Therapy of Lyme borreliosis in children

Summary A retrospective open study was conducted to determine the efficacy of penicillin and ceftriaxone in children with skin manifestations of Lyme borreliosis (solitary erythema migrans, multiple erythemata, borrelial lymphocytoma) and neuroborreliosis, respectively. One hundred sixty children were treated with penicillin and 41 with ceftriaxone for an average of 12 days. Serum antibodies to borreliae were determined before therapy and 2–3 and 4–6 weeks thereafter. At admission 44%/26%, 8%/42%, and 40%/35% of erythema migrans, borrelial lymphocytoma and neuroborreliosis patients, respectively, were IgM/IgG positive. Four to 6 weeks after treatment the percentage of seropositives was 20%/15%, 8%/61%, and 21%/44%, respectively. A 3 months follow-up was completed with 151 children. No child showed clinical evidence of illness, nor were there abnormalities in laboratory parameters.

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Therapie der Lyme-Borreliose bei Kindern

Zusammenfassung In einer offenen, retrospektiven Studie an Kindern wurde die Wirksamkeit von Penicillin bei der Behandlung von Hautmanifestationen der Lyme-Borreliose (Erythema migrans, n=160, Borrelien-Lymphozytom, n=26) und die Wirksamkeit von Ceftriaxon zur Behandlung der Neuroborreliose (n=41) untersucht. Die Therapiedauer betrug durchschnittlich 12 Tage. Serum-Antikörper wurden vor der antibiotischen Behandlung und 2–3 und 4–6 Wochen danach bestimmt. Zum Zeitpunkt der ersten Untersuchung waren 44%/26%, 8%/42% und 40%/35% der Erythema migrans-, Borrelien-Lymphozytom-bzw. Neuroborreliose-Patienten IgM/IgG positiv. Vier bis 6 Wochen nach Behandlung war der Anteil der Seropositiven 20%/15%, 8%/61% bzw. 21%/44%. Untersuchungen 3 Monate nach Behandlung konnten bei 151 Kindern (65%) durchgeführt werden. Keines der Kinder zeigte klinische Anzeichen einer Erkrankung oder einer chronischen Form der Lyme-Borreliose, ebenso gaben die Ergebnisse der Laboratoriumsuntersuchungen keinen Hinweis auf Anomalien.

     

Duodenal duplication. Case report and review of the literature

A case of duodenal duplication (cyst) in a 42-year-old male is reported. The late manifestation of this rare, little-known, but noteworthy congenital malformation was characterized by repeated attacks of acute pancreatitis and development of a high, duodenal obstruction. Radiographic examination and fiberoptic endoscopy was followed by exploratory laparotomy which demonstrated the accurate diagnosis. A review of the literature including 39 duodenal duplications in more than 300 duplications of the alimentary tract is presented.     

Comparative biology of human T-cell lymphotropic virus type 1 (HTLV-1) and HTLV-2

HTLV-1 and HTLV-2 are highly related complex retroviruses that have been studied intensely for nearly three decades because of their association with neoplasia, neuropathology, and/or their capacity to transform primary human T lymphocytes. The study of HTLV also represents an attractive model that has allowed investigators to dissect the mechanism of various cellular processes, several of which may be critical steps in HTLV-mediated pathogenesis. Both HTLV-1 and HTLV-2 can efficiently immortalize and transform T lymphocytes in cell culture and persist in infected individuals or experimental animals. However, the clinical manifestations of these two viruses differ significantly. HTLV-1 is associated with adult T-cell leukemia (ATL) and a variety of immune-mediated disorders including the chronic neurological disease termed HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). In contrast, HTLV-2 is much less pathogenic with reports of only a few cases of variant hairy cell leukemia and neurological disease associated with infection. The limited number of individuals shown to harbor HTLV-2 in association with specific diseases has, to date, precluded convincing epidemiological demonstration of a definitive etiologic role of HTLV-2 in human disease. Therefore, it has become clear that comparative studies designed to elucidate the mechanisms by which HTLV-1 and HTLV-2 determine distinct outcomes are likely to provide fundamental insights into the initiation of multistep leukemogenesis.     

Screening for drugs of abuse in oral fluid--correlation of analysis results with serum in forensic cases

The testing of saliva or oral fluid at the roadside could be a powerful tool to detect drivers under the influence of drugs and has several advantages over urine screening. In 177 cases of individuals suspected of driving under the influence of drugs, oral fluid was collected at the roadside and analyzed in parallel to serum samples. The study was performed to investigate the variability of oral fluid analysis results in relation to blood/serum. In 45% of the cases single-drug use was found, and in 50% poly-drug use was found. Cannabis was most prevalent (78%), and 70% of these individuals were also positive for tetrahydrocannabinol in serum. Overall, 97% of oral fluid samples positive for any substance were also positive in serum. Comparing data of oral fluid and serum for amphetamine, MDMA, morphine, benzoylecgonine, and tetrahydrocannabinol, the sensitivities were 100%, 97%, 87%, 87%, and 92%, respectively. Overall specificity and accuracy were in the range of 91-98%. Discrepancies between a negative oral fluid sample and a positive serum sample could be explained by analytical insensitivity in the lower volume of oral fluid analyzed (estimated for 0.1 mL confirmation vs. 1 mL of serum) or a shorter detection window in oral fluid. The low prevalence of discrepancies with positive oral fluid and negative serum results (2-9% of the cases) may be explained by persistent oral contamination especially for orally consumed drugs, like MDMA and cannabis. It is concluded that the detection of a psychoactive substance in oral fluid taken at the roadside is highly predictive for the detection of the corresponding drug or its metabolite in serum. Oral fluid testing is therefore suitable for the efficient confirmation of drug use of drivers suspected of being under the influence of drugs.     

Robotic resection of an ectopic goiter in the mediastinum

We report the first robotic resection of an ectopic mediastinal thyroid adenoma in a 72-year-old woman. This intervention was part of staged management for excessive bilateral cervical goiter with intrathoracic dispersion. The robotic resection was found to be feasible and safe. The robotic operating system offers better visual control and operative accuracy than does conventional thoracoscopy.     

Physicians ask for more problem-solving information to promote and support breastfeeding

Physicians (n=262) were surveyed about their breastfeeding promotion practices, knowledge, and areas in which they need more information in order to be more influential with patients in the initiation and duration of the process. Over half (51%) reported no or limited education in breastfeeding, whereas only 9% reported adequate education. A knowledge assessment indicated almost half (42%) did not know certain viruses can be transmitted through breast milk. There were also mixed responses to the need for vitamin D supplementation. Promotion practices included most (82%) thinking the physician has a primary role in the feeding decision, and most did discuss the benefits with patients; however, only 54% would recommend breastfeeding to a patient who had decided to bottle-feed. Problem-solving was the main area physicians reported needing more education. Partnerships with dietetics professionals may fill the gaps in the support needed to increase rates of breastfeeding.     

Chondroitins 4 and 6 sulfate in osteoarthritis of the knee: a randomized, controlled trial

OBJECTIVE: To determine whether chondroitin sulfate (CS) is effective in inhibiting cartilage loss in knee osteoarthritis (OA). METHODS: In this randomized, double-blind, placebo-controlled trial, 300 patients with knee OA were recruited from an outpatient clinic, from private practices, and through advertisements. Study patients were randomly assigned to receive either 800 mg CS or placebo once daily for 2 years. The primary outcome was joint space loss over 2 years as assessed by a posteroanterior radiograph of the knee in flexion; secondary outcomes included pain and function. RESULTS: Of 341 patients screened, 300 entered the study and were included in the intent-to-treat analysis. The 150 patients receiving placebo had progressive joint space narrowing, with a mean +/- SD joint space loss of 0.14 +/- 0.61 mm after 2 years (P = 0.001 compared with baseline). In contrast, there was no change in mean joint space width for the 150 patients receiving CS (0.00 +/- 0.53 mm; P not significant compared with baseline). Similar results were found for minimum joint space narrowing. The differences in loss of joint space between the two groups were significant for mean joint space width (0.14 +/- 0.57 mm; P = 0.04) and for minimum joint space width (0.12 +/- 0.52 mm; P = 0.05). CS was well tolerated, with no significant differences in rates of adverse events between the two groups. CONCLUSION: While there was no significant symptomatic effect in this study, long-term treatment with CS may retard radiographic progression in patients with OA of the knee. However, the clinical relevance of the observed structural results has to be further evaluated, and further studies are needed to confirm the structural effects of CS.