Confocal laser scanning microscopy as a new valuable tool in the diagnosis of onychomycosis – comparison of six diagnostic methods

Onychomycosis is common and can mimic several different nail disorders. Accurate diagnosis is essential to choose the optimum antifungal therapy. The aim of this study was to evaluate the use of confocal laser scanning microscopy (CLSM) and optical coherence tomography (OCT) as new non‐invasive diagnostic tools in onychomycosis and to compare them with the established techniques. In a prospective trial, 50 patients with suspected onychomycosis and 10 controls were examined by CLSM and OCT. Parallel KOH preparation, culture, PAS‐staining and PCR were performed. PCR showed the highest sensitivity, followed by CLSM, PAS and KOH preparation. OCT offered the second best sensitivity but displayed the lowest specificity. CLSM and KOH preparation showed a high specificity and CLSM offered the best positive predictive value, similar to KOH preparation and OCT. Fungal culture showed the lowest sensitivity and the worst negative predictive value, yet culture and PCR are the only techniques able to identify genus and species. In summary, CLSM was comparable to PAS staining and superior to KOH preparation. Due to the low specificity we assess OCT not as appropriate. In the differentiation of species PCR outplays the fungal culture in terms of time and sensitivity.     

Mode of delivery and its influence on women's satisfaction with childbirth

Objective

Many factors affect women's satisfaction with the experience of childbirth. Some of these are known, but most have not been fully evaluated. The influence of the mode of delivery is unclear. This study investigated the extent to which satisfaction with childbirth depends on the mode of delivery, and evaluated factors determining postpartum satisfaction.

Study design

Women with singleton pregnancies at term were included prospectively. After childbirth, all women meeting the inclusion criteria received a standardised questionnaire – the German version of Salmon's Item List (SIL-Ger) – for completion before discharge to evaluate the birth experience. The chi-squared test, Fisher's exact test, and Kruskal–Wallis test were used for statistical analysis. Univariate and multivariate linear regression analyses were used to assess associations between demographic and pregnancy-associated variables and variables influencing the perception of childbirth in the total SIL-Ger score. Univariate and multivariate binary logistic regression models were used to evaluate effects of demographic and clinical parameters on SIL-Ger scores of <70 versus SIL-Ger scores of ≥70. All covariates with a P value ≤ 0.10 in the univariate analysis were included in multivariate logistic regression models. All tests were two-sided, and P values < 0.05 were considered statistically significant.

Results

The analysis included 335 questionnaires. No differences were observed between different modes of delivery (normal 84.5 ± 14.6, primary caesarean 87.0 ± 13.5, secondary caesarean 83.2 ± 13.8, emergency caesarean 79.3 ± 7.3, operative vaginal delivery 83.9 ± 13.6; P = 0.503). Multivariate analysis identified two independent factors associated with higher SIL-Ger scores: good/very good satisfaction with childbirth (P < 0.001) and good/very good involvement in decision-making afterwards (P = 0.005). Severe pain perception during childbirth was associated with lower SIL-Ger scores (P = 0.003). Absence of a person of trust during childbirth was linked with scores < 70 (P = 0.005), indicating a negative experience. Good/very good satisfaction with childbirth (P < 0.001) reduced the probability of a score < 70.

Conclusion

Mode of delivery does not directly influence women's satisfaction with childbirth. Involvement in decision-making, support during labour and effective analgesia appear to be the most important factors that improve women's birth experience.     

übergewicht, Hirsutismus und tiefe Stimme bei einer Jugendlichen

The case of an adolescent female with a hormone-producing adrenal tumor is reported. The patient was characterized by virilization and Cushing??s syndrome. Dehydroepiandrosterone sulfate (DHEA-S) and androstenedione levels were considerably elevated but cortisol excretion showed only a moderate increase. The most common presenting sign of hormone-producing adrenal tumors is virilization particularly in combination with weight gain und accelerated growth velocity. A complete radical operation is the therapy of choice. The tumor was completely resected and 3.5 years after diagnosis there has been no recurrence.     

Radiochemotherapy in patients with primary glioblastoma comparing two temozolomide dose regimens

PURPOSE: To evaluate toxicity and outcomes in patients with primary glioblastoma (GB) treated with postoperative radiochemotherapy (RCHT) with temozolomide (TMZ) comparing two dose regimens. METHODS AND MATERIALS: A total of 160 patients with histologically confirmed GB were treated with postoperative RCHT with TMZ. Of the patients, 66 were female and 94 were male, with a median age of 60 years. After the primary diagnosis, a biopsy had been performed in 42 patients; a subtotal and total resection was conducted in 66 and 52 patients. Postoperative radiotherapy was applied with a median dose of 60 Gy with a median fractionation of 5 x 2Gy/week. Concomitant TMZ was prescribed at 50 mg/m(2) in 123 patients (Group A) and at 75 mg/m(2) in 37 patients (Group B). Patients were followed in 3-months intervals, with a median follow-up of 13 months. RESULTS: Overall survival (OS) rates in Group A vs. Group B were 67% and 79% at 1 year and 43% vs. 49% at 2 years, respectively (p = 0.69). Progression-free survival was 49% vs. 54% at 1 year and 22% vs. 29% at 2 years (p = 0.31). Hematologic toxicity was not statistically significant over the 6-week RCHT period except for a significant decrease in platelets during Week 6 (p = 0.01) in Group B. CONCLUSIONS: Overall survival seems to be comparable in both groups, although longer follow-up and a larger group of patients are needed to corroborate these results. Lower dosing of TMZ also is associated with a more beneficial toxicity profile.     

Co-dergocrine mesylate inhibits the increase in plasma catecholamines caused by nifedipine in essential hypertension

Summary Co-dergocrine mesylate (Cod), which inhibits norepinephrine secretion by stimulating presynaptic dopamine receptors, and has no known metabolic side effect, has an additive antihypertensive effect to that of Nifedipine (Nif). Plasma norepinephrine, epinephrine, renin activity and aldosterone have been measured after acute administration of Nif and Cod alone and in combination to 18 patients with a diastolic blood pressure > 105 mm Hg in a cross-over, randomized, double-blind study. Every patient received 4 mg Cod then 20 mg Nif, placebo then 20 mg Nif and 4 mg Cod then placebo. The second treatment was always given 1 h after the first medication. Blood pressure was measured before and every 15 min during the study period. Blood for measurement of catecholamines, aldosterone and renin activity was collected before medication, 1 h after the first dose and 90 min after the second treatment.Blood pressure was significantly lower (P < 0.05) where Cod preceded Nif. Cod caused a significant decrease in plasma norepinephrine from 293 to 202 pg · ml^–1 and in epinephrine from 67 to 55 pg · ml^–1. The Nif-induced increase in norepinephrine from a pre-treatment value of 293 pg · ml^–1 with preceding Cod to 331 pg · ml^–1 was much less than the increase with placebo as premedication, from 284 to 440 pg · ml^–1. Nif caused an increase in renin activity but no increase in aldosterone.Nif-related side effects, such as flushing and headache, occurred in 6 patients of whom 5 had no received Cod as premedication. Due to the stabilizing action of Cod on catecholamines and on the side effects of Nif, Cod may be preferable to other antihypertensives in augmenting the antihypertensive action of Nif.     

High affinity regulation of cardiac Cl– and Ca2+ conductances by (13R)-spiroforskolin

The effects of a new forskolin derivative, (13R)-spiroforskolin, on the ventricular cAMP-activated chloride current (I_Cl(cAMP)) and the atrial L-type calcium current (I_Ca,L) were measured by means of whole-cell recording from isolated guinea-pig cardiac myocytes at 30°C and 20–22°C, respectively. In contrast to forskolin, the derivative contains a tetrahydrofuran rather than a tetrahydropyran moiety. (13R)-spiroforskolin activated I_Cl(cAMP) in 58% of the ventricular myocytes studied. The concentration required for the half maximal effect (EC₅₀ value) amounted to 9.6×10^–11 M and was lower than the EC₅₀ value for forskolin (2.4×10^–8 M). (13R)-spiroforskolin evoked a smaller maximal I_Cl(cAMP) amplitude than forskolin. The rundown of the (13R)-spiroforskolin-activated I_Cl(cAMP) was faster than that of the forskolin-induced current. Neither forskolin nor (13R)-spiroforskolin in maximally effective concentrations increased I_Cl(cAMP) in cells containing high concentrations of cAMP. Furthermore, as an activator of atrial I_Ca,L (13R)-spiroforskolin displayed a smaller activation and a lower EC₅₀ value (5.8×10^–10 M) than forskolin (EC₅₀ value: 3.7×10^–7 M). The effect of (13R)-spiroforskolin was observed in only 30% of the atrial cells studied. None of the drugs exerted a stimulatory effect in atrial cells containing a high [cAMP]. The washout of the drug effect was significantly faster in (13R)-spiroforskolin- than in forskolin-treated atrial myocytes. We conclude that (13R)-spiroforskolin as a forskolin derivative displays unique characteristics. It is a more potent but less efficacious activator of cardiac ionic conductances than the parent compound. The results suggest that (13R)-spiroforskolin, like forskolin, most probably exerts its effects via stimulation of the adenylyl cyclase. Received: 25 May 1998 / Accepted: 30 July 1998