Clinical symptoms and signs in sore throat patients with large colony variant β-haemolytic streptococci groups C or G versus group A

BACKGROUND: The role of large colony streptococci groups C or G as pathogen agents in sore throat has been questioned. AIM: To analyse clinical features of patients with large colony streptococci groups C or G compared with patients with group A streptococci (GAS) and with negative cultures. DESIGN OF STUDY: Prospective study of patients with sore throat. SETTING: Two Norwegian general practices in Stokke and Kongsberg communities with 6500 patients.METHOD: Frequency of clinical features in the three patient categories including the four Centor criteria (fever, anterior cervical lymphadenopathy, tonsillar exudates, and lack of cough), degree of pain on swallowing, pharyngeal rubor, C-reactive protein (CRP) values, patient age between 3 and 14 years, and duration of symptoms before seeing the doctor. A logistic regression analysis to find independent predictors was performed. RESULTS: Out of 306 patients with a sore throat, 244 were adults and 62 were children under 10 years old; 40% were men. One hundred and twenty-seven had GAS, 33 had streptococci groups C or G, and 146 had negative throat cultures. Forty-eight per cent of the GAS patients and 45% of the C or G patients met three or four of the Centor criteria. The logistic regression revealed that in patients with GAS considerable pain on swallowing, an age of 3-14 years and a duration of symptoms of < or =3 days or less were significantly associated with GAS infection in addition to the Centor criteria. The same results were found when all streptococci were analysed together, in addition elevated CRP was significant. In patients with streptococci group C or G an elevated CRP-value was significantly associated. CONCLUSION: Patients with tonsillitis caused by streptococcus groups C or G have, to a large extent, the same clinical picture as patients with GAS. Large colony streptococci groups C and G should be considered as throat pathogens in line with GAS.     

Intragastric blood flow in the etiology of duodenal ulcer--new aspects of surgical treatment

In the experiment on dogs and in patients with duodenal ulcer disease, it was established that the regulation of acid production besides the vagal nerves was mediated by the intragastric gastrin transport with the blood flow. A method of preoperative diagnosis of the intensity of intragastric blood flow permitting to define more accurately the indications for the choice of a method for surgical treatment has been developed. Supplementation of the selective proximal vagotomy with circular mucosectomy at the boundary between the antrum and body of a stomach enhances the effectiveness of operation due to reduction of the antral gastrin influence on the acid-producing zones of the stomach.     

Effect of vagotomy on intramural gastric plexus--the problem of reinnervation of the stomach after vagotomy

In dogs, only fundus and body, or antrum were denervated. At the period of up to 5 years after vagotomy, no complete parasympathetic reinnervation of the stomach occurs.     

Die verwendung der autologen vena femoralis bei vena-cava-superior-thrombose

We report on a 52-year old male patient who underwent implantation of an insulin pump because he had diabetes and in whom superior vena cava syndrome developed as a long-term complication. After unsuccessful lysis therapy superficial femoral vein was implanted to form a bypass from the internal jugular vein to the right atrium. The postoperative course was uneventful from the aspects of both the bypass and the leg after explantation of the superficial femoral vein. The bypass is still patent 7 months after the operation, and the patient has no symptoms. Autogenous superficial femoral vein can be used successfully in the reconstruction of large venous vessels. It should be the graft of choice for young patients with benign diseases. We compare our result and those obtained with different substitutes described in the literature that have been used for reconstruction in superior vena cava syndrome.

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Die verwendung der autologen vena femoralis bei vena-cava-superior-thromboseFallbericht mit literaturübersicht

Zusammenfassung Bei einem 52jährigen, männlichen Patienten trat nach Implantation einer Insulinpumpe als Spätkomplikation eine Thrombose der Vena cava superior auf. Nach erfolgloser Lysetherapie wurde ein Venajugularis-rechtsatrialer-Venenbypass mit autologer Vena femoralis durchgeführt. Der postoperative Heilungsverlauf war sowohl von Seiten des gefäßrekonstruktiven Eingriffs, als auch von Seiten der Venenentnahmestelle komplikationslos. Der Bypass ist 7 Monate postoperativ offen und der Patient beschwerdefrei. Die autologe Vena femoralis eignet sich zur Rekonstruktion großer venöser Gefäße ausgezeichnet. Sie sollte v. a. bei benignen Prozessen und jüngeren Patienten als autologes Bypassmaterial dem Kunststoff vorgezogen werden. Das Ergebnis wird mit verschiedenen Gefäßsubstituten, die bei Verschluß der oberen Hohlvene verwendet werden, verglichen.

     

Orofaziale Regulationstherapie nach Castillo Morales

The goal of Castillo-Morales’ orofacial therapy is to improve the coordination of oral motor functions in cooperation with other body systems. The processes involved in sucking, biting, chewing and swallowing are stimulated by specific techniques of sensory stimulation such as touching, stroking, stretching, exerting pressure or the vibration of mimic and tongue-bone musculature, as well as massage of the gums and palate or the application of technical apparatus. Sufficient head and posture control is fundamental and must be the first goal. Successful therapy, especially for ICP-children, has been documented in progress reports and case studies. As yet, however, there is no evidence of specific effects on eating and speech functions. Therefore, the therapy can be recommended only in order to achieve specific goals and for a limited time, being aware of the risk of overstimulation.     

Ruptur der langen Bizepssehne und operative Therapiestrategien

Zusammenfassung Die Ruptur der langen Bizepssehne beruht auf ihrer anatomischen Disposition und, bedingt durch die biomechanische Belastung, zu 90% auf degenerativen Veränderungen. In der Regel finden sich begleitende Verschleißschäden anderer Strukturen des Schultergelenks wie der Rotatorenmanschette. Es wird ein Überblick über die Häufigkeit und den Entstehungsmechanismus von Rupturen der langen Bizepssehne sowie gängige operative Behandlungskonzepte gegeben. Die Rolle und das anatomisch-funktionelle Prinzip der Sehne des Caput longum im komplexen dynamischen System des Schultergelenks werden erläutert. Eingang finden die klinische Symptomatik, Beschreibungen sowie Wertungen apparativer diagnostischer Verfahren. Der Stand derzeit etablierter Operationstechniken wird unter Darstellung von Vor- und Nachteilen beleuchtet und diskutiert. Des Weiteren werden die selbst favorisierte Methode und die gesammelten Erfahrungen dargestellt.     

Interleukin 1 receptor antagonist (IL1RA) in acute leukaemia: IL1RA is both secreted spontaneously by myelogenous leukaemia blasts and is a part of the acute phase reaction in patients with chemotherapy- induced leucopenia

Abstract: Blast cells derived from peripheral blood of patients with acute myelogenous leukaemia (AML) were cultured in vitro and interleukin 1 receptor antagonist (IL1RA) concentrations determined in culture supernatants. AML blasts derived from patients classified as AML-M4 and AML-M5 subtype showed an increased release of IL1RA. IL1α and IL1β caused a similar increase in AML blast release of IL1RA, and addition of anti-ILl antibodies decreased IL1RA release. IL1RA release from AML blasts was also increased by stem cell factor, tumour necrosis factor α (TNFα), granulocyte-macrophage colony-stimulating factor and macrophage colony-stimulating factor, whereas interleukin 3, interleukin 6, leukaemia inhibitory factor and granulocyte colony- stimulating factor did not significantly alter IL1RA release. When investigating IL1RA serum levels, serum concentrations were decreased in acute leukaemia patients with chemotherapy-induced cytopenia compared with healthy controls. Serum levels of both IL1RA as well as IL1β and soluble TNFα receptors increased when the leucopenic patients developed complicating bacterial infections.     

Presynaptic regulation of the electrically evoked release of endogenous dopamine from the isolated neurointermediate lobe or isolated neural lobe of the rat pituitary gland in vitro

Summary Isolated neurointermediate lobes (NILs) or isolated neural lobes (NLs) of the rat pituitary gland were incubated in Krebs-HEPES solution which contained pargyline and the dopamine uptake inhibitor GBR 12921. The release of endogenous dopamine was determined by HPLC with electrochemical detection. Electrical stimulation of the pituitary stalk induced a frequency-dependent release of dopamine.The release of dopamine from the combined NIL evoked by stimulation at 15 Hz was increased by 130% in the presence of the dopamine D2 receptor antagonist, (–)-sulpiride; the (+)-enantiomer of sulpiride had virtually no effect. When the stimulation frequency was 3 Hz (–)-sulpiride caused an increase in dopamine release by 230%. A similar increase was observed in the presence of domperidone, another dopamine D2 receptor antagonist.The dopamine receptor agonists, apomorphine and quinpirole, had no significant effects on the evoked release of dopamine indicating that under the present incubation conditions endogenous dopamine may have been maximally activating the autoinhibition. However, in the presence of 1 mol/l (–)-sulpiride, apomorphine as well as quinpirole reduced the evoked release of dopamine in a concentration-dependent manner.The dopamine D1 receptor selective antagonist, SCH 23390, had no effect on the evoked release of dopamine at a concentration of 1 mol/1. Only at a concentration of 10 mol/l did SCH 23390 cause a small increase in dopamine release; this effect was, however, abolished in the presence of 1 mol/1(–)-sulpiride.In the presence of 1 mol/l (–)-sulpiride neither clonidine, yohimbine, 5-methoxytryptamine nor metitepine significantly affected the release of dopamine from the NIL evoked by stimulation at 3 Hz.In the NL, the release of dopamine is inhibited by endogenous opioids. For this reason, naloxone 1 or 10 mol/1 was present in the experiments on isolated NLs. Domperidone and (–)-sulpiride, but not (+)-sulpiride, increased the release of dopamine from the NL evoked by electrical stimulation at 15 Hz by about 90%. SCH 23390 caused a significant increase in dopamine release at 10 mol/l, but not at 1 mol/lIn conclusion, the release of endogenous dopamine from the neurons terminating in the intermediate and neural lobe of the pituitary gland is inhibited via dopamine receptors of the D2 type.Abbreviations DOPAC dihydroxyphenylacetic acid - 5-HT 5-hydroxytryptamine - HPLC high performance liquid chromatography - IL intermediate lobe - NIL neurointermediate lobe - NL neurallobe Send offprint requests to K. Racké at the above address