Diagnostik und Therapie akuter Beschwerden nach „HWS-Distorsion“ in Deutschland

Whiplash injury of the cervical spine is a relevant medical and socioeconomic problem, which is still the subject of controversy. We performed a survey to evaluate the current status of diagnostics, classification, treatment, and doctors' subjective opinions at surgical and trauma departments in Germany. A total of 1568 hospitals were addressed to answer a standardized questionnaire on their proceedings and opinions concerning whiplash injury. We received 540 (34.44%) completed questionnaires. There was overall agreement concerning the need for physical examination. The radiological assessment included an a.p. and a lateral plain X-ray of the cervical spine in 82.6%. The indication for functional X-rays in flexion/extension was inconsistent. On average they were performed in 39.1% of all patients. In most cases (68.9%) whiplash injury was not classified; 13.2% of doctors used the classification according to the Quebec Task Force and 13.9% according to Erdmann. A cervical collar was prescribed in 85%. While 30% of patients received only a cervical collar, 55.6% underwent additional physiotherapy. Only 8.3% were treated by physiotherapy without immobilization. The doctors' subjective opinions indicated psychological factors to be important for long-lasting problems, but not for the acute period of complaints. There is no homogeneous concept for diagnostics, classification, and treatment of patients who suffered a whiplash injury in Germany. This situation reflects the current problems in management of this condition. Scientific evidence for functional treatment to avoid adverse influence of immobilization by cervical collars has not yet been transferred to our daily routine in Germany.     

Correlation between HRCT findings,pulmonary function tests and bronchoalveolar lavage cytology in interstitial lung disease associated with rheumatoid arthritis

A prospective study correlating high-resolution computed tomography (HRCT), lung function tests (PFT) and bronchoalveolar lavage (BAL) cytology in patients with interstitial lung disease (ILD) associated with rheumatoid arthritis (RA). Fifty-three RA patients with suspected ILD (19 men, 34 women) underwent 71 HRCT (14 of 53 with sequential HRCT, mean follow-up 24.3 months). The HRCT evaluation by two observers on consensus included a semi-quantitative characterisation of lesion pattern and profusion on representative anatomical levels. Fifty-two HRCT were followed by PFT and BAL. Agreement or discordance of HRCT-, PFT- and BAL findings were analysed with Pearsons correlation, score and McNemars test. Tobacco-fume exposure was estimated in pack years. Smoking/non-smoking groups were compared with Students t test. In 49 of 53 patients, HRCT was suggestive of ILD associated with RA (66 of 71 HRCT). Reticular lesions were found in 40 of 53 patients, in 15 of 40 presenting as mixed pattern with ground-glass opacities (GGO). Pure reticular patterns predominated in patients with long duration of ILD (p>0.01). Pure GGO were not observed. Lesion profusion was highly variable and correlated moderately negative with diffusion capacity (mean 88.2% (SD±20.9%); r=–0.54; p<0.001) and very weak with vital capacity and FEV1 (mean values 92.2% (SD±18.3%); r=–0.27; p<0.05 and 89.8% (SD±17.5%); r=–0.31; p<0.01). In patients with GGO, BAL differentials tended towards neutrophilia (=0.39; p=0.04; McNemar test p>0.2), but not towards lymphocytosis (=0.10; p=0.23; McNemar test p>0.2). Differences in smoking history were not significant (p>0.1). The HRCT appears most appropriate for the detection and follow-up of ILD associated with RA. The PFT and BAL correlate only partially with lesion profusion or grading on HRCT, but they contribute valuable information about dynamic lung function and differential diagnoses (pneumonia, medication side effects).     

The sternal fracture: radiographic analysis of 200 fractures with special reference to concomitant injuries

BACKGROUND: Previous studies have shown that trauma-hemorrhagic shock (T/HS) causes significant alterations in red blood cell (RBC) deformability and shape. Gender is becoming well recognized as a modulating factor in the pathophysiologic response to trauma. We hypothesize that female subjects are more resistant to adverse effects of T/HS on RBC deformability and shape than male subjects because of estrogen protection. METHODS: Elongation index, a measure of RBC deformability, was examined in six male rats and four groups of female rats at different stages of the estrous cycle (six animals per group) before and 6 hours after T/HS by laser ektacytometry. RBC shape was determined by scanning electron microscopy. Lipid peroxidation was evaluated by measurement of malonyldialdehyde in plasma 6 hours after T/HS. RESULTS: Male rats had a significant decrease in RBC elongation index after T/HS as compared with preshock values. RBC deformability of the proestrous (PES) and estrous female rats did not decrease after T/HS. Postshock RBC deformability values in metestrous and diestrous female rats did not differ from male rats. Male rats and metestrous and diestrous females had a significant increase in the percentage of abnormally shaped RBCs immediately after shock and during the postresuscitation period. In PES and ES female rats, RBC shape distribution did not significantly change after T/HS. Plasma malonyldialdehyde levels at 6 hours post-T/HS were higher in the male rats than in PES female rats. CONCLUSION: These data show that high levels of estrogen in female rats are protective against shock-induced RBC damage and suggest that this effect is associated with a decrease in lipid peroxidation.     

Pulmonary renal syndrome

Pulmonary-renal syndrome is a potentially life-threatening disorder, characterised by diffuse alveolar hemorrhage on the basis of pulmonary capillaritis in association with rapidly progressive glomerulonephritis. It can originate from various systemic autoimmune diseases. ANCA-associated vasculitides account for approximately 60% and Goodpasture's syndrome for approximately 20% of the cases. Fulminant pulmonary capillaritis can result in acute respiratory failure with the more subtle forms only being detectable by bronchoalveolar lavage. Kidney biopsy displays extracapillary proliferating glomerulonephritis and renal immunohistology facilitates detection of the underlying systemic disease. By accelerating the diagnosis of the specific underlying disease, auto-antibody testing fosters rapid initiation of treatment and thereby strongly improves the prognosis of pulmonary-renal syndrome. Intense immunosuppression with cyclophosphamide and glucocorticoids, augmented by plasmapheresis in the event of Goodpastures's syndrome, is the mainstay of therapy. Supportive measures such as temporary ventilation and hemodialysis have further reduced mortality.     

Soluble receptor for advanced glycation endproducts (sRAGE) effectively reduces tumor growth as a single agent and in combination with doxorubicin in a spontaneous mammary tumor model

Introduction: The receptor for advanced glycation endproducts (RAGE), a member of the immunoglobulin family interacts with distinct ligands that have been implicated in various pathophysiologic states such as diabetes, atherosclerosis, inflammation as well as tumor growth. We have previously demonstrated that blockade of RAGE in tumors raised in mice from rat C6 glioma cells or murine Lewis lung carcinoma effectively reduced tumor growth, invasion and metastases. Blockade of RAGE has also previously been shown to halt the progression of breast tumors in a murine model that spontaneously produces breast tumors. We hypothesize that the addition of RAGE antagonists to standard chemotherapeutic agents for breast cancer may enhance the effectiveness of monotherapy. Methods: Female MMTV transgenic mice (5-8 weeks) were divided into four groups: (1) Control group-no treatment, (2) doxorubicin (DOX) 2 mg/kg IP weekly x 4 weeks (3) sRAGE 20 μg IP daily x 4 weeks and (4) DOX 2 mg/kg IP weekly x 4 weeks and sRAGE 20 μg IP daily x 4 weeks. The mice were sacrificed and tumors harvested on treatment day 35 and were weighed and measured. Results: There was no difference in tumor weight between the control mice (n = 9) and DOX-treated mice (n = 4) (0.192 g v. 0.193). The administration of sRAGE (n = 7) decreased tumor weight to 0.12 g and the combination of sRAGE and DOX (n = 8) decreased tumor weight by a third (0.192 g v. 0.061 g, p = 0.11). While the mean tumor volume in the control mice was 316.7 mm³, sRAGE decreased tumor volume to 89.65 mm³ and the combination of sRAGE and DOX decreased tumor volume by 6.5 fold (316.7 mm³ vs. 48.08 mm³, p = 0.006). The mean tumor volume in the DOX treated group was 500.9 mm³. Conclusions: RAGE antagonists suppress local tumor growth in transgenic mice with spontaneously occurring cancer in an early intervention model. The addition of sRAGE, a low molecular weight RAGE antagonist, to doxorubicin enhanced the effectiveness of this standard chemotherapy agent.     

Important effect of food on the bioavailability of oral testosterone undecanoate

STUDY OBJECTIVE: To assess the effects of food on the bioavailability of testosterone undecanoate, testosterone, and 5alpha-dihydrotestosterone (DHT) after administration of a new oral testosterone undecanoate formulation, Andriol Testocaps. DESIGN: Randomized, open-label, crossover study with a 1-week washout period. SETTING: Clinical pharmacology unit. SUBJECTS: Sixteen healthy postmenopausal women. INTERVENTION: Single oral doses of testosterone undecanoate 80 mg were administered either during a fasting period or after consumption of a standardized continental breakfast. MEASUREMENTS AND MAIN RESULTS: Serum concentrations of testosterone undecanoate were assayed by liquid chromatography with mass spectrometry detection; testosterone and DHT were assayed by gas chromatography with mass spectrometry detection. Serum concentrations of testosterone, testosterone undecanoate, and DHT were low to negligible when testosterone undecanoate was administered to subjects in a fasting state; these values were significantly higher when the test drug was coadministered with food. For testosterone, the maximum serum concentration and area under the plasma concentration-time curve were 0.67 ng/ml and 5.37 ng x hr/ml, respectively, in the fasting state, versus 10.7 ng/ml and 56.4 ng x hr/ml, respectively, in the fed state. The same parameters were also significantly higher for testosterone undecanoate and DHT in the fed versus fasting subjects. CONCLUSION: Food increases the bioavailability of testosterone undecanoate, testosterone, and DHT. For proper absorption, Andriol Testocaps must be taken with meals.     

Recurrent eosinophilic mastitis

Systemic diseases rarely present with manifestations in the breast. Disorders such as sarcoidosis and pyoderma gangrenosum have been described to produce signs and symptoms in the breast. Peripheral eosinophilia is a systemic disease associated with a finite group of conditions including asthma, allergic or atopic disease, collagen vascular disease, and parasitic infection. In addition it has been described in association with several malignancies. A 50-year-old woman with a history of asthma and significant eosinophilia presented with an enlarging breast mass. Complete excision of the mass revealed eosinophilic mastitis. Two years later the patient again presented with a large mass in the same breast. Repeat excision demonstrated the same pathology. The clinical significance of this lesion is important because it presents as an enlarging, painless, dominant mass. Excision is necessary for management and to conclusively rule out malignancy. Its recurrence despite excision to negative margins, however, may indicate that control of the eosinophilia--and possibly the underlying disorder--is important to prevent further recurrence.     

Small colony variants of Staphylococcus aureus and pacemaker-related infection

We describe the first known case of a device-related bloodstream infection caused by Staphylococcus aureus small colony variants. Recurrent pacemaker-related bloodstream infection within a 7-month period illustrates the poor clinical and microbiologic response to prolonged antimicrobial therapy in a patient infected with this S. aureus subpopulation.Infections caused by Staphylococcus aureus range from mild skin infections to acute life-threatening diseases such as pneumonia, osteomyelitis, and endocarditis. However, S. aureus may also cause a chronic disease with persistent and recurrent infections. Skin and soft tissue infections, chronic osteomyelitis, and persistent infections in patients with cystic fibrosis have been associated with small colony variants, a naturally occurring subpopulation of the species S. aureus (1–6). S. aureus small colony variants are characterized as electron transport deficient bacteria because of their auxotrophism to hemin or menadione or are recognized as thymidine-dependent. These variants produce very small, mostly nonpigmented and nonhemolytic colonies. In addition, they also demonstrate various other features that are atypical for S. aureus, including reduced coagulase production, failure to use mannitol, and increased resistance to aminoglycosides and cell-wall active antibiotics (3–10). Furthermore, the ability of these variants to persist intracellularly within nonprofessional phagocytes has been described (3,5,11). Because of their fastidious growth characteristics and unusual morphologic appearance, small colony variants present a challenge both to the microbiologist and the clinician, often resulting in misidentification and misinterpretation (1,2,7,8). Prerequisite for recovering and identifying these variants is the application of extended conventional culture and identification techniques (3,5,8). We report the first case of a pacemaker-related bloodstream infection caused by S. aureus small colony variants. This case illustrates the poor clinical and microbiologic response to prolonged antimicrobial therapy in patients infected with these variants.