Capsaicin‐induced neurogenic inflammation in the skin in patients with symptoms induced by odorous chemicals

Background: Intradermal injection of capsaicin induces the axonal release of neuropeptides, vasodilatation and flare, e.g. neurogenic inflammation. The spatial profile of neurogenic inflammation in the skin has been studied in various experimental models. Polarization spectroscopy imaging introduced recently may be used for the quantitative assessment of the temporal profile of neurogenic inflammation expressed as erythema intensity. Purpose: In the present study, we aimed to compare capsaicin‐induced erythema intensity with the flare area in patients with symptoms induced by odorous chemicals, thereby comparing the temporal and spatial profiles of neurogenic inflammation. Methods: Sixteen patients fulfilling Cullen's criteria for multiple chemical sensitivity (MCS) and 15 eczema (EC) patients with airway symptoms elicited by odorous chemicals were compared with 29 age‐matched, healthy controls. Participants were administered two intradermal injections of capsaicin 3.3 and 33 μM. Erythema intensity was measured by polarization spectroscopy imaging and flare response was quantified by visual inspection. Results: Erythema intensity and flare area did not differ between patients and controls, and they were not correlated. Erythema intensity and flare area showed a dose‐dependent increase (P<0.05). Erythema intensity increased with age at 3.3 μM but not at 33 μM capsaicin, whereas the flare area increased with age at both concentrations (P<0.05). Conclusion: Capsaicin‐induced erythema intensity and visual flare were normal in patients with MCS and EC patients with airway symptoms from odorous chemicals. Polarized light spectroscopy was a useful method for the measurement of the rapid temporal changes in erythema of experimental reactions.     

Self‐reported quantity of daily water intake and urine output in healthy young

Water is an essential nutrient and adequate intake and output of water is required for health maintenance. Water homeostasis is vital for life and optimal function and considerable interest surrounds the issue of recommendations for water consumption in healthy individuals. Few studies are available about self‐reported water intake and urine output. The aim of this study was to assess the quantity of water intake and urine output in 24‐h period in healthy young individuals. This prospective study was carried out on 31 students aged 18–24 years undergoing nursing education in a University during January 2011 in Sakarya, Turkey. Healthy young individuals were recruited for determination of the quantity of water taken in and urine excretion along 24 h; they recorded fluid input and urine output. The students collected the data during weekend break. In our study, the total daily fluid intake (mL) for females was 2082·6 ± 687·1 and the total daily fluid intake (mL) for males was 2720·8 ± 717·4. The total daily quantity of urine (mL) for females was 1623·4 ± 602·4 and the total daily quantity of urine (mL) for males was 1818·3 ± 420·6. This research may be the source for similar studies that could include seasonal changes, climates, cultures and different age groups.     

Gesundheits?konomische Aspekte und finanzielle Probleme in der Pr?natalmedizin und Geburtshilfe

The diagnosis-related groups (DRG) system of financing healthcare in Germany will lead to disparities in patient care and medical services rendered in prenatal and obstetric medicine. The high costs related to the treatment of high-risk pregnancies in the level I clinics indicate that there are significant shortcomings in cost reimbursement and currently these issues are inadequately addressed by the DRG system. The high costs arise from the more specialized care provided by level I centers, which treat patients with more complicated conditions and require longer hours of hospital staff. The lack of a distinction between the requirements of different intrauterine treatment options in prenatal medicine leads to underfunding such that, for example, the material costs of some interventions are not covered by the DRG pricing and reimbursement system. Resulting from the financial deficits in the level I centers and facilities of specialized medicine is a major deterioration of their organization and staffing, which has significant implications on the training and continued education of young doctors. This system, which to the present time has been an inadequate means of covering the costs of hospital outpatient and inpatient services, raises concerns of insufficient incentives for the training and continued education of young physicians. This may result in a decrease in quality of care in the field of obstetric and prenatal medicine.     

Coexisting Bicuspid Aortic and Pulmonary Valves with Normally Related Great Vessels Diagnosed by Live/Real Time Three‐Dimensional Transesophageal Echocardiography

Coexistence of bicuspid aortic and pulmonary valves in the same patient is a very rare entity identified mainly during surgery and postmortem. To the best of our knowledge, only one case has been diagnosed by two‐dimensional echocardiography in a newborn with malposition of the great arteries but no images were presented. Here, we are reporting the first case of bicuspid pulmonary and aortic valves diagnosed by live/real time three‐dimensional transesophageal echocardiography in an adult with normally related great arteries.     

The role of postoperative positioning after DSAEK in preventing graft dislocation

Purpose: The aim of the study was to evaluate the importance of immediate postoperative supine patient positioning after Descemet stripping automated endothelial keratoplasty (DSAEK). Methods: Forty eyes from 40 patients who underwent DSAEK were randomized into two groups: 20 patients sat in a chair for 2 hr postoperatively (group 1), and 20 patients were placed in a supine position (group 2) for the same time interval. At the end of surgery, the anterior chamber was fully filled with air, aiming at an intraocular pressure (IOP) of approximately 20 mmHg. The dislocation rate in the two groups was registered. IOP was measured 2 hr postoperatively and compared with endothelial cell loss at 6 months. Results: There was no statistically significant difference in the dislocation rate between the two groups (p = 0.548): two patients (10%) in group 1 and one patient (5%) in group 2. Endothelial cell loss at 6 months was 29.6% and 29.7% in group 1 and 2, respectively. There was no correlation between the IOP 2 hr after surgery and endothelial cell loss at 6 months (p = 0.741). Conclusion: Supine positioning does not seem to be of crucial importance in avoiding graft dislocation in DSAEK when the anterior chamber is fully filled with air for 2 hr postoperatively.