[Benefits of a multimodular outpatient training program for patients with COPD]. / Effekte eines multimodularen ambulanten Trainingsprogramms für Patienten mit COPD.

BACKGROUND: The partition and chronological sequence of the different training items and modalities necessary for an effective training of patients with chronic obstructive pulmonary disease (COPD) remains a subject of debate. We investigated the combination of effective components of pulmonary rehabilitation in the settings outpatient lung sports group, home-based training and training in a gym. METHODS: Subjects were randomized to a 12-month training program and a no training group. PATIENTS AND MAIN RESULTS: The training group (n = 10, mean age: 62.5 years, FEV1 53.4% predicted) reached an average increase in peakVO2 of 10% (p = 0.01) from 1.30 +/- 0.41 L/minute to 1.44 +/- 0.38 L/minute, in peak work rate of 14% (p = 0.007) from 82 +/- 39 W to 93 +/- 43 W and in the six-minute walking distance of 79 meters (p = 0.003), whereas in the control group (n = 9, mean age: 63.2 years, FEV1 53.7% predicted) no significant changes were observed. The quality of life obtained by use of the SF36-questionnaire and SGRQ also significantly improved in the training group, but not in the control group. CONCLUSION: This outpatient rehabilitation program is effective and appropriate for long-term rehabilitation of patients with COPD.

[Results of neurorehabilitation. An outcome study 20 months after stroke]. / Ergebnisse der Neurorehabilitation. Eine Outcomestudie 20 Monate nach Schlaganfall.

65 stroke survivors who were discharged home after completing an in-patient rehabilitation program were evaluated at home 20 months post-stroke by physiotherapists. 59 patients (91%) still lived in the community. Functional abilities remained stable with only 11% deteriorating and 25% improving in basal activities of daily living (BADL). 58% of patients needed assistance for at least one BADL and 46% showed signs of impaired cognition. Falls occurred in more than half of patients. Rehospitalisation was common (31%). Aside from living partners, care was provided by relatives in 58% and by home services in 46%. 25% of patients attended day care. Nearly half of patients still received rehabilitative therapy, especially if marked initial deficit was present. In conclusion, 20 months post stroke the majority of survivors who have completed rehabilitation successfully experience persistent limitations but remain in a stable functional status. This seems to be true for more severely disabled patients, too, if rehabilitative therapies, home services and day care are consequently provided.

Elemental mercurial poisoning.

A 39-year-old man injected 40 mL of elemental mercury in an attempted suicide 3 years before coming to our facility. No specific treatment regimen had been done since then. Chest x-ray films showed mercury deposits in the lungs, as well as around the injection site. The mercury concentration in his blood was at 96.3 micrograms (0.480 nmol/L), thus significantly elevated (given a reference range of up to 2 micrograms Hg/L), as was the renal mercury elimination. Despite mercurial deposits within the pulmonary circulation, the pulmonary function showed normal values, with no reduction of the diffusion capacity. There were signs of polyneuropathy. The patient was given sodium dimercaptopropanesulfate (Dimaval) for mercury complexation. This case report outlines the diagnosis and therapy for mercurial poisoning through metallic mercury.

Infection by Candida albicans inhibits apoptosis of human monocytes and monocytic U937 cells.

Infectious microorganisms can differently induce or inhibit apoptosis of immunocompetent effector and host cells. In this study we examined the influence of an infection by Candida albicans (C. albicans) on programmed cell death of monocytic U937 cells and human monocytes. Basal and tumor necrosis factor alpha (TNF-alpha)-induced DNA fragmentation of U937 cells was significantly inhibited by an infection with C. albicans. Enhanced apoptosis of U937 cells, induced by TNF-alpha, caused a diminished candidacidal activity of the effector cells, whereas inhibition of apoptosis by granulocyte-macrophage colony-stimulating factor (GM-CSF) was paralleled by an intensified host defense. Pretreatment of U937 cells or monocytes with the cyclooxygenase blocker indomethacin completely abolished the reduction of DNA fragmentation induced by the yeast. Studying the underlying mechanisms we found that C. albicans induced formation of prostaglandin E2 (PGE2) by U937. Exogenous administration of PGE2 down-regulated apoptosis of U937 or human monocytes to a similar extent as did fungal infection. Activation of protein kinase A by the cAMP analogue 8-bromo-cAMP inhibited U937 apoptosis, as did PGE2. On the other hand, rp-cAMP, a blocker of the cAMP-dependent signal transduction, restored and elevated DNA fragmentation levels down-regulated by C. albicans. U937 cells expressed the bcl-2 protein but the infection with fungi or PGE2 treatment did not increase proto-oncogene expression. Monocytic effector cells may therefore strengthen the defense against C. albicans by an autocrine feedback regulation via a PGE2-dependent, cAMP-transduced inhibition of apoptosis.

Predictive value of IgG subclass levels for infectious complications in renal transplant recipients.

Renal allograft recipients are at risk to acquire infectious disease complications primarily after an intensified immunosuppressive therapy. In this study, serum levels of IgG, IgA, IgM and IgG subclasses were compared between transplant patients after different anti-rejection regimen and evaluated as possible predictive markers for infectious implications. Thirty-six renal transplant recipients in the early posttransplantation period were allocated into three subgroups: group 1 consisted of 15 subjects with good primary graft function standing under a basal triple drug immunosuppression; patients of group 2 (n = 9) had a very early acute rejection episode which was treated by high steroid doses and patients of group 3 (n = 12) required antithymocyte globulin (ATG) therapy for acute rejection. Immune parameters were studied 5 weeks after transplantation, when basal triple drug immunosuppression was continued in all patients. Twenty-three age-matched patients under chronic hemodialysis were recruited as a control group. Total IgG serum levels were reduced in transplant patients compared to dialysis subjects, whereas IgA and IgM levels were not altered. IgG subclass analysis revealed, that IgG1 levels were similar in stable transplant compared to chronic hemodialysis patients, but were significantly reduced in rejection patients after steroid pulses or ATG therapy. IgG3 levels were significantly reduced in all transplant recipients compared to dialysis patients without differences between the transplant subgroups. IgG2 and IgG4 subclass levels were similar in all studied subjects. IgG subclass abnormalities were paralleled by a reduction of lymphocyte subsets in rejection patients of groups 2 and 3, which may be the basis for an altered Ig class switching. Seven out of 36 studied transplant patients had severe infections in the early posttransplantation period with four cases of viral infections. Patients with infections had significantly lower IgG1 levels and CD4 positive lymphocyte numbers but similar total IgG levels compared to patients without infections. So IgG1 levels may be of value to predict the occurrence of infectious complications in renal allograft recipients in the early posttransplantation period.

[Frequent airway infections]. / Gehäufte Infekte der Luftwege.

A 44-year-old patient experienced increasing shortness of breath and cough with yellow expectoration. Physical findings of the patient were not remarkable, whereas x-ray chest examination revealed cicatricial changes of the lower fields of the right lung. Laboratory findings showed a significant reduction of plasma gamma-globulin levels due to a global deficiency of all immunoglobulins. An infectious origin of the immunoglobulin deficiency was not detected. After exclusion of other acquired etiologic conditions, the diagnosis of a variable immunodeficiency syndrome was established. After antibiotic treatment with gyrase-inhibitors, an immunoglobulin-substitution program was initiated. Immediately after the start of an immunoglobulin infusion, the patient developed an allergic reaction. Pretreatment with antihistamine drugs eliminated allergic symptoms. Following immunoglobulin treatment, incidence and severity of infectious diseases were significantly reduced.