170. Bougierung und Intubierung maligner Oesophagusstenosen

Zusammenfassung Von 46 palliativ durchgeführten Tubusimplantationen wurde in 22 Fällen der endoskopische und in 24 Fällen der operative Weg mittels Gastrotomie gewählt. Es werden die unterschiedlichen Implantationsverfahren hinsichtlich ihrer Komplikationen (Letalität, Perforationen, Blutungen, Tubusdislokationen und -occlusionen sowie pulmonale Folgen), der Krankenhausaufenthaltsdauer, der Überlebensrate und des Kostenfaktors verglichen. Dabei erweist sich das endoskopische Implantationsverfahren gegenüber dem operativen Vorgehen in bezug auf die Krankenhausaufenthaltsdauer (7 Tage im Vergleich zu 26 Tagen), dementsprechend auf die Krankenhauskosten sowie die Klinikletalität (9,5% im Vergleich zu 28%) und auf die postoperative Morbidität als überlegen.     

Intraabdominal abscesses — Percutaneous catheter drainage versus operative treatment

Summary From 65 patients with 73 abscesses 38 were treated by operation and 27 by PCD. The mean duration of drainage was 6.8 days (OP) and 7.4 days (PCD) respectively. In the surgical group 2 patients needed reintervention and 1 died due to sepsis. In the PCD group 1 patient had to be operated on because of insufficient drainage and 1 died after perforation of the colon.With modern techniques of imaging (Ultrasound, CT) PCD is a useful tool in the therapeutic regimen of intraabdominal abscesses. PCD has to be considered as definitive treatment or preparation for surgical eradication. Above all indication to PCD depends on localization and cause of the abscess.Abbrevations PCD Percutaneous Catheter Drainage - OP Operation - CT Computed Tomography     

Cholera control on Guam, 2000

During April, 2000, the island of Pohnpei began experiencing an outbreak of cholera and during June and July of the same year four cases of cholera representing 3 separate introduction events were identified on Guam. Two of these events were associated with eating reef fish imported from Pohnpei. Following the imposition of a narrowly-focused ban on the importation of inshore seafood and processed food products from Pohnpei, no additional local or imported cases of cholera were detected on Guam.     

Parathyroid cytology: avoiding diagnostic pitfalls

BACKGROUND: Interpretation of parathyroid fine-needle aspirates (FNA) remains problematic not only because this type of specimen is rare but also because the pertinent literature is very limited. We systematically reviewed parathyroid FNAs in our files and sought to delineate additional diagnostic criteria. DESIGN: Review of all thyroid and parathyroid aspirates from January 1990 to June 1998 disclosed 12 parathyroid lesions. The final diagnoses included four parathyroid adenomas, one intrathyroidal hyperplastic parathyroid, one intrathyroidal parathyroid adenoma, one atypical parathyroid adenoma (all confirmed by histologic screening or immunocytochemistry), and five parathyroid cysts (all confirmed by immunoassay). Papanicolaou and Diff Quik-stained smears of the parathyroid FNAs were reviewed. The cytologic features were compared and contrasted with those of thyroid FNAs to establish criteria for differential diagnoses. RESULTS: The FNAs of the five parathyroid cysts yielded virtually acellular fluid with a characteristic water-clear appearance and markedly elevated levels of parathyroid hormone. The remaining seven aspirates consisted of moderately cellular smears that showed an admixture of architectural features. Common patterns included cohesive three-dimensional groups, disorganized sheets, papillary fragments, microfollicles, and a single case showing lymphoidlike smears. Although the cells were generally small and round to oval, all cases demonstrated mild to moderate anisokaryosis. The nuclei were hyperchromatic E with coarsely granular chromatin reminiscent of that of small lymphocytes. Occasional nucleoli were noted. Although the cytoplasm was usually pale blue and finely granular with ill-defined borders, two cases showed well-delineated cytoplasmic membranes. Less common findings included cytoplasmic granulation, vacuolization, and rare oxyphilic cells. Naked nuclei were noted in the background of all of the aspirates to varying degrees. Other background findings included the presence of colloidlike material, macrophages, and lymphocytes. One interesting finding that to date has not been reported is the presence of nuclear overlapping (100%) and nuclear molding (71%), which is an uncommon finding in thyroid aspirates. CONCLUSIONS: FNAs of the parathyroid can be easily confused with that of the thyroid, not only because of the clinical similarity between these two types of lesions but also because of the overlap in cytomorphologic features of the aspirated cells. Although no one single cytomorphologic feature is diagnostic, a combination of cytologic parameters noted earlier should raise the possibility of a parathyroid lesion. Aspirates of parathyroid cysts show acellular water-clear fluid with elevated parathyroid hormone measurements.     

Role of the microvascular endothelium in progressive renal disease

The role of the vascular endothelium in progressive renal disease is not well understood. This review presents evidence that progressive renal disease is characterized by a progressive loss of the microvasculature. The loss of the microvasculature correlates directly with the development of glomerular and tubulointerstitial scarring. The mechanism is mediated in part by a reduction in the endothelial proliferative response, and this impairment in capillary repair is mediated by alteration in the local expression of both angiogenic (vascular endothelial growth factor) and antiangiogenic (thrombospondin 1) factors in the kidney. The alteration in balance of angiogenic growth factors is mediated by both macrophage-associated cytokines (interleukin-1beta) and vasoactive mediators. Finally, there is intriguing evidence that stimulation of angiogenesis and/or capillary repair may stabilize renal function and slow progression and that this benefit occurs independently of effects on BP or proteinuria. Therefore, angiogenic agents may represent a novel therapeutic approach for slowing the progression of renal disease.     

A role for uric acid in the progression of renal disease

Hyperuricemia is associated with renal disease, but it is usually considered a marker of renal dysfunction rather than a risk factor for progression. Recent studies have reported that mild hyperuricemia in normal rats induced by the uricase inhibitor, oxonic acid (OA), results in hypertension, intrarenal vascular disease, and renal injury. This led to the hypothesis that uric acid may contribute to progressive renal disease. To examine the effect of hyperuricemia on renal disease progression, rats were fed 2% OA for 6 wk after 5/6 remnant kidney (RK) surgery with or without the xanthine oxidase inhibitor, allopurinol, or the uricosuric agent, benziodarone. Renal function and histologic studies were performed at 6 wk. Given observations that uric acid induces vascular disease, the effect of uric acid on vascular smooth muscle cells in culture was also examined. RK rats developed transient hyperuricemia (2.7 mg/dl at week 2), but then levels returned to baseline by week 6 (1.4 mg/dl). In contrast, RK+OA rats developed higher and more persistent hyperuricemia (6 wk, 3.2 mg/dl). Hyperuricemic rats demonstrated higher BP, greater proteinuria, and higher serum creatinine than RK rats. Hyperuricemic RK rats had more renal hypertrophy and greater glomerulosclerosis (24.2 +/- 2.5 versus 17.5 +/- 3.4%; P < 0.05) and interstitial fibrosis (1.89 +/- 0.45 versus 1.52 +/- 0.47; P < 0.05). Hyperuricemic rats developed vascular disease consisting of thickening of the preglomerular arteries with smooth muscle cell proliferation; these changes were significantly more severe than a historical RK group with similar BP. Allopurinol significantly reduced uric acid levels and blocked the renal functional and histologic changes. Benziodarone reduced uric acid levels less effectively and only partially improved BP and renal function, with minimal effect on the vascular changes. To better understand the mechanism for the vascular disease, the expression of COX-2 and renin were examined. Hyperuricemic rats showed increased renal renin and COX-2 expression, the latter especially in preglomerular arterial vessels. In in vitro studies, cultured vascular smooth muscle cells incubated with uric acid also generated COX-2 with time-dependent proliferation, which was prevented by either a COX-2 or TXA-2 receptor inhibitor. Hyperuricemia accelerates renal progression in the RK model via a mechanism linked to high systemic BP and COX-2-mediated, thromboxane-induced vascular disease. These studies provide direct evidence that uric acid may be a true mediator of renal disease and progression.     

Adolescent same-sex romantic attractions and relationships: implications for substance use and abuse

OBJECTIVES: Nationally representative data were used to examine associations of romantic attractions and relationships with substance use and abuse. METHODS: Data from the Add Health Study were examined. Youths reporting same-sex and both-sex romantic attractions and relationships were compared with those reporting opposite-sex attractions. Survey regression and logistic regression were used to control for sample design effects. RESULTS: In the case of certain outcomes, romantic attraction affected males differently than females. Youths with both-sex attractions were at a somewhat higher risk for substance use and abuse than were heterosexual youths; females with same-sex attractions were also at higher risk for some outcomes. Sexual-minority youths varied little from heterosexual youths in regard to trajectories of substance use and abuse. CONCLUSIONS: These findings highlight the importance of distinguishing between youths with only same-sex attractions and those with both-sex attractions. These findings also call into question previous findings indicating that sexual-minority youths are automatically "at risk."