Die Pneumonie auf Reisen

Approximately 1% of the travellers visiting tropical and subtropical regions develop respiratory tract infections or pneumonia during or after their trip.Of the febrile episodes in returning travellers, up to 11% are caused by respiratory tract infections.The spectrum of causative agents includes those seen in temperate regions, with legionellosis being diagnosed increasingly, and a number of other agents which are rare or absent in temperate regions.On a worldwide scale, the most common causative agents of pneumonia are Streptococcus pneumoniae,Haemophilus influenzae,Mycoplasma pneumoniae and Chlamydia pneumoniae.Besides, tuberculosis, legionellosis, and influenza constitute special risks for travellers.Very rare causes of imported pneumonia which are limited to certain regions include tularemia, anthrax, melioidosis, glanders, plague, and infections with dimorphic fungi such as histoplasmosis, coccidioidomycosis, and North or South American blastomycosis. Ubiquitous but rare causes of travel-associated pneumonia are Coxiella burnetii,Chlamydia psittaci,Chlamydia trachomatis,Actinomyces spp., RSV and Hanta viruses, Toxoplasma gondii and Cryptococcus neoformans (European blastomycosis). In addition, lung involvement in generalized diseases after long-distance traveling has to be considered like falciparum malaria, typhus, ehrlichiosis, amebiasis,brucellosis, viral hemorrhagic fevers and others. In case of pneumonia and eosinophilia, an allergic etiology, aspergillosis, or helminthiasis should be considered.Fever and eosinophilia after traveling in tropical regions should also evoke suspicion of Katayama syndrome. In the early stages of some nematode infections (Ascaris lumbricoides, Strongyloides stercoralis, Necator americanus and Ancylostoma Duodenalis), larval migration may provoke lung infiltrates associated with peripheral eosinophilia.Rare causes of eosinophilia-associated lung infiltrates or lung involvement in travellers include infections with lung flukes, echinococcosis, Larva migrans, Dirofilaria immitis, and Toxocara spp.     

Circulating anticoagulant in a family with prolonged bleeding time and factor VIII deficiency

A circulating anticoagulant against factor VIII activity was demonstrated in the plasma of a boy from a family with both factor VIII deficiency and prolonged bleeding time. However, the factor VIII- related antigen, ristocetin-induced platelet aggregation activity, platelet retention in glass bead columns, platelet aggregation with adenosine 5'-diphosphate, collagen and epinephrine, and clot retraction among affected members were normal. The electrophoretic mobility of factor VIII-related antigen on crossed immunoelectrophoresis was normal. The inactivation of factor VIII activity by the inhibitor was time dependent and was nonlinear as the concentration of the inhibitor was increased. Immunotyping showed that the inhibitor was IgG with k light chains.     

Survival and failure analysis in stage II endometrial cancer using the revised 1988 FIGO staging system

Fifty-one patients with Stage II endometrial carcinoma diagnosed between 1974 and 1987 were restaged according to the FIGO 1988 revisions for endometrial carcinoma. Patients were divided into Stage IIA, those patients with cervical glandular involvement without stromal invasion, and Stage IIB, those patients having stromal invasion of the cervix. Tumor grade was also assessed. Patients were treated with radiation therapy alone, pre-operative radiation therapy followed by a simple hysterectomy, or a simple hysterectomy followed by postoperative radiation therapy. The 5-year actuarial survival for Stage IIA was 86% and the 5-year actuarial survival for Stage IIB was 46% (p = 0.06). The 5-year local recurrence rate in each group was 9%. Stage IIA had a distant metastases rate of 14% whereas 44% of the patients in Stage IIB developed distant disease (p = 0.06) at 5 years. The grade of the tumor did not play a role in local recurrence. However, when tumor grade was analyzed with respect to distant disease, 14% of patients with grade 1 tumors developed distant metastases, 31% of patients with grade 2 tumors developed distant metastases, and most significantly, 63% of patients with grade 3 tumors developed distant metastases (p = 0.004). There was no statistically significant relationship between stromal invasion and tumor grade. This study concludes that grade is the greatest predictor of survival, with only 37% of grade 3 patients surviving at 5 years. As a predictor of survival, stromal invasion is of less significance than grade (p = 0.06 vs. p = 0.004). Death most often occurs because of distant metastases, and local failure is rare and is not dependent on the degree of cervical involvement or grade.