Response of spider leg veins to pulsed diode laser (810 nm): a clinical, histological and remission spectroscopy study

BACKGROUND

Spider leg veins are common. Their treatment with laser or intensed light therapy shows generally variable success rates and often adverse side effects such as hyper- or hypopigmentation. This study was performed to investigate whether pulsed diode laser (810 nm) treatment is effective and safe.

METHODS

Thirty-five female patients with spider leg veins were included in this prospective trial. They were treated twice with a pulsed diode laser (810 nm; spot size 12 mm, frequency 2-4 Hz, pulse width 60 msec, fluence 80-100 Jcm(-2)). Laser therapy was performed on day 0 and day 14. Clinical assessments were carried out before and immediately after the first laser therapy, after 2 weeks, 8 weeks, and one year. Skin biopsies were taken before and immediately after the first laser treatment, and after 10 weeks. Contact-free remittance spectroscopy was performed before laser treatment, immediately after the first treatment, after 2 weeks and 8 weeks.

RESULTS

After the first treatment 15 patients showed a complete disappearance (CR) of spider leg veins; in the remaining 20 patients a remarkable improvement (RI) was noted (n=35). After six months of follow-up CR was seen in 6 patients, RI in 6, a stable situation in 9, and scar formation in 1 patient (n=21). The effect was almost completely stable during one year of follow-up. The examination of histological specimens before and after laser treatment showed no cellular inflammatory reaction. The mean vascular area was significantly reduced after the first (p<0.05) and after the second (p<0.05) laser treatment. Spectral analysis showed a marked decrease of peaks for oxygenized haemoglobin immediately after laser treatment and during the follow-up. Safety profile was excellent without purpuric reaction or pigmentary changes. Mild scarring was observed in two patients at the end of follow-up.

CONCLUSIONS

Pulsed diode laser therapy (810 nm) is an effective and safe treatment option for spider leg veins. The effects can be seen immediately. Objective monitoring by non-invasive remission spectroscopy and histology of biopsy specimens demonstrates selectivity of the laser action.

Why the conservation of forest genetic resources has not worked

Genetic diversity is indispensable for long-term forest sustainability and is therefore mentioned in numerous binding and nonbinding political covenants calling for action. Nevertheless, there are significant obstacles to the conservation of forest genetic resources. We discuss hindrances to genetic conservation, mainly in Europe. We identified impediments by reviewing the literature and on the basis of the experiences of the authors in this field and their participation in related political processes. The impediments include (1) difficulties in assessing and monitoring genetic erosion and human impacts (e.g., by the lack of markers showing adaptive variation and the lack of record keeping on the use and transfer of forest-tree germplasm), (2) complexities of European national structures that make the development of a common strategy toward forest genetic conservation problematic, (3) lack of effective forest governance in many parts of the world, (4) the general unattractiveness of genes as flagships in raising public awareness, (5) lack of integration of genetic aspects into biodiversity conservation, and (6) the fact that scientists and politicians are often at cross-purposes. To overcome these impediments, forest geneticists and their peers in species conservation have to participate more actively in decision making. In doing so, they must be prepared to face challenges on 2 fronts: participating in political processes and the provision of significant research findings to ensure that decisions with respect to forest genetic diversity are politically implementable and effectively address targets.

Side-effects of topical androgenic and anabolic substances and steroids. A short review

There is an increasing interest, including androgenic and anabolic substances (AAS). The uncritical use may be associated with severe adverse effects. We observed five patients with different patterns of adverse reaction to AAS: two females and three males, they were identified when seeking medical help and advice. The following adverse effects from of AAS have been observed: deepening of the voice due to topical use of AAS in an anti-cellulite cream; circumscribed hypertrichosis and late onset acneiform eruptions due to testosterone replacement therapy after ovariectomy; homolateral gynecomastia and infertility, acne and striae distensae in males using injectable AAS.

CONCLUSIONS

ASS can trigger significant adverse effects. An interdisciplinary approach may be necessary for evaluation. The dermatologists should be familiar with the adverse effects.

No sympatric speciation here: multiple data sources show that the ant Myrmica microrubra is not a separate species but an alternate reproductive morph of Myrmica rubra

No aspect of speciation is as controversial as the view that new species can evolve sympatrically, among populations in close physical contact. Social parasitism has been suggested to yield necessary disruptive selection for sympatric speciation. Recently, mitochondrial DNA phylogeography has shown that the ant Myrmica microrubra is closely related to its host, Myrmica rubra, leading to the suggestion that sympatric speciation has occurred. We investigated the relationships between the two ant forms using mitochondrial and nuclear DNA sequences, microsatellite genotyping and morphometrics. Molecular phylogenetic and population structure analyses showed that M. microrubra does not evolve separately to its host but rather shares a gene pool with it. Probability analysis showed that mitochondrial DNA data previously adduced in favour of sympatric speciation do not in fact do so. Morphometrically, M. microrubra is most readily interpreted as a miniature queen form of M. rubra, not a separate species. Myrmica microrubra is not an example of speciation. The large (typical M. rubra) and small (M. microrubra) queen forms are alternative reproductive strategies of the same species. Myrmica microrubraSeifert 1993 is consequently synonymized here with M. rubra Linnaeus, 1758.

Lipoid proteinosis

The case of a 37-year-old woman with lipoid proteinosis is presented. The first symptoms of hoarseness of voice occurred in puberty. Additional symptoms included beaded eyelid papules, macroglossia with yellowish papules, yellowish deposits of soft palate, popular eruption in the axillary area and tuberous nodules on the elbows.

Aetiology and surgical treatment of childhood blepharoptosis

AIMS

To describe the aetiology, demography, surgical management, and outcome of a cohort of paediatric ptosis patients in a large tertiary referral oculoplastic centre.

METHODS

A case note review of all patients undergoing ptosis surgery below the age of 16 years in a tertiary referral oculoplastic unit documenting the laterality, aetiology, severity of ptosis, indications for and type of surgery undertaken, the proportion of good, suboptimal, and poor surgical outcomes, re-operations, and level of patient satisfaction.

RESULTS

340 patients (82% (280/340) unilateral, 18% (60/340) bilateral ptosis) with myogenic (79%, 269/340), aponeurotic (5%, 16/340), neurogenic (11%, 37/340), mechanical (2%, 6/340), apparent (1%, 2/340), and syndrome related (3%, 10/340) ptosis underwent anterior (41%, 141/340) and posterior (26%, 90/340) levator resection, frontalis suspension with mersilene (9%, 29/340) and autogenous fascia lata (17%, 59/340), levator transposition (5%, 15/340) and other surgery (1%, 6/340) for visual (43%, 141/333) and cosmetic (57%, 189/333) indications. 77% (260/340) of patients achieved a good outcome, 10% (35/340) a suboptimal outcome, and 13% (45/340) a poor outcome requiring re-operation. There was no statistically significant difference in surgical outcome between patients with mild, moderate, or severe ptosis and with good, moderate, or poor levator function. The level of recorded patient satisfaction with the surgical outcome was 90% (206/229).

CONCLUSIONS

Results suggest that most groups of paediatric ptosis patients, including those with poor levator function and severe ptosis, achieve satisfactory results with the appropriate ptosis surgery.

Botulinum toxin A in anal fissures: a modified technique

BACKGROUND

Anal fissures are common and painful. Botulinum toxin A (BTXA) is considered to be the most potent non-surgical treatment; however, no attention has been paid to associated hyperhidrosis.

AIM

To compare traditional BTXA treatment of muscular spasticity in anal fissures with combined treatment of spasticity and focal hyperhidrosis of the anal fold and perianal skin.

SETTING

Outpatient department of a dermatological hospital.

PATIENTS AND METHODS

Ten patients with chronic anal fissures (of more than 6 months duration who failed to respond to conservative treatment and who had refused surgery) associated with focal hyperhidrosis as assessed by Minor's sweat test were investigated in an open, two-armed trial. Intramuscular injections of 20-25 U BTXA (Botox) were performed in group A (n = 5). In group B (n = 5) those injections were combined with intracutaneous injection of 30-50 U BTXA to treat focal hyperhidrosis. Mean follow-up was 5 months.

RESULTS

Five of five patients in group B but only two of five patients in group A experienced a complete remission despite the fact that relief of pain was evident in eight of 10 patients within 2 weeks. Patient satisfaction with treatment was high but slightly better in group B.

CONCLUSIONS

This open trial suggests that combined therapy of both muscular spasticity and focal hyperhidrosis may provide better results than intramuscular injections alone in anal fissure therapy with BTXA.

Clinical, radiological and pathological examination of periocular dermoid cysts: evidence of inflammation from an early age

INTRODUCTION

Periocular dermoid cysts are common and leakage of the lipid or keratin contents leads to an inflammation-often asymptomatic-around the cyst, which may cause adherence of the dermoid cyst to neighbouring structures.

PURPOSE

To investigate the frequency of clinical and radiological signs of inflammation with periocular dermoid cysts, to relate this to the histopathological examination of the excised specimens, and to assess whether the degree of inflammation is related to age at presentation.

PATIENTS AND METHODS

A retrospective non-comparative series of 124 patients with periocular dermoid cysts that had undergone imaging. Case-notes were reviewed for clinical and histopathological details and there was independent review of the radiological imaging.

RESULTS

Surgery was undertaken at between 1 and 66 years of age, most patients being under 10 years, and the duration of symptoms varied from 4 weeks to 30 years. Symptoms of inflammation-mainly intermittent lid swelling with localised redness and pain-occurred in all age groups, the proportion being greatest in the fourth decade. Clinical signs of inflammation at the time of clinic visit were relatively few, although 8% had some localised erythema and 7% had tenderness at the site of lesion. In more than two-thirds of the excised cysts, pathological examination demonstrated various degrees of chronic inflammation, even in those cysts removed before the age of 5 years.

CONCLUSION

Even if the patient does not have symptoms or signs of inflammation, most periocular dermoid cysts show histological evidence of inflammation due to leakage of the lipid and keratin contents from the cyst, the incidence being similar at all ages.

Treatment of recalcitrant psoriatic arthritis with anti-tumor necrosis factor-alpha antibody

Currently available treatments for psoriatic arthritis are either not completely effective or toxic in some patients. As tumour necrosis factor (TNF)-alpha is involved in both the joint and skin involvement in psoriatic arthritis, blockade of TNF-alpha seems a reliable way to treat patients with this disease. We report two patients with progressive recalcitrant psoriatic arthritis treated with low-dose methotrexate (7.5 mg, once per week) in combination with intravenous chimeric monoclonal anti-TNF-alpha antibody (infliximab, 3 mg/kg body weight). Both showed a dramatic and rapid response in the reduction of pain, followed by improvement of laboratory and clinical signs of joint inflammation. Skin disease also responds after a short delay. The observation shows that infliximab is effective and well tolerated in patients with recalcitrant progressive psoriatic arthritis. Different kinetics of symptom release during treatment suggest a variable role for TNF-alpha in disease pathways of pain, joint inflammation and skin involvement.

Intracutaneous botulinum toxin A versus ablative therapy of Hailey-Hailey disease--a case report

BACKGROUND

Hailey-Hailey disease is an autosomal-dominant blistering disease affecting the intertriginous skin. Dermabrasion and ablative laser treatment are known to be curative. Sweating is a common aggravating factor. Botulinum toxin A (BTXA) has been shown to inhibit sudoriferic nerves.

OBJECTIVE

To evaluate whether a treatment with BTXA induces remissions and can compete with ablative therapy. To compare dermabrasion with erbium:YAG laser therapy.

METHOD

Case report with side-by-side comparison. We used intracutaneous BTXA on both sides of the submammary region. Four days later a limited area of 25 cm(2) on each side was treated with either dermabrasion or erbium:YAG laser. The follow-up was 12 months.

RESULTS

Wound healing was complete within 7 days after erbium:YAG laser and two weeks after dermabrasion. Areas treated with BTXA alone also showed complete remission within two weeks. During a follow-up, no relapse occurred with either treatment.

CONCLUSION

BTXA is capable of inducing remissions of Hailey-Hailey disease without abrasion for at least 12 months. Among ablative treatments, erbium: YAG laser therapy leads to a more rapid wound closure than dermabrasion, with both causing complete remissions.

Treatment of chronic radiation ulcers with recombinant platelet-derived growth factor and a hydrophilic copolymer membrane

We report on a 59-year-old woman suffering from cutaneous T-cell lymphoma of the mycosis fungoides type, who developed chronic ulcerating radiation dermatitis after total body electron beam irradiation with a cumulative dose of 36 Gy. The painful and easily bleeding ulcers could be markedly improved using a combined approach with topical platelet-derived growth factor gel and hydrophilic copolymer membranes.

Treatment of common warts and actinic keratoses by Er:YAG laser

BACKGROUND AND OBJECTIVES

The use of ablative lasers in the treatment of common warts and precancerous actinic keratoses has been reported in the literature, showing variable response rates and relapse rates. The erbium:YAG laser (Er:YAG) with a wavelength of 2.94 microm allows precise ablation avoiding strong inflammation. The authors have evaluated the potential benefits of Er:YAG laser treatment for difficult-to-treat warts and actinic keratoses.

PATIENTS AND METHODS

A total of 69 patients with difficult-to-treat warts (periungual or plantar) with a mean age of 30.1 +/- 16.1 years (range 11-58 years), and 29 patients with actinic keratoses with a mean age of 73.5 +/- 9.7 years (range 58-90 years) were treated by Er:YAG laser. Ablative therapy was performed with a spot size of 3 mm, a frequency between 8 Hz and 15 Hz, and a fluence of 5.7-11.3 J cm(-2) (warts) or 5.7-7.1 J cm(-2) (actinic keratoses).

RESULTS

After a single laser treatment a complete response (CR) was observed in 50 patients with warts (72.5%). Plantar warts were more resistant (13.5% non-responder) compared with periungual warts (5.9% non-responder). Twelve patients with a CR showed a relapse within 3 months after treatment (24.0%). All but one suffered from plantar warts. Twenty-six patients with actinic keratoses showed a CR after a single laser treatment, and in three patients a partial response (PR) was achieved. None of the patients treated with Er:YAG laser developed pigment changes, wound infections or scarring.

CONCLUSION

Treatment of common epithelial lesions such as common warts or actinic keratoses by Er:YAG laser is safe and effective. In patients with plantar warts, however, a significant rate of relapse may occur, requiring additional therapy.

Recessive epidermolysis bullosa dystrophicans (Hallopeau-Siemens)--improvement of wound healing by autologous epidermal grafts on an esterified hyaluronic acid membrane

Epidermolysis bullosa dystropicans of the Hallopeau-Siemens type (HS-EBD) is an autosomal-recessive blistering disease. Skin fragility due to mutations in structural proteins is responsible for further development of chronic and painful wounds, skin infections and sepsis. There is no causative treatment available. We present a case report with HS-EBD and longstanding painful wounds treated with autologous keratinocytes on an esterified hyaluronic acid membrane. Two out of three wounds treated showed a complete take of the graft. They improved markedly with a stable result over 12 months until now. Even autologous keratinocyte grafting may have a beneficial effect on chronic wounds in HS-EBD despite the fact that the genetic defects are unchanged.

Lower relapse rate of botulinum toxin A therapy for axillary hyperhidrosis by dose increase

BACKGROUND

Primary focal hyperhidrosis is a common condition that gives rise to functional and emotional problems and may disturb professional and social life. Recently, low-dose intracutaneous injections of botulinum toxin A have been shown to induce a temporary anhidrosis, with relapses occurring usually after 4 to 6 months.

OBJECTIVE

To evaluate the short- and long-term effectiveness and possible adverse effects of high-dose botulinum toxin therapy in the treatment of axillary hyperhidrosis.

DESIGN

In an open study, patients with focal hyperhidrosis were treated with intracutaneous injections of botulinum toxin A (Botox; Allergan Inc, Irvine, Calif). A total dose of 200 U of botulinum toxin A was used once per axilla. Patients were observed for up to 15 months.

SETTINGS

University medical center.

PATIENTS

Twenty-four patients with axillary hyperhidrosis were treated. Their ages ranged from 19 to 58 years (mean +/- SD, 34.8 +/- 12.4 years).

MAIN OUTCOME MEASURES

Reduction of sweating as assessed by the Minor iodine-starch test and planimetry of hyperhidrotic areas. Patients were interviewed at the end of follow-up about their satisfaction with this treatment.

RESULTS

Within 6 days, all patients reported cessation of excessive sweating. The mean +/- SD area of excessive sweating identified by the Minor iodine-starch test decreased from 19.27 +/- 11.95 cm2 to 0.25 +/- 0.61 cm2 (P<.001). The mean follow-up was 10.0 +/- 2.8 months (range, 5-15 months). Four patients (17%) reported a return of axillary hyperhidrosis after 7 to 10 months. All patients who experienced relapse showed an excellent response to a second treatment. The only adverse effects reported were temporary pain and burning during the injections. No muscular weakness, insensitivity, or systemic reactions were observed.

CONCLUSIONS

High-dose botulinum toxin A seems to be as safe as low-dose botulinum toxin A in the treatment of axillary hyperhidrosis. The preliminary data suggest a lower rate of relapse.

Ectopic orbital meningioma: a case report and review

PURPOSE

To describe a well-documented case of ectopic orbital meningioma, to review the literature on the subject, and to recommend treatment.

METHODS

Neuroradiologic investigations were suggestive of orbital meningioma. The patient underwent total excision of the mass, which was subsequently examined by light microscopy and immunohistochemistry.

RESULTS

The patient was diagnosed with ectopic orbital meningioma which was locally invasive. The tumor was surgically excised, and did not recur during a 42-month follow-up interval.

CONCLUSIONS

Ectopic orbital meningiomas are rare tumors that develop from ectopic arachnoid tissue. Although locally invasive, the prognosis is favorable if the tumor is completely removed.

[Diagnosis of pyruvate kinase deficiency in the presence of an elevated reticulocyte count]

HISTORY AND CLINICAL FINDINGS

Three members of one family (mother, now aged 44 years; daughter, now aged 23 years, and son, now aged 19 years) have had chronic haemolytic anaemia since their infancy. All three have had several blood transfusions a year because of haemoglobin (Hb) concentrations as low as 5 g/dl due to intermittent increases in haemolysis. Despite an unclear diagnosis all three had splenectomies: their spleens had been enlarged to about 5-7 cm below the rib margin. After splenectomy their haemoglobin concentration rose to 9-12 g/dl and the previously raised reticulocyte count of 150-250/1000 rose further to 400-700/1000. None of the patients had symptoms other than a slight decrease in exercise tolerance. They were admitted to hospital for further evaluation. Physical examination was unremarkable except for slight jaundice and well healed splenectomy scar.

TESTS

All three patients had normochromic haemolytic anaemia (Hb 10-12 g/dl), bilirubin 2-3 mg/dl, lactate dehydrogenase activity 400-600 U/l). The reticulocyte count was raised to 420-690/1000. In all of them pyruvate kinase (PK) activity was normal or slightly increased if related to Hb concentration. Reticulocytes from healthy persons were isolated by density-gradient centrifugation so that samples could be prepared with different numbers of reticulocytes: PK activity was found to be dependent on the sample's reticulocyte count. In the three patients PK deficiency could, therefore, only be diagnosed by taking into account the raised reticulocyte count.

CONCLUSION

As reticulocytes have a higher PK activity than erythrocytes the reticulocyte count must be taken into account when assessing the significance of a given value of this enzyme's activity.

Enzyme-linked immunosorbent assay for Salmonella serology using lipopolysaccharide antigen

Enzyme-linked immunosorbent assay (ELISA) using Salmonella lipopolysaccharide (LPS) to measure specific IgG titers in cattle has proven useful. Serology can be used to assess vaccine responses and infection rates, to detect carriers, and to aid in epidemiologic studies. The objective of this study was to assess cross-reactions using sera from cattle vaccinated with different Salmonella serogroups. ELISA plates using lipopolysaccharide from serogroup B, C1, C3, D1 or E1 as the plate antigens were tested. LPS was extracted from Salmonella typhimurium (Serogroup B; somatic antigens 01, 4, 12), S. montevideo (C1; 06, 7), S. kentucky (C3; 08, 20), S. dublin (D1; 01, 9, 12) and S. anatum (E1; 03, 10) using the Westphal method. Fifteen cows were found to be seronegative for all 5 of these serogroup antigens. Each cow was then vaccinated 3 times at 2-week intervals with a killed Salmonella bacterin. The 15 different serotypes used for vaccination were chosen to represent a wide array of Salmonella serogroups with a wide array of somatic "O" antigens expressed, including somatic antigens 1, 2, 3, 4, 6, 7, 8, 9, 10, 11, 12, 13, 14, 18, 19, 20, 22, 23, 25, and 27. With each antigen tested, the highest ELISA titers were seen with sera from cattle vaccinated with homologous O antigens, indicating that reactions were highly O antigen-specific. Some cross reactions between subgroups sharing one O factor antigen were found; these titers were lower than those found with homologous serogroups sharing 2 or more antigens. Only serum from the cow vaccinated from S. anatum (group E; antigens 03, 10) cross-reacted at a low titer with group C1 (O somatic antigens 6, 7) and D1 (O somatic antigens 1, 9, 12) plate antigens, with which no somatic antigens were shared. We conclude from these results that Salmonella serology using LPS antigens is highly O antigen-specific and predictable.

Rehabilitation of a child with partial unilateral cryptophthalmos and multiple congenital anomalies

PURPOSE

This paper describes the surgical rehabilitation of a child with craniofacial anomalies, unilateral syndactyly, and partial unilateral cryptophthalmos associated with inferior colobomata of the iris and optic nerve and agenesis of the inferior rectus and inferior oblique muscles. The clinical presentation of cryptophthalmos is described.

METHODS

The medical literature since the original description of cryptophthalmos in 1872 was reviewed to define patterns of inheritance and the incidence of associated anomalies.

RESULTS

Including this patient, 149 case reports of cryptophthalmos were identified. In two families transmission from parent to child suggests dominant inheritance. None of the five dominant cases had any other anomalies, and all had bilateral complete cryptophthalmos. The incidence of cryptophthalmos in the remaining families is consistent with autosomal recessive inheritance. This group includes patients with bilateral, unilateral, and partial cryptophthalmos. Other anomalies are common, including those of the ear and nose, limbs, genitourinary system, and mouth and palate. Mortality in the perinatal period is associated with renal agenesis, laryngeal atresia, and pulmonary hypoplasia.

CONCLUSIONS

Cryptophthalmos is a rare congenital anomaly with two patterns of inheritance.

Production of Salmonella serogroup D (O9)-specific enzyme-linked immunosorbent assay antigen

Serologic testing to detect persistent IgG titer directed at Salmonella lipopolysaccharide (LPS) has proven useful in detecting Salmonella carrier cattle without clinical signs of disease and in seroepidemiologic studies. Although little cross-reactivity exists between most Salmonella serogroups, groups B (O1, 4 [5], 12) and D (O1, 9, 12) share somatic (LPS cell wall) antigens O1 and O12, which results in some cross-reactions. This may be unimportant in most instances, because group-B and group-D carriers need to be identified and culled. It may be desirable in some situations, such as when trying to control S dublin, to determine which serogroup is present in a given herd. For this reason, a procedure to produce a pure O9 group-D antigen was developed. Salmonella dublin (group D) was grown by use of standard procedures, and LPS was extracted by use of the phenol-water method. The LPS was then oxidized with sodium periodate, dialyzed, reduced with sodium borohydride, cleaved with hydrochloric acid, and again dialyzed. This procedure successfully cleaved the saccharides comprising O antigens 1 and 12, leaving a pure O9 ELISA antigen. Sera from cattle vaccinated or naturally infected with S typhimurium, S agona, and S schwarzengrund (all group B), S montevideo (group C1), and S dublin (group D) were tested by ELISA, using modified and unmodified antigens. When the ELISA antigen used was the chemically modified (pure O9) group-D antigen, elimination of cross-reactions confirmed the structural loss of cross-reacting O1 and O12 antigens.

Prevalence of salmonellae in cattle and in the environment on California dairies

Milk samples were collected from all lactating cows on 60 dairies (mean number of cows/dairy, 584; range, 66 to 2,834) randomly selected from 701 California dairies enrolled in the Dairy Herd Improvement Association program. Samples were tested, by means of an ELISA, for antibodies against Salmonella serogroup B, C1, and D1 antigens (somatic antigens O1, 4, 6, 7, 9, 12). Blood samples were collected from all cows with positive results and tested for serologic evidence of exposure to salmonellae. Samples for bacteriologic culture (pooled feces from 20 randomly selected calves, swabs of wet areas and feces from calf pens and dairy hospital pens, drag swab sample from wastewater lagoon, and samples of feed components) were also collected from all 60 dairies. Seven (11.7%) of the 60 dairies each had 1 sample that yielded Salmonella organisms (3 S typhimurium, 1 S dublin, 1 nonmotile Group D salmonella, 1 S derby, and 1 S oranienberg). Five of the Salmonella isolates came from the hospital pens and 2 came from calf pens. Thirty-three dairies did not vaccinate cattle against salmonellosis, and of these, 24 (72.7%) had > or = 1 seropositive cow (titer > or = 200), and 20 (61%) had > or = 1 persistently seropositive cow (titer for each of 2 blood samples collected > or = 60 days apart was > or = 200). Of the 27 dairies that did vaccinate cows against salmonellosis, 24 (89%) had > or = 1 seropositive cow, and 21 (78%) had > or = 1 persistently seropositive cow.(ABSTRACT TRUNCATED AT 250 WORDS)

Extracapsular cataract extraction and posterior-lip sclerectomy with viscoelastic

A review of 15 cases suggests that posterior-lip sclerectomy can be performed safely with extracapsular cataract extraction (ECCE) and posterior chamber lens implantation. The anterior chamber was filled with viscoelastic at the end of each procedure; no case required reoperation for shallow chamber or hypotony. The mean intraocular pressure after 1 year was 12.1 mm Hg. The astigmatism induced by the triple procedure did not differ significantly from that caused by ECCE alone during the initial 2 postoperative years. A new mathematical model that describes the change over time of postoperative astigmatism associated with these procedures is described.

[The value of the x-ray findings in the follow-up of the adult respiratory distress syndrome. A retrospective analysis]

Serial chest x-rays of 23 ARDS patients, taken in an 24 hour interval, were retrospectively analysed. Radiographic patterns of ARDS were divided into five stages and were related to corresponding parameters of respiratory status. Characteristic findings on chest x-ray films occurred after a short latency period following the clinical onset of ARDS. There was a close relationship between the time of maximum radiographic changes and maximum loss of lung function. The progression through successive radiologic stages was in many cases accompanied by a significant deterioration of functional parameters. Distinction between survivors and non-survivors was achieved while considering maximum radiographic abnormalities. The results suggest significance of serial chest x-rays in diagnosis and course estimation of ARDS.

Relation between plasma K+ and ventilation during incremental exercise after glycogen depletion and repletion in man

1. We have examined the relationship between expiratory ventilation (VE), plasma potassium concentration ([K+]P), blood lactate concentration ([Lac-]B), and plasma pH (pHP) in five trained men before and after glycogen depletion and repletion in two successive incremental bicycle ergometer tests (tests A and B). 2. Though pHP was significantly higher after glycogen depletion (in relation to normal or repleted conditions) VE and [K+]P also tended to be higher. 3. There was no constant relation between the magnitude or the direction of change in lactic acidosis, or VE and [K+]P, respectively. Instead, a close temporal relationship between changes in VE and [K+]P was found. 4. A non-linear increase in VE occurred independently of changes in pHP or [Lac-]B, but could be well predicted from a non-linear increase in [K+]P. 5. These findings indicate that lactic acidosis had no deciding effect on exercise ventilation in these experiments. They are consistent with the idea that the potassium increase may contribute to the ventilatory drive during exercise.

Prevention of infection in acute leukemia

In a randomized study comparing cotrimoxazole plus colistin with ciprofloxacin, each in combination with nonabsorbable antimycotics, the incidence of major infections in terms of septicemias and pneumonias as well as of minor infections and episodes of unexplained fever (FUO) was higher in patients treated with ciprofloxacin. In cases of microbiologically documented infections, gram-positive cocci dominated by far. In surveillance cultures of oral washings and of feces, gram-negative enterobacteria were only rarely detected; however, large numbers of cultures were positive for Acinetobacter species. There were four cases of documented Pneumocystis carinii pneumonia in patients not receiving cotrimoxazole. The incidence of documented mycotic infections as well as the detection of fungi in surveillance cultures was similar in both treatment groups. A decrease in the number of adverse events, especially of allergic reactions, could not be achieved by the administration of ciprofloxacin. In conclusion, cotrimoxazole plus colistin in combination with nonabsorbable antimycotics remains the standard regimen for prevention of infection in patients with acute leukemia undergoing aggressive remission induction therapy. A detailed analysis of study II will be prepared for publication.

Interrelationship between pH, plasma potassium concentration and ventilation during intense continuous exercise in man

During resting conditions plasma hydrogen ion concentration ([H+]P) is known to influence ventilation (VE), whereas the control of plasma potassium concentration ([K+]P) at rest and of both [K+]P and VE during exercise are controversial issues. To obtain more information about these variables during muscular work, eight trained men performed two successive intense continuous cycle-ergometer tests, the first (test I) during metabolic acidosis, the second (test II) with an alkalotic pH. No correlation was found between [H+]P and [K+]P or VE in the direction of change of these variables in test I. Furthermore, no correlation between [H+]P and [K+]P in test I and II was seen. Instead [K+]P and VE changed in relation to the exercise intensity. We suggest that the results confirm [K+]P as an indicator of muscular stress. In addition, the similar behaviour of relative values of [K+]P and VE changes in test I (r = 0.9, m = 1.0, where m is the slope of the regression curve) supports the hypothesis that extracellular potassium controls VE and thereby [H+]P also.

Prognostic significance of splenic follicle size in splenectomized idiopathic thrombocytopenic purpura patients

The prognostic significance of splenic follicle (B-lymphocyte compartment) size was studied in 62 patients splenectomized for idiopathic thrombocytopenic purpura (ITP). Patients with hyperplasia of splenic follicles (mean follicle diameter greater than 500 micron) were more likely to relapse or to develop additional autoimmune disorders than patients without hyperplastic splenic follicles (mean follicle diameter less than 500 micron) (p less than 0.01). The enlargement of splenic follicles had a positive predictive value of 27% and a negative predictive value of 100% for a poor outcome of splenectomy. Thus, the histological examination of spleens surgically removed for ITP seems to be an appropriate method to obtain the first indication of the possible long-term effect of splenectomy almost immediately after the operation.

Selective decontamination of the digestive tract and fungal infection in acute leukemia patients

For prevention of infection we used an SD design including antibacterial (trimethoprim 480 mg/daily, sulfamerazine 720 mg/daily, and polymyxin 0.25 mg/daily) and antifungal (4-6 million IU nystatin/daily) components. We analyzed retrospectively 138 treatment periods in 108 patients. The intensified chemotherapy resulted in severe granulocytopenia below 0.1 x 10(9)/liter over 25.2 days. In 19 patients there was suspicion of major fungal infection; therefore they were given amphotericin B and 5-fluocytosine. Fourteen of them died; major fungal infections were documented in 5 cases. In 18% of all the deceased we found major fungal infections. There was a correlation between fungal infection, the late stages of the hematological malignancy, and the lesions on the oropharyngeal mucosa. However, in terms of the serological and culture findings no correlation appeared to exist between the group with and the group without fungal infection. The SD regime is meant to suppress the Candida cell concentration in the digestive tract but has no influence on Aspergillus in the respiratory tract.

[Thrombocyte substitution, 2: Thrombocyte preparations and determining the effectiveness of thrombocyte transfusion]

The success of a transfusion of thrombocytes is influenced by numerous factors concerning both the preparation of the platelet concentrate and the recipient. In a long-term substitution of thrombocytes on account of the appearance of immunological and unspecific consumption processes the control of the effectiveness is indicated. The determination of the thrombocyte increment and the resonance thrombography are suitable for this purpose. Fever, sepsis, splenomegaly and haemorrhage cause a diminution of the increase of thrombocytes after transfusion. Isoantibodies have the greatest influence on the shortening of the survival time of transfused thrombocytes. The corrected increase of thrombocytes (CI) 1 hour after the transfusion is lowered under 5.0 Gpt/l (m2). Directives are given for the transfusion and statement of the success of thrombocyte concentrate in patients with leukaemia and malignant tumours.

[Serum iron and serum copper in patients with lymphogranulomatosis]

The serum iron and serum copper level was determined in fifteen patients with lymphogranulomatosis before and during the course of the therapy. While the serum copper was increased in all stages, for the serum iron only in the stages III and IV a tendency to diminution was found. With obtaining the remission a significant increase of the serum iron and a significant decrease of the serum copper developed. The normalization of serum iron and serum copper suggests a remission, the dissociation of the two parameters an activity of the lymphogranulomatosis.

[Successful therapy of uncontrollable macrohematuria caused by the cyclophosphamide-injured bladder]

An uncontrollable bleeding of the urinary bladder was successfully treated using a 4% formalin strip tamponade with vesico-ureteral reflux and supportive therapy with thrombocyte concentrates and transfusions of fresh blood. Non-toxic side-effects of oxazaphosphorin derivates and modern methods of prophylaxis using a uroprotectic are presented. Previously the use of formalin together with vesicoureteral reflux was contraindicated; in this case it was successfully applied for the first time via the suprapubic route using a strip tamponade.

[Hepatogenic anemia]

Anaemias with multivariate pathogenesis are frequently observed in chronic liver diseases. Among our patients 44.4 per cent (132 of 297) had an anaemia. The hepatogenic anaemia which appeared most frequently in patients with liver cirrhosis and carcinoma of the liver was in most cases normochromic (75 per cent), at a small proportion hypochromic (17.4 per cent) and rarely hyperchromic (7.6 per cent). Initial phases of an anaemia were more frequently registered by means of the counting of erythrocytes than by means of the determination of haemoglobin, which is to be traced back to the frequently existing volume macrocytosis. Leptomacrocytes, target cells and acanthocytes are observed as further forms of macrocytes in liver diseases. Among the possible individual factors the more frequently appearing latent and more rarely existing manifest haemolysis prevailed in 82 per cent of the examined patients. A hypersplenism, however, was present only in 24 per cent of the patients, vitamin B12 and folic acid deficiency as well as signs of the ineffective erythropoiesis relatively more infrequently occurred. Additional occult haemorrhages or an increase of the plasma volume may lead to an anaemia in latent haemolysis. As to the diagnosis a basis programme and an enlarged programme are reported on. The therapy has to take into consideration the treatment of the basic disease and the deficiency conditions or disturbances established.