Prevalence of joint, entheseal, tendon, and bursal findings in young, healthy individuals by musculoskeletal ultrasound.

OBJECTIVE: The purpose of this study was to determine the prevalence of joint, enthesis, bursa, and tendon ultrasound findings in large and medium joints of young, healthy individuals. METHOD: Ultrasound assessment of large and medium joints, bursae, tendons, and entheses was performed in healthy individuals below the age of 30 years. Participants also underwent bioelectrical impedance analysis and conducted supervised weight training to determine maximum strength. The prevalence of ultrasound findings was calculated and a binary logistic regression model was applied to evaluate factors associated with the present findings. RESULTS: Fifty-one healthy individuals (52.9% female) with a mean age of 23.7 years were included in this study. Joint effusion in at least one joint was observed in 72.6% of the individuals (n = 37) and entheseal pathology in at least one enthesis was detected in 27.5% (n = 14). A binary logistic regression model indicated a significant association between reported hours of sports activity per week and the prevalence of effusion in the knee (p = 0.017). In addition, associations were observed between entheseal pathology in at least one entheseal site and body mass index (BMI) (p = 0.015) as well as fat mass index (p = 0.026). CONCLUSION: Joint effusion in large and medium joints, as well as entheseal hyperperfusion, bursal effusion, and tendon sheath effusion, are found in healthy individuals. Hours of sports activity per week, BMI and fat mass index showed significant associations with the findings in joints and entheses.

Role of antibiotic treatment after surgical debridement of superficial hand infections in 180 patients.

Considering the rising prevalence of antimicrobial resistance and the lack of recommendations on antibiotic treatment, the present study evaluated the necessity of local and systemic antibiotic therapy in addition to surgical debridement in superficial hand infections. Superficial hand infections were defined as not involving tendons, joints or bone. Data were analyzed for 180 patients, assigned to three study groups according to postoperative antimicrobial treatment. Patients in group I were treated with both systemic and local antibiotics; in group II antimicrobial therapy was limited to local antibiotics in the form of subcutaneous gentamicin bead chains; group III did not receive any antibiotic treatment after surgical debridement. Patients were followed up at two weeks and at three months. Immobilization time and length of stay were longer in group I, but there were no significant differences between the groups in terms of revision rate or recovery of hand function assessed by measurement of finger mobility, grip strength and the Disabilities of the Arm, Shoulder and Hand score at follow-up. Antibiotic treatment of hand infections should be considered carefully and reserved for specific indications: e.g., severe infections and selected patients such as those with diabetes or immunocompromising diseases.

Adrenal cancer: relevance of different grading systems and subtypes

Purpose The subclassification of adrenal cancers according to the WHO classification in ordinary, myxoid, oncocytic, and sarcomatoid as well as pediatric types is well established, but the criteria for each subtype are not sufficiently determined and the relative frequency of the different types of adrenal cancers has not been studied in large cohorts. Therefore, our large collection of surgically removed adrenal cancers should be reviewed o establish the criteria for the subtypes and to find out the frequency of the various types. Methods In our series of 521 adrenal cancers the scoring systems of Weiss et al., Hough et al., van Slooten et al. and the new Helsinki score system were used for the ordinary type of cancer (97% of our series) and the myxoid type (0.8%). For oncocytic carcinomas (2%), the scoring system of Bisceglia et al. was applied. Results Discrepancies between benign and malignant diagnoses from the first thee classical scoring systems are not rare (22% in our series) and could be resolved by the Helsinki score especially by Ki-67 index (more than 8% unequivocally malignant). Since all our cancer cases are positive in the Helsinki score, this system can replace the three elder systems. For identification of sarcomatoid cancer as rarest type in our series (0.2%), the scoring systems are not practical but additional immunostainings used for soft tissue tumors and in special cases molecular pathology are necessary to differentiate these cancers from adrenal sarcomas. According to the relative frequencies of the different subtypes of adrenal cancers the main type is the far most frequent (97%) followed by the oncocytic type (2%), the myxoid type (0.8%) and the very rare sarcomatoid type (0.2%). Conclusions The Helsinki score is the best for differentiating adrenal carcinomas of the main, the oncocytic, and the myxoid type in routine work (AU)

Adrenal cancer: relevance of different grading systems and subtypes.

PURPOSE: The subclassification of adrenal cancers according to the WHO classification in ordinary, myxoid, oncocytic, and sarcomatoid as well as pediatric types is well established, but the criteria for each subtype are not sufficiently determined and the relative frequency of the different types of adrenal cancers has not been studied in large cohorts. Therefore, our large collection of surgically removed adrenal cancers should be reviewed o establish the criteria for the subtypes and to find out the frequency of the various types. METHODS: In our series of 521 adrenal cancers the scoring systems of Weiss et al., Hough et al., van Slooten et al. and the new Helsinki score system were used for the ordinary type of cancer (97% of our series) and the myxoid type (0.8%). For oncocytic carcinomas (2%), the scoring system of Bisceglia et al. was applied. RESULTS: Discrepancies between benign and malignant diagnoses from the first thee classical scoring systems are not rare (22% in our series) and could be resolved by the Helsinki score especially by Ki-67 index (more than 8% unequivocally malignant). Since all our cancer cases are positive in the Helsinki score, this system can replace the three elder systems. For identification of sarcomatoid cancer as rarest type in our series (0.2%), the scoring systems are not practical but additional immunostainings used for soft tissue tumors and in special cases molecular pathology are necessary to differentiate these cancers from adrenal sarcomas. According to the relative frequencies of the different subtypes of adrenal cancers the main type is the far most frequent (97%) followed by the oncocytic type (2%), the myxoid type (0.8%) and the very rare sarcomatoid type (0.2%). CONCLUSIONS: The Helsinki score is the best for differentiating adrenal carcinomas of the main, the oncocytic, and the myxoid type in routine work. Additional scoring systems for these carcinomas are generally not any longer necessary. Signs of proliferation (mitoses and Ki-67 index) and necroses are the most important criteria for diagnosis of malignancy.

Farmers' valuation of incentives to produce genetically modified organism-free milk: Insights from a discrete choice experiment in Germany.

This paper investigates farmers' willingness to participate in a genetically modified organism (GMO)-free milk production scheme offered by some German dairy companies. The empirical analysis is based upon discrete choice experiments with 151 dairy farmers from 2 regions in Germany. A conditional logit estimation reveals a strong positive effect of the price premium on offer. Reliable feed monitoring and free technical support increase the likelihood of scheme adoption, the latter however only in farms that have been receiving technical support in other fields. By contrast, any interference with the entrepreneurial autonomy of farmers, through pre-arranged feed procurement or prescriptive advice on the part of the dairy company, lowers acceptance probabilities. Farmers' attitudes toward cultivation of genetically modified soy, their assessment of the market potential of GMO-free milk and future feed prices were found to be significant determinants of adoption, as are farmer age, educational status, and current feeding regimens. Respondents requested on average a mark-up of 0.80 eurocents per kilogram of milk to accept a contract. Comparison of the estimates for the 2 regions suggests that farmers in northern Germany are, on average, more likely to convert to genetically modified-free production; however, farmers in the south are, ceteris paribus, more responsive to an increase in the price premium offered. A latent class model reveals significant differences in the valuation of scheme attributes between 2 latent classes of adopters and nonadopters.

[Repeated measurement of memory with valenced test items: verbal memory, working memory and autobiographic memory]. / Messwiederholung von Gedächtnistests unter Berücksichtigung der Valenz des Testmaterials: verbales Gedächtnis, Arbeitsgedächtnis und autobiografisches Gedächtnis.

A large number of questions in clinical and/or experimental neuropsychology require the multiple repetition of memory tests at relatively short intervals. Studies on the impact of the associated exercise and interference effects on the validity of the test results are rare. Moreover, hardly any neuropsychological instruments exist to date to record the memory performance with several parallel versions in which the emotional valence of the test material is also taken into consideration. The aim of the present study was to test whether a working memory test (WST, a digit-span task with neutral or negative distraction stimuli) devised by our workgroup can be used with repeated measurements. This question was also examined in parallel versions of a wordlist learning paradigm and an autobiographical memory test (AMT). Both tests contained stimuli with neutral, positive and negative valence. Twenty-four participants completed the memory testing including the working memory test and three versions of a wordlist and the AMT at intervals of a week apiece (measuring points 1. - 3.). The results reveal consistent performances across the three measuring points in the working and autobiographical memory test. The valence of the stimulus material did not influence the memory performance. In the delayed recall of the wordlist an improvement in memory performance over time was seen. The tests on working memory presented and the parallel versions for the declarative and autobiographical memory constitute informal economic instruments within the scope of the measurement repeatability designs. While the WST and AMT are appropriate for study designs with repeated measurements at relatively short intervals, longer intervals might seem more favourable for the use of wordlist learning paradigms.

[Internet presence of psychiatrists in private practice. Status, chances and legal framework]. / Internetauftritte niedergelassener Psychiater. Status quo, Möglichkeiten und gesetzliche Vorgaben.

BACKGROUND: Physicians increasingly use home pages to call attention to their practice. Based on predefined criteria, this study examines the web presence of psychiatrists and medical psychotherapists in private practice. METHODS: All registered psychiatrists and psychotherapists of six northern German states were examined in May 2010 with regards to existence and quality of their web presence. Homepages were evaluated by means of a standardized criteria catalogue with 42 items. Statistical analysis comprised descriptive and analytic approaches (ANOVA, linear models). RESULTS: The analysis included 956 physicians, 168 of whom (17.6%) had a web presence. More physicians in city states had a web presence as compared to those in states with larger territories. However, there was no difference between eastern and western states. Male as compared to female physicians more often possessed an Internet presence. The average score was 19 (± 5.2) out of 42 items, with practices with more than one physician scoring higher than single physician practices. Websites often contained general information about the practice, medical services and diseases, and rarely online services, professional information about the physician, access for disabled, emergency services and holiday substitution. Legal requirements were not sufficiently considered by more than half of the physicians. CONCLUSION: Only a smaller number of psychiatrists and psychotherapists in private practice make use of their own web presence. The quality of information varies. The criteria catalogue used in this study may offer a guideline for development of a good quality Internet presence. A consensus Internet guideline with participation of physician chambers and medical societies would be of use to establish quality standards.

Nitric acid trihydrate (NAT) in polar stratospheric clouds.

A comprehensive investigation of polar stratospheric clouds was performed on 25 January 2000 with instruments onboard a balloon gondola flown from Kiruna, Sweden. Cloud layers were repeatedly encountered at altitudes between 20 and 24 kilometers over a wide range of atmospheric temperatures (185 to 197 kelvin). Particle composition analysis showed that a large fraction of the cloud layers was composed of nitric acid trihydrate (NAT) particles, containing water and nitric acid at a molar ratio of 3:1; this confirmed that these long-sought solid crystals exist well above ice formation temperatures. The presence of NAT particles enhances the potential for chlorine activation with subsequent ozone destruction in polar regions, particularly in early and late winter.

Chemical analysis of polar stratospheric cloud particles

A balloon-borne gondola carrying a particle analysis system, a backscatter sonde, and pressure and temperature sensors was launched from Kiruna, Sweden, on 25 January 1998. Measurements within polar stratospheric cloud layers inside the Arctic polar vortex show a close correlation between large backscatter ratios and enhanced particle-related water and nitric acid signals at low temperatures. Periodic structures in the data indicate the presence of lee waves. The H2O/HNO3 molar ratios are consistently found to be above 10 at atmospheric temperatures between 189 and 192 kelvin. Such high ratios indicate ternary solution particles of H2O, HNO3, and H2SO4 rather than the presence of solid hydrates.

Sodium chloride transport of normal and dietary enlarged rat cecum in vitro.

Sodium chloride transport across isolated cecum mucosa was investigated in normal rats and rats with adaptive cecum growth induced by dietary polyethylene glycol (PEG). The normal cecum absorbed Cl in excess of Na with a small short-circuit current (ISC). Dietary adaptation led to large equivalent increments of Na and Cl net absorption without adequate ISC change. Inhibitor studies (mucosal amiloride 10(-3) and 10(-4) M; mucosal 4, 4-diisothiocyanatostilbene-2,2-disulfonic acid 5 x 10(-5) M; serosal furosemide 10(-3) M; serosal ouabain 10(-3) M) suggested that normal cecal NaCl absorption involves electroneutral Na/H and Cl/HCO3 exchange at the apical and Na-K-ATPase-mediated exit across the basolateral cell membrane. Dietary adaptation stimulates the loosely coupled antiports and possibly activates a small serosally located NaCl cotransport. Comparative histology showed flattening of all tissue layers and widening of crypts in PEG animals. Crypt widening may facilitate ion access to underutilized transport sites and, at least in part, explain the increased absorption of the enlarged cecum.

Gastrointestinal intramural hematoma, a complication of endoscopic injection methods for bleeding peptic ulcers: a case series.

In a prospective study, all patients with peptic ulcer bleeding were documented between February 1984 and April 1992. A total of 227 patients were treated by local injection of epinephrine followed by laser application and injection of polidocanol or fibrin tissue adhesive. In five of these patients, intramural hematomas developing at the former bleeding site one to three days after endoscopic treatment were observed. The presenting symptoms were abdominal pain, nausea, and vomiting. The diagnosis was established by endoscopy, abdominal ultrasound, computed tomography, or laparotomy. In four of our five patients, the bleeding site and hematoma were located in the duodenum. All patients suffered from severe underlying diseases, and showed a clear disturbance of coagulation parameters. In three patients, acute pancreatitis occurred concurrently with the hematoma, probably due to obstruction of the papilla of Vater or compression of the pancreas caused by the hematoma.

The left and gender relations -- criticism and self criticism -- what is the way forward?

PIP: This essay of the month discusses some of the lessons to be learned from the collapse of socialism in Eastern Europe and applied to the new opportunities in South Africa to undue patriarchal systems and transform gender relations. In South Africa socialism and equitable gender relations will be manifested in the care with which the Reconstruction and Development Program is implemented in gender sensitive ways. Economic transformations for women are of great importance, but so are political empowerment, state policy, and addressing social problems. Socialists must be aware of class relations and within that context gender relations. National liberation struggles offer a sense of direction in the integration of gender relations into development. Nicaraguan women have established Houses of Women, which provide legal, health, maternity, and day care services as a means of engaging women in a mass-driven approach. In Costa Rica the Vanguard Party recognizes the obstacles to the political engagement of women as husbands' attitudes, child care, and household responsibilities. Perestroika contributes new ideas about the social problems of family life. Gorbachev's address to the 27th Congress provides suggestions about shortening women's work day and granting paid maternity leave of 18 months. Paid sick leave for care of sick children would be increased for women. Special allowances would be given to low income families with children aged under 12 years of age. Preschool education would be expanded. In South Africa some of these proposals could be applied for men and women in the course of job creation while supporting within the political process the familial and social responsibility of men. Thus South Africa can avoid the problems of men loafing rather than helping relieve their wives of some of the burdensome tasks of infant care. Socialism in South Africa must specifically address the damage from apartheid, which particularly scarred youth and children. Community Life Centers should be established for psychological and social work counseling. Crime, violence, and social dislocation can be solved through addressing the personal in a political and organizational manner by political party policies, nongovernmental organizations, and government activities. Attention to socioeconomic issues and democratizing structures does not go far enough.^ieng

A computer-based approach to quality improvement for telephone triage in a community AIDS clinic.

Observation of the current procedure for telephone triage in a community-based acquired immunodeficiency syndrome (AIDS) clinic and a retrospective chart audit identified opportunities for improvement in the process for the management of telephone triage encounters. Specifically, it pointed out that the nurses faced difficulties in accessing relevant clinical data, and that a large number of data were missing in the documentation for the encounter. Five design goals for a computer-based system to improve the management of the telephone triage encounter were generated by an interdisciplinary project team. A computer-based approach to management of the telephone triage encounter complemented by the development of performance standards and guidelines has the potential to improve both the process of telephone triage and the documentation of the triage encounter.

[Broad beans as a cause of acute hemolytic anemia]. / "Dicke Bohnen" als Auslöser einer akuten hämolytischen Anämie.

A previously healthy 17-year-old Greek boy suddenly developed jaundice of sclerae and skin. In addition, physical examination revealed a pale appearance. He also reported feeling tired and weak. The haemoglobin level was 9.6 g/dl, lactate dehydrogenase activity 335 U/l, bilirubin concentration 3.2 mg/dl (direct bilirubin 0.7 mg/dl, indirect bilirubin 2.5 mg/dl), haptoglobin concentration 48.8 mg/dl. As haemolytic anaemia was assumed, direct questioning elicited the fact that the patient had, for the first time in his life, eaten 300 g of broad beans (Vicia faba) on each of two days, namely 3 and 2 days before the appearance of jaundice. Absence of glucose-6-phosphate dehydrogenase activity in the red blood corpuscles confirmed the diagnosis of favism. On symptomatic treatment both the enzyme activities and the bilirubin level fell to normal within one week, and the haemoglobin level was 15.7 g/dl after 4 weeks.

A needs analysis for computer-based telephone triage in a community AIDS clinic.

This study describes the complexity of the telephone-triage task in a community-based AIDS clinic. We identify deficiencies related to the data management for and documentation of the telephone-triage encounter, including inaccessibility of the medical record and failure to document required data elements. Our needs analysis suggests five design criteria for a computer-based system that assists nurses with the telephone-triage task: (1) online accessibility of the medical record, (2) ability to move among modules of the medical record and the triage-encounter module, (3) ease of data entry, (4) compliance with standards for documentation, and (5) notification of the primary-care physician in an appropriate and timely manner.

[Treatment strategy and results in primary inoperable rectal cancer]. / Behandlungsstrategie und Ergebnisse beim primär inoperablen Rectumcarcinom.

The authors report their experience with laparotomy in patients with rectal carcinoma to identify those patients with locally non-resectable primary cancer of the rectum who may be treated initially by high-dose radiotherapy. The goal of this so-called "staging laparotomy" is to assess mobility and tumor size by means of bimanual palpation, to stage the abdominal cavity and to create total fecal diversion by performing an endcolostomy in order to condition these patients for maximum tolerance during the protracted radiotherapy course (greater than 50 Gy/5-6 weeks). The formation of an endcolostomy seems to avoid severe morbidity and even mortality of high-dose radiotherapy without delay of further surgery. Twenty-two patients with locally advanced rectal carcinoma were treated in this way. The tumor was resectable in 18 of the 20 patients who underwent relaparotomy after high-dose radiotherapy. Six out of the 13 patients with a radical resection died with evidence of disease during the follow-up (2 with local disease). One patient died with no evidence of disease after 5 years and 6 patients are still alive without disease after an average of 37 months (15-67 months).

Effects of n-3 fatty acids on fluid and electrolyte transport in rat intestine in vivo and in vitro.

Potential therapeutic benefits of dietary n-3 fatty acids are presently evaluated in arteriosclerotic and chronic inflammatory diseases. Because some other long-chain fatty acids inhibit intestinal fluid absorption, the effects of docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) on fluid and electrolyte transport were tested in rat colon and jejunum. In ligated colon loops in vivo, DHA (10(-5)-10(-3) M luminally) diminished net sodium and fluid absorption, and stimulated net potassium secretion. Similar but smaller effects were produced by EPA. In the jejunum, transport parameters were not influenced by DHA and EPA. In isolated distal colonic mucosa in vitro, DHA (10(-4)-10(-3) M on the mucosal side) reduced the electrical resistance, potential difference, short-circuit current and the net absorption of sodium and chloride due to increased unidirectional serosal to mucosal fluxes. These changes were prevented when calcium was replaced by strontium in the bathing solution. The data suggest that n-3 fatty acids increase colonic conductance indirectly by binding luminal calcium.