Myokardiale Beteiligung des Eosinophilie-Syndroms bei einer Fadenwurminfektion Nachweis regionaler Myokardrestriktion mittels Pulswellen-Gewebe-Doppler-Echokardiographie

Zusammenfassung Fallbericht: Wir berichten über eine 57jährige Patientin, die zur Abklärung vermehrter eosinophiler Granulozyten aufgenommen worden war. Diagnostik: Die ausführliche Diagnostik ergab zunächst ein Eosinophilie-Syndrom mit Infiltrationen in das Knochenmark und in die Lunge. Klinisch imponierten zunehmend pektanginöse Beschwerden mit Zeichen einer Myokardinsuffizienz. Die daraufhin durchgeführte invasive Diagnostik ergab einen unauffälligen Koronarstatus. Deshalb wurden unter dem Verdacht einer myokardialen Beteiligung Endomyokardbiopsien entnommen, die histologisch das Bild einer Endokarditis parietalis fibroplastica Löffler ergaben. Serologische Untersuchungen nach Parasiten erbrachten schließlich im ELISA-Test positive Titer für eine Fadenwurminfektion durch Toxocara, die im Verlauf noch anstiegen. Die weiterführende Diagnostik mittels Pulswellen-Gewebe-Doppler-Echokardiographie verifizierte die myokardiale Beteiligung im Sinne einer restriktiven Füllungsstörung. Schlußfolgerung: Eine myokardiale Beteiligung durch Eosinophilie, hervorgerufen durch Toxocara, wurde bisher nicht beschrieben. Die Diagnostik mittels Pulswellen-Gewebe-Doppler-Echokardiographie erlaubt die regionale Differenzierung restriktiver Füllungsstörungen, wodurch die Bedeutung dieser neuen diagnostischen Möglichkeit bei myokardialen Erkrankungen dokumentiert werden konnte. Abstract Case Report: The case of a 57-year-old woman is reported who was admitted for peripheral hypereosinophilia. Diagnosis: Detailed investigations revealed first of all a hypereosinophilic syndrome with infiltration of bone marrow and lung. The patient suffered more and more from angina pectoris with signs of heart failure. Coronary angiography was therefore carried out which showed normal coronary arteries. With suspicion of myocardial involvement endomyocardial biopsies were performed which revealed the presence of Löfflers endocarditis parietalis fibroplastica. Finally, serological studies for parasites disclosed a positive ELISA test for Toxocara, confirmed later to be rising. Conclusion: Myocardial involvement of hypereosinophilia, caused by Toxocara is not described until now. Further diagnostic by means of pulsed wave tissue Doppler echocardiography provided regional differentiation of a restrictive filling pattern which documented the importance of this new diagnostic tool in myocardial illness.     

Feasibility of a mass vaccination campaign using a two-dose oral cholera vaccine in an urban cholera-endemic setting in Mozambique

We conducted a study to assess the feasibility and the potential vaccine coverage of a mass vaccination campaign using a two-dose oral cholera vaccine in an urban endemic neighbourhood of Beira, Mozambique. The campaign was conducted from December 2003 to January 2004. Overall 98,152 doses were administered, and vaccine coverage of the target population was 58.6% and 53.6% for the first and second rounds, respectively. The direct cost of the campaign, which excludes the price of the vaccine, amounted to slightly over 90,000 dollars, resulting in the cost per fully vaccinated person of 2.09 dollars, which is relatively high. However, in endemic settings where outbreaks are likely to occur, integrating cholera vaccination into the routine activities of the public health system could reduce such costs.     

Calcium absorption is not increased by caseinophosphopeptides

BACKGROUND: One of the suggested health benefits of caseinophosphopeptides (CPPs) is their ability to enhance calcium absorption. This possibility is based on the assumption that they resist proteolysis in the upper gastrointestinal tract and maintain calcium in a soluble form at alkaline pH in the distal ileum. OBJECTIVE: The effects of CPP-enriched preparations (containing candidate functional food ingredients) on calcium absorption from a calcium lactate drink were tested. DESIGN: A randomized crossover trial was undertaken in 15 adults in whom we measured the absorption of calcium from a calcium lactate drink (drink A: 400 mg Ca as lactate) and 2 preparations enriched with forms of CPP (1.7 g each; drinks B and C). Both drinks B and C contained 400 mg Ca as calcium lactate plus approximately 100 mg CPP-derived calcium). Each volunteer received the 3 drinks in random order. Absorption was measured by the dual-label calcium stable-isotope technique. RESULTS: The quantity of calcium absorbed was significantly lower from drink A (103 mg) than from drink B (117 mg; P = 0.012) or drink C (121 mg; P = 0.002), which indicated a positive effect of the CPPs. However, because the CPP preparations contributed additional calcium besides that found in the calcium lactate (drink A), fractional absorption of calcium from drink B (23%) was slightly but significantly (P = 0.015) lower than that from drink A (26%). CONCLUSIONS: The differences in calcium absorption are unlikely to have any biological significance. CPPs are unsuitable as candidate ingredients for functional foods that are designed to deliver improved calcium nutrition.     

Granulocyte-colony stimulating factor in the prevention of postoperative infectious complications and sub-optimal recovery from operation in patients with colorectal cancer and increased preoperative risk (ASA 3 and 4)¶Protocol for a controlled clinical trial developed by consensus of an international study group¶Part two: design of the study

GENERAL DESIGN: Presentation of a new type of a study protocol for evaluation of the effectiveness of an immune modifier (rhG-CSF, filgrastim): prevention of postoperative infectious complications and of sub-optimal recovery from operation in patients with colorectal cancer and increased preoperative risk (ASA 3 and 4). This part describes the design of the randomised, placebo controlled, double-blinded, single-centre study performed at an university hospital (n = 40 patients for each group). OBJECTIVE: The trial design includes the following elements for a prototype protocol: * The study population is restricted to patients with colorectal cancer, including a left sided resection and an increased perioperative risk (ASA 3 and 4). * Patients are allocated by random to the control or treatment group. * The double blinding strategy of the trial is assessed by psychometric indices. * An endpoint construct with quality of life (EORTC QLQ-C30) and a recovery index (modified Mc Peek index) are used as primary endpoints. Qualitative analysis of clinical relevance of the endpoints is performed by both patients and doctors. * Statistical analysis uses an area under the curve (AUC) model for improvement of quality of life on leaving hospital and two and six months after operation. A confirmatory statistical model with quality of life as the first primary endpoint in the hierarchic test procedure is used. Expectations of patients and surgeons and the negative affect are analysed by social psychological scales. CONCLUSION: This study design differs from other trials on preoperative prophylaxis and postoperative recovery, and has been developed to try a new concept and avoid previous failures.