Cutaneous leishmaniasis: Clinical report of two cases and review of the recent literature

With 1–1.5 million cases reported every year cutaneous leishmaniasis represents an increasing health problem. The course of cutaneous leishmaniasis varies from a single self‐healing ulcer to a persistent ulcer or progressive mucosal disease with nasopharyngeal destruction. An enormous array of topical and systemic treatment modalities has been endorsed. The response to treatment depends on the species of parasite as well as the host's immunological and genetic status. Species‐specific treatment guidelines based on evidence from controlled studies are highly desirable. We present two cases of cutaneous leishmaniasis, one in a child and one during pregnancy, reviewing various diagnostic and therapeutic measures with special attention to problems in young and pregnant patients.     

Bloqueio do plano do eretor da espinha com técnica de múltiplos cateteres para esofagectomia aberta: relato de caso

Background and objective

Erector spinae plane block is a valid technique to provide simultaneously analgesia for combined thoracic and abdominal surgery.

Die Atemarbeit von Säuglingen bei Atmung durch Endotrachealkatheter

Zusammenfassung Wir bestimmten an sechs Säuglingen im Alter von 6 Monaten die zusätzliche Atemarbeit, die bei Atmung durch Loennecken-Katheter der Charrièrestufen 18, 16, 14 und durch einen neuen Katheter der Stufe 14 mit nur sehr kurzem stenotischem Anteil von den Säuglingen aufgewendet wird. Dabei stellten wir fest, daß im günstigsten Fall bei einem Katheter der Stufe 18 die Atemarbeit verdoppelt und im ungünstigsten Fall bei einem Katheter der Stufe 14 auf das 28fache erhöht wird. Der neue Katheter der Stufe 14 liegt in seiner Wirkung zwischen den Stufen 18 und 16 der Loennecken-Katheter.Ausgeführt mit Mitteln der Deutsehen Forschungsgemeinschaft und der Dr. Karl Wilder-Stiftung des Verbandes der Lebensversicherungsunternehmen e. V.Wir danken unserer technischen Assistentin Frau U.Loebell und Herrn cand. med. K. J.Grusz für ihre Mithilfe bei der Ausführung der Messungen und der Auswertung der Meßergebnisse.     

Investigations on neurotoxicity of chemical substances at the workplace

Summary A cross-sectional study was performed in order to investigate the influence of chronic lead-exposure on the peripheral nervous system. We examined 148 male workers of a storage battery manufacturing plant, who had been exposed to lead metal and inorganic lead compounds for 1 to 28 years (mean 11 years). Fifteen workers with non-occupational risks of peripheral neuropathy (former diseases, alcohol abuse, medication) were excluded from the study. The investigation program comprised: case history, physical examination, analyses of blood- and urine-samples and determination of maximal motor, mixed and sensory conduction velocity (NCV) of the ulnar and median nerve of the right forearm. Objectively no worker showed any signs of health effects related to lead exposure. The Biological Monitoring included the determination of (1) Blood-lead level (Pb-B), (2) Free erythrocyte porphyrins (FEP), (3) -Aminolevulinic acid dehydratase (ALA-D) and (4) -Aminolevulinic acid in urine (ALA-U). Further time-weighted-average (TWA)-values of Pb-B were calculated on the basis of several determinations over the period 1975–1981. The following actual (TWA) median values resulted: Pb-B 53 g/dl (54 g/dl), ALA-U 5.6 mg/l (8.4 mg/l), FEP 2.0 mg/l (2.0 mg/l). The Biologischer Arbeitsstoff Toleranz Wert (BAT) of 70 g//dl for Pb-B was exceeded in 15 workers (11%), and of 15 mg/l for ALA-U in 30 cases (23%). In comparison with age-matched controls, the lead workers showed a mild slowing of NCV with mean values between 0.8 and 2.0 m/s. Multiple stepwise regression analyses revealed statistically significant correlations between the four NCV and age as well as Pb-B. There were better correlations by using TWA than actual data of Pb-B. Consideration of the results of the regression analyses, together with an evaluation of the individual neurophysiological status as a function of internal lead exposure, a dose-effect-relationship was found only in the case of Pb-B exceeding 70 g/dl. From our study it is concluded that chronic lead exposure resulting in blood-lead levels of below 70 g/dl is no occupational risk causing a functionally significant slowing of nerve conduction velocities.With Grants from the Deutsche Forschungsgemeinschaft, Bonn (Project no. Va 23/19-1)     

Arbeitsmedizinische Vorsorgeuntersuchungen in der Bundesrepublik Deutschland

Zusammenfassung In der Medizin, ganz besonders in der Arbeitsmedizin, tritt die Prävention zunehmend in den Vordergrund. Das System der arbeitsmedizinischen Vorsorgeuntersuchungen in der Bundesrepublik Deutschland wird geschildert: 40 Berufsgenossenschaftliche Grundsätze für arbeitsmedizinische Vorsorgeuntersuchungen. 1983 wurden 1,4 Mio., 1984 1,45 Mio. Vorsorgeuntersuchungen registriert. Bei 2, 1 bzw. 1,8 % resultierten gesundheitliche Bedenken, davon 0,9 bzw. 0,8 % nur befristet.In den letzten Jahren wurden bei der Prävention von Gesundheitsschäden am Arbeitsplatz durch normierte und gezielte arbeitsmedizinische Vorsorgeuntersuchungen grosse Fortschritte erzielt. Es handelt sich hierbei auch zukünftig um eine bedeutsame und vielfältige Aufgabe der Arbeitsmediziner.

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Programs of health surveillance at the workplace in the Federal Republic of Germany

Summary Prevention is of increasing importance in medicine, particularly in occupational medicine. The programs of health surveillance at the workplace in the Federal Republic of Germany are discussed. In 1983, 1,400,000 examinations of employees were performed; exclusion criteria were fulfilled in 2,1 % (0,9% only temporarily). In 1984 the respective numbers were 1,450,000 examinations (1,8%, 0,8%). During the last few years, health surveillance programs markedly have improved the efficiency of prevention of occupational diseases. They will be an important task for occupational physicians in the future.

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Examens médicaux pour la prévention des maladies professionnelles en RFA

Résumé En médecine, et particulièrement en médecine du travail, la prévention prend de plus en plus d'importance. Le présent article traite de l'organisation des examens prophylactiques en République fédérale allemande (RFA) dans le domaine de la médecine du travail: il existe 40 «principes syndicalistes» («Berufsgenossenschaftliche Grundsätze») les concernant. En 1983, 1,4 million d'examens ont été enregistrés, en 1984, 1,45 million. Dans le 2,1% des cas, respectivement le 1,8%, on a dû faire des réserves sur l'état de santé des personnes examinées, réserves temporaires dans le 0,9%, respectivement le 0,8 % des cas.De grands progrès ont été réalisés ces dernières années dans la prévention des maladies professionnelles grâce des contrôles médicaux normalisés et orientés. A l'avenier également, il s'agira là d'une activité importante et variée pour les médecins du travail.

     

Teratologic studies on the Himalayan rabbit: new aspects of thalidomide-induced teratogenesis

The aim of our study was to determine the period of maximum sensitivity for the induction of characteristic malformations with thalidomide (TH) in Himalayan rabbits. TH was administered orally in different doses (50, 100, 150 and 200 mg/kg) four times at 24-h intervals starting at 192 h of gestation. The malformations affected various organs: renal defects (dysplasia) and limb anomalies (dysmelia) — which had never occurred spontaneously in this strain — appeared as dose-dependent effects of the drug. By administering single doses of TH (200 and 300 mg/kg body wt) between hours 192 and 264 of gestation, we discovered the different periods of maximum sensitivity for induction of renal dysplasia (clearly prior to the 220th h of gestation) and dysmelia (between hours 230 and 240 of gestation). The types of limb malformations that we observed in the rabbit were identical to those produced in man following the intake of TH. Three doses of TH (300 mg/kg each) given between hours 222 and 228 of gestation produced characteristic limb malformations in 9 of 11 litters treated. These results make it possible to conduct in vivo experiments on a readily available laboratory animal with minor drug exposure of the gravid dam and under avoidance of toxic side effects.     

Guidewire-Controlled Advancement of the Amplatz Thrombectomy Device

The Amplatz Thrombectomy Device (ATD) is a percutaneous rotational catheter proven to homogenize thrombus. The catheter design allows neither application over a coaxial running guidewire nor the use of the device as a monorail system. We report a technical modification that provides guided advancement of the catheter over a wire in order to prevent failure of application and to facilitate the interventional procedure. Received: 0/00/00/Accepted: 0/00/00     

胰腺癌细胞株对氟尿嘧啶存在固有不敏感性

目的 研究胰腺癌细胞株是否对氟尿嘧啶（5-FU）具有固有或获得性不敏感。方法 用SRB方法检测5-FU对胰腺癌细胞株AsPC-1,Capan-1,Mia-PaCa-2,Panc-1和T3M4的毒性作用。结果 5-FU对所有胰腺癌细胞株的IC50都很高，其中Mia-PaCa-2和Panc-1细胞株对5-FU最不敏感（IC50=12，13nmol/L)。即使是在5-F鄣敏感的Capan-1细胞株，其IC50仍相当高（473pmol/L)。这些细胞株对5-FU的IC50甚至高出其临床常用剂量给药时血浆药物浓度的1-56倍。结论 大多数胰腺癌细胞株对5-FU固有不敏感，这些发现也许能作为临床上5-FU对胰腺癌疗效差的解释之一。     

First Trimester Development of the Human Nigrostriatal Dopamine System

The aim of the present study was to characterize the morphological and neurochemical differentiation of mesencephalic dopaminergic neurons in human embryos, derived from elective first trimester abortions. Embryonic brain tissue was taken for analysis of tyrosine hydroxylase (TH) by immunohistochemistry and Western blot, and for analysis of endogenous dopamine (DA) content using HPLC-ED. TH expression was first detected at 3.5 weeks of gestational age (Carnegie stage 11) by immunohistochemical staining of the primordial sympathetic trunk along both sides of the neural tube. In sagittal sections of the intact 4.5-week-old embryo, a small, distinct population of rounded, densely packed TH-immunoreactive perikarya with short primary processes was seen in the midbrain. During the latter half of the first trimester, the number of TH-stained cells as well as the length and number of axonal processes projecting toward and into the developing neostriatum increased rapidly. At the end of the first trimester, varicose fibers could be detected in the striatal anlage. In order to verify that TH was the antigen recognized by the antibodies used for immunohistochemistry on human tissue specimens, mesencephalic tissue of 5–10 weeks gestation was analyzed by Western blot technique. A single, homogeneous band with the apparent molecular weight of approximately 60 kDa was clearly detected at 5 weeks of age. The amount of TH/mg total protein increased at least 10-fold between 5–10 weeks of gestation. For comparison, the mesencephalon and the forebrain/basal ganglia were analyzed for endogenous DA content using HPLC-ED. DA was first detected at 5.5 weeks of gestational age in both mid- and forebrain, and DA levels were found to increase exponentially from 7 to 7.5 weeks of age, reaching 4–5.5 ng DA/mesencephalon and 50–75 ng DA/g caudate nucleus–putamen anlage at the end of the first trimester. Together, morphological and biochemical data presented here constitute evidence for a very early appearance, migration, and differentiation as well as functional development of human mesencephalic dopaminergic neurons and their projections into target areas during the first trimester.