Stoffwechseluntersuchungen bei Zuführung Eines Neuen Eiweisspräparates

Ohne ZusammenfassungFERDINAND FLURY zum 60. Geburtstag gewidmet.     

High dose rate brachytherapy of localized prostate cancer

OBJECTIVE: We evaluated the safety and efficacy of high dose rate (HDR) brachytherapy using Iridium-192 (Ir 192) and 3D conformal external beam radiotherapy in patients with localized prostate cancer. METHODS: A total of 444 patients with localized prostate cancer underwent combined radiotherapy with interstitial Ir 192 and 3D conformal external beam radiotherapy between December 1992 and March 2001. The 230 patients, treated between December 1992 and December 1997 were analyzed. All patients underwent laparoscopic pelvic lymph node dissection to exclude patients with lymphatic involvement. Ir 192 was delivered twice with a 1-week interval in HDR remote control technique. The interstitial dose from December 1992 to December 1993 was 10Gy, after December 1993 the dose was reduced to 9Gy per treatment session. The interstitial application was followed by external beam radiation of 45Gy for cT1-cT2 and 50.4Gy for cT3 tumor (40Gy from December 1992 to December 1993). Progression was defined as biochemical failure according to ASTRO criteria, e.g. three consecutive PSA rises following the PSA nadir. RESULTS: The median PSA value decreased from 12.8 to 0.93ng/ml 12 months after treatment. Median PSA value was 0.47 after 24 months, 0.30ng/ml after 36 months and 0.18ng/ml after 60 months. 68% of the biopsies were negative 24 months after therapy. Progression-free rate was 100% for cT1 tumors, 75% for cT2 and 60% for stage-cT3 on 5-year follow-up. Five-year overall survival was 93%, 5-year disease-specific survival was 98%. Initial PSA value <10ng/ml, low stage and low grade were significantly related to 5-year progression-free survival. CONCLUSIONS: Combined HDR brachytherapy with Ir 192 is an alternative treatment option especially for patients with cT3 prostate cancer. Initial PSA value, stage and grade, are important prognostic factors.     

Surgical strategy in aortoesophageal fistulae: endovascular stentgrafts and in situ repair of the aorta with cryopreserved homografts

OBJECTIVE: The surgical treatment of aortoesophageal fistulae (AEF) has a high morbidity and mortality rate. We report our experience with the sequential use of endovascular thoracic stentgrafts and cryopreserved aortic homografts for in situ repair of the descending thoracic aorta. METHODS: In a 7-year period, 6 patients with AEF were treated at our center. After primary endovascular repair in all cases, 4 patients subsequently underwent in situ repair of the descending thoracic aorta with cryopreserved homografts. Long-term antibiotic therapy was given in all cases. Recent clinical status and radiologic findings on follow-up studies of each patient were analyzed. The mean follow-up time was 35 months (range, 2-76). RESULTS: Endovascular stentgraft repair was technically successful in all cases. Two patients were not candidates for open surgical repair because of their medical condition; they both died within 8 weeks after discharge from the hospital, 1 from recurrent septic episodes, and the other from upper gastrointestinal bleeding. One of 4 patients who had undergone open surgical repair died 1 year later from upper gastrointestinal bleeding that occurred presumably due to an infectious degeneration of the homograft after secondary infection with a methacillin-resistant Staphyloccocus aureus. In 1 case persistent paraplegia and in another case persistent renal failure occurred. CONCLUSION: The use of cryopreserved homografts is a valuable alternative to in situ repair with prosthetic vascular grafts or extra-anatomic reconstructions in the surgical treatment of AEF. Endovascular stentgraft placement plays a role as a bridging procedure in emergency situations.     

Darmbrand (Enteritis necroticans) Eine historische und aktuelle übersicht

Zusammenfassung In den Jahren 1946 bis 1948 trat in Lübeck und anderen Städten Norddeutschlands eine epidemisch verlaufende Infektion auf, die bis dahin nicht bekannt war. Die Erkrankung wurde aufgrund ihrer Morphologie als Darmbrand (Enteritis necroticans) bezeichnet. Untersuchungen ergaben, dass es sich bei dem Infektionserreger um Clostridium perfringens Typ C handelte. In der Folge konnten die Pathogenese der Enteritis necroticans und eine krankheitsauslösende Bedeutung des #-Toxins von Clostridium perfringens Typ C gesichert werden. Entsprechend konnte durch die Immunisierung gegen dieses Toxin die Inzidenz der Enteritis necroticans in Papua-Neuguinea, einem Land, in dem die Erkrankung in bestimmten Regionen noch heute endemisch ist, deutlich gesenkt werden. Wenngleich der Darmbrand in Europa eine kaum noch auftretende Erkrankung ist, so ist mit seinem epidemischen Auftreten besonders in Notstandsgebieten zu rechnen. Die vorliegende Arbeit soll an die in Lübeck aufgetretene Darmbrandepidemie erinnern, eine Darstellung der Epidemiologie, Pathogenese und Therapie der Erkrankung unter Berücksichtigung inzwischen gewonnener Erkenntnisse geben und andere durch Clostridium perfringens induzierte Erkrankungen abgrenzen. Abstract Enteritis necroticans, locally called "Darmbrand", is a severe and life threatening infectious disease which was epidemic in Northern Germany after World War II. Darmbrand had a limited appearance, occurring only for a few years. In Lübeck many cases were diagnosed in 1946/1948 and the book "Darmbrand, Enteritis necroticans" was published in 1949 by clinicians and pathologists. Enteritis necroticans is also known as a tropical cause of bloody diarrhea and is caused by Clostridium perfringens Type C (type #-toxin). The disease is related to pig feasts in Papua New Guinea. Although necrotizing enterocolitis is now a rather rare disease we must be aware of the appearance of this fulminant entity. This paper represents a review on the historic and current aspects of enteritis necroticans and discusses the epidemiology, pathogenesis and treatment of this disease.     

Deposition of Alzheimer's beta-amyloid is inversely correlated with P-glycoprotein expression in the brains of elderly non-demented humans

Deposition of the beta-amyloid peptide (Abeta) in the brain occurs during normal ageing and is substantially accelerated in patients with Alzheimer's disease. Since Abeta is continuously produced in the brain, it has been suggested that a clearance mechanism should exist to prevent its accumulation and subsequent aggregation. Until now, little attention has been paid to the possible role of P-glycoprotein (P-gp), a member of the ATP binding cassette superfamily of transporter proteins, in the pathogenesis of Alzheimer's disease. A recent study demonstrated that Abeta40 and Abeta42 interact directly with P-gp. We therefore hypothesized that Abeta accumulation in the brain would correlate inversely with the degree of vascular P-gp expression. To study early pathogenetic factors that influence the deposition of Abeta, at routine autopsies, brain tissue samples were taken from 243 non-demented subjects who died between the ages of 50 and 91 years. Vascular P-gp expression and the number of Abeta40- and Abeta42-positive senile plaques were assessed immunohistochemically in the medial temporal lobe. In addition, the apolipoprotein E (apoE) genotypes, as well as multiple drug resistance gene 1 ( ) polymorphisms (exon 2, G-1A; exon 21, G2677T/A; exon 26, C3436T), were also determined for each case. P-gp expression was not correlated with genotypes, but we found a significant inverse correlation between P-gp expression and the deposition of both Abeta40 and Abeta42 in the medial temporal lobe. Our results provide the first evidence in human brain tissue that the accumulation of Abeta may be influenced by the expression of P-gp in blood vessels, and suggest that P-gp may influence the elimination of Abeta from brain.     

Unusually quick resorption of an intracerebral hemorrhage in congenital afibrinogenemia

Neuroimaging diagnostics of cerebral hemorrhage in congenitally afibrinogenic patients may be compromised by different pitfalls. We describe the case of a 28-year-old patient with the diagnosis of congenital afibrinogenemia who suffered a large intracerebral hemorrhage. Initial cerebral computed tomography showed typical bleeding, but follow-up cerebral CT scans 1 and 2 weeks later revealed an unusually quick and subtotal resorption of hemorrhage with only a small hypodense lesion within the former bleeding area left. Imaging findings and differential diagnosis are discussed with respect to previous reports about intracerebral hemorrhage in afibrinogenemia.     

Changes of body image and body awareness in eating-disorder and non eating-disorder patients after inpatient-therapy

Altered body image and body awareness have significant clinical implications not only for patients with eating disorders. We evaluated therapy-outcome including distortions in body image in 61 inpatients using two instruments assessing body image (FKB-20 Clement and L?we, and FBeK Strauss and Richter-Appelt ). Eating disorder subjects, as expected, showed the most severely disturbed body image with negative attitudes towards their own body and restricted body dynamics. While body image improved over all diagnostic groups after treatment, anorectic patients improved less than others. This finding confirms the clinical observation of the limited therapeutic influence on body image distortions in anorectic patients. Our results show, that the body image questionnaire FKB-20 discriminates well between healthy and psychosomatically diseased patients and is a suitable instrument for process- and outcome-evaluation.     

Geographic variation in groundwater iodine and iodine deficiency in Israel, The West Bank and Gaza

BACKGROUND: Iodine deficiency during pregnancy and infancy is the world's most common preventable cause of mental retardation. Previous studies have shown a high incidence of goiter and low groundwater iodine concentrations in northern Israel. OBJECTIVE: We examined the relationship between low groundwater iodine and iodine deficiency in pregnant women and schoolchildren. SUBJECTS AND METHODS: We measured the urinary iodine excretion of school-children in the West Bank and Gaza and rural and urban pregnant women in Western Galilee (an area known to have low groundwater iodine concentrations). We also measured iodine concentrations in groundwater in various locations in the West Bank and Gaza. RESULTS: Lower urinary iodine excretion was found among pregnant Arab women living in rural Western Galilee (101+/-7 microg iodine/g creatinine). 20% of them excreted <50 microg I/g creatinine. This is relatively less than found among pregnant Jewish women living in cities in the same area (154+/-13 microg I/g creatinine). Low iodine concentrations (<5 microg/l) were found in groundwater in the Nablus, Ramallah, Bethlehem highlands, as compared to normal concentrations in the lowland districts of the West Bank and Gaza. In a cohort of 728 schoolchildren aged 8-10, 10% (range 8-13%) of children from areas of low groundwater iodine had low levels of urinary iodine excretion, as compared to only <5% of those from districts with groundwater iodine concentrations >10 microg/l. CONCLUSIONS: Lower concentrations of groundwater iodine are related to low urinary iodine excretion in Israel, the West Bank and Gaza.