Chemische charakterisierung des kettenaufbaus und kristallisationsverhaltens von copolymeren aus 3,3-bis(chlormethyl)oxetan und β-propiolacton

Copolymers of 3,3-bis(chloromethyl)oxetane ( 1 ) and β-propiolactone ( 2 ) were produced by cationic polymerisation. The copolymers contained up to a mole fraction of 0,16 of units derived from β-propiolactone (PL). The copolymerization features were investigated and the copolymerization parameters were determined. The copolymers were crystallized and the single crystals characterized by their composition and morphology. The distribution of the PL-units over the crystals was studied by selective ester cleavage in the amorphous phase of the suspended single crystals. The results were compared with those of a degradation-reaction using the dissolved copolymers. The copolymerization of 3,3-bis(chloromethyl)oxetane and β-propiolactone gives rise to a copolymer in which blocks of 3,3-bis(chloromethyl)oxetane ((-BCMO)_n-) alternate with blocks of a statistical copolymer of BCMO- and PL-units. The average length of the homogeneous BCMO-blocks is independent of the composition of the investigated monomer-mixtures within the investigated range of mixing. In the lamellar single crystals the homogenous BCMO-blocks build up the crystalline phase, whereas the BCMO-PL-blocks are excluded into the amorphous regions.     

Bone scanning and diagnosis of reflex sympathetic dystrophy secondary to herniated lumbar disks.

In two cases, reflex sympathetic dystrophy (RSD) was due to herniated intervertebral disk at L4-5. In both cases, bone scanning with technetium 99m pyrophosphate was of value and its use is recommended in diagnosing mild or early cases of RSD. RSD may be the cause of persisting pain after disk surgery.     

Incidence and risk factors for the occurrence of non-AIDS-defining cancers among human immunodeficiency virus-infected individuals

BACKGROUND: The objective of this study was to determine the rates and predictors of non-AIDS-defining cancers (NADCs) among a cohort of human immunodeficiency virus (HIV)-infected individuals. METHODS: The authors conducted a retrospective study of 4144 HIV-infected individuals who had 26,916 person-years of follow-up and who had open access to medical care at 1 of the United States military HIV clinics during the years 1988-2003. Cancer incidence rates were race specific and were adjusted for age; these were compared with national rates using logistic regression to assess predictors of NADC development. RESULTS: One hundred thirty-three NADCs were diagnosed with a rate of 980 diagnoses per 100,000 person-years. The most frequent NADCs were skin carcinomas (basal cell and squamous cell), Hodgkin disease, and anal carcinoma. The results showed that there were higher rates of melanoma, basal and squamous cell skin carcinomas, anal carcinoma, prostate carcinoma, and Hodgkin disease among the HIV-infected cohort compared with age-adjusted rates for the general United States population. Predictors of NADCs included age older than 40 years (odds ratio [OR], 12.2; P < 0.001), Caucasian/non-Hispanic race (OR, 2.1; P < 0.001), longer duration of HIV infection (OR, 1.2; P < 0.001), and a history of opportunistic infection (OR, 2.5; P < 0.001). The use of highly active antiretroviral therapy (HAART) was associated with lower rates of NADCs (OR, 0.21; P < 0.001). A low CD4 nadir or CD4 count at diagnosis (< 200 cells/mL) was not predictive of NADCs. CONCLUSIONS: The most frequent NADCs were primary skin malignancies. Melanoma, basal and squamous cell skin carcinomas, anal carcinoma, prostate carcinoma, and Hodgkin disease occurred at higher rates among HIV-infected individuals. The implementation of screening programs for these malignancies should be considered. Most risk factors for the development of NADCs are nonmodifiable; however, the use of HAART appeared to be beneficial in protecting against the development of malignant disease.     

Mucous adenocarcinoma of the urinary bladder (urachal carcinoma) (author's transl)

A report is presented of 5 cases of urachal carcinomas (3 women and 2 men). The mucous adenocarcinomas were located on the apex of the urinary bladder. In 3 cases partial cystectomy and in 2 cases a subtotal cystectomy were performed. Two patients were treated with cytostatics postoperatively. The prognosis of urachal carcinomas is poor. 3 patients had metastases to the bones, cerebrum and peritoneum. Diagnostic and therapeutic procedures are discussed.     

Sequenzielles Neugeborenen-Hörscreening (TEOAE/AABR) reduziert Recall-Rate

BACKGROUND: 1-2/1,000 newborns are affected by connatal permanent hearing impairment. Clinical diagnosis is often delayed. This demands newborn hearing screening (NHS). Some questions regarding the optimal method remain unsolved. METHODS: The newborns in the obstetrical department (low-risk group) are tested by automated transitory evoked otoacustic emissions (TEOAE). TEOAE-fail is followed by automated auditory brainstem response (AABR) examination. All sick newborns admitted to the pediatric department (high-risk group) are primarily tested using AABR. Pathological AABR-testing leads to pedaudiological diagnostic work-up. RESULTS: In the low-risk group, 82 out of 1,584 newborns failed TEOAE-testing (recall 5.18%). Only 5 of these patients failed consecutive AABR examination (recall 0.32%). Permanent hearing loss was finally confirmed in 3 children (0.13%). 10 out of 755 newborns in the high-risk group failed AABR-testing (1.32%). In 6 of these children, hearing loss was confirmed (0.79%). CONCLUSION: A two-tier screening process as described is able to reduce recall rate, overall expenses and parental anxiety.     

Trimethoprim-sulfamethoxazole plus topical antibiotics as therapy for acute otitis media with otorrhea caused by community-acquired methicillin-resistant Staphylococcus aureus in children

OBJECTIVE: To report our experience in identification and treatment of acute otitis media (AOM) with otorrhea secondary to community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA), which is seen in children at increasing rates. DESIGN: Clinical and laboratory records were retrospectively reviewed between January 2003 and December 2003. SETTING: Primary pediatric clinic. PATIENTS: Six pediatric patients who had AOM with otorrhea caused by CA-MRSA. MAIN OUTCOME MEASURES: Clinical resolution of AOM with otorrhea. RESULTS: All patients had acute-onset otorrhea associated with their AOM. Five patients had tympanostomy tubes and 1 had perforation of the tympanic membrane. None of the patients were responding to treatment with oral antibiotics (amoxicillin sodium-clavulanate potassium, cefpodoxime proxetil, and cefprozil) or fluoroquinolone ear drops (ofloxacin, ciprofloxacin). Specimens were obtained from the ears for cultures, and MRSA was present in the cultures. The organisms were resistant to levofloxacin and erythromycin in all patients and resistant to clindamycin hydrochloride in 2 patients. The cultures were sensitive to trimethoprim-sulfamethoxazole, gentamicin sulfate, rifampin, and vancomycin hydrochloride. All patients were treated successfully with oral trimethoprim-sulfamethoxazole and ear drops (gentamicin sulfate or polymyxin B sulfate-neomycin sulfate-hydrocortisone [Cortisporin]). CONCLUSIONS: The rising rate of CA-MRSA as a cause for many pediatric infections is a major concern. It is very important to obtain cultures from patients with nonresponsive or persistent otorrhea with AOM to look for MRSA and determine the sensitivity of the pathogen to antibacterial therapy. Trimethoprim-sulfamethoxazole is a good choice for initial, empirical therapy when combined with a topical agent for AOM with otorrhea if CA-MRSA is suspected. Further studies are needed to determine whether there is a link between the overuse of topical fluoroquinolones in pediatric patients and the recent rising rate of CA-MRSA.