[Bronchogenic cyst: a rare cause of a retroperitoneal mass]

BACKGROUND

Bronchogenic cysts are developmental abnormalities of the primitive foregut which typically occur in the lung. Subdiaphragmatic and, especially, retroperitoneal locations are rare. The histopathological definition consists of the presence of ciliated epithelium together with cartilage or bronchial mucous glands.

CASE PRESENTATION

We report on a 49-year-old patient with the incidental finding of a large cystic mass between the diaphragm and the stomach. Imaging studies suggested an adrenal tumour. Surgical resection and postoperative follow-up were uneventful. Histological examination revealed the surprising diagnosis of a bronchogenic cyst.

CONCLUSION

Bronchogenic cysts must be considered in the differential diagnosis of retroperitoneal cystic lesions. Regardless of being asymptomatic most of the time, surgical resection is recommended to obtain definitive histological diagnosis and avoid future complications.

[The hypersensitive gastrointestinal tract--dietary components with negative effects in the intestine]

Symptoms like abdominal pain, bloating and diarrhea are often associated with the ingestion of lactose, fructose or gluten containing nutrients. The prevalence of lactose intolerance, fructose malabsorption and celiac sprue is quite high. If the symptoms are interpreted in the right way, the diagnosis and the treatment are easy. The ingestion of lactose or fructose containing food leads only to unpleasant symptoms, but in gluten sensitive patients an inflammation and destruction of the small intestinal mucosa develops. The consequences are an impaired absorption of macro- and micronutrients with their specific symptoms. The patients with lactose intolerance and fructose malabsorption can avoid the symptoms if they stick to a low lactose or fructose containing diet. On the other hand, patients with celiac sprue need a life-long gluten-free diet to heal the mucosa, to ameliorate the symptoms and to avoid relapses.

Efficacy of partially hydrolyzed guar gum-added oral rehydration solution in the treatment of severe cholera in adults

BACKGROUND

Partially hydrolyzed guar gum (PHGG) is a water-soluble fiber if added to oral rehydration solution (ORS) and undergoes fermentation in the colon liberating short chain fatty acids (SCFAs). SCFAs potentiate the effect of ORS, reducing the severity of diarrhea.

AIM

To examine the effect of PHGG-added ORS in reducing the stool output and duration of diarrhea in adult cholera.

METHODS

195 male patients were studied in a randomized controlled trial: (a) 65 received ORS + 25 g PHGG; (b) 65 received ORS + 50 g PHGG, and (c) 65 received ORS alone (control). Major outcomes were stool weight and duration of diarrhea.

RESULTS

No significant differences were found in mean +/- SD stool weight (g/kg b.w.) during the first and second 24 h. In the subgroup analysis (excluding very high purging patients, stool weight in the first 24 h was >10 kg), the stool weight (g/kg b.w.) was significantly reduced in the first 24 h in both groups receiving PHGG (PHGG 25 g, 136 +/- 68 vs. PHGG 50 g, 144 +/- 49 vs. control, 176 +/- 43, p = 0.01).

CONCLUSION

PHGG-added ORS might have a beneficial effect in moderately purging adult cholera. However, further studies are warranted to confirm the preliminary findings.

Double-pionic fusion of nuclear systems and the "ABC" effect: approaching a puzzle by exclusive and kinematically complete measurements

The ABC effect-a puzzling low-mass enhancement in the pipi invariant mass spectrum, first observed by Abashian, Booth, and Crowe-is well known from inclusive measurements of two-pion production in nuclear fusion reactions. Here we report on the first exclusive and kinematically complete measurements of the most basic double-pionic fusion reaction pn-->dpi;{0}pi;{0} at beam energies of 1.03 and 1.35 GeV. The measurements, which have been carried out at CELSIUS-WASA, reveal the ABC effect to be a (pipi)_{I=L=0} channel phenomenon associated with both a resonancelike energy dependence in the integral cross section and the formation of a DeltaDelta system in the intermediate state. A corresponding simple s-channel resonance ansatz provides a surprisingly good description of the data.

Adhesion of oral streptococci to all-ceramics dental restorative materials in vitro

In recent years, patients have benefited from the development of better and more esthetic materials, including all-ceramics dental restorative materials. Dental plaque formation on teeth and restorative materials plays an important role in the pathogenesis of oral diseases. This study investigates initial adhesion of stationary phase streptococcal species to different all-ceramics dental restorative materials. The saliva-coated materials were incubated with the bacteria for 1 h in an in vitro flow chamber which mimics environmental conditions in the oral cavity. Number and vitality of adhering bacteria were determined microscopically after staining. Surface roughness and the composition of the materials had no distinctive influence on bacterial adhesion. However, S. mutans and S. sobrinus adhered about tenfold less numerous to all materials than the other streptococcal species. Further, there was a correlation between bacterial vitality and materials' glass content. The results showed that early plaque formation was influenced predominantly by the presence of the salivary pellicle rather than by material dependent parameters whereas the composition of the all-ceramics appeared to have influenced the percentage of viable cells during the adhesion process. This presented in vitro technique may provide a useful model to study the influence of different parameters on adherence of oral streptococcal species.

Influence of CD4+/CD25+ regulatory T cells on atherogenesis in patients with end-stage kidney disease

Atherosclerosis, which is influenced by both traditional and nontraditional cardiovascular risk factors and has been characterized as an inflammatory process, is considered to be the main cause of the elevated cardiovascular risk associated with chronic kidney disease. The inflammatory component of atherosclerosis can be separated into an innate immune response involving monocytes and macrophages that respond to the excessive uptake of lipoproteins and an adaptive immune response that involves antigen-specific T cells. Concurrent with the influx of immune cells to the site of atherosclerotic lesion, the role of the adaptive immune response gradually increases. One of those cells are represented by the CD4+/CD25+ Tregs, which play indispensable roles in the maintenance of natural self-tolerance and negative control of pathological, as well as physiological, immune responses. Altered self-antigens such as oxidized LDLs may induce the development of CD4+/CD25+ Tregs with atheroprotective properties. However, atherosclerosis may be promoted by an imbalance between regulatory and pathogenic immunity that may be represented by the low expression of the forkhead box transcription factor (Foxp3) in CD4+/CD25+ Tregs. Such a defect may break immunologic tolerance and alter both specific and bystander immune suppression, leading to exacerbation of plaque development. Patients with end-stage kidney disease (ESKD) display a cellular immune dysfunction and accelerated atherosclerosis. Uremic solutes that accumulate during ESKD may be involved in these processes. In patients with ESKD and especially in those that are chronically hemodialyzed, oxidative stress induced by oxidized LDLs may increase CD4+/CD25+ Treg sensitivity to Fas-mediated apoptosis as a consequence of specific dysregulation of IL-2 expression. This review will focus on the current state of knowledge regarding the influence of CD4+/CD25+ Tregs on atherogenesis in patients with ESKD, and the potential effect of statins on the circulating number and the functional properties of these cells.

[Malnutrition in hospitals--a pilot study]

RATIONALE

Malnutrition in hospitals is often not assessed and malnourished patients rarely receive specific nutritional therapy.

METHODS

50 consecutive patients were assessed using the Nutritional Risk Score (NRS). 22 patients (intervention group, IG) with > or = 3 points were treated with 3 daily servings of a high-protein, high-caloric supplement. 28 patients (non-intervention-group, NIG) with < 3 points received standard hospital food. Body weight, body-mass-index (BMI) and laboratory values were obtained at admission and discharge. The amount of calorie and protein intake was compared to daily requirements.

RESULTS

Median duration of hospital stay was longer in the IG (24 d vs. 13 d, p < 0.01) and duration raised with the number of points in the NRS. Patients in the IG only had decreased albumin values (-2.9 g/l, p < 0.01), whereas patients in the NIG showed loss of body weight (-1.3 kg, p < 0.01), BMI (-0.45 kg/m2, p < 0.01) and albumin values (-2.4 g/l, p <0.01) during their stay. Transferrin levels remained unchanged. Median daily intake of calories and proteins was similar in both groups. In the IG, the percentage of required calorie (94% vs. 79%, p < 0.01) and protein (80% vs. 68%, p < 0.01) intake was higher and the number of patients with intake of < 75% of estimated calorie (7 (32%) vs. 11 (39%), p = 0.01) and protein (13 (59%) vs. 22 (79%), p = 0.04) requirements was lower.

CONCLUSIONS

Patients in the IG were more likely to maintain their nutritional status although their hospital stay was significantly longer.

Comparison of two antacid preparations on intragastric acidity--a two-centre open randomised cross-over placebo-controlled trial

BACKGROUND

Rennie and Riopan Gel are 2 of the most well-known and popular over-the-counter antacids; for heartburn symptoms, pain relief is fast with both preparations. A direct comparison with respect to intragastric acidity has not been done yet. The aim of our study was therefore to compare the effects of both preparations on intragastric acidity of fasting volunteers.

METHODS

The study was conducted as an open, randomised, placebo-controlled, 2-centre cross-over study. On different days, 24 healthy adult volunteers (11 males and 13 females) received equimolar acid-neutralising amounts of either Riopan Gel (800 mg magaldrate) or 2 tablets of Rennie (680 mg calcium carbonate and 80 mg magnesium carbonate) or no drug (control) with a wash-out period of at least 4 days between applications. The intragastric pH was measured for 3 h by intragastric pH-metry. The primary endpoint was the median time lag before intragastric pH >3.0 was reached for 10 consecutive min after drug administration.

RESULTS

For both antacids, the median pH during the first 30 min after drug administration was statistically significantly different from placebo (p < 0.05), but there was a statistically significant increase in pH during the first 5 min for Riopan Gel only.

CONCLUSION

Compared to placebo, both antacids (Rennie and Riopan Gel) have short-lasting effects on intragastric acidity. There is no statistically significant difference between the 2 preparations, except in the first 5 min, indicating a faster onset of action for Riopan Gel. We conclude that the antacid formulation (tablet or liquid) has little influence on intragastric acidity.

[Esophageal intramural pseudodiverticulosis]

We report two cases of esophageal intramural pseudodiverticulosis (EIPD). EIPD is a rare condition characterized by multiple flask-shaped outpouchings in the esophageal wall representing dilated excretory ducts of submucosal glands. Dysphagia is the leading symptom. On endoscopy, minute openings in the esophageal wall, and sometimes a segmental candida esophagitis or a benign stenosis not originating from an erosive reflux esophagitis are found.

[Fluorescence cytology. Improvement of urinary cytology]

Urothelial cancer of the bladder is a frequent disease, and urinary cytology often is used as a routine diagnostic tool. But this technique has an impaired sensitivity in low-grade tumours, and as a subjective method it is highly dependent on the experience of the cytologist. Here we present the technique of fluorescence cytology as an improvement of conventional cytology. This method is potentially able to compensate for the disadvantages of urinary cytology as it is an automated process that uses the principles of 5-Ala-induced photodynamic diagnosis (PDD).

[Septic arthritis of the wrist]

BACKGROUND

Septic arthritis of the wrist is correlated with a high morbidity. To show diagnostic and therapeutic options we reviewed the patients treated with wrist infections at our institution for one year.

METHODS

The data of ten patients who were treated for septic arthritis of the wrist in 2003 and 2004 were collected in a retrospective survey. Etiology, risk factors, microorganism and resistance data were recorded.

RESULTS

Six infections were of an iatrogenic nature (four following surgery, one joint puncture and one joint injection). In nine cases there was a single arthritis of the wrist. One patient had oligoarthritis. In four cases Staphylococcus aureus, in one Proteus mirabilis and in one Pseudomonas aeroginosa were identified. In four cases, no microorganism could be identified. Two of the patients suffered from diabetes mellitus, one had rheumatoid arthritis. There was no significant elevation in the white blood cell count with 9.2 (4.5 - 12.5) x 10 (9)/L. Arthroscopic debridement and synovialectomy could be performed in one case. In the other cases open surgery was necessary. In four cases partial bone resection was required. Local antibiotics were installed in eight cases. All infections healed. In nine patients the joint was immobilized with an external fixation device. All patients received systemic antibiotics. Four wrists ended in an arthrodesis, one in a four-corner fusion. On average, two (1 - 6) surgical interventions were necessary per patient. The six patients without an arthrodesis had a range of motion in extension/flexion of 30-0-24 degrees.

CONCLUSION

Surgical treatment is sufficient in septic arthritis of the wrist. However, an early diagnosis and therapeutic intervention are essential to avoid a permanent disability.

Convergent evolution of eye ultrastructure and divergent evolution of vision-mediated predatory behaviour in jumping spiders

All jumping spiders have unique, complex eyes with exceptional spatial acuity and some of the most elaborate vision-guided predatory strategies ever documented for any animal of their size. However, it is only recently that phylogenetic techniques have been used to reconstruct the relationships and key evolutionary events within the Salticidae. Here, we used data for 35 species and six genes (4.8 kb) for reconstructing the phylogenetic relationships between Spartaeinae, Lyssomaninae and Salticoida. We document a remarkable case of morphological convergence of eye ultrastructure in two clades with divergent predatory behaviour. We, furthermore, find evidence for a stepwise, gradual evolution of a complex predatory strategy. Divergent predatory behaviour ranges from cursorial hunting to building prey-catching webs and araneophagy with web invasion and aggressive mimicry. Web invasion and aggressive mimicry evolved once from an ancestral spartaeine that was already araneophagic and had no difficulty entering webs due to glue immunity. Web invasion and aggressive mimicry was lost once, in Paracyrba, which has replaced one highly specialized predation strategy with another (hunting mosquitoes). In contrast to the evolution of divergent behaviour, eyes with similarly high spatial acuity and ultrastructural design evolved convergently in the Salticoida and in Portia.

Pharmakologische Therapie von Transitstörungen

Der gastrointestinale Transit kann durch eine gesteigerte oder gehemmte Motilität gestört sein. Pharmakologisch können wir die Motilität im Gastrointestinaltrakt aktivieren oder hemmen. Am Beispiel der funktionellen Dyspepsie und der Gastroparese werden die vor allem im oberen Magendarmtrakt wirksamen Prokinetika Metoclopramid und Domperidon, Erythromycin und Tegaserod diskutiert. Bei der medikamentösen Therapie der chronischen Obstipation kommen Fasern, Gleitmittel, osmotische und sekretorische Laxantien zum Einsatz. Die Therapie des Reizdarmsyndroms basiert auf den Leitsymptomen. Steht die Obstipation im Vordergrund werden Fasern, iso-osmotische Laxantien und Tegaserod eingesetzt. Bei Schmerzen als Leitsymptom können Spasmolytika oder Trizyklische Antidepressiva versucht werden. Das Reizdarmsyndrom mit Diarrhö spricht auf Loperamid gut an.

Prä- und Probiotika

Es wird heute postuliert, dass die regelmäßige Einnahme von Prä- und Probiotika gesundheitsfördernd ist. Aufgrund der in vitro und in vivo gezeigten Effekte auf die intestinale Flora, die Darmbarriere und das Immunsystem kann dies theoretisch abgeleitet werden. Der wissenschaftliche Beweis zur Gesundheitsförderung steht aber beim Menschen noch aus. Prä- und Probiotika sind im Darm sehr aktiv und beeinflussen die intestinalen Bakterien, welche an metabolischen, trophischen und protektiven Mechanismen beteiligt sind. Präbiotika stimulieren das Wachstum von apathogenen Bakterien und erhöhen dadurch die Konzentration von kurzkettigen Fettsäuren im Darm. Die kurzkettigen Fettsäuren sind äußerst aktive Substrate im Dickdarm. Probiotika hemmen die Vermehrung von pathogenen Bakterien, verhindern die Translokation von Bakterien und Toxinen und modulieren das intestinale Immunsystem. Für einige Krankheitsbilder (Colitis ulcerosa, Pouchitis, Diarrhö) konnten therapeutische, bzw. prophylaktische Effekte mit Prä- und Probiotika nachgewiesen werden. In den nächsten Jahren werden sicher weitere Indikationen für Prä- und Probiotika einzeln oder zusammen verabreicht, dazu kommen.

Persistent inhibition of FLIP(L) expression by lentiviral small hairpin RNA delivery restores death-receptor-induced apoptosis in neuroblastoma cells

Neuroblastoma represents the most common and deadly solid tumour of childhood, which disparate biological and clinical behaviour can be explained by differential regulation of apoptosis. To understand mechanisms underlying death resistance in neuroblastoma cells, we developed small hairpin of RNA produced by lentiviral vectors as tools to selectively interfere with FLIP(L), a major negative regulator of death receptor-induced apoptosis. Such tools revealed highly efficient in interfering with FLIP(L) expression and function as they almost completely repressed endogenous and/or exogenously overexpressed FLIP(L) protein and fully reversed FLIP(L)-mediated TRAIL resistance. Moreover, interference with endogenous FLIP(L) and FLIP(S) significantly restored FasL sensitivity in SH-EP neuroblastoma cell line. These results reveal the ability of lentivirus-mediated shRNAs to specifically and persistently interfere with FLIP expression and support involvement of FLIP in the regulation of death receptor-mediated apoptosis in neuroblastoma cells. Combining such tools with other therapeutic modalities may improve treatment of resistant tumours such as neuroblastoma.

Introductory to the ESPEN Guidelines on Enteral Nutrition: Terminology, definitions and general topics

The ESPEN guidelines on enteral nutrition are the first evidence-based European recommendations for enteral nutrition. They were established by European experts for a variety of disease groups. During guideline development it became evident that terms and definitions in clinical nutrition have been used inconsistently depending on medical disciplines as well as regional and personal preferences. Therefore, to increase explanatory accuracy it was necessary to unify them. In this chapter terms and definitions used throughout all guidelines are explained. Additionally answers to more general questions, which might be important in most indications are dealt with, i.e. use of fibre containing and diabetes formulae.

ESPEN Guidelines on Enteral Nutrition: Pancreas

The two major forms of inflammatory pancreatic diseases, acute and chronic pancreatitis, require different approaches in nutritional management, which are presented in the present guideline. This clinical practice guideline gives evidence-based recommendations for the use of ONS and TF in these patients. It was developed by an interdisciplinary expert group in accordance with officially accepted standards and is based on all relevant publications since 1985. The guideline was discussed and accepted in a consensus conference. In mild acute pancreatitis enteral nutrition (EN) has no positive impact on the course of disease and is only recommended in patients who cannot consume normal food after 5-7 days. In severe necrotising pancreatitis EN is indicated and should be supplemented by parenteral nutrition if needed. In the majority of patients continuous TF with peptide-based formulae is possible. The jejunal route is recommended if gastric feeding is not tolerated. In chronic pancreatitis more than 80% of patients can be treated adequately with normal food supplemented by pancreatic enzymes. 10-15% of all patients require nutritional supplements, and in approximately 5% tube feeding is indicated.

An European survey of structure and organisation of nutrition support teams in Germany, Austria and Switzerland

BACKGROUND & AIMS

Nutritional support teams (NST) have been demonstrated to be an excellent mechanism for identifying patients in need of nutrition support, improving the efficacy of nutrition support in a variety of hospital environments. Focus of this study was the investigation of function, structure and organisation of NST in Germany (D), Austria (A) and Switzerland (CH).

METHODS

Prospective investigation of the function, structure and organisation of NST in D, A and CH, using standardised questionnaires.

RESULTS

From a total of 3071 hospitals in D, A and CH, NST have been established at 98 hospitals (3.2%). Their main activities were creating nutritional regimes (100%), education (87%) and monitoring nutrition therapy (92%). In general, the NST are not independently operating units but are affiliated to a special discipline. Seventy-one per cent of the physicians, 40% of the nurses and 69% of the dieticians in the NST held a nutrition-specific additional qualification. A total of 12% of the physicians, 37% of the nurses and 46% of the dieticians are exclusively responsible for the NST. A reduction of complications (88%) and cost saving (98%) were indicated since their establishment. The NST received in 32% funding support.

CONCLUSION

In D, A, CH neither a uniform nor comprehensive patient care by NST existed in 2004. Standards of practice, development of guidelines in clinical nutrition and better documentation in NSTs are necessary. Special efforts should be aimed at education of NST members and financing of teams.

[Pyrocarbon prosthesis for finger interphalangeal joint replacement. Experience after one year]

The long-term results of finger joint replacement, particularly the proximal interphalangeal (PIP) joint, have mostly been disappointing according to a review of the international literature and our own experiences. The recently developed pyrolytic carbon implants (Ascension Orthopedics, Austin, Texas) for replacing the PIP joint were evaluated retrospectively regarding range of motion, functionality, and relief of pain. In our hospital 17 PIP joints were replaced with pyrolytic carbon implants in 16 patients by an offset stem technique inserted without cement. This study included 13 patients; we excluded three patients because of follow-up <3 months. Prerequisites were adequate collateral ligaments, bone stability, and sufficient or at least reconstructable extensor tendons. The purpose of this study was to evaluate the 1-year outcome (minimum 270, maximum 360 days) regarding range of motion, implant stability based on radiological and clinical parameters, and relief of pain using a pre- and postoperative visual and verbal analogue scale.There was an improved range of motion of the PIP joint from 0-28-51 preoperatively to 0-22-77 postoperatively (average value). On the visual analogue scale (0 no pain, 10 incapacitating pain) we achieved pain relief at rest and in motion of 80%. On the verbal analogue scale there was an improvement of 62%. The results of this study demonstrate that pyrolytic carbon implants reduce pain and are functionally superior to arthrodesis. A precise and individual postoperative protocol is necessary for beneficial results.

Intraoperative 3D-Bildgebung am Handgelenk mit einem mobilen isozentrischen C-Bogen

In addition to conventional radiological C-arm image amplifiers used for intraoperative imaging, now a new mobile C-arm image amplifier with an option for three dimensional imaging (Iso-C 3D) is available to visualize reduction of fractures and position of implants. In a wrist-model three titanium pins were placed and three holes of different length were drilled. Distances between the pins and the depths of the drilled holes were calculated in conventional computer tomographic scans and Iso-C 3D scans in perpendicular, 30 degree and 90 degree position of the gantry and compared to actual distances and depths. There were no significant differences between the actual measured distances and those measured by CT scans and Iso-C 3D scans. Furthermore, gantry position had no significant effect upon the results. Iso-C 3D scans are as reliable as conventional CT scans for intraoperative controlling of implant positioning.

Die Kraftübertragung am Handgelenk nach Skaphoid-, Trapezium- und Trapezoideumfusion

Scaphotrapeziotrapezoid (STT) arthrodesis has been proposed to stabilise the radial column and to redirect the load away from the lunate. Midterm effects on force transmission are still unclear. Six patients who were treated with triscaphe arthrodesis were examined after an average of 5 years using CT osteoabsorptiometry of both wrists. STT arthrodesis had been performed in four cases with Kienböck's disease type IIIb and in two cases of scaphotrapeziotrapezoid arthritis. At all contralateral wrists peak mineralisations were found beyond the lunate fossa and in the scaphoid fossa of the distal radius. At the side with STT arthrodesis there was only one peak. In five cases this density maximum was beyond the scaphoid fossa and in one case half beyond the lunate and half beyond the scaphoid fossa. Triscaphe arthrodesis allows load transmission from the lunate to the radial column.

Handgelenkläsionen in der direkten MR-Arthrographie im Vergleich zur Arthroskopie des Handgelenks

BACKGROUND

Wrist arthroscopy is routinely used for diagnosis of ligamentous lesions to the wrist. Although it is very sensitive and specific, it is also more invasive than other available diagnostic techniques.

METHOD

In a prospective trial, 125 patients (80 men, 45 women) 37 years old (+/- 12) with clinical evidence of wrist lesions were evaluated with direct wrist arthro MRI. Within 24 hours following direct arthro MRI wrist arthroscopy was performed. The surgeons and radiologists were not aware of the other results until completion of their investigation. Specificity, sensitivity, positive predictive value, negative predictive value and accuracy were determined.

RESULTS

According to the MRI findings, lesions of the TFCC were suggested in 70 patients (56 % of all patients). In 65 cases this was confirmed by wrist arthroscopy. In the remaining 55 patients no TFCC lesions were detected by MRI. However in three cases TFCC lesions were found by arthroscopy. In the remaining 52 patients MRI accurately excluded TFCC lesions. There was a correlation of MRI and arthroscopy in detecting TFCC lesions in 93.6 %. Sensitivity was 94 %, specificity 89 %, positive predictive value 91 % and negative predictive value 93 %. Complete scapholunate ligament tears were detected by MRI in 12 (9.6 %) cases. Correlation with wrist arthroscopy was 99 %, sensitivity 92 %, specificity 100 %, positive and negative predictive value 100 % and 99 %, respectively. Accuracy for incomplete scapholunate lesions (n = 17, 13.6 %) and lunotriquetral tears (n = 4, 3.2 %) was poor (sensitivity 59 % and 25 %, specificity 100 % and 99 %).

CONCLUSION

Though sensitivity of MRI arthrography approaches that of arthroscopy, it cannot replace it at the moment. However, it is a potent additional tool for wrist diagnosis if intraarticular contrast is used. It can facilitate diagnosis and indications for surgery of the wrist. It may make arthroscopic and more invasive interventions for diagnostic purposes avoidable in future.

Partially hydrolysed guar gum supplemented comminuted chicken diet in persistent diarrhoea: a randomised controlled trial

BACKGROUND

Partially hydrolysed guar gum (Benefiber) added to a diet is fermented in the colon, producing short chain fatty acids, which improve intestinal function, including colonic salt and water absorption.

AIMS

To evaluate the effect of Benefiber supplemented comminuted chicken diet in the treatment of persistent diarrhoea.

METHODS

One hundred and sixteen children (aged 5-24 months), presenting to Dhaka Hospital with a history of watery diarrhoea for more than 14 days (persistent diarrhoea), were randomised to receive either: (1) comminuted chicken diet with Benefiber (study diet); or (2) comminuted chicken diet without Benefiber (control diet). The study period was seven days.

RESULTS

Of 116 children, 57 received the study diet and 59 received the control diet. Diarrhoea resolved in a greater number of children with the study than with the control diet (46/55 (84%) v 36/58 (62%); odds ratio 3.12, 95% CI 1.19 to 8.4). Survival analysis for the duration of diarrhoea also showed a reduced duration of diarrhoea in children receiving the study diet. There was also a trend in daily stool reduction in children receiving the study diet, significant on days 4-7.

CONCLUSION

Results show that Benefiber supplemented comminuted chicken diet enhances recovery of children with persistent diarrhoea, indicating its therapeutic potential.

In-medium isovector piN amplitude from low-energy pion scattering

Differential cross sections for elastic scattering of 21.5 MeV positive and negative pions by Si, Ca, Ni, and Zr have been measured as part of a study of the pion-nucleus potential across the threshold. The "anomalous" repulsion in the s-wave term was observed, as is the case with pionic atoms. The extra repulsion can be accounted for by a chiral-motivated model where the pion decay constant is modified in the medium. Unlike in pionic atoms, the anomaly cannot be removed by merely introducing an empirical on-shell energy dependence.

Palmare winkelstabile Plattenosteosynthese der instabilen distalen Radiusfraktur

Internal fixation of distal radius fractures often shows the problem of secondary dislocation due to dorsal comminution and osteoporosis. Although dorsal plating systems provide good stabilization, the intraoperative control of reduction is difficult in the comminuted area with high incidence for the need of cancellous bone graft. Occurrence of extensor tendon complications including tendonitis and rupture is not uncommon. The use of fixed angle devices by a palmar approach has demonstrated the advantage of better visualization and control at the fracture side. The subchondrale support of the articular surface by fixed angle pegs or screws prevents secondary dislocation allowing early mobilization. Better soft tissue coverage is associated with a low complication rate. 62 patients (average age 55 years) were treated with different fixed angel devices according to the fracture type and underwent retrospective evaluation with mean follow-up of 11 months (6-23 months). According to the AO Classification there were 3 A2, 24 A3, 7 B3, 14 C1, 9 C2 und 5 C3 fractures. The majority beside the B3 types and one C3 fracture were dorsally displaced. All of them showed healing without relevant secondary loss of reduction. Mean DASH score reached 19 points.