Mikrobiologie und Diagnostik nichttuberkul?ser Mykobakterien

In recent years, several new techniques for the diagnostic workup of nontuberculous mycobacteria (NTM) have been introduced into laboratories. The use of nucleic acid amplification techniques for species identification has replaced the conventional biochemical methods. The detection of NTM directly from specimens is difficult because of the low bacterial load in the specimens and no standardized method is available yet. Thus, despite the recent improvements the microscopic and the cultural investigation of the specimens is still the reference standard in the diagnosis of NTM.     

Der Thenarlappen – eine sichere Methode zur Deckung von Hautdefekten im Hohlhandbereich

The thenar flap is a local cutaneous flap providing simple coverage of skin defects especially in the distal palm of the hand. It represents a radial distal pedicled cutaneous and subcutaneous transposition flap of the random pattern type. In the majority of cases it is indicated in Dupuytren’s disease with severe contracture of both the 4th and 5th metacarpophalangeal (MP) joints. The thenar flap is an excellent alternative to the open palm technique of McCash or full thickness skin grafts. In 1,116 faciectomies due to Dupuytren’s disease (mostly stages 3 and 4 according to Iselin) 72 thenar flaps were performed to cover skin defects in the distal palm of the hand. Wound healing was uneventful in 70 cases (97?%) and in 2 instances (3?%) there was partial necrosis of the flap with secondary healing. No revision surgery was required in any of the cases and 27 patients were available for follow-up after 3.5 years. At follow-up the range of motion and the degree of recurrence were examined and the MP joints could be almost completely extended. None of the flaps showed any evidence of recurrence. The thenar flap is a safe and simple procedure which is easy to prepare. Even larger defects in the palm of the hand are suitable to be covered by this flap. Compared to other procedures for soft tissue coverage in our opinion the thenar flap should be the method of choice especially in Dupuytren’s disease.     

Migration Status, Work Conditions and Health Utilization of Female Sex Workers in Three South African Cities

Intersections between migration and sex work are underexplored in southern Africa, a region with high internal and cross-border population mobility, and HIV prevalence. Sex work often constitutes an important livelihood activity for migrant women. In 2010, sex workers trained as interviewers conducted cross-sectional surveys with 1,653 female sex workers in Johannesburg (Hillbrow and Sandton), Rustenburg and Cape Town. Most (85.3 %) sex workers were migrants (1396/1636): 39.0 % (638/1636) internal and 46.3 % (758/1636) cross-border. Cross-border migrants had higher education levels, predominately worked part-time, mainly at indoor venues, and earned more per client than other groups. They, however, had 41 % lower health service contact (adjusted odds ratio = 0.59; 95 % confidence interval = 0.40–0.86) and less frequent condom use than non-migrants. Police interaction was similar. Cross-border migrants appear more tenacious in certain aspects of sex work, but require increased health service contact. Migrant-sensitive, sex work-specific health care and health education are needed.     

Comparative biochemical parameters in deceased and living patients in a follow-up intervention study of cardiovascular patients

After the laboratory-diagnostical spectrum had been analysed by means of a representative check of probationer with a state suspected of heart and vessel diseases on the screen of the X-ray mass examination in longitudinal section and cross-section with derived conclusions the results had been checked by means of comparison with the dead and not dead of this population in the follow up. The parameter sedimentation rate of erythrocyte, blood sugar, the enzymes "ASAT" and "ALAT" and total cholesterol with stronger pronounced proneness could substantiate the causal connection to this population of persons suffering from a heart disease as well. Hence followed derived relations to the severe degree of heart and vessel disease and beside this to the prognostical estimation of the disease for the parameter uric acid, hemoglobin/hematocrit and creatinine in the serum. The number of leucocytes, the serum protein, the separation of fractions of serum protein and lability test of serum by electrophoresis did not result in any findings, which allowed any connection with heart and vessel diseases, also concerning the persons who died in the course of the study, so that the demand for a differentiated, well-aimed differential-diagnostical use of these expensive research methods also for this extreme situation is substantiated once more. The results are discussed in comparison as well as in connection with the results found out of the total check and in dependence of age and sexes.     

Acute protection against exercise-induced bronchoconstriction by formoterol, salmeterol and terbutaline.

The onset of bronchoprotection as obtained by various beta2-agonists has not been examined in a comparitive study. In this study, the onset of bronchodilation and protection against exercise-induced bronchoconstriction in asthmatics after inhalation of the long-acting beta2-agonists formoterol and salmeterol and the short-acting beta2-agonist terbutaline were measured. Twenty-five subjects with asthma and a history of exercise-induced bronchoconstriction (mean baseline forced expiratory volume in one second (FEV1): 90% predicted; mean fall in FEV1 after exercise: 31% from baseline) were enrolled in this double-blind, double-dummy, placebo-controlled, randomized, four-period crossover study. Exercise challenges were performed on 12 days at either 5, 30, or 60 min after inhalation of a single dose of formoterol (12 microg Turbuhaler), salmeterol (50 microg Diskus), terbutaline (500 microg Turbuhaler) or placebo. Exercise-induced bronchoconstriction (maximum fall in FEV1 or area under the curve) did not differ significantly between terbutaline, formorerol and salmeterol either 5, 30, or 60 min after inhalation of the study medication. In contrast, the onset of bronchodilation was slower after salmeterol compared to terbutaline and formoterol (p<0.05, each), which both showed a similar time course. At all time points between 5 and 60 min, formoterol provided significantly greater bronchodilation than salmeterol (p<0.05). These data indicate that equipotent doses of the bronchodilators salmeterol, formoterol and terbutaline were similarly effective with respect to their short-term protective potency against exercise-induced bronchoconstriction, despite the fact that the time course of bronchodilation was significantly different between the three beta2-agonists.     

Helicobacter pylori infection, not gastroesophageal reflux, is the major cause of inflammation and intestinal metaplasia of gastric cardiac mucosa

OBJECTIVE: The etiology of inflammation below the normal Z-line is an area of intense debate. Some suggest this is the earliest change of chronic gastroesophageal reflux disease (GERD), whereas others indict Helicobacter pylori (H. pylori) as the main cause. The aim of this study was to evaluate the relationship among inflammation of gastric cardiac mucosa (carditis), H. pylori infection, and intestinal metaplasia in patients with GERD and Barrett's esophagus compared with age-matched controls. METHODS: Patients with GERD and Barrett's esophagus were compared with controls undergoing endoscopy for a variety of other conditions. Endoscopic biopsy specimens from the gastric cardia (obtained on retroflexed view), fundus, and antrum were evaluated for inflammation, H. pylori infection, and intestinal metaplasia. RESULTS: The prevalence of H. pylori infection did not significantly differ among the study populations: controls (42%), GERD (33%), and Barrett's esophagus (27%) (p = 0.20). However, the prevalence of carditis significantly decreased from the control group (30%) to those with GERD (23%) and Barrett's esophagus (11%) (p = 0.03). Overall, 42 of 51 (82%) patients with carditis had H. pylori; all had pangastritis. The prevalence of cardia intestinal metaplasia also significantly decreased from the control group (15%) to those with GERD (4%) and Barrett's esophagus (0%) (p = 0.003). Of 13 patients with cardia intestinal metaplasia, 12 had carditis, 10 had H. pylori infection, and seven had intestinal metaplasia elsewhere in the stomach. CONCLUSIONS: Inflammation of gastric cardiac mucosa decreases in prevalence from controls to patients with GERD and Barrett's esophagus and correlates strongly with H. pylori infection. Cardia intestinal metaplasia is associated with H. pylori-related cardiac inflammation and intestinal metaplasia elsewhere in the stomach.     

Correlates of urinary, fecal, and dual incontinence in older African-American and white men and women

OBJECTIVES: To determine prevalence and correlates of urinary (UI), fecal (FI), and dual (DI) incontinence in community‐dwelling older adults. DESIGN: Cross‐sectional, population‐based in‐home survey. SETTING: Three rural and two urban Alabama counties (1999–2001). PARTICIPANTS: Stratified random sample of 1,000 Medicare beneficiaries aged 65 and older: 25% African‐American men, 25% white men, 25% African‐American women, 25% white women. MEASUREMENTS: UI defined as involuntary urine loss at least monthly; FI defined as “In the past year, have you had any loss of control of your bowels, even a small amount that stained the underwear?” Independent variables were sociodemographics, medical history, and activities of daily living (ADLs) excluding toileting. Multinomial logistic regression models were constructed using UI, FI, and DI as dependent variables. RESULTS: UI, FI, and DI prevalences were 27%, 6%, and 6%, respectively. White women had higher prevalence of UI (41.1% vs 24.6%, P<.001) and DI (18.5% vs 8.0%, P=.07) but not FI (4.4% vs 3.8%, P=.83) than African‐American women. Men had no racial differences in prevalence (UI 22.2%, FI 7.7%, DI 4.6%). In women, UI, FI, and DI correlates included higher Charlson comorbidity score and depressive symptoms and greater ADL difficulty for UI and DI. In men, UI was associated with prostate disease and depressive symptoms; FI with chronic diarrhea, history of transient ischemic attack (TIA), and poor self‐perceived health; and DI with history of TIA, foot and leg swelling, and depressive symptoms. CONCLUSION: Women had racial differences as well as similar correlates of incontinence subtypes, whereas men did not.     

Impaired transforming growth factor-beta signaling in idiopathic pulmonary arterial hypertension

Mutations in transforming growth factor-beta family receptor-II, bone morphogenetic protein receptor-2, and activin-like kinase-1 have been associated with pulmonary hypertension. In the present study, we determined that pulmonary arteries in normal lungs and in lungs of patients with emphysema and idiopathic pulmonary arterial hypertension comparably expressed transforming growth factor-beta receptors I and II, Smad(1, 5, 8), Smad2, Smad3, Smad4, phosphorylated Smad(1, 5, 8), and phosphorylated Smad2 (the latter two both indicative of active in vivo signaling) in endothelial cells, as assessed by immunohistochemistry and quantitative morphometry. Medial or intimal smooth muscle cells had weak or absent expression of these molecules. In clear contrast to endothelial cell expression in pulmonary arteries and in endothelial cells lining incipient vessels within plexiform lesions of hypertensive lungs, endothelial cells present in the core of the lesions lacked expression of all examined members of the signaling molecules. These findings were made irrespective of the mutation status of bone morphogenetic protein receptor-2 in hypertensive patients. Our findings suggest that pulmonary artery endothelial cells in both normal and severely hypertensive lungs have active transforming growth factor-beta family signaling, and that loss of signaling might contribute to the abnormal growth of endothelial cells in plexiform lesions in idiopathic pulmonary arterial hypertension.