Identifikation des auslösenden Agens bei unklarer Bewusstlosigkeit mehrerer Patienten

Substance abuse in all combinations imaginable repeatedly poses a challenge to the rescue team. Rapid identification of substances allows not only specific measures in addition to a mere symptomatic therapy, but also adequate risk evaluation. In the case described with an unusual cooperation of emergency medical services and fire department, the use of gas chromatography and mass spectrometry allowed better judgment of the clinical course. Knowledge of the effects of the substance consumed allowed safe discharge of five patients who were initially admitted with changes in the state of awareness up to unconsciousness.     

Late Steroid Withdrawal Following AB0-Incompatible Renal Transplantation

Background

Current evidence on steroid withdrawal following AB0-incompatible (AB0i) renal transplantation is low. We compared clinical outcomes of patients who agreed to late steroid withdrawal and patients who remained on steroid treatment.

Dual Actions of Enflurane on Postsynaptic Currents Abolished by the γ-Aminobutyric Acid Type A Receptor β3(N265M) Point Mutation

Background: At concentrations close to 1 minimum alveolar concentration (MAC)-immobility, volatile anesthetics display blocking and prolonging effects on [gamma]-aminobutyric acid type A receptor-mediated postsynaptic currents. It has been proposed that distinct molecular mechanisms underlie these dual actions. The authors investigated whether the blocking or the prolonging effect of enflurane is altered by a point mutation (N265M) in the [beta]3 subunit of the [gamma]-aminobutyric acid type A receptor. Furthermore, the role of the [beta]3 subunit in producing the depressant actions of enflurane on neocortical neurons was elucidated.

Methods: Spontaneous inhibitory postsynaptic currents were sampled from neocortical neurons in cultured slices derived from wild-type and [beta]3(N265M) mutant mice. The effects of 0.3 and 0.6 mm enflurane on decay kinetics, peak amplitude, and charge transfer were quantified. Furthermore, the impact of enflurane-induced changes in spontaneous action potential firing was evaluated by extracellular recordings in slices from wild-type and mutant mice.

Results: In slices derived from wild-type mice, enflurane prolonged inhibitory postsynaptic current decays and decreased peak amplitudes. Both effects were almost absent in slices from [beta]3(N265M) mutant mice. At clinically relevant concentrations between MAC-awake and MAC-immobility, the anesthetic was less effective in depressing spontaneous action potential firing in slices from [beta]3(N265M) mutant mice compared with wild-type mice.     

Inhaled dry powder mannitol in children with cystic fibrosis: A randomised efficacy and safety trial

Introduction

Inhaled mannitol has beneficial effects on lung function, mucociliary clearance, quality of life and sputum properties. This trial examined the efficacy of inhaled mannitol in children with cystic fibrosis (CF).

Wirsungorrhagia or Hemoductal Pancreatitis: Report of a Case and Review of the Literature

An unusual case of gastrointestinal hemorrhage due to rupture of the splenic artery into the pancreatic duct in a patient with chronic pancreatitis is described. The diagnosis was suspected by observing blood coming from the papilla of Vater during duodenoscopy and corroborated by findings seen on splenic arteriography. Previously reported cases are reviewed. An etiology is discussed and a classification suggested. This obscure cause of gastrointestinal bleeding should be suspected when the more common causes of bleeding have been satisfactorily ruled out.     

Establishment of two new myeloma cell lines from bilateral pleural effusions: evidence for sequential in vivo clonal change

Two new human myeloma cell lines have been established from a 36-year- old woman with refractory IgG kappa multiple myeloma in whom bilateral malignant pleural effusions developed. The malignant plasma cells from each effusion were set up in a liquid culture using an L-15 medium containing catalase, glutathione, selenous acid, ascorbic acid, insulin, transferrin, additional glutamine hydrocortisone, and 2- mercaptoethanol and designated as M-3 medium. Two IgG kappa cell lines, LB -831 and LB-832, were established and proved to be Epstein-Barr virus negative using the internal repeat sequence DNA probe. Characteristic plasma cell morphology was evident by light and electron microscopy. Immunotyping revealed an IgG kappa , B1+, B2-, Ia (HLA- DR)+, CALLA+ phenotype for each cell line as well as for the original pleural fluid and bone marrow myeloma cells. The supernatants also contained IgG kappa, beta 2 microglobulin, and large amounts of osteoclast-activating factor (indicating bone-resorbing activity). Cytogenetic analysis of the LB-831 cell line revealed a nearly triploid highly abnormal karyotype with numerous clonal chromosomal abnormalities involving chromosomes 1, 3, 5, 7, 13, and 15; several structurally abnormal marker chromosomes; and a putative homogeneously staining region on chromosome 7p at band p22. Analysis of the LB-832 cell line revealed several additional clonal abnormalities. These additional cytogenetic changes suggest that in vivo sequential clonal evolution occurred in this patient. Therefore, two new but related cell lines have been established, which should prove useful for further biological studies.     

Hereditary hemolytic anemia caused by diverse point mutations of pyruvate kinase gene found in Japan and Hong Kong

We identified four distinct point mutations in homozygous pyruvate kinase (PK) variants in Japanese and Chinese patients with chronic nonspherocytic hemolytic anemia. All gene abnormalities were missense mutations that caused single amino acid substitutions. 1261A (Q421K) and 1436A (R436H), which were identified in PK Sendai and PK Shinshu, had been found in unrelated Japanese and Amish PK variants, respectively. The clinical severity and extremely low residual erythrocyte PK activity of PK Shinshu as well as of the Amish PK might be caused partly by aberrant splicing, because the 1436A mutation changes a nucleotide at the last nucleotide in the exon 10. Recently, we diagnosed a 42-year-old Japanese woman with chronic nonspherocytic hemolytic anemia as having a homozygous PK deficiency. DNA sequencing of the variant PK gene showed a homozygous missense mutation at 1403GCT- ->GTT, resulting in a single amino acid substitution from 468la-->Val. The gene mutation is likely to impair the allostericity of this enzyme, speculated from the tertiary structure. A homozygous missense mutation in PK Hong Kong, a boy of a non-Han southern Chinese minority group, was identified in exon 7 of the human L-PK gene, 941ATT-->ACT, resulting in a single amino acid substitution from 314lle-->Thr. The R- PK activity is expected to be severely affected, because the mutated amino acid residue is located between the 313 Lys and the 315 Glu, which are very important for acid-base catalysis and magnesium binding, respectively. Both the R- and M2-type PK were shown by polyacrylamide gel electrophoresis of the PK Hong Kong erythrocyte lysate, and this is the first report of a homozygous individual whose erythrocytes contain the immature (M2)-type isozyme.     

MR 间接关节造影术诊断肩袖病变

目的：回顾性研究评价肩袖(RM)病变MR间接关节造影术的价值,并与关节镜检相比较。方法：对疑有肩部病变的63例病人检查：斜冠状位和轴位T1序列平扫、轴位FLASH-2D序列以及斜冠状位T2W和PDW序列。静脉内给予0.1mmol Gd-DTPA/kg体重后,肩部主动活动和重复T1序列,借助感兴趣区(ROI)技术定量测量肌腱内的信号强度(SI)和衡量对比剂增强CE。在32例病人其结果经关节镜证实。结果：冈上肌腱的平均信号强度(SI),在给对比剂前后,在各种病变(退化、撞击、不完全撕裂和完全撕裂)明显高于正常结果(P＜0.05)。同样,按百分比计算的对比增强(CE)也是如此(P＜0.05)。检出了9例完全撕裂和3例撞击综合征患者(平扫/增强后二者敏感性100％)。诊断了6例不完全破裂,其中3例假阳性,1例假阴性;敏感性75％,特异性50％。结论：MR间接关节造影术改善了RM病变的影像表现。然而用它探查不完全撕裂也有欠缺,因为要确切区分肌腱的退变与不完全撕裂还很困难。 华中科技大学同济医学院附属同济医院汪玲译胡国栋校 摘自 Fortschr Rontgenstr 2000,172:686-691     

Duration of work disability after low back injury: a comparison of administrative and self-reported outcomes.

BACKGROUND: Workers' compensation wage replacement data have recently been used to estimate time to return to work (RTW) and the number of work days lost after occupational injury. The degree to which indemnity-based measures reflect self-reported work disability has until now not been studied. METHOD: Kaplan-Meier curves of administrative and self-reported measures of duration of work disability were compared within a sample of 433 low back injury claimants followed up for 1 to 3.7 years. RESULTS: Administrative measures consistently and significantly underestimated the duration of disability when compared to self-reported measures of RTW. The difference between the estimated mean number of work days lost for comparable administrative and self-reported measures ranged from 142 to 334 days. CONCLUSIONS: Number of work days lost after low back injury is substantially underestimated by measures based on the duration of wage replacement benefits. This calls into question the adequacy of indemnity benefits and underscores the need for disability prevention programs.