Disseminated herpes zoster mimicking rheumatoid vasculitis in a rheumatoid arthritis patient on etanercept.

Tumor necrosis factor-alpha (TNFalpha)-blocking agents are immunomodulating agents introduced for treatment of a variety of chronic inflammatory disease conditions. Adverse effects include an increased incidence of infections. Clinically, these infections often have atypical presentations that may hamper prompt diagnosis. In our report of a patient on etanercept therapy for rheumatoid arthritis, the correct diagnosis was delayed because disseminated herpes zoster was clinically mimicking vasculitis. Initially assuming rheumatoid vasculitis, immunosuppression was increased, resulting in worsening of skin lesions. Only an extended work-up, including a skin biopsy and viral cultures, established the correct diagnosis. Management of varicella zoster virus (VZV) infection primarily focuses on early initiation of antiviral therapy to control VZV replication. Therapy with intravenous acyclovir followed by oral valacyclovir allowed complete resolution of acute skin changes. In immunosuppressed patients, the possibility of infection with atypical presentation must always be kept in mind, and that this might mimic other disease conditions. Broad differential diagnosis and an extended diagnostic workup help in establishing the correct diagnosis.

Triaziflam and Diaminotriazine derivatives affect enantioselectively multiple herbicide target sites.

Enantiomers of triaziflam and structurally related diaminotriazines were synthesized and their herbicidal mode of action was investigated. The compounds caused light and dark-dependent effects in multiple test systems including heterotrophic cleaver and photoautotrophic algal cell suspensions, the Hill reaction of isolated thylakoids and germinating cress seeds. Dose-response experiments revealed that the (S)-enantiomers of the compounds preferentially inhibited photosystem II electron transport (PET) and algae growth with efficacies similar to that of the herbicide atrazine. In contrast, the (R)-enantiomers of the diaminotriazines were up to 100 times more potent inhibitors of growth in cleaver cell suspensions and cress seedlings in the dark than the (S)-enantiomers. The most active compound, the (R)-enantiomer of triaziflam, inhibited shoot and root elongation of cress and maize seedlings at concentrations below 1 microM. The meristematic root tips swelled into a club shape which is typical for the action of mitotic disrupter herbicides and cellulose biosynthesis inhibitors. Microscopic examination using histochemical techniques revealed that triaziflam (R)-enantiomer blocks cell division in maize root tips 4 h after treatment. The chromosomes proceeded to a condensed state of prometaphase but were unable to progress further in the mitotic cycle. Disruption of mitosis was accompanied by a loss of spindle and phragmoplast micotubule arrays. Concomitantly, cortical microtubules decreased which could lead to isodiametric cell growth and consequently to root swelling. In addition, a decline in cellulose deposition in cell walls was found 24 h after treatment. Compared to the (R)-form, triaziflam (S)-enantiomer was clearly less active. The results suggest that triaziflam and related diaminotriazines affect enantioselectively multiple sites of action which include PET inhibitory activity, mitotic disruption by inhibiting microtubule formation and inhibition of cellulose synthesis.

A performance-based clinical achievement program.

A performance-based incentive plan demonstrates staff competence and objectively evaluates the standards used in the clinical achievement program. The position statement/performance evaluation consists of seven nursing standards; scoring guidelines measure each nurse's achievements and ensure equity.

Auxin herbicides induce H(2)O(2) overproduction and tissue damage in cleavers (Galium aparine L.).

The phytotoxic effects of auxin herbicides, including the quinoline carboxylic acids quinmerac and quinclorac, the benzoic acid dicamba and the pyridine carboxylic acid picloram, were studied in relation to changes in phytohormonal ethylene and abscisic acid (ABA) levels and the production of H(2)O(2) in cleavers (Galium aparine). When plants were root-treated with 10 microM quinmerac, ethylene synthesis was stimulated in the shoot tissue, accompanied by increases in immunoreactive levels of ABA and its precursor xanthoxal. It has been demonstrated that auxin herbicide-stimulated ethylene triggers ABA biosynthesis. The time-course and dose-response of ABA accumulation closely correlated with reductions in stomatal aperture and CO(2) assimilation and increased levels of hydrogen peroxide (H(2)O(2)), deoxyribonuclease (DNase) activity and chlorophyll loss. The latter parameters were used as sensitive indicators for the progression of tissue damage. On a shoot dry weight basis, DNase activity and H(2)O(2) levels increased up to 3-fold, relative to the control. Corresponding effects were obtained using auxin herbicides from the other chemical classes or when ABA was applied exogenously. It is hypothesized, that auxin herbicides stimulate H(2)O(2) generation which contributes to the induction of cell death in Galium leaves. This overproduction of H(2)O(2) could be triggered by the decline of photosynthetic activity, due to ABA-mediated stomatal closure.

[Intramural pregnancy with vague symptoms]. / Symptomarme intramurale Gravidität.

The clinical course of an intramural pregnancy in a 28-year-old nullipara is reported. Clinical and sonographic symptoms were not specific. The diagnosis was suspected on laparoscopy. At laparotomy, evidence of incipient rupture of the uterus was found, but no intraperitoneal hemorrhage. The gestational sac was removed without opening the uterine cavum, and the localization within the myometrium was confirmed histologically. Intramural pregnancy is a rare event whose pathogenesis is not clear. Surgical treatment with conservation of the uterus is possible in some cases.

In vitro and in vivo allergenicity of recombinant Bet v 1 compared to the reactivity of natural birch pollen extract.

BACKGROUND: Diagnostic procedures using natural extracts show only limited quantitative correlation between in vivo and in vitro results. Highly pure recombinant allergens might show more predictive findings. OBJECTIVE: The aim of this study was to compare natural birch pollen extract (BPE) and recombinant Betula verrucosa (rBet v 1) for their diagnostic value comparing skin prick tests (SPTS) and nasal provocation tests (NPTS) with specific IgE in the serum. METHODS: Thirty-four patients allergic to birch pollen and five healthy controls were investigated. SPT and NPT were performed with BPE and rBet v 1 at different concentrations. Specific serum IgE was measured by the Pharmacia CAP system. RESULTS: Commercial BPE and rBet v 1 (10 micro g/mL) were able to elicit similar allergenic reactions in vivo and IgE binding in vitro. SPT reflects immediate-type allergy as determined by NPT to a higher degree than specific IgE, for both reagents. To cause allergic reactions in NPT, higher amounts of rBet v 1 were needed than for skin tests and the sensitivity was lower than with BPE. CONCLUSION: rBet v 1 alone is sufficient for a reliable diagnosis of birch pollen allergy in most patients and induces comparable skin test reactivity as BPE, but less allergic reactions in nasal provocations.