How Much Drool Is Too Much?

A 3-year-old boy presented to the emergency department with a chief complaint of “lethargy” and was found to have ptosis with eventual respiratory failure and need for emergent intubation. There is a broad differential for a patient with respiratory failure, and careful physical examination and history are imperative to reduce morbidity and prevent mortality. After further evaluation and workup, the diagnosis is ultimately revealed.     

Public Response to Elevated Nitrate in Drinking Water Wells in Wisconsin

The authors conducted a survey by mail of Wisconsin families who had their well water tested for nitrate to (a) assess their awareness and compliance with the state's health advisories for nitrate, (b) evaluate their reaction(s) to their test results, and (c) compare demographic differences between exposure levels. Owners of contaminated wells (i.e., > 12.9 mg/l nitrate-nitrogen) were more likely to have lived on a farm, had lower annual incomes, and had older and shallower wells than families whose wells were low in nitrate (i.e., < 2.0 mg/l nitrate-nitrogen). Most respondents were aware of the advisories for pregnant women and infants and, in accordance with these advisories, the majority of families with nitrate-contaminated drinking water took no remedial action. Given that many rural families consume nitrate-contaminated water daily, scientists should conduct additional research to determine whether chronic ingestion of nitrate-contaminated water poses a significant health threat to these families.     

Zystische Adventitiadegeneration (CAD) der A.?femoralis superficialis: eine Rarit?t

The case of a 52-year-old woman with a cystic adventitial degeneration (CAD) of the superficial femoral artery is reported. The changing intensity of the complaints and the typical sonogram were decisive for the final diagnosis. The affected part of the vessel was replaced by a segment of vein. The patient was prescribed 100?mg aspirin daily for life. The seldom seen CAD is a rarity in the area of the superficial femoral artery.     

The lymphatic system in clinically localized urothelial carcinoma of the bladder: Morphologic characteristics and predictive value

ObjectiveTo assess the lymphatic vessel density (LVD) and lymphangiogenesis in urothelial carcinoma of the bladder (UCB) and to identify predictors of progression in patients treated by transurethral resection (TUR).Materials and methodsOne hundred eleven patients who underwent TUR for UCB were retrospectively included. Lymphatic endothelial cells were stained immunohistochemically [D2-40 (podoplanin) antibody in all samples; Prox-1, LYVE-1, and VEGFR-3 (Flt-4) in subgroups]. LVD was measured in representative intratumoral (ITLVD), peritumoral (PTLVD), and nontumoral (NTLVD) areas using standardized criteria. Double-immunostainings with D2-40/CD-34 were performed to distinguish between blood and lymphatic vessels, and D2-40/Ki-67 stainings were done to detect lymphangiogenesis. Lymph-specific parameters were correlated with pathologic and clinical characteristics. In patients with non-muscle-invasive UCB (n = 76) univariable and multivariable analyses were performed to identify predictors of progression.ResultsThe PTLVD was significantly higher than ITLVD and NTLVD (P < 0.001). Proliferating lymphatic vessels were observed in all specimens assessed with D2-40/Ki-67. Characteristic suburothelial D2-40 positivity was observed in noninvasive pTa tumors. LYVE-1-stainings revealed the existence of tumor-associated macrophages. The presence of intratumoral lymphatic vessels was significantly associated with higher tumor stage, high grade, and sessile growth (all P < 0.001). Muscle-invasive tumors (P = 0.020), higher grade (P = 0.026), the presence of lymphovascular invasion (P < 0.001), and concomitant carcinoma in situ (CIS) (P = 0.020), sessile growth (P = 0.004), and loss of suburothelial D2-40 positivity (P = 0.031) were associated with disease progression in univariable analysis. LVD values in any area were not significantly associated with progression despite detection of proliferating lymphatic vessels. The presence of concomitant CIS was identified as an independent predictor of progression on multivariable analysis (P = 0.041; hazard ratio 4.620).ConclusionsA high peritumoral LVD is present in clinically localized UCB. The presence of intratumoral lymphatic vessels correlates with characteristics of aggressive disease. Lymphangiogenesis occurs; however, the lymph-specific parameters tested in this study cannot be used to predict progression following TUR. The presence of concomitant CIS is an important risk factor for later disease progression in patients with non-muscle-invasive UCB. Our results contribute to the understanding of metastatic tumor spread in UCB.     

Immunologie der Harnwege

The human urinary tract represents an impressive mechanical barrier against infection. Its immediate anatomical proximity to the gastrointestinal tract predisposes it to invasion and infection by enteric bacteria. Thus the immune system of the urinary tract represents an essential and powerful means to repel bacterial, viral and parasitic intruders, protecting sensitive organ systems such as the kidneys. The innate immune system comprises specific urothelial surface receptors named Toll-like receptors that sense small molecules derived from pathogens and initiate an early immune response. The adaptive immune system encompasses both cellular (T-lymphocytes) and humoral effectors (antibodies). Secretory immunoglobulin A, which mediates the mucosal immune response, is of particular importance. The complex cross-linking for innate and adaptive immune response as well as humoral and cellular effectors is the key to the urinary tract immune system and to its defense against pathogenic microorganisms.     

Bronchoscopic management of airway obstruction in pediatric endobronchial tuberculosis

The present report describes a case of severe airway obstruction caused by endobronchial tuberculosis in an 11-year-old girl who was successfully treated by bronchoscopic balloon dilation. This case illustrates the insidious presentation and the increasingly important role of bronchoscopic intervention in the management of endobronchial tuberculosis. In addition, a brief literature review of the condition in the pediatric age group is included.