Duodenojejunal intussusception due to an inflammatory fibroid polyp: a mimic of acute pancreatitis.

SUMMARY: This report describes an extremely unusual cause of acute pancreatitis. It highlights the value of cross-sectional imaging, in the absence of alcohol and gallstone aetiology, to establish a diagnosis and direct management. Computed tomography (CT) revealed a duodenal jejunal intussusception. A benign inflammatory fibroid tumour, acting as a lead point, was surgically resected and the patient made an unremarkable recovery without further episodes of acute pancreatitis.

Energy-dependent dynamics of keV to MeV electrons in the inner zone, outer zone, and slot regions.

We present observations of the radiation belts from the Helium Oxygen Proton Electron and Magnetic Electron Ion Spectrometer particle detectors on the Van Allen Probes satellites that illustrate the energy dependence and L shell dependence of radiation belt enhancements and decays. We survey events in 2013 and analyze an event on 1 March in more detail. The observations show the following: (a) at all L shells, lower energy electrons are enhanced more often than higher energies; (b) events that fill the slot region are more common at lower energies; (c) enhancements of electrons in the inner zone are more common at lower energies; and (d) even when events do not fully fill the slot region, enhancements at lower energies tend to extend to lower L shells than higher energies. During enhancement events the outer zone extends to lower L shells at lower energies while being confined to higher L shells at higher energies. The inner zone shows the opposite with an outer boundary at higher L shells for lower energies. Both boundaries are nearly straight in log(energy) versus L shell space. At energies below a few 100 keV, radiation belt electron penetration through the slot region into the inner zone is commonplace, but the number and frequency of "slot filling" events decreases with increasing energy. The inner zone is enhanced only at energies that penetrate through the slot. Energy- and L shell-dependent losses (that are consistent with whistler hiss interactions) return the belts to more quiescent conditions.

Depressive symptoms in Parkinson disease correlate with impaired global and specific cognitive performance.

Consecutive patients in a Movement Disorders Center with Parkinson disease (PD) were offered to undergo complete neuropsychological testing and to complete the Beck Depression Inventory (BDI), regardless of their cognitive and behavioral status. A total of 82 patients were included in this cross-sectional study and had a mean age of 67.7 years, formal education of 14.8 years, PD duration of 101 months, Unified Parkinson Disease Rating Scale-Motor ''off'' score of 36.96, Mini-Mental State Examination (MMSE) score of 27.8 (range 19-30), and BDI score of 10.23 (SD 8.65). Beck Depression Inventory scores did not correlate with disease duration or motor scores but inversely correlated with the MMSE scores (r = -0.40; P < .001) and total Dementia Rating Scale (DRS) scores (r = -0.33; P < .01). Using a univariate regression analysis controlling for age, gender, education, and total Unified Parkinson Disease Rating Scales (UPDRS) score, the BDI scores had a significant and unique relationship with MMSE scores. However, when the BDI scores were correlated with specific cognitive domains, only the Boston Naming Test and the Hopkins Verbal Learning Test (HVLT) delayed recall remained significant after Bonferroni correction. Similarly, when comparing the cognitive performance of patients with PD who scored >14 on the BDI versus those who scored <14, only the mean score of the Boston Naming Test was different between the 2 groups. Our study shows that while depressive symptoms correlated with global cognitive performance, naming, verbal memory, and language are the most susceptible cognitive domains affected with depressive symptoms.

Pegylated polystyrene particles as a model system for artificial cells.

Pegylated polystyrene particles (PS-PEG) were prepared as a model system for artificial cells, by modification of carboxyl polystyrene particles (PS-COOH) with homo- and hetero-bifunctional polyethylene glycols (PEG, MW 1500, 3400, and 5000) containing an amino end group for immobilization and an amino, hydroxyl, or methoxy end group that is exposed at the surface after immobilization. Protein adsorption from human plasma dilutions (85 v %) onto PS-PEG with a PEG surface concentration higher than 40 pmol/cm2 was reduced up to 90-95% compared with protein adsorption onto PS-COOH with a final protein surface concentration of approximately 30 ng/cm2. Two-dimensional gel electrophoresis analyses showed that 30% of the total amount of adsorbed proteins onto PS-PEG are dysopsonins (i.e., nonadhesive proteins like albumin and apolipoproteins). For PS-COOH, <15% of the amount of adsorbed proteins are dysopsonins. In addition, the generation of terminal complement compound (TCC) by PS-PEG particles with a PEG surface concentration lower than approximately 55 pmol/cm2 is not significant. The low protein adsorption, the relatively high percentage of adsorbed dysopsonins, and the low level of complement activation may prevent the uptake of PS-PEG by the mononuclear phagocytic system (MPS) in vivo. Moreover, PS-PEG (PEG surface concentration > approximately 35 pmol/cm2) shows minimal interaction with cultured human umbilical vein endothelial cells (HUVEC), which mimics the endothelial lining of the blood vessel wall.

[The long-run development of mortality in Germany]. / Die langfristige Entwicklung der Sterblichkeit in Deutschland.

The paper deals with the long-run development in mortality at individual ages in Germany by using a relative index of change in probabilities to die. The mortality at early childhood ages diminished to about one percent of what it was in the first German life table of 1871/81. Changes in infant mortality alone were responsible for 25 percent of the total increase in "life expectancy at birth" in the observation period. Changes in mortality at ages below 10 accounted for roughly 50 percent of change in life expectancy at birth. In the second part of the paper the measurement concept is used to evaluate assumptions about the future course of mortality in Germany. The most recent official forecast by the German Statistical Office is used to demonstrate the principle. The official assumptions about the future mortality proof to be unrealistically conservative. At ages below 20 the latest available data on mortality are more favorable than what is assumed for the year 2050.

[Antirheumatics - Which to choose]. / Antirheumatika -- Qual der Wahl.

The vast amount of so-called antirheumatics that have flooded the pharmaceutical market in recent time makes it practically impossible for the physician to distinguish between positive and negative therapeutical effects of these drugs. We have therefore tried, based upon the pharmaco-dynamical and pharmaco-kinetical results as well as clinical experience, to give rational advice as to application of antirheumatic substances in general practice. It has shown, that as in all of the subdivisions of pharmatherapeutics the best therapy is to treat patients with only a small contingent of name drugs, whose side-effects and dangers are exactly known.

Results with tamoxifen in advanced mammary carcinoma.

The results of a study with tamoxifen (TAM) (10 mg three times daily) in advanced breast cancer are reported. Of 44 patients, 24 showed a remission and 20 a progression. Of the 17 patients in whom an oestrogen receptor (ER) determination in tumour tissue had been carried out, 12 were receptor-positive (ER+) and five receptor-negative (ER-). Nine of the 12 ER+ cases (75%) responded to the treatment with TAM. Of the five ER- patients, one showed remission and four progression.

[ECG changes and peripheral blood pressure during endoscopic study of the stomach]. / Ekg-Veränderungen und peripheres Blutdruckverhalten bei der endoskopischen Untersuchung des Magens.

It is reported on alterations of ECG and blood pressure appearing in 51 patients during endoscopic examination of the stomach. Above all, these alterations consisted of repolarisation disturbances with a partial preterminal negative T and isolated supraventricular extrasystoles. Atrioventricular blocks or spreading of the QRS-complex were not observed. In all patients a distinct increase in frequency was present while the endoscope was introduced. Since regression of all these alterations would occur after examination, a vegetative-functional stimulus might be the inducing factor. In endoscopic examinations the risk of any incidents appearing in connection with the system of coronary circulation is minimal. In patients with considerable previous damage of the heart caution is advised.