murine model for extrahepatic biliary atresia.

The cause of extrahepatic biliary atresia (EHBA) remains unknown, and even an animal model is still lacking. Observations in a murine infectious model (newborn Balb/c mice infected with rhesus rotavirus group A [RRV]) reported extrahepatic biliary obstruction similar to findings in children who have EHBA. In the present study, this animal experiment was repeated, and the clinical and histomorphologic changes were observed over 3 weeks. Eighty-nine newborn mice were infected with RRV, and 67% showed signs of cholestasis and delayed growth. Eight of these animals recovered spontaneously whereas the others remained icteric. Fourty-six pups were prepared for microscopic examination following a 2-day interval. From the fifth day, the whole biliary tract showed edematous swelling with cellular infiltration. Ten days later, in the extrahepatic bile duct, a transformation took place in which concentric infiltration led to complete obstruction, sometimes with prestenotic dilatation. The intrahepatic changes showed reactive necrosis and proliferation of the small bile ducts. In one 19-day-old mouse, a ballooning dilatation was observed, similar to a developing choledochal cyst. Infection with RRV induces in newborn Balb/c mice a cholestatic clinical picture with different courses of the disease leading mostly to complete biliary obstruction and secondary hepatic changes similar to EHBA in children. This is the first animal model for EHBA with complete obstruction of the extrahepatic bile duct induced by infection. These findings present a new basis for further studies.

[Diagnosis and therapy of lymphoid tumors of the orbits]. / Diagnostik und Therapie lymphoider Tumoren der Orbita.

For the evaluation of neoplastic orbital lesions an interdisciplinary concept is crucial and includes modern imaging techniques as well as rhinosurgical approaches to the orbit. During a 14-year period 6 primary malignant orbital lymphomas and 9 cases of orbital pseudotumors were managed at our department. In most of the cases an exophthalmus with painful swelling of the eyelids, diplopia and a loss of vision were the clinical symptoms. Imaging using CT or MRI revealed homogeneous tissue formations that could not be clearly demarcated from adjacent orbital structures. By a rhinosurgical approach a biopsy was performed of each lesion without surgical complications. Following diagnosis the localized malignant lymphomas of the orbit were irradiated. In one patient systemic spread of tumor required multi-drug chemotherapy. Two patients died as the result of the sequleae of disseminated plasmocytomas. Patients with orbital pseudotumors were treated with systemic steroids. Two patients were also irradiated. No malignant transformation of any orbital pseudotumor was observed in this series. Our experiences show that careful histological evaluation of lymphoid orbital masses is necessary for correct diagnosis, especially since this has great impact on treatment and prognosis. Depending on the localization of a lesion medial orbitotomy by a rhinosurgical approach has proven to be a safe method for performing a biopsy or extirpating tumor.

[Rare differential diagnosis of breast tumor. Giant cell tumor of the ribs]. / Seltene Differentialdiagnose bei einem Mammatumor. Riesenzelltumor der Rippen.

We report a case of a breast tumor. As carcinoma of the breast was suspected, a biopsy was taken and a very rare osteoclastoma originating in the rib was identified. Semimalignant bone tumors tend to recur locally. The symptoms are nonspecific; the initial diagnosis is often made late. To differentiate the diagnosis, one should think about primary and secondary bone diseases and tumors of the organs of the thorax. In our case, the tumor was completely resected, including the ribs, and the defect was covered with a corium plasty. In this way, we are able to save the breast. We discuss different methods for covering chest wall defects.

[Distant metastasis of renal cell carcinomas to the head-neck area]. / Fernmetastasierung von Nierenzellkarzinomen in den Kopf-Hals-Bereich.

BACKGROUND: Metastases of hypernephroma to the head and neck, especially to the larynx, are rare occurrences. PATIENTS: We report on two cases with solitary spread in the head and neck. A 73-year-old woman who underwent nephrectomy because of a hypernephroma six years ago had a manifestation in the right false vocal cord, which was resected by laser surgery. The specimen of the strumectomy in the other patient revealed a metastasis of an asymptomatic hypernephroma to the thyroid gland and finally led to correct diagnosis of the primary tumor. RESULTS: The female patient refused any further treatment and died of cachexia with tumor dissemination four months later. The other patient is still living with a local recurrence after palliative irradiation and administration of interleukin-2 and alpha-interferon. CONCLUSIONS: In absence of other tumor manifestations, choosing an adequate therapy can be difficult because of the long survival rates in some patients even after hematogenous spread and the unpredictable behavior of this malignancy.

True aneurysms of the palmar arch of the hand: a report of two cases.

We report on two cases of true aneurysms of the palmar arch, both of which were post-traumatic. One was due to repetitive blunt trauma and the other to a glass cut wound. Both aneurysms were detected clinically as pulsating masses without functional disorders. The presence of elastic fibres and smooth muscle in the aneurysm wall proved it to be a true aneurysm. Both aneurysms were excised and replaced by a vein graft from the foot.