E. coli Nissle 1917 is a safe mucosal delivery vector for a birch-grass pollen chimera to prevent allergic poly-sensitization.

Allergic poly-sensitization affects a large number of allergic patients and poses a great challenge for their treatment. In this study we evaluated the effects of the probiotic Escherichia coli Nissle 1917 (EcN) expressing a birch and grass pollen allergen chimera 'Bet v 1, Phl p 1 and Phl p 5' (EcN-Chim) on allergy prevention after oral or intranasal application in poly-sensitized mice. In contrast to oral application, intranasal pretreatment with EcN-Chim prior to poly-sensitization led to a significant reduction of lung inflammation (eosinophils, IL-5, and IL-13 in bronchoalveolar lavage) along with suppressed levels of allergen-specific serum IgE. The suppression was associated with increased levels of allergen-specific IgA in lungs and serum IgG2a along with increased Foxp3, TGF-ß, and IL-10 mRNA in bronchial lymph nodes. In vitro EcN induced high levels of IL-10 and IL-6 in both lung and intestinal epithelial cells. Importantly, using in vivo imaging techniques we demonstrated that intranasally applied EcN do not permanently colonize nose, lung, and gut and this strain might therefore be a safe delivery vector against allergy in humans. In conclusion, our data show that intranasal application of recombinant EcN expressing a multiallergen chimera presents a novel and promising treatment strategy for prevention of allergic poly-sensitization.

Correction: E. coli Nissle 1917 is a safe mucosal delivery vector for a birch-grass pollen chimera to prevent allergic poly-sensitization.

Following the publication of this article, the authors have requested that the Acknowledgements section be amended to include the financing source of the study. The correct Acknowledgments should be as follows: We gratefully acknowledge funding from the Austrian Science Fund SFB F46 and DK MCCA W1248-B30, OeAD-GmbH grants (FR13/2016) and from the Amadeus partnership Hubert Curein French and Austrian program. We thank the BioImaging Center of Lille (Frank Lafont) for the use of the IVIS Lumina XR. We gratefully thank Katharina Ambroz, Elke Korb, Karin Baier, Erika Garner-Spitzer, Joshua Tobias, Gwenaëlle Verbrugghe, and Jéremy Desramaut for their technical assistance and helpful discussions.

Cardiogenic shock due to tachycardiomyopathy after heart transplantation: successful treatment with ivabradine.

Tachycardia-induced cardiomyopathy refers to an impairment in left-ventricular function due to chronic or prolonged tachycardia. We describe a heart transplant patient who developed cardiogenic shock due to tachycardia-induced cardiomyopathy. Low-output failure was further aggravated by administration of a short-acting beta-blocker during invasive hemodynamic monitoring. In contrast, heart rate control by administration of increasing doses of ivabradine supported recovery from cardiogenic shock and led to an improvement in the patient's clinical condition as well as left-ventricular function during follow-up.

The elderly patient at risk.

As the baby-boom generation turn age 65, it is important that nurses are informed about the unique problems of the elderly patient, particularly because the elderly represent the highest percentage of clients in hospitals, homecare, and long-term and subacute nursing facilities. Infusion nurses, particularly those in homecare, are in a pivotal position to proactively identify acute illness at an early stage and thereby improve outcomes in this vulnerable population. To do this, infusion nurses must understand the normal changes that come with aging, the profile of the elderly patient at greatest risk for poor outcomes, and the often-atypical presentation of illness. Additionally, infusion nurses must be informed about tools used to assess and monitor the patient's status. Finally, infusion nurses must understand the increased potential for iatrogenesis in the elderly and provide proactive interventions to avert its occurrence to improve quality of life and outcomes for this population.

Contrast-enhanced power Doppler sonography: improved detection of characteristic flow patterns in focal liver lesions.

PURPOSE: The aim of this study was to evaluate whether intravenous injection of an ultrasound contrast agent aids in the visualization of focal liver lesions on power Doppler images. METHODS: Fifty patients with focal liver lesions were studied by B-mode and power Doppler sonography before and after intravenous injection of the contrast agent Levovist (galactose-based microbubbles; 10 ml of a concentration of 300 mg/ml). Thirty-two patients had malignant liver lesions (19 metastases, 12 hepatocellular carcinomas, 1 cholangiocellular carcinoma), while 18 had benign lesions (12 hemangiomas, 2 focal nodular hyperplasias, 4 others). RESULTS: After contrast medium injection, the number of lesions with no intralesional flow dropped from 18 to 9. Flow signal intensity was rated subjectively as marked on contrast-enhanced images in 17 patients; only 4 patients had marked flow on precontrast images. On precontrast studies, central flow in 10 lesions and peripheral flow in 29 lesions could be observed. After enhancement, the numbers increased to 18 and 34 lesions, respectively. CONCLUSIONS: On power Doppler images, a greater number of intratumoral vessels are seen in focal liver lesions after contrast medium administration.

[Radiotherapy of humero-scapular periarthritis using ultra-hard photons. Evaluation by MRI findings]. / Strahlentherapie der Periarthritis humeroscapularis mit ultraharten Photonen. Vergleich mit kernspintomographischen Befunden.

PURPOSE: Evaluation of MRI in radiotherapy of humeroscapular periarthritis. PATIENTS AND METHODS: Seventy-seven patients with humeroscapular periarthritis prospectively underwent MRI before radiotherapy. RESULTS: Six months after radiotherapy, 34% of the patients had achieved complete pain relief, 35% major pain relief. Twenty percent had only slight improvement and 12% no improvement. Positive correlation of radiotherapy outcome and MRI findings could be shown for acute tendinitis, erosions, and complete and incomplete ruptures of the supraspinatus tendon. CONCLUSIONS: Radiotherapy is highly effective in the treatment of humeroscapular periarthritis. The indication can be improved using MRI.

[Multi-project angiography in the imaging of cerebral aneurysm]. / Multiprojektionale Angiographie zur Darstellung zerebraler Aneurysmen.

In spite of procedures such as CT angiography, MR angiography, and rotation angiography, panangiography is still indispensable in therapeutic planning for cerebral aneurysms. It is the only method that provides exact details about the size, anatomic localization, and multiplicity of aneurysms as well as relation to surrounding vessels, the presence of an aneurysmal neck, and for the evaluation of the collateral circulation required to answer the question if endovascular therapy is possible. In addition, panangiography still exhibits the highest selectivity in the detection of cerebral aneurysms.

Septum orbitale: high-resolution MR in orbital anatomy.

PURPOSE: The purpose of this study was to ascertain whether MR imaging, with the use of a surface coil, can accurately show small intraorbital structures; in particular, the septum orbitale. METHODS: Examinations of 26 patients who underwent unilateral orbital high-resolution MR imaging for different indications were evaluated to differentiate the septum orbitale from related structures, such as the aponeurosis of the levator palpebrae, the superior tarsal (Müller's) muscle, and the superior orbital (Whitnall's) ligament. RESULTS: A subtle differentiation of the septum orbitale was obtained in 23 patients (88%) and of the levator aponeurosis and Müller's muscle in 24 patients (92%). The orbicularis oculi muscle and the submuscular fibroadipose tissue were reliably identified in all patients. CONCLUSIONS: High-resolution MR imaging is suitable for differentiating small intraorbital structures. Nevertheless, an exact depiction of the septum orbitale remains very much dependent on the cooperation of the patient. The site of orbital disease can be determined precisely and in a noninvasive manner in relation to the septum orbitale.

Computed tomography with iodine-free contrast media.

The purpose of this work was to evaluate the enhancement of different concentrations of gadolinium (Gd), ytterbium (Yb) and iodine in vitro and in vivo. Comparisons were made of the enhancement (HU) of Gd, Yb and iodine in concentrations ranging from 0.1 to 30 mg/ml. In vivo dynamic CT studies were performed in ten dogs with 0.5 M Gd, Yb and iodine. Time-density curves were achieved in aorta and liver. The in vitro studies confirmed a decrease in the enhancement in this order: Gd (120 kV) > Gd (137 kV) > Yb (120 kV) > Yb (137 kV) > iodine (120 kV) > iodine (137 kV). The specific enhancement of Gd was 40.8 (120 kV), of Yb 34.2 and of iodine 29.6 HU. The enhancement of the liver decreases from 21 HU (Gd) to 19 HU (Yb) and 12 HU (iodine). Gd and Yb achieved a higher aortal enhancement than iodine (190 vs 157 HU) All contrast media were well tolerated. Equimolar concentrations of Gd and Yb show a higher in vitro contrast and enhancement than iodine.

[Monostotic Paget's disease as differential diagnosis in osteolysis of the tibia]. / Monostotischer M. Paget als Differentialdiagnose einer Osteolyse in der Tibia.

Monostotic Paget's disease has a well known appearance in radiography. Only in exceptions is a further diagnostic procedure necessary. The value of MRI and scintigraphy is demonstrated on an osteolytic lesion of the tibia.

[Computerized tomography differentiation of hepatocellular carcinoma and cholangiocellular tumors]. / Computertomographische Differenzierung von hepatozellulären Karzinomen und cholangiozellulären Tumoren.

20 patients with hepatocellular carcinomas (HCC) and 18 patients with tumours of the biliary passages and gallbladder (CAC)) were examined via angio-CT without table increment and via spiral CT. Evaluation of the time-density curve of angio-CT showed more rapid and greater enhancement in case of HCC, whereas CAC were characterised by slower and lesser contrast medium uptake than the surrounding hepatic tissue. Superior differential diagnostic information was obtained via angio-CT, whereas spiral CT yields the best information on extent and number of hepatic tumours.

A major renal artery aneurysm as the cause of a hydronephrosis with renovascular hypertension.

In general, renal artery aneurysms occur very rarely. This study reports on a 9-cm renal artery aneurysm which was erroneously thought to be a renal cyst, and which, as a result of depression of the renal parenchym and the ureteropelvic junction, led to arterial hypertension and consecutive, reduced function hydronephrosis.

Value of magnetic resonance imaging in staging carcinomas of the oral cavity and oropharynx.

The value of magnetic resonance imaging (MRI) in preoperative tumor (T) staging was assessed prospectively in 46 patients with malignant carcinomas of the oropharynx and oral cavity. In each case, the MRI findings were compared with the preoperative clinical and postoperative histopathologic findings. MRI showed an accuracy of 89% in identifying the T stage, as compared with the histopathologic result. The accuracy of the clinical examination was 78%. Compared with the clinical examination, MRI is particularly suited for differentiating T3/T4 and the larger T2 tumors. MRI tends to overinterpret the T stage when the neighboring tissues are inflamed or edematous, as it allows no demarcation between inflamed or edematous tissue and tumor. Moreover, normal oropharyngeal mucous membrane and intrinsic tongue muscle both absorb contrast medium. In the clinical examination, the T stage is often underestimated, as the depth of infiltration and bone involvement cannot always be determined with certainty. The ability of MRI to give an axial, coronal, and sagittal image allows an exact preoperative view of tumor spread and assessment of infiltration into adjacent structures.

[Color duplex sonography of liver transplantation. The vascular status]. / Farbduplexsonographie vor Lebertransplantation. Der Gefässstatus.

The present study deals with the value of CDS in liver transplantation. Between September 1988 and October 1991 CDS of hepatic vessels was carried out in 194 liver transplants. Flow direction and flow velocity in the portal vein could be demonstrated in 97%. Measurement of flow velocity indicates the extent of portal hypertension; this can be confirmed by determining flow direction in the splenic and superior mesenteric veins. In 47 of 179 patients venous collaterals were demonstrated and in 15 of 179 patients there was retrograde flow in the splenic vein. In 95% of patients CDS indicated flow direction in the hepatic artery and in 93% in the hepatic veins. Thrombosis of liver vessels (portal and hepatic veins) was demonstrated in 11 out of 13 patients by means of CDS.

[Diffuse demineralization of the lumbar spine. Magnetic resonance tomography studies of osteoporosis and plasmacytoma]. / Diffuse Demineralisation der Lendenwirbelsäule. Magnetresonanztomographische Untersuchungen bei Osteoporose und Plasmozytom.

On plain radiographs, diffuse infiltration of the spine in multiple myeloma may present as diffuse demineralization. Differentiation from osteoporotic changes is then difficult. 15 patients with multiple myeloma and 15 patients with osteoporosis were prospectively examined by MRI using plain and contrast enhanced gradient echo techniques. Examinations were evaluated for lesions and diagnosis was made by two independent observers. Contrast enhancement was visible in lesions detected in myeloma patients and in compression fractures. Fractures could be differentiated from malignant lesions by the fact that there was no multiplicity of enhancing lesions. Contrast enhanced opposed phase gradient echo sequences seem suited for the detection of vertebral involvement in myeloma.

[Feasibility of the differential diagnostic imaging of neck lymphomas]. / Möglichkeiten der bildgebenden Differentialdiagnostik der Halslymphome.

In 51 patients with cervical swellings, pretherapeutic examinations by ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) were carried out for the confirmation of exclusion of cervical lymph node metastases. By use of the M/Q ratio and morphological criteria, it is possible with ultrasound to differentiate between relatively enlarged lymph modes and lymph node metastasis with a certainly of > 90%. This was only possible in CT after administration of contrast media and the success rate was lower (72%). Both by use of the M/Q ratio and contrast medium administration, MRI is able to distinguish between lymph node metastases and reactively altered lymph nodes. Differentiation between Hodgkin/non-Hodgkin lymphomas of the neck and reactively enlarged lymph nodes is also possible with the aid of the M/Q ratio. In such cases, sonography and MRI are superior to CT. A certain differentiation between lymph node metastases and Hodgkin/non-Hodgkin lymphomas is only possible in some cases. However, there are indicative criteria for differential diagnosis. A delineation between specific lymph node inflammations and glomus carotid tumors is also possible because of the differing take-up of contrast medium in CT and MRI and via doppler sonographic criteria.