[Confusion, tachypnea, and tachycardia in a 71-year-old man with type 2 diabetes mellitus]. / Bewusstseinsstörung, Tachypnoe und Tachykardie bei einem 71-jährigen Patienten mit Diabetes mellitus Typ 2.

Patients with type 2 diabetes who present with confusion and/or abdominal pains should be screened for sodium-glucose cotransporter 2 (SGLT-2)-induced diabetic ketoacidosis. Severe acidosis was diagnosed despite only moderately increased blood sugar levels. If so, immediate ICU treatment is essential.

[Procalcitonin in the intensive care unit : Differential diagnostic and differential therapeutic possibilities]. / Prokalzitonin auf der Intensivstation : Differenzialdiagnose und Differenzialtherapie.

Procalcitonin (PCT) is formed in IL6-mediated, IL8-mediated, and TNFα-mediated systemic inflammation conditions, in multiple organs and structures of the body. In patients with sepsis, significantly increased PCT levels are found. The PCT levels are highly correlated with the severity of the illness, and decreased PCT levels under therapy correlates with a better prognosis. In the differential diagnosis, measuring the PCT level helps differentiate between bacterial and viral infections. Noninfectious inflammatory reactions can, however, show moderately increased PCT levels. Cut-off values depend on renal and hepatic function. A therapeutic algorithm using PCT levels could be used for determining duration of a course of antibiotics, which can reduce antibiotic usage. In this paper, the differential diagnostic and differential therapeutic possibilities of PCT levels for critically ill patients are discussed.

What is the preferred concentration of ethanolamine oleate for sclerotherapy of oral vascular anomalies?

BACKGROUND: This study compared three different concentrations of EO (1.25%, 2.5% and 5%) for the treatment of oral vascular anomalies (OVAs). MATERIAL AND METHODS: This was a retrospective comparative analysis of patients with OVAs treated with EO. Anomalies smaller than 20 mm were included. The patients were treated with 1.25% (G1), 2.5% (G2), and 5% (G3) and clinical data were obtained. The number of sessions, the final volume and dose of EO were statistically analyzed to verify effectiveness and safety of the treatment. The different concentrations of EO were compared considering the number of sessions, the final volume and total dose of EO. Analysis of covariance (ANCOVA) was used to evaluate the influence of covariates on the outcomes. A p-value < 0.05 was considered significant. RESULTS: Nineteen women and 11 men with a median age of 54 years were included. The OVAs were most frequent in the lip (n=14) and cheek (n=9). All lesions exhibited complete clinical healing within 28 days. Patients of G3 required fewer sessions than those of G2 (p=0.017), a lower final volume compared to the other groups (p<0.001), and a lower total dose than G1 (p<0.001). Patients of G1 used a lower total dose than G2 (p=0.003). CONCLUSIONS: The concentration of 5% EO performed better than 1.25% and 2.5% for sclerotherapy of OVAs measuring up to 20 mm. This preliminary result should be the preferred concentration of EO to provide an effective and safe treatment of OVAs.

Effectiveness and safety of foam sclerotherapy with 5% ethanolamine oleate in the treatment of low-flow venous malformations in the head and neck region: a case series.

The aim of this study was to evaluate the effectiveness and safety of 5% ethanolamine oleate (EO) foam in the treatment of low-flow venous malformations in the head and neck region. Seventeen consecutive patients (six male, 11 female) and 34 low-flow venous malformations were enrolled. The vascular anomalies ranged between 20mm and 80mm in size. The typical clinical indication was a swelling (88.2%) with a purple colour (85.3%); the most frequent location was the tongue (23.5%). Ethanolamine oleate foam was produced via the Tessari method and applied at 10mg per 1cm to the vascular anomalies. This process resulted in the highest clinical healing score in 64.7% of cases, and half of the patients reported a high level of satisfaction (score >9). In the majority of cases (88.2%), the patients reported that the pain immediately postoperative was mild or moderate. There were direct relationships between vascular anomaly size and the volume of EO applied, the number of sessions, and healing (P<0.05). No recurrence was observed during 6 months of follow-up. This case series showed the effectiveness and safety of 5% EO foam for the treatment of venous malformations in the head and neck region.

Device-related complications of long-term intrathecal drug therapy via implanted pumps.

STUDY DESIGN: Case series. OBJECTIVES: To evaluate the risk of pump- and catheter-related complications of intrathecal drug delivery systems. SETTING: Tertiary care center in Switzerland. METHODS: The medical records of all in- and out-patient adults treated at our institution during a 12-year period were reviewed. All patients that had received intrathecal drug therapy via an implanted pump were invited to a structured interview. RESULTS: One hundred patients, representing therapy with 175 implanted pumps and 132 intrathecal catheters over 552 years, participated in the study. During the observation period, 217 surgical procedures (including 100 primary pump implants) and 5863 pump refills were performed. The annual rate for complications requiring surgical measures was 10.5%, with 35% being pump related and 65% being catheter related. The incidence of infections in our patients was 0.7% per year; all infections appeared during the first 3 months after implantation of the first pump. CONCLUSIONS: Complication rates of the patients treated in our center, where we have long-term experience with the indication, implantation and continuous care of patients with intrathecal infusion systems, are in the lowest ranges when compared with other published studies. We consider intrathecal testing before implantation, standardized perioperative procedures and consequent long-term care of the patients in a specialized outpatient clinic to be essential factors for the avoidance of complications.

The role of toxicokinetics in xylene-induced ototoxicity in the rat and guinea pig.

In the rat, some aromatic solvents cause a high level of ototoxicity that is characterized by damage to outer hair cells in the cochlea, which results in irreversible hearing loss. However, there is a vast difference in their potency. Among the three isomers of xylene, only para-xylene has been shown to be ototoxic in the rat. Moreover, all the species do not show the same susceptibility to ototoxic solvents, the rat being the most susceptible and the guinea pig seeming resistant to this ototoxic effect. The objective of the study was to determine whether toxicokinetic factors could explain the differences in ototoxicity observed among the three isomers of xylene in the rat and the species-dependent ototoxicity in the rat and the guinea pig. Blood and brain concentrations of each isomer were monitored in Sprague-Dawley rats treated orally by gastric intubation with a single dose or a 10 day-repeated treatment of 8.47 mmol/kg (an ototoxic dosage for para-xylene) of each isomer. Moreover, histology of the cochlea was carried out and the toxicokinetics of meta-xylene was monitored in rats treated with a single dose or a 10 day-repeated treatment of 16.94 mmol/kg meta-xylene, a non-ototoxic isomer. Similarly, histology of the cochlea was carried out and the toxicokinetics of para-xylene was followed in guinea pigs treated by gavage with a single dose or a 10 day-repeated treatment of 8.47 mmol/kg para-xylene. Finally, the blood and brain concentrations of para-xylene were measured in both the rats and the guinea pigs after a 4-h exposure to 1800 ppm of para-xylene. Among the three isomers studied, para-xylene yielded the highest blood and brain concentrations in the acutely and repeatedly exposed rats. When given a high dosage of meta-xylene (16.94 mmol/kg), the rats showed blood and brain concentrations of meta-xylene in the same order as those obtained with 8.47 mmol/kg para-xylene, but no outer hair cell loss was observed. No outer hair cell loss was observed in the guinea pigs treated with para-xylene. Whatever the exposure pattern, the blood and brain concentrations of para-xylene in the rats were 3.1-9.5 times higher than those measured in the guinea pigs. These results indicate that toxicokinetic factors cannot explain the differences in ototoxicity observed with the three isomers in the rat. However, they suggest that the differences in susceptibility to para-xylene observed between the rats and the guinea pigs might be due to toxicokinetic factors.

'Treatise on the Spinal Marrow and its Diseases' (Anatomy, functions and general considerations on its diseases) by Ollivier d' Angers CP (1796-1845).

STUDY DESIGN: Collecting and analyzing all possible documents by internet, and consulting medical libraries in different countries. OBJECTIVE: To focus on the work of Ollivier d'Angers who, in the beginning of the 19th century, spent most of his professional life studying the spinal cord, marrow (SM), or medulla spinalis, and publishing the first comprehensive treatise on the subject in 1824. SETTING: ParaDoc database, Swiss Paraplegic-Centre, 6207 Nottwil, Switzerland, in collaboration with Paul Dollfus, ISCoS/Paradoc, Mulhouse, France. RESULTS: Some of d'Angers's clinical descriptions, observations and also pathologic findings, described in the successive editions of his treatise, were very much in advance of his time. CONCLUSIONS: To our knowledge, this was the first comprehensive treatise, in 1824, at least in France. It gave a clear picture on the matter of the SM and in that period of medical history.

Determination of short-term exposure with a direct reading photoionization detector.

The use of a direct reading photoionization detector (PID) to determine short-term solvent exposures is described in the present paper. To assess the relevance of such a total exposure evaluation it was necessary to compare it with the real concentration of pollutants. This comparison was made by measuring in parallel with the PID determination the concentration of each pollutant using a standard technique, i.e. sampling on charcoal tubes and subsequent analysis by gas chromatography. Laboratory tests showed that the linearity of the answer of the PID is good for many compounds and for a mixture of these compounds. Similar tests were carried out for painters in workplaces with the same good correlations (determination coefficient r2 close to 1) between the PID response and the real concentration of the pollutants measured on the sampling tubes. The use of PID also allowed determination of the exposure profile of the workers and comparison of the short-term exposure to the corresponding limit values. Many cases of the short-term limit values being exceeded were revealed by use of the PID, although very few cases of the long-term limit values have been found by the usual sampling (charcoal tube) and analytical (gas chromatography) methods.

Differential association of polymorphisms in the TNFalpha region with psoriatic arthritis but not psoriasis.

OBJECTIVE: To investigate the potential association of tumour necrosis factor alpha (TNFalpha) microsatellite and promoter alleles with psoriatic arthritis (PsA). METHODS: DNA from 89 white patients with PsA, 65 patients with psoriasis, and 99 healthy white controls was investigated for two TNFalpha promoter (-238 and -308) and three microsatellite polymorphisms (TNFa, c, and d). Patients had previously been studied by serology for HLA class I antigens and by sequence-specific polymerase chain reaction for DRB1* alleles. In addition, TNFalpha production of Ficoll separated peripheral blood mononuclear cells (PBMC) into culture supernatants after stimulation with lipopolysaccharide, alphaCD3 antibodies, phytohaemagglutinin, and streptococcal superantigen C was determined. RESULTS: A significant, HLA class I independent increase of the TNFa6c1d3 haplotype was found in the group with PsA but not among patients with psoriasis (32% v. 8%, pc<0.008; relative risk (RR)=5.3). In addition, patients with PsA showed a marked decrease of the TNF308A promoter allele (6% v. 18%; pc<0.008; RR=3.5) compared with healthy controls, which was independent of the increased frequency of the -238A polymorphism in this group. PBMC from patients with PsA secreted significantly less TNFalpha than cells from patients without arthritis. In particular, the TNFa6 microsatellite was associated with decreased TNFalpha production. CONCLUSION: These data indicate that allelic variations at the TNFalpha locus influence susceptibility to PsA. Decreased production of TNFalpha is at least in part genetically determined and might be related to the development of arthritis. However, the association of the TNF308G allele with the disease also points to other disease related haplotypes with still unknown susceptibility genes.

Thermal convection for large Prandtl numbers.

The Rayleigh-Bénard theory by Grossmann and Lohse [J. Fluid Mech. 407, 27 (2000)] is extended towards very large Prandtl numbers Pr. The Nusselt number Nu is found here to be independent of Pr. However, for fixed Rayleigh numbers Ra a maximum in the Nu(Pr) dependence is predicted. We moreover offer the full functional dependences of Nu(Ra,Pr) and Re(Ra,Pr) within this extended theory, rather than only give the limiting power laws as done in J. Fluid. Mech. 407, 27 (2000). This enables us to more realistically describe the transitions between the various scaling regimes.

Scaling hypothesis leading to extended self-similarity in turbulence.

A scaling hypothesis leading to extended self-similarity (ESS) for structure functions (the qth order moments of the magnitude of the longitudinal component velocity differences) in isotropic, homogeneous turbulence is proposed. This is done by generalizing the scale variable r to rg(r/L), with a crossover function g. By extending the refined self-similarity, it is shown that the presented scaling also leads to ESS for structure functions of the energy dissipation rate fluctuations, and to ESS bridging relations between velocity and dissipation rate moments. Extended self-similarity on the basis of a universal crossover function g strictly holds toward the outer scale (L) range only. Yet we find at least approximate ESS toward the viscous, inner scale (l) range. Furthermore, the probability densities for the velocity differences and the energy dissipation rate fluctuations which are compatible with this ESS are offered.

Discriminating mild parkinsonism: methods for epidemiological research.

Methods for the efficient and accurate detection of parkinsonism are essential for epidemiological studies. We sought to determine whether parkinsonism could be detected by a neurologist from a videotaped assessment and whether neurobehavioral methods (motor, cognitive, and sensory) discriminated between patients with Parkinson's disease (PD) and controls. Fifteen patients with mild PD (Hoehn and Yahr I-III) were compared to 15 age-, sex-, and education- matched controls. Each participant underwent a videotaped neurological examination (based on the Unified Parkinson's Disease Rating Scale, UPDRS), administered by a trained technician, and reviewed by a neurologist, as well as a series of neurobehavioral tests. The neurologist identified PD patients with 86% sensitivity and 100% specificity. Among the neurobehavioral tests, finger tapping, combined with one or more among olfaction, visual contrast sensitivity, or Paired Associates Learning, correctly classified 90%, or more, of subjects. Individual psychological tests did not discriminate reliably between groups. We conclude that videotaped assessments of parkinsonism or objective tests of motor and sensory function can accurately detect patients with PD. Both approaches have potential for identifying PD cases, but the latter may be more efficient for screening.

Multiscale correlations and conditional averages in numerical turbulence

The equations of motion for the nth order velocity differences raise the interest in correlation functions containing both large and small scales simultaneously. We consider the scaling of such objects and also their conditional average representation with emphasis on the question of whether they behave differently in the inertial or the viscous subranges. The turbulent flow data are obtained by Navier-Stokes solutions on a 60(3) grid with periodic boundary conditions and Re lambda = 70. Our results complement previous high Re data analysis based on measured data [A. L. Fairhall, V. S. L'vov, and I. Procaccia, Europhys. Lett 43, 277 (1998)] whose preference were the larger scales, and the analysis of both experimental and synthetic turbulence data by [R. Benzi and co-workers, Phys. Rev. Lett. 80, 3244 (1998); Phys. Fluids 11, 2215 (1999)]. The inertial range fusion rule is confirmed and insight is obtained for the conditional averages (the local dissipation rate conditioned on the velocity fluctuations).

Dementia in rural primary care practices in Lake County, Oregon.

Procedures used in assessing patients with dementia in rural settings are little studied. Among all patients aged 65 years and older in the four primary care practices in Lake County, Oregon, dementia cases were identified from computerized office databases using preselected International Classification of Diseases, Ninth Edition, codes. A semi-structured chart review determined (1) a dementia diagnosis, (2) cognitive and functional domains assessed, and (3) diagnostic studies performed. Of 1540 available records, 30 had dementia. Nineteen of them met National Institute of Neurological and Communicative Diseases and Stroke-Alzheimer's Disease and Related Disorders Association criteria for Alzheimer's disease (AD). Cognitive impairment was documented in 73% of the 51 identified charts and all with AD. Laboratory studies were recorded in 33% overall and in 42% with AD. Neuroimaging was documented in 18% overall and in 16% with AD. The prevalence of documented dementia in these rural practices may be low, possibly because cases of mild dementia may not be labeled as such. Laboratory studies were performed in a minority of cases of dementia.

Different transcriptional activity and in vitro TNF-alpha production in psoriasis patients carrying the TNF-alpha 238A promoter polymorphism.

Genes encoded on chromosome 6 within the major histocompatibility complex region are thought to play an important role in the pathogenesis of psoriasis. A potential candidate gene is tumor necrosis factor alpha. The tumor necrosis factor alpha promoter contains several polymorphisms including two G-->A transitions at position -308 and -238, which are the most common in Caucasian populations. The TNF238.2 (-238A) allele has been strongly associated with psoriasis. We have investigated the effect of the -238 and -308 variants on transcription of the tumor necrosis factor alpha gene in luciferase reporter gene assays. In addition, peripheral blood mononuclear cells of 47 patients with psoriasis and 43 controls were stimulated with different antigens and mitogens (streptococcal sonicate and superantigen, lipopolysaccharide, phorbol-12-myristate, phytohemagglutinin, CD3 antibodies) and tumor necrosis factor alpha production was measured in supernatants by enzyme-linked immunosorbent assay. The psoriasis-associated tumor necrosis factor alpha promoter allele TNF238.2 showed a significantly decreased transcriptional activity. Peripheral blood mononuclear cells carrying this allele produced significantly less tumor necrosis factor alpha after stimulation with T cell mitogens and streptococcal antigens in comparison to controls. The promoter allele TNF238.2 seems to influence tumor necrosis factor alpha production; a possible role in the pathogenesis of psoriasis has to be further evaluated.

Test-retest reliability of psychological and neurobehavioral tests self-administered by computer.

A series of 12 psychological and 7 neurobehavioral performance tests were administered twice to a nonclinical normative sample with 1 week between administrations. The tests were presented in a self-administered computerized format. One week test-retest reliabilities were comparable to conventional administration formats. The results suggest that individual test reliability is not affected when tests are administered as part of an extensive multi-measure battery. Computer administered test reliability coefficients also were compared to a Mixed Format (computer-conventional) administration with mixed format reliabilities generally similar to the reliabilities of published conventional tests but also generally lower than same format testing. Compared to psychological test reliability, neurobehavioral test reliability appeared more vulnerable to decreases with mixed format testing. These conclusions should not be generalized to all computer implemented tests as the qualities of the test implementation will affect the outcome.