Vinorelbine in bladder-preserving multimodality treatment for muscle-invasive bladder cancer-a valid option for cisplatin-unfit patients?

PURPOSE: Treatment of muscle-invasive bladder cancer (MIBC) remains challenging, especially for elderly and/or comorbid patients. Patients who are unfit for or refuse surgery should receive bladder-preserving multimodality treatment (BPMT), consisting of transurethral resection of the bladder tumor (TURB) followed by combined chemoradiotherapy (CRT). We aimed to investigate the effectiveness of vinorelbine, a chemotherapeutic agent not routinely used for MIBC, in patients referred to CRT who are unfit for standard chemotherapy and would thus rely solely on radiotherapy (RT). METHODS: We retrospectively analyzed 52 consecutive patients with MIBC who received standard CRT with cisplatin (n = 14), CRT with vinorelbine (n = 26), or RT alone (n = 12). Primary endpoints were median overall survival (OS) and median cancer-specific survival (CSS). Secondary endpoints were median local control (LC), median distant control (DC), and OS, CSS, LC, and DC after 1, 2, and 3 years, respectively. RESULTS: Median OS and CSS were significantly higher for patients who received vinorelbine as compared to RT alone (OS 8 vs. 22 months, p = 0.003; CSS 11 months vs. not reached, p = 0.001). Median LC and DC did not differ significantly between groups. Vinorelbine was well tolerated with no reported side effects >grade II. CONCLUSION: Our results suggest that CRT with vinorelbine is well tolerated and superior to RT alone in terms of OS and CSS. Therefore, this treatment regime might constitute a new treatment option for patients with MIBC who are unfit for or refuse surgery or standard chemotherapy. This study encourages a randomized controlled trial to compare this new regime to current standard therapies.

Expanding the phenotype of DNAJC3 mutations: A case with hypothyroidism additionally to diabetes mellitus and multisystemic neurodegeneration.

Identification of this additional patient from a distant part of the originally described pedigree (Synofzik et al. 2014) confirms pathogenicity of DNAJC3 mutations. Hypothyroidism is a newly identified feature in addition to the known phenotype (diabetes with multisystemic neurodegeneration).

Fibrinogen supplementation ex vivo increasesclot firmness comparable to platelet transfusion in thrombocytopenia.

BACKGROUND: Fibrinogen concentrate can improve clot firmness and offers a better safety profile than platelet concentrates. Reduction or avoidance of blood transfusions represents a strategy to reduce associated risks. We investigated whether supplementation of fibrinogen concentrate ex vivo can compensate for clot strength as compared with platelet transfusion in vivo METHODS: One hundred patients in need of platelet transfusion (PT) were enrolled. Blood samples were collected immediately before PT and at 1 h and 24 h after PT. Fibrinogen concentrate was added to these citrated whole blood samples at concentrations of 50, 100, 200 and 400 mg kg-1 and the maximum clot firmness (MCF) was analysed using ROTEM thromboelastometry. RESULTS: Fibrinogen supplementation increased MCF significantly and dose-dependently before and after PT. The effect of fibrinogen concentrate (equivalent to doses of 100 and 200 mg kg-1) ex vivo was comparable to that of PT in vivo, whereas 400 mg kg-1 fibrinogen significantly improved MCF compared with PT (P < 0.001). CONCLUSIONS: Fibrinogen concentrate can match the effect of PT on MCF in thrombocytopenia. This potential alternative haemostatic intervention should be evaluated in clinical trials.

[Surgical therapy of secondary elephantoid lymphedema of the eyelids]. / Chirurgische Therapie sekundärer, elefantoider Lymphödeme der Lider.

Because of the disfiguring changes they cause, prominent secondary lymphedemas of the face represent an extreme burden for afflicted patients. Many of these patients already have considerable restrictions imposed upon their quality of life as a consequence of the primary cancer therapy. Therapeutic options are often limited, mainly comprising physical therapy and pharmacological interventions. Only in exceptional cases is surgical therapy a treatment facility. We report the successful surgical treatment of a patient with secondary elephantoid lymphedema following primary radiochemotherapy for squamous cell cancer of the base of the tongue.

[A 55-year old Thai male patient with acute right upper quadrant abdominal pain]. / Akute rechtsseitige Oberbauchschmerzen bei einem 55-jährigen thailändischen Patienten.

We report on a 55-year-old Thai male who presented during a visit to Germany with acute abdominal pain in the right upper quadrant and signs of cholestasis. The diagnosis of liver fluke infection (opisthorchiasis) was confirmed by the detection of the characteristic eggs of Opisthorchis viverrini in stool microscopy. The patient was treated with praziquantel. Opisthorchiasis is a common parasitic disease and major public health problem in Southeast Asia and in Eastern Europe.

IGRP and insulin vaccination induce CD8+ T cell-mediated autoimmune diabetes in the RIP-CD80GP mouse.

Autoimmune diabetes is characterized by autoantigen-specific T cell-mediated destruction of pancreatic islet beta cells, and CD8(+) T cells are key players during this process. We assessed whether the bitransgenic RIP-CD80 x RIP-LCMV-GP (RIP-CD80GP) mice may be a versatile antigen-specific model of inducible CD8(+) T cell-mediated autoimmune diabetes. Antigen-encoding DNA, peptide-loaded dendritic cells and antigen plus incomplete Freund's adjuvant were used for vaccination. Of 14 pancreatic proteins tested by DNA vaccination, murine pre-proinsulin 2 (100% of mice; median time after vaccination, 60 days) and islet-specific glucose-6-phosphatase catalytic subunit-related protein (IGRP) (77%, 58 days) could induce diabetes. Vaccination with DNA encoding for zinc transporter 8, Ia-2, Ia-2ß, glutamic acid decarboxylase 67 (Gad67), chromogranin A, insulinoma amyloid polypeptide and homeobox protein Nkx-2.2 induced diabetes development in 25-33% of mice. Vaccination with DNA encoding for Gad65, secretogranin 5, pancreas/duodenum homeobox protein 1 (Pdx1), carboxyl ester lipase, glucagon and control hepatitis B surface antigen (HBsAg) induced diabetes in <20% of mice. Diabetes induction efficiency could be increased by DNA vaccination with a vector encoding a ubiquitin-antigen fusion construct. Diabetic mice had florid T cell islet infiltration. CD8(+) T cell targets of IGRP were identified with a peptide library-based enzyme-linked immunospot assay, and diabetes could also be induced by vaccination with major histocompatibility complex (MHC) class I-restricted IGRP peptides loaded on mature dendritic cells. Vaccination with antigen plus incomplete Freund's adjuvant, which can prevent diabetes in other models, led to rapid diabetes development in the RIP-CD80GP mouse. We conclude that RIP-CD80GP mice are a versatile model of antigen specific autoimmune diabetes and may complement existing mouse models of autoimmune diabetes for evaluating CD8(+) T cell-targeted prevention strategies.

Postinterventional pain and complications of sonographically guided interventions in the liver and pancreas.

PURPOSE: Sonographically guided interventions in abdominal organs are routine procedures with rare severe complications. However, potential patient discomfort or pain is frequently not addressed in the literature. MATERIALS AND METHODS: In a prospective 1-year study, the peri- and postinterventional pain of patients undergoing sonographically guided punctures of the liver and pancreas was analyzed. Data acquisition was done with a standardized questionnaire. This included three numeric rating scales (NRS) ranging from "0" to "10" to be answered at puncture and 1 hour and 4 hours later. Data concerning complications and administered analgesic medication was acquired from the patients' charts. RESULTS: 223/274 patients could be analyzed (83 %). 91 women (40.8 %) and 132 men (59.2 %) were included. The mean age was 56.0 yrs. Overall the average level of pain was 2.98  at puncture, 1.21 after 1 hour and 0.71 after 4 hours. In patients with diagnostic biopsies, the pain levels were 3.37(0  h)/1.33(1  h)/0.71(4  h) for liver parenchyma, 2.64(0  h)/0.95(1  h)/0.65(4  h) for focal liver lesions and 3.1(0  h)/1.9(1  h)/1.1(4  h) for pancreatic punctures. The pain levels at therapeutic interventions were 3.00(0  h)/2.00(1  h)/0.50(4  h). Female and younger (< 50 yrs) patients had statistically significantly more pain at puncture and 1 hour postintervention. Only minor complications occurred (0.9 %). CONCLUSION: Severe pain after sonographically guided interventions is rare. Most patients suffer only from mild pain postinterventionally.

Effect of different blood-guided conditioning programmes on skeletal muscle ultrastructure and histochemistry of sport horses.

The effects of three different blood-guided conditioning programmes on ultrastructural and histochemical features of the gluteus medius muscle of 2-year-old sport horses were examined. Six non-trained Haflinger horses performed three consecutive conditioning programmes of varying lactate-guided intensities [velocities eliciting blood lactate concentrations of 1.5 (v1.5 ), 2.5 (v2.5 ) and 4 (v4 ) mm respectively] and durations (25 and 45 min). Each conditioning programme lasted 6 weeks and was followed by a 5-week resting period. Pre-, post- and deconditioning muscle biopsies were analysed. Although training and detraining adaptations were similar in nature, they varied significantly in magnitude among the three different conditioning programmes. Overall, the adaptations consisted in significant increases in size of mitochondria and myofibrils, as well as a hypertrophy of myofibrillar ATPase type IIA muscle fibres and a reduction in number of type IIx low-oxidative fibres. Together, these changes are compatible with a significant improvement in both muscle aerobic capacity and muscle strength. The use of v1.5 and v2.5 as the exercise intensities for 45 min elicited more significant adaptations in muscle, whereas conditioning horses at v4 for 25 min evoked minimal changes. Most of these muscular adaptations returned towards the pre-conditioning status after 5 weeks of inactivity. It is concluded that exercises of low or moderate intensities (in the range between v1.5 and v2.5 ) and long duration (45 min) are more effective for improving muscle features associated with stamina and power in sport horses than exercises of higher intensity (equivalent to v4 ) and shorter duration (25 min).

[Innovative prolapse surgery without mesh implants]. / Innovative Deszensuschirurgie ohne Gewebeersatz.

BACKGROUND: In many countries, such as France, England, USA, Canada, Australia, and New Zealand, alloplastic material in prolapse surgery has been paused due to the US Food and Drug Administration (FDA) warning, and restricted in other countries like the Netherlands and Sweden. For Europe and thus Germany, the SCENIHR report allows alloplastic material to be used for prolapse repair after recurrence and in other special situations. QUESTION: Which established and innovative prolapse surgeries without alloplastic material are currently available? METHODS: A literature search was carried out on established, guideline-compliant pelvic floor surgeries without alloplastic material as well as innovative new approaches. RESULTS: An established procedure for a defect in the anterior compartment is anterior colporrhaphy, which is associated with a high recurrence rate. The double-layered anterior colporrhaphy is a new approach and so far is associated with an improved 19-month outcome. Apical pelvic organ prolapse can be corrected by sacrouterine ligament fixation and vaginal sacrospinous fixation. New innovative techniques include laparoscopic unilateral pectineal suspension and the use of the semitendinosus tendon autograft to perform pectopexy or sacropexy. However, long-term data are still pending. In case of a posterior vaginal wall prolapse, posterior colporrhaphy is the therapy of choice and is associated with good success rates. CONCLUSION: Well-known surgical procedures with native tissue are experiencing a renaissance and new, innovative surgical approaches with good postoperative results are being developed. However, long-term studies are still necessary.

Small-bowel capsule endoscopy in patients with gastrointestinal food allergy.

BACKGROUND: Food allergy may present with a plethora of gastrointestinal and extraintestinal symptoms such as abdominal pain, diarrhea, cardiocirculatory symptoms, cutaneous reactions, or rhinitis. Macropathological lesions like lymphofollicular hyperplasia and erosive or ulcerative lesions have seldom been described in gastroscopy and colonoscopy previously. METHODS: Fifteen patients presenting with unspecific abdominal symptoms in which food allergy was detected in due course were included. During the examination process, those patients showed various indications for small-bowel capsule endoscopy, such as weight loss and anemia. RESULTS: Fourteen (93.3%) of the 15 small-bowel capsule endoscopies could be assessed, showing nonerosive lesions such as erythema, swelling, and lymphoid hyperplasia in 8 patients (57.1%) and erosive lesions such as aphthoid lesions, erosions, and petechiae in 4 patients (28.6%) with food allergy. CONCLUSION: In 15 patients with confirmed food allergy and after exclusion of other diseases, 12 (85.7%) showed various unspecific nonerosive or erosive mucosal lesions within the small bowel, resulting, however, partially in grave consequences such as anemia. Lymphoid hyperplasia was the most prominent finding in 7 patients (50%), albeit infectious disease had been excluded. Anemia improved within 1 year after adequate antiallergic treatment.

Physiological and blood biochemical variables in horses exercising on a treadmill submerged in water.

The blood lactate concentration (LA) and heart rate (HR) of 10 horses exercising in water on a treadmill were examined. With the water at 10 and 50% of the withers height (WH), the blood LA increased up to mean values around 1.9 mm during the standardized exercise test (SET) until after step 3 of 5 (each step lasted 5 min, speed increasing step by step). Thereafter, blood LA of horses remained constant, while with the water at 80% of WH, the blood LA decreased from the mean peak of 2.16 ± 0.62 mm after the 4th step. The HR of the horses increased to 132 ± 14 beats/min until the 3rd step of SET with the water at 10% of WH, up to the 2nd step with the water at 50% (134 ± 10 beats/min) and up to the 1st step only with the water at 80% of WH (134 ± 10 beats/min). In another SET, horses were exercised five times for 5 min at the maximal attainable speed of 5.5 m/s in water at 20% of the withers height in step 1, 35% in step 2, 49% in step 3, 63% in step 4 and 77% in step 5. On using this SET, blood LA increased to 1.91 ± 0.25 mm until after the 2nd step and decreased after the 3rd step. The HR increased between before commencing SET and the 1st step (143 ± 13 beats/min) and remained constant thereafter. In conclusion, increasing water height and speed of exercise does not augment continuously blood LA and HR of horses exercising in water treadmills.

[Unexplained fever and B-symptoms in a young male Black African]. / Unklares Fieber und B-Symptome bei einem jungen Schwarzafrikaner.

An immunocompetent Nigerian developed a fulminant hemophagocytic lymphohistiocytosis due to Epstein-Barr virus reactivation. The patient initially presented with fever, hepatosplenomegaly and pancytopenia. The clinical status of our patient deteriorated quickly despite treatment with corticoids. Escalation of immunosuppressive treatment was not possible. He died of lung, liver and circulatory failure in our intensive care unit.Hemophagocytic lymphohistiocytosis is a rare disease characterized by inflammation due to prolonged and excessive activation of antigen-presenting cells. High plasma ferritin levels and phagocytosis of hematopoetic cells in bone marrow, spleen and liver lead to the diagnosis. Hemophagocytic lymphohistiocytosis should therefore be included in the differential diagnosis in patients with persistent fever, hepatosplenomegaly and cytopenia.

[Glyphosate detection in the duodenal fluid of horses with gastric ulcer syndrome]. / Glyphosatnachweis in der Duoden­alflüssigkeit bei Pferden mit Magenulzerasyndrom.

INTRODUCTION: The hay producing plants, concentrate, straw and meadows could be contaminated by the aerosols of glyphosate based herbicide during spraying process of crops and pre-harvest desiccation treatment of cereals. The aim of this study is to investigate the concentration of glyphosate in the duodenal fluid of horses with gastric ulcer syndrome. The stomach and duodenum of referred untreated horse patients (n=92) with colic, weight loss, diarrhoea, anemia or performance intolerance were endoscopically examined right after the admission. Duodenal fluid (40 ml) was collected from the duodenal region where the papilla duodeni major is located. Hematology and clinical chemistry data were examined. The concentration of glyphosate in serum and duodenal fluid samples were analysed using a competitive ELISA and control analysis had also been done with HPLC. Statistical differences between groups were determined by the non-parametric Mann-Whitney-test using a significant level of p≤0,05. Glyphosate was detected in all duodenal fluid (median 12,2 ng/ml; 1st quartile 4,0 ng/ml; 3rd quartile 19,3 ng/ml; min 0,6 ng/ml; max. 192,9 ng/ml) and blood samples (1,79 ng/ml; 1,0 ng/ml; 2,8 ng/ml; 0,2 ng/ml; 3,7 ng/ml) of all horses. Glyphosate concentrations of duodenal fluid samples are significantly higher than in blood samples (Mann Whitney U-test, p≤0,05). The concentration of glyphosate in the duodenal fluid was significantly higher in horses with squamous gastric disease (grade 4/4; n=11/92) compared to horses with normal squamous mucosa (grade 0/4, n=10/92) (median: 19,8 ng/ml versus 8,4 ng/ml). Horses with glandular gastric disease and a grade 4/4 (n=9/92) had higher concentrations of glyphosate in the duodenal fluid than horses with normal glandular mucosa (grade 0/4; n=9/92) (median: 19,2 versus 11,1). The Gamma-Glutamyltransferase (GGT) enzyme activity is significantly higher in the group of horses with lower concentration of glyphosate in the duodenal fluid (≤12,2 ng/ml) compared with the group with higher concentration of glyphosate (>12,2 ng/ml) (median 279,5 versus 101,9 U/L). During autumn the horses had higher concentrations of glyphosate in duodenal fluid (n=18; median 14,3) compared with lower concentrations in spring time (n=34; median 8,1 ng/ml). Horses kept around big cities had significantly higher concentrations of glyphosate in the duodenal fluid in comparison to horses living in the countryside (medians 17,8 ng/ml versus 7,5 ng/ml).

INTRODUCTION: L'herbicide glyphosate, y compris le surfactant, est utilisé contre les mauvaises herbes dans l'agriculture, les maisons, les jardins et les parcs, les bords de route ainsi que sur les remblais des voies ferrées. La pulvérisation de cet herbicide engendre sa dispersion et donc la contamination des champs, des prairies et des pâturages et, par conséquent, des céréales, du foin, de la paille et du haylage, entraînant ainsi une ingestion orale chez les chevaux. Afin de déterminer l'étendue de l'utilisation du glyphosate dans la région du centre de l'Allemagne et d'identifier un éventuel facteur de risque pour le déclenchement du syndrome de l'ulcère gastrique, le liquide duodénal a été testé par rapport au glyphosate chez des patients équins. Les chevaux référés et non traités (n=92) présentant des antécédents de colique, d>amaigrissement, de diarrhée, d>anémie ou de baisse de performance ont été soumis à une gastroduodénoscopie le jour de leur admission. La graduation des lésions des muqueuses de l'estomac et du duodénum a été effectuée, 40 ml de liquide duodénal ont été aspirés et 20 ml de sang ont été prélevés en parallèle. Des analyses hématologiques et chimiques du sang ainsi que des analyses chimiques du liquide duodénal ont été effectuées. Le glyphosate a été détecté dans le sérum et le liquide duodénal à l'aide d'un test ELISA direct et compétitif et, parallèlement, d'une chromatographie liquide haute performance. Le glyphosate a été détecté dans le liquide duodénal (médiane 12,2 ng/ml, 1er quartile 4,0 ng/ml ; 3e quartile 19,3 ng/ml ; min 0,6 ng/ml ; max 192,9 ng/ml) et dans le sang (1,79 ng/ml ; 1,0 ng/ml ; 2,8 ng/ml ; 0,2 ng/ml ; 3,7 ng/ml) de tous les chevaux étudiés. La concentration de glyphosate dans le liquide duodénal est significativement plus élevée que dans le sang (test U de Mann Whitney, p≤0,05). Les chevaux présentant des lésions cutanées (n=11/92) ou glandulaires (n=9/92) de la muqueuse gastrique de grade 4/4 présentaient des concentrations de glyphosate dans le liquide duodénal significativement plus élevées ou plus élevées que ceux de grade 0/4 (n=10 et 9 respectivement) (médiane : 19,8 ng/ml versus 8,4 ng/ml ou 19,2 ng/ml versus 11,1 ng/ml). L'activité de la gamma-glutamyltransférase (GGT) dans le liquide duodénal était significativement plus élevée (médiane de 279,5 U/L) dans le groupe de chevaux présentant une faible concentration de glyphosate (≤12,2 ng/ml) que dans le groupe de chevaux présentant une concentration plus élevée de glyphosate (>12,2 ng/ml) (médiane de 101,9 U/L). La concentration de glyphosate était plus élevée pendant l'automne (n=18 ; médiane 14,3 ng/ml) et plus faible au printemps (n=34 ; médiane 8,1 ng/ml). Des concentrations significativement plus élevées de glyphosate dans le liquide duodénal ont été mesurées chez les chevaux détenus autour des grandes villes (17,8 ng/ml) par rapport aux chevaux vivant dans les zones rurales (7,5 ng/ml).

Brugada-like cardiac disease in myotonic dystrophy type 2: report of two unrelated patients.

BACKGROUND: Myotonic dystrophy type 2 (DM2) is an autosomal dominant multisystem disorder caused by CCTG repeat expansions within intron 1 of the ZNF9 gene on chromosome 3q. Cardiac conduction disturbances, supraventricular arrhythmias, and cardiomyopathy are described in DM2 but Brugada-like features have not yet been reported. Brugada syndrome (BS) is a genetically heterogeneous cardiac conduction disorder which is characterized by a significant ST-segment elevation upon ECG evaluations and bears an increased risk for sudden cardiac death. CASE REPORTS: We report two unrelated patients with genetically confirmed DM2 who developed clinical relevant cardiac arrhythmias with syncopal events from 35 (patient 1) and 47 years (patient 2). Brugada-like ECG findings were present in both patients. Family history was negative for BS, but the mothers of both index patients were also affected by DM2 and had different ventricular rhythm disturbances. SCN5A gene sequencing revealed an unknown genetic variant c.4140 C > A, p.N1380K, in patient 1, while no mutation was detected in patient 2. DISCUSSION: Our observations may suggest that Brugada-like cardiac arrhythmias can occur in DM2, as this seems also to be the case in DM1. The chance association of two independent inherited disorders has to be considered and cannot be excluded in one of our patients. However, on statistical grounds, this possibility cannot explain all observed cases of DM with Brugada-like cardiac disease.

Efficacy of contrast-enhanced US versus CT or MRI for the therapeutic control of percutaneous radiofrequency ablation in the case of hepatic malignancies.

PURPOSE: The goal of this study was to assess the informative value of contrast-enhanced ultrasound after radiofrequency ablation (RFA). Patients who had undergone RFA of malignant liver tumors were followed up with contrast-enhanced sonography (CEUS), computed tomography (CT) and/or magnetic resonance tomography (MRI), and the outcomes were compared. MATERIALS AND METHODS: 76 patients undergoing 194 RFAs for 118 hepatic neoplasms (n = 55 HCC, n = 63 metastases) in the course of a 7-year period were examined post-interventionally using CEUS and CT or MRI. During follow-up (gold standard of evaluation), contrast agent rim accumulations with a diameter greater than 5 mm and a growth rate of at least 25 % were counted as a recurrence. RESULTS: CEUS-CT comparison group: A total of 65 scan pairs were compared. In 54 cases (83.1 %) the findings were the same with either method. In 7 cases (10.8 %) CEUS confirmed the correct diagnosis, and in 2 cases (3.1 %) only CT was correct. In 2 cases (3.1 %) both methods yielded incorrect results. Diagnostic accuracy (DA): CEUS 93.8 %, CT 86.2 %. CEUS-MRI comparison group: In 23 cases (88.5 %) of a total of 26 scan pairs, the findings were the same for both CEUS and MRI. In 3 discordant cases only CEUS confirmed the correct diagnosis (3 cases, 11.5 %). Diagnostic accuracy DA (n = 26): CEUS 100 %, MRI 88.4 %. CONCLUSION: CEUS performs equally to CT and MRI in the follow-up of patients treated for liver tumors by RFA.

Effect of conditioning horses every third day at v10 on measures of fitness.

This study examined the effect of exercising horses five times per fortnight with two bouts of 5 min duration at their v(10) with 2 days between consecutive exercise sessions. Five Anglo-Arabian horses were treadmill-conditioned for 6 weeks. A standardized exercise test (SET) was performed at the beginning of the conditioning period (CP) to determine the blood lactate-running speed (BLRS) and the heart rate-running speed (HRRS) relationship and the SET was repeated every 2 weeks. After each SET, the BLRS relation was used to calculate the horse's speed (v = velocity), which produced a blood lactate concentration (LA) of 10 mmol/l (v(10) ) and 4 mmol/l (v(4) ). From the HRRS was calculated the speed at which the horses had a heart rate of 180 b/min (v(180) ). Each horse was then conditioned for the next 2 weeks five times at its individual v(10) for two 5-min bouts. Exercise speed was individually adapted to the new v(10) every 2 weeks. In addition, horses were submitted to another SET prescription to determine the peak oxygen consumption (VO(2 peak) ) before, after 3 weeks and at the end of CP. The v(4) of horses increased during the CP (p < 0.05). v(180) did not change (p > 0.05). VO(2 peak) increased in the first 3 weeks of CP (p < 0.05) and levelled off afterwards (p > 0.05). The conclusion drawn was that exercising horses five times per fortnight at their v(10) for two 5-min bouts with 2 days between consecutive exercise sessions improved v(4) and VO(2 peak) but not v(180).

[Hypertrophic osteoarthropathy. Bamberger-Marie disease]. / Hypertrophe Osteoarthropathie. Marie-Bamberger-Syndrom.

Hypertrophic osteoarthropathy (HOA) is the classical neoplastic disease in rheumatology characterized by a combination of digital clubbing, joint and bone pain, and proliferative periostitis. This combination of symptoms should initiate an intensive search for an underlying malignant disease usually of thoracic organs. Here we report the case of a patient with HOA and neuroendocrine carcinoma of the esophagus. Other non-malignant disorders of the lungs, heart and other organs should be considered in the differential diagnosis. In addition, rare cases of a primary hereditary form of HOA exist and the genetic background has recently been discovered. Thus, new insights into the pathophysiology have improved diagnostic and therapeutic options for this disorder.

APPC--a new standardised coding system for trans-organisational PACS retrieval.

OBJECTIVES: As part of a general strategy to integrate the health care enterprise, Austria plans to connect the Picture Archiving and Communication Systems (PACS) of all radiological institutions into a nationwide network. To facilitate the search for relevant correlative imaging data in the PACS of different organisations, a coding system was compiled for all radiological procedures and necessary anatomical details. RESULTS: This code, called the Austrian PACS Procedure Code (APPC), was granted the status of a standard under HL7. Examples are provided of effective coding and filtering when searching for relevant imaging material using the APPC, as well as the planned process for future adjustments of the APPC. DISCUSSION: The implementation and how the APPC will fit into the future electronic environment, which will include an electronic health act for all citizens in Austria, are discussed. A comparison to other nationwide electronic health record projects and coding systems is given. Limitations and possible use in physical storage media are contemplated.

[Spectrum and bleeding complications of sonographically guided interventions of the liver and pancreas]. / Spektrum und Blutungskomplikationen sonografisch gesteuerter Interventionen an Leber und Pankreas.

PURPOSE: Sonographically guided fine-needle punctures (p.) are considered to be a low risk procedure. Interventions with needles with a larger diameter seem to cause more complications. In search of potential complications, we examined 1923 sonographically guided interventions of the liver and pancreas in a retrospective analysis. MATERIALS AND METHODS: We examined the coherence of the kind of intervention and complications. We considered bleeding with a need for transfusion and/or a need for surgical treatment as complications. Diseases and medication increasing the probability of post-interventional bleeding were also detected. RESULTS: 1923 sonographically guided interventions in the abdomen (1800 in the liver, 123 in the pancreas) were analyzed (n = 1696 diagnostic interventions, n = 227 therapeutic interventions). Needles with diameters > 1 mm were primarily used. Drainage and radiofrequency ablation (RFA) (12 % of all interventions) were performed with devices with diameters between 2 - 3.96 mm. A need for transfusion was found in 8 / 1923 patients (0.4 %), predominantly in the first 24 h. There was no significant correlation between coagulation preventing drugs (heparin, NSAIDs, antiaggregants) and bleeding events. Patients who suffered from liver cirrhosis with a thromboplastin time of < 50 % had a higher risk of post-interventional bleeding than patients with liver cirrhosis and a thromboplastin time > 50 %. Furthermore, therapeutic interventions showed higher complication rates than diagnostic procedures. CONCLUSION: Severe bleeding complications with a need for transfusion in sonographically guided procedures are rare (0.4 %). Our results showed that liver cirrhosis with a low thromboplastin time (< 50 %) seems to be the most important risk factor for patients. Overall, sonographically guided interventions are safe and have low complication rates considering careful performance and contraindications.