Apoptosis in lymph node granulomas from white-tailed deer (Odocoileus virginianus) experimentally infected with Mycobacterium bovis

Apoptosis is a morphologically and biochemically distinct mechanism of cell death seen in many physiological conditions as well as in various infectious diseases. To examine apoptosis in tuberculous white-tailed deer, 32 deer were each given an intra-tonsillar injection of 300 colony-forming units of Mycobacterium bovis. Medial retropharyngeal lymph nodes were collected at 15, 28, 42, 56, 89, 180, 262 and 328 days after inoculation. Microscopical sections of lymph nodes were labelled for apoptotic cells by the terminal deoxynucleotidyl transferase nick end labelling (TUNEL) method. TUNEL, and other morphological changes within developing granulomas, were analysed and quantified by computerized image analysis. TUNEL within granulomas was greatest 28 days after inoculation and had declined to negligible levels by 328 days. Granuloma enlargement was due primarily to an increase in size of the caseo-necrotic core of the granuloma and not to increased inflammatory cellular infiltrate. These findings suggested that cell death within M. bovis -induced granulomas in white-tailed deer was due mainly to mechanisms other than apoptosis.     

Post-dural puncture headache in young adults: comparison of two small-gauge spinal catheters with different needle design

Background. To reduce the risk of post-dural puncture headache(PDPH) in continuous spinal anaesthesia, small-gauge spinalcatheter systems with different techniques of dural perforationhave been developed. Methods. Two systems, the catheter through-needle technique(MicroCatheter, Portex, UK) and the catheter over-needle technique(22G Spinocath®, B. Braun, Germany), were used in 18 younghealthy volunteers (age 18–30 yr), who were enrolled ina neuroendocrinological investigation for analysis of neuropeptidesin cerebrospinal fluid (CSF). After intermittent sampling ofCSF (17x0.5 ml over 4 h), the catheter was removed and the developmentof PDPH and pain intensity were documented prospectively bythe subjects in a standardized headache assessment (11-pointnumerical rating scale [NRS]). Results. The study revealed a high overall incidence of PDPH(78%) with no significant differences between groups (P=0.26).However, the over-needle group showed a significantly shorterduration of PDPH (2.4 [SD 2.3] vs 5.1 [3.1] days, P=0.050) andlower maximum pain intensity (3.1 [2.9] vs 7.3 [3.4] NRS, P=0.014)than the through-needle group. Conclusions. The results demonstrate a potential benefit ofthe catheter over-needle technique for the reduction of theduration and intensity of PDPH.     

Effect of low-density lipoprotein cholesterol apheresis on blood viscosity

Few studies have been designed to study the hemodynamic effects of low-density lipoprotein apheresis, especially on whole blood viscosity. Six patients with cardiovascular disease and hypercholesterolemia underwent a single low-density lipoprotein apheresis, resulting in significant reductions in whole blood viscosity at all shear rates.     

Osteoporotic treatment options in geriatric patients

Due to the demographic changes of the last few decades, there has been a significant increase in the number of osteoporotic fractures. After a fracture, geriatric patients are at particularly high risk for an increase of their functional impairments as well as a loss of independence and quality of life. In spite of the severe medical and socioeconomic consequences of fragility fractures, osteoporotic treatment and prevention are still insufficient. Based on the current literature, the pharmacological and nonpharmacological treatment options as well as new surgical techniques for geriatric patients are reviewed.     

Clostridium-difficile-Infektion bei geriatrischen Patienten

Clostridium difficile is the main cause of nosocomial antibiotic-associated diarrhea in adults in Europe and North America. Infections with C. difficile typically occur in elderly patients with comorbidities and prior antibiotic therapy. Other risk factors are proton pump inhibitors, which are taken by many elderly patients. The main virulence factors are toxins A and B. The clinical spectrum ranges from asymptomatic colonization to severe disease with abdominal complications and sepsis. The current diagnostic gold standard is anaerobic culture but is impractical in routine use due to the long duration. Proven techniques involve glutamate dehydrogenase, toxins A and B immunoassays and PCR. First infections and recurrences can be treated with 400–500 mg metronidazole 3 times a day for 10 days. Further recurrences, serious infections or patients ?with more than two positive pred?ictors should be treated orally with 125 mg vancomycin 4 times a day for at least 10 days. Fidaxomicin, rifaximin, stool transplantation and monoclonal antibodies are promising alternative therapies.