Feeding problems in young PKU children

Behavioural feeding problems were found to be more prevalent in a group of 15 PKU children aged 1-5 years when compared to non-PKU controls. The parents of PKU children identified poorer appetites ( p < 0.01), a more limited range of foods consumed ( p < 0.03) and more gastrointestinal symptoms such as vomiting and constipation ( p < 0.03) than control children. The children were slower to feed ( p < 0.03), were more likely to dislike sweet foods and some ate separately from the rest of the family at mealtime ( p < 0.03). The effects on normal feeding behaviour should be considered when advocating strict diet therapy for young PKU children.     

HIV associated arthritis: case report and review of the literature

HIV infection can be associated with different types of arthropathies which are often underdiagnosed. We present the case of a 52 year old HIV positive man on highly active antiretroviral therapy including indinavir who developed an acute painful oligoarthritis. We present this case on HIV associated arthritis and include a review on other HIV specific types of arthritis (acute symmetric arthritis and painful articular syndrome) which are assumed as entities exclusively apparent in HIV patients. The pathophysiology of arthritis in HIV infected patients is not yet completely understood but a direct role of the HIV on the initiation of synovitis is suspected in some of them. Additionally, there is evidence that antiretroviral drugs, in particular the protease inhibitor indinavir, can lead to arthritic complications as well.     

Carotid artery dissection in ergotamine abuse

The case of a 65-year-old male migraine patient with spontaneous internal carotid artery dissection is presented. He had been abusing ergotamine compounds for several years on at least 15 days per month. A possible association between arterial dissection and ergotamine abuse is discussed.     

Zur Korrelation klinisch-apparativer Differenzialdiagnosen mit neuropathologischen Diagnosen bei Patienten mit Aids

BACKGROUND: During the course of HIV infection, the majority of patients develop opportunistic cerebral neuro-manifestations. If conventional diagnostic tools are not sufficient, a stereotactic biopsy is often necessary. PATIENTS AND METHODS: In order to evaluate the correctness of the clinical diagnosis of cerebral neuro-manifestations in HIV-infected patients, we compared the results of cerebral biopsy or autopsy with the previous clinical diagnosis. A total of 19 biopsies and 49 autopsies could be analyzed. RESULTS: Except for HIV-associated encephalopathy, we detected a very high conformity between the clinical and the neuropathological diagnoses. We obtained the best sensitivity for progressive multifocal leukoencephalopathy (PML), whereas for cerebral toxoplasmosis the worst sensitivity and specificity was identified. CONCLUSION: We conclude that the diagnosis of PML can be made on clinical grounds alone, whereas the diagnosis of cerebral toxoplasmosis and lymphoma often requires a biopsy, which should be performed early.     

Clarion 1.2 standard electrode array with partial space-filling positioner: radiological and histological evaluation in human temporal bones

The purpose of this study was to evaluate whether use of a positioner for situating the Clarion 1.29 standard electrode array in close proximity to the modiolus, causes damage to fine intra-cochlear structures, and to provide a comparison with results obtained for insertions of the array performed without a positioner. The study was performed in seven freshly frozen human temporal bones. Electrode location and intra-cochlear trauma was analysed using cross-sectional imaging and histological analysis. Insertion of the Clarion array did not reveal major trauma. The devices inserted with the positioner showed a consistently closer location of the electron array towards the modiolus, however, insertion resulted in significant displacement of both the electrode array and the positioner resulting in severe destruction of the basilar membrane and osseous spiral lamina along the length of the basal and middle turns. The devices inserted with the positioner resulted in major trauma to the basilar membrane and osseous spiral lamina. Therefore, systematic safety studies in larger samples of human temporal bones should be performed and the results carefully evaluated before implantation can be recommended unreservedly.     

Ocular complications of the virostatic drug cidofovir

Cidofovir, a nucleotide analogue virostatic drug is effective in the treatment of herpes virus infections. However, cytomegaly infection is the prime indication due to its adverse effects. There is growing evidence suggesting cidofovir's effectiveness against progressive multifocal leukoencephalopathy (PML) caused by a reactivation of JC-virus. Chronic ocular hypotension which seems to be therapy refractory and anterior uveitis are considered to be the most serious ocular complications of cidofovir. Secondary side effects such as macular folds, retinal or choroidal detachment can result in a permanent loss of vision. Little is known about the pathology of reduced intraocular pressure and only few reports deal with therapeutical attempts to compensate this complication. Abandoning cidofovir presently remains the only therapeutic option. To avoid serious damage it is of utmost importance to monitor all patients undergoing cidofovir administration for signs of anterior uveitis and ocular hypotension.     

Phantomschmerz nach Enucleatio bulbi

ZusammenfassungHintergrund Phantomschmerzen sind ein in vielen chirurgischen Disziplinen bekanntes Symptom. Bei ophthalmologischen Patienten wurde das Auftreten von Phantomschmerzen nach Enukleation mit Ausnahme einer Pilotstudie [19] bislang nicht systematisch untersucht.Fragestellung Ziel war es, an einem umfassenden Kollektiv von Patienten mit standardisiertem operativen Vorgehen das Auftreten von Phantomschmerzen nach Enukleation zu erheben und die Relation zu verschiedenen prä- und postoperativen Faktoren zu analysieren.Patienten und Methoden Standardisierte retrospektive Befragung von Patienten nach Enukleation.Ergebnisse Phantomschmerzen nach Enukleation berichteten 24/94 Probanden (26%). Phantomschmerzen wurden überwiegend (17/24) selten (<einmal monatlich) und nur von 2/24 häufiger als an 4 Tagen/Monat angegeben. Patienten mit Phantomschmerzsymptomatik waren häufiger von anderen perioperativen Schmerzsymptomen (präoperativer Augenschmerz, prä- und postoperative Kopfschmerzsymptomatik, alle p<0,0025) betroffen als Patienten ohne Phantomschmerzen.Schlussfolgerungen Phantomschmerzen des Auges werden bei etwa 1/4 aller Patienten nach Enukleation mit niedriger Symptomfrequenz beobachtet. Eine perioperative Augen- bzw. Kopfschmerzsymptomatik korreliert signifikant mit dem Auftreten von Phantomschmerzen.In Auszügen vorgetragen auf der 99. Jahrestagung der Deutschen Ophthalmologischen Gesellschaft in Berlin, 29.9.–2.10.2001.