DNA-Chips in der Diagnostik hämatologischer Neoplasien

In hematological malignancies, gene expression profiling using DNA-microarrays led to the discovery of novel lymphoma and leukemia subgroups. The heterogeneous entity of diffuse large B-cell lymphoma could be subdivided into the germinal center B-cell-like and the activated B-cell-like subtype which differ in pathogenesis and clinical behavior. In leukemia, existing entities defined by morphological, cytogenetic, molecular and immunophenotypic criteria were confirmed on the global gene expression level; in addition, new important molecular subgroups could be identified. In retrospective clinical lymphoma and leukemia studies, robust gene expression signatures were discovered that predict the clinical course at the time of diagnosis. Given the huge potential of the DNA-microarray technology, application in the routine diagnostic setting appears possible.     

Präoperative Schmerzschulung

Background

The present research was performed to investigate the influence of preoperative information on pain given by the nursing staff on postoperative pain perception in patients.

Methods

A randomized controlled interventional study was conducted in 93 patients undergoing cardiac surgery at the University Hospital Erlangen. One day before the surgery all participants were evaluated using the Eysenck Personality Questionnaire, patients of the treatment group were additionally trained by a member of the nursing staff in pain behaviour. After discharge from the intensive care unit the pain experience of the patients was evaluated using standardized questionnaires.

Results

Of the 93 patients, 73 finished the study protocol and were analyzed. The pain experience was not significantly different between the two study groups. Patients with increased levels of neuroticism (characterized by emotional lability) regardless of study group more frequently reported pain values above 3/10.

Conclusion

No significant modulation of postoperative pain experience was achieved by preoperative information on pain. However, it cannot be ruled out that this intervention, particularly in view of the reduction in anxiety, may form a significant element of perioperative pain management.     

Interstitielle Lungenerkrankungen

Interstitial pneumonia is a rare disease, posing a diagnostic challenge to pneumologists, pediatricians, radiologists and pathologists. Only by the combined efforts of the European Respiratory Society (ERS) and the American Thoracic Society (ATS) has has been possible to standardize the formerly different European and Northern American nomenclature of interstitial lung diseases (alveolitis versus interstitial pneumonia) in adults and to clearly and unambiguously define the diagnostic criteria. The ATS/ERS classification of 2002 comprises seven entities: usual interstitial pneumonia (UIP), non-specific interstitial pneumonia (NSIP), desquamative interstitial pneumonia (DIP), respiratory bronchiolitis-associated interstitial lung disease (RB-ILD), cryptogenic organizing pneumonia (COP), lymphocyte interstitial pneumonia (LIP), and acute interstitial pneumonia (AIP). Using the ATS/ERS classification of interstitial pulmonary diseases in premature infants, infants and children is problematic, since UIP, RB-ILD and AIP do not occur at this age. Although infants with severe respiratory insufficiency may sometimes show morphological features similar to DIP or NSIP, this entity should rather be classified as chronic pneumonitis of infancy (CPI) because of differences in etiology, pathogenesis and prognostic outcome.     

EGFR-Expression in pulmonalen neuroendokrinen Zellhyperplasien

15 cases of pulmonary neuroendocrine cell hyperplasia (carcinoid-tumorlets, diffuse idiopathic pulmonary neuroendocrine cell hyperplasia/DIPNECH) and 20 neuroendocrine pulmonary tumors (10 carcinoid tumors, 5 large cell neuroendocrine, and 5 small cell neuroendocrine lung carcinomas) were immunohistochemically analyzed for the expression of epidermal growth factor receptor (EGFR, = HER-1). All cases of neuroendocrine cell hyperplasia exhibited a maximum EGFR expression (score 3 in 100% of cells) showing predominantly membranous, partly cytoplasmic staining. 4 ot the 10 carcinoid tumors were strongly positive for EGFR, whereas the other 6 were EGFR-negative. A total of 90% of large cell neuroendocrine and small cell neuroendocrine carcinomas were negative for EGFR. Overexpression of EGFR in pulmonary neuroendocrine cell hyperplasia might be significant for the pathogenesis of these lesions. As DIPNECH is characterized by clinical signs and symptoms including mild cough and obstructive functional impairment, a specific antagonistic therapeutic trial could aim at blocking EGFR/HER-1 or its subsequent signal transduction pathway.     

Standards und Fallstricke der In-vitro-Diagnostik der Insektengiftallergie

In patients with a history of anaphylactic sting reactions, in-vitro tests are performed in order to demonstrate venom sensitization to the causative venom. Measurement of specific IgE-antibodies (sIgE) to the natural composite venom represents the standard in-vitro method to demonstrate venom sensitization. If sensitization to the composite venom cannot be demonstrated, one may determine sIgE to recombinant allergen compounds, in order to demonstrate sensitization to molecular venom allergens. Moreover, several cellular tests are available to confirm venom sensitization. Herein basophils, which carry cell-bound sIgE, can be used to produce a confirmatory response upon incubation with venom allergens. Reactions to both honey bee and vespid venom may either indicate true double sensitization or cross sensitization. The identification of antibodies cross-reacting to venoms and to other allergen sources does not exclude clinical relevance. Elevated baseline serum tryptase is a risk factor for severe systemic reactions after a field sting and during venom immunotherapy (VIT), the latter in particular for VIT with vespid venom. Serum tryptase measurement should, therefore, be included into routine diagnostics of venom allergy. The measurement of IgG-antibodies specific to venom is not recommended for routine work-up. None of the mentioned in-vitro tests, which may be used before, during or after VIT, allow, however, a precise prognosis with respect to future sting reactions, or to side effects and to the efficacy of VIT, respectively. To validate the reason for a VIT, one should also consider patient history and results of other tests.     

Zellulitis

Cellulite is a condition affecting the dermal and subdermal compartment and developing on thighs and buttocks of almost every woman. Macroscopically, cellulite is characterized by dimpling, visible either spontaneously or after provoking maneuvers. While published concepts on the pathophysiology of cellulite are in parts inconclusive or contradictory, there are at least some recent studies describing or confirming structural and anatomic changes on dermal and subdermal tissues: (1) A gender specific dimorphism with subdermal septae oriented orthogonally towards the skin surface as well as protrusion of fat tissue into the dermis. (2) These intradermal fat protrusions additionally correlate with the presence of cellulite. (3) There is also a correlation between the thickness of the subdermal fat layer and the presence of cellulite. (4) Cellulite also correlates with focal hypertrophic subcutaneous septae and a reduced density of septae in general. Treatment of cellulite aims at (1) the reduction of the subcutaneous fat layer, (2) increase in dermal thickness and elasticity and (3) dissection of hypertrophic connective tissue septae, responsible for the most pronounced dermal indentions. A variety of treatment options have evoleved ranging from topical retinol to interstitial laser     

Neurobiologische Subtypen der Altersdepression

With age, increasing biological constraints on functioning are often aggravated by increases in multimorbidity. These effects, however, not only have an impact on somatic, but also psychological processes. In geriatric depression, for instance, there are both effects of recurrent depressive episodes on the neurobiology of the disorder as well as effects of cardiovascular comorbidity that interact with brain areas associated with the perception and regulation of emotions. These biobehavioral interactions have strong implications for both the differential diagnosis and treatment of geriatric depression.     

Kardiovaskuläre und hämostaseologische Sicht retinaler Gefäßverschlüsse

Background

Sudden pain-free impairment of vision often occurs due to acute occlusions of retinal blood vessels. Retinal vascular occlusion can be distinguished into the more frequent venous and to a lesser degree arterial events but mixed pictures also occur.

Objectives

Summary of the current literature regarding interdisciplinary diagnosis and therapy of retinal blood vessel occlusions.

Materials and methods

Selective literature review considering clinically relevant cardiovascular and hemostaseological aspects.

Results

The anatomical localization of the occlusion by the ophthalmologist can give important indications for further medical diagnostic and therapeutic decisions. Arterial occlusions are mostly caused by thromboembolisms and the source should be identified and treated. Venous occlusions are mostly due to local processes with a prothrombotic background or venous stasis associated with arterial hypertension. Prognostically, the localization, extent and duration of retinal ischemia are decisive factors.

Conclusions

Vascular ocular occlusions are frequently secondary to internal disorders and therefore pose an interdisciplinary challenge.     

Pharmakokinetik intravitreal applizierter VEGF-Inhibitoren

Background

In addition to topical, periocular and systemic administration, intravitreal injection has been established in recent years as an additional standard procedure for ophthalmological drug delivery. This route of administration is now most frequently used for the therapy of retinal diseases with vascular endothelial growth factor (VEGF) inhibitors.

Material and methods

A selective literature review and an analysis of own research data were carried out.

Results

Intravitreal administration achieves high drug concentrations in the target tissue while minimizing systemic drug exposure. Depending on properties such as molecular weight and binding capacity to the neonatal Fc receptor, intravitreally applied VEGF inhibitors can exhibit relevant differences in intraocular and systemic pharmacokinetics. Moreover, the pharmacokinetics can be affected by properties of the individual eye, such as ocular volume, vitreous liquefaction, and prior vitrectomy.

Conclusions

Pharmacokinetics of intravitreally administered drugs determine both the duration of ocular effect and the degree of systemic exposure and are thus of clinical relevance with regard to the reinjection strategy and systemic safety.     

Pathologie-Websites im World Wide Web

Being a global information network, the internet has becoming increasingly important for pathologists as a medium for professional communication and information. Although a large number of pathology-specific websites (PSWs) are accessible on the internet, the potentials of PSWs are still barely known. Since there is no global catalog for all the pathology websites, certain PSWs are difficult to find on the internet. PSWs offer lavishly illustrated education material for undergraduates and postgraduates in pathology, but may also be very useful as reference books or as an instrument of continuing medical education (CME) for experienced pathologists. The spectrum of PSW media comprises electronic training manuals, journals, case collections, photo-archives, and even complete section series of virtual microscopy. PSWs are available at any time, can be updated permanently and linked to further online sources of information. We demonstrate how to find PSWs and present an annotated list of some 100 of the best PSWs.