Burden of hip fracture on inpatient care: a before and after population-based study

Summary  

We estimated the excess hospital expenditure attributable to osteoporotic hip fracture (HF) within a population of 6,019 patients. Post-fracture excess of hospital days was 23.1, including 22.7 days in rehabilitation care. HF might result from a patient's pre-fracture poor health status rather than predispose to a worsening of such pre-existing conditions.     

Neuroendokrine Neoplasien des gastroenteropankreatischen Systems

Neuroendocrine neoplasms (NEN) appear to be morphologically homogeneous, however, biologically and clinically they are a very heterogeneous tumor group. They can occur in every organ but are most common in the lungs and the gastroenteropancreatic system (GEP). In order to unify and improve the diagnosis and therapy of GEP-NEN the European Neuroendocrine Tumor Society (ENETS) has developed guidelines over the last 5 years. In consideration of these guidelines the TNM classification of the Union for International Cancer Control (UICC) was introduced in 2009 and only 1 year later the new GEP-NEN classification of the World Health Organization (WHO) was presented. This review summarizes the new classification and the morphological diagnosis of GEP-NEN. Based on these classifications an optimal prognostic stratification of GEP-NEN is possible which is the basis for imaging and treatment and allows a comparison of large tumor collectives.     

Long-term remission of an advanced recurrent endometrial cancer in a heavily pretreated patient using a combined regimen with bevacizumab and metronomic cyclophosphamide

The treatment of advanced endometrial cancer remains a challenge and the range of valuable treatments remains limited. Recently, the monoclonal vascular endothelial growth factor--antibody bevacizumab as a single-agent regimen or in combination with different chemotherapeutic approaches has been approved as a therapeutic option for several solid tumors. First, clinical trials evaluating the use of bevacizumab in endometrial cancers have been completed, but the results have not been published yet. A 59-year-old patient with advanced recurrent endometrial cancer presented at our institution suffering from increasing abdominal discomfort. She had been extensively pretreated using radiotherapeutic approaches and multiple chemotherapeutic regimens. The level of cancer antigen 125 (CA 125) was rising and a cystic pelvic mass was detected, consistent with a persistent local tumor relapse. As several cytotoxic treatment attempts had failed, we decided to induce a combined therapy with bevacizumab (intravenously) and metronomic cyclophosphamide (orally) as an individual treatment option. After 6 weeks of treatment, the patient's abdominal complaints had completely disappeared, CA 125 had decreased significantly to nearly baseline levels, and the previously detected cystic pelvic mass could no longer be seen. No significant side effects could be observed besides a mild fatigue. During the following weeks, CA 125 levels continued to decrease, and the patient experienced a long-time remission in fine condition for 10 months before PD. Bevacizumab in combination with metronomic cyclophophamide can be a well-tolerated salvage treatment option for patients with advanced, heavily pretreated recurrent endometrial cancer that exacts further evaluation within clinical trials.     

Cytopathological and chemico‐physical analyses of smears of mucosa surrounding oral piercing

Oral Diseases (2010) 16 , 160–166 Objective: The aim of this comparative study was to analyze cytopathologically and chemico‐physically the mucosa surrounding oral piercing to correlate results with adverse tissue signs. Materials and methods: The tongue superficial mucosa of 15 young subjects (control group) and the superficial mucosa surrounding oral piercing of 15 young subjects (test group, TG) were smeared on slides, Papanicolaou stained and analyzed under the optical microscope. Some smears were prepared for (back‐scattered) scanning electron microscope (SEM) and X‐ray microanalysis to study piercing fragments. Results: Smears of TG displayed a variable extent of bacterial cytolysis of epithelial cells, fungi, hyperkeratosis, parakeratosis, granulocyte infiltration, calcium formations and bacterial flora; the four last statistically significant (P < 0.05). Foreign bodies surrounded by keratinocytes were detected under both light and SEM. X‐ray microanalyses highlighted piercing alloy aggression, ion release and an inverse gradient of ion concentration inside keratinocytes. Conclusions: The pathological findings in smears correlated with adverse effects of oral piercing. Ion release may be related to direct toxic effects and belated reactions because of metal sensitization. A strict regulation of piercing is warranted.     

Autoantibody reactivity in serum of patients with major depression, schizophrenia and healthy controls

The present study assessed 25 patients with unipolar major depression and 34 patients with schizophrenia along with 50 healthy, non-psychiatric controls for the presence of serum antinuclear (ANA), smooth muscle (SMA), anti-endothelial (AEA), anti-sarcolemma (ASA), thyroid gland (TGA) and parietal cell (PCA) antibodies. In the group of patients with major depression, the frequency of elevated ANA, TGA and PCA was significantly higher than in the control group. In addition, the group of patients with schizophrenia significantly more often showed increased levels of ANA and SMA than the control group of healthy volunteers. When the two psychiatric groups were compared, PCA serum titers in major depression and SMA values in schizophrenia were significantly more frequently elevated, whereas values of AEA and ASA showed no difference. These results point towards the existence of an unspecific (auto) immune disposition or reaction in at least a subgroup of patients with major depression and schizophrenia.     

Dopaminergic modulation of auditory cortex-dependent memory consolidation through mTOR

Previous studies in the auditory cortex of Mongolian gerbils on discrimination learning of the direction of frequency-modulated tones (FMs) revealed that long-term memory formation involves activation of the dopaminergic system, activity of the protein kinase mammalian target of rapamycin (mTOR), and protein synthesis. This led to the hypothesis that the dopaminergic system might modulate memory formation via regulation of mTOR, which is implicated in translational control. Here, we report that the D1/D5 dopamine receptor agonist SKF-38393 substantially improved gerbils' FM discrimination learning when administered systemically or locally into the auditory cortex shortly before, shortly after, or 1 day before conditioning. Although acquisition performance during initial training was normal, the discrimination of FMs was enhanced during retraining performed hours or days after agonist injection compared with vehicle-injected controls. The D1/D5 receptor antagonist SCH-23390, the mTOR inhibitor rapamycin, and the protein synthesis blocker anisomycin suppressed this effect. By immunohistochemistry, D1 dopamine receptors were identified in the gerbil auditory cortex predominantly in the infragranular layers. Together, these findings suggest that in the gerbil auditory cortex dopaminergic inputs regulate mTOR-mediated, protein synthesis-dependent mechanisms, thus controlling for hours or days the consolidation of memory required for the discrimination of complex auditory stimuli.