Die progressive multifokale Leukoenzephalopathie

Zusammenfassung □ Pathogenese  Die progressive multifokale Leukoenzephalopathie ist eine Entmarkungserkrankung des Zentralnervensystems, die durch eine Reaktivierung des JC-Virus hervorgerufen wird und bei etwa 5% aller Patienten mit HIV-Infektion auftritt. Nach den gegenw?rtigen Vorstellungen zur Pathogenese der progressiven multifokalen Leukoenzephalopathie handelt es sich um eine persistierende Infektion, die im Rhamen einer Abschw?chung der zellul?ren Immunit?t bei der HIV-Infektion reaktiviert wird. Als m?gliche Persistenzorte kommen Niere, Knochenmark, Lymphozyten oder das Zentralnervensystem selbst in Betracht. □ Diagnose  Die Diagnose einer progressiven multifokalen Leukoenzephalopathie wird durch das klinische Bild, das durch variable neurologische Herdsymptome gekennzeichnet ist, die Kernspintomographie des Gehirns und den Virusnachweis im Liquor gestellt. □ Therapie  Eine gesicherte erregerspezifische Therapie ist derzeit nicht m?glich. Mit der hochaktiven antiretroviralen Kombinationstherapie oder Cidofovir ergeben sich m?glicherweise neue therapeutische Optionen.      

Loss of expression of the candidate tumor suppressor gene ZAC in breast cancer cell lines and primary tumors.

Loss of chromosome 6q21-qter is the second most frequent loss of chromosomal material in sporadic breast neoplasms suggesting the presence of at least one tumor suppressor gene on 6q. We recently isolated a cDNA encoding a new zinc finger protein which we named ZAC according to its functional properties, namely induction of apoptosis and control of cell cycle progression. ZAC is expressed in normal mammary gland and maps to 6q24-q25, a recognized breast cancer hot spot on 6q. In the present report, we investigated the possible inactivation of ZAC in breast cancer cell lines and primary tumors. We detected no mutation in ZAC coding region in a panel of 45 breast tumors with allelic imbalance of 6q24-q25. However, a survey of eight breast cancer cell lines showed a deeply reduced (three cell lines) or complete loss of (five cell lines) ZAC expression. Treatment of three of these cell lines with the methylation-interfering agent 5-azacytidine induced ZAC re-expression. In addition, Northern blot and RNase protection assay analysis of ZAC expression in 23 unselected primary breast tumors showed a reduced expression in several samples. Together with its functional properties and chromosomal localization, these findings substantiate ZAC as a good candidate for the tumor suppressor gene on 6q24-q25.     

PSEUDOHYPOALDOSTERONISM Clinical, Biochemical and Morphological Studies in a Long-term Follow-up

ABSTRACT. A boy with pseudohypoaldosteronism was followed from birth to the age of 7 years. Failure to thrive, vomiting, dehydration, hyponatraemia and urinary sodium loss were prominent findings. Urinary excretion of corticosteroid metabolites was normal. Before treatment, excessively high plasma renin concentration was found, associated with a marked activation of aldosterone secretion. A renal biopsy showed pronounced hypertrophy of the juxtaglomerular apparatus. Persisting metabolic acidosis and an insufficient urinary acidifying capacity suggested the presence of distal renal tubular acidosis. Treatment with sodium bicarbonate and sodium chloride from 19 to 31 months of age resulted in normal growth and normal physical and mental development. The plasma electrolytes were normalized but a pronounced activation of the renin–aldosterone system persisted after therapy, and on sodium restriction this system responded with a considerable further activation.     

Urinary tract infection in infants and children evaluated by ultrasound

Fifty-nine pediatric patients with urinary tract infection (UTI) underwent renal ultrasonography, excretory urography, and voiding cystourethrography. The imaging procedures were analyzed retrospectively to determine their relative effectiveness in detecting abnormalities that might predispose the patient to UTI. Voiding cystourethrography provided valuable information, particularly the presence or absence of vesicoureteral reflux, that could not be obtained from the other procedures. Excretory urography was less specific than ultrasonography in the majority of patients, with the exception of those who had renal scarring. The authors recommended ultrasonography as the initial imaging procedure in the evaluation of children with UTI. When the sonogram is normal, excretory urography is not considered necessary, but voiding cystourethrography is thought to be essential. If sonography is abnormal, excretory urography and/or other follow-up studies are indicated.     

Physical Therapy and Complementary and Alternative Medicine: An Educational Tool for Enhancing Integration

In an outpatient rehabilitation setting, both patients’ use and therapists’ knowledge of complementary and alternative medicine (CAM) varies widely. Based on this observation and a recognition of CAM as an emerging practice area for rehabilitation professionals, it was felt that a thorough and consistent approach to the education and orientation of physical therapists to the world of CAM and integrative care was needed. This special interest paper will describe one center’s approach, development, and use of a unique and comprehensive training manual designed to provide both a structured and standardized approach for educating physical therapists about CAM and related therapeutic modalities. This innovative teaching tool allows for multiple methods of content delivery within a multidisciplinary format and can be used for those who practice currently or desire to practice in an integrative care environment.