Unilesional plantar mycosis fungoides treated with topical photodynamic therapy - case report and review of the literature.

BACKGROUND: Unilesional mycosis fungoides (UMF) and pagetoid reticulosis (PR) are variants of mycosis fungoides. Conventional therapy comprises surgical excision or radiotherapy, which may be associated with long-term side effects, especially when the lesion is located at a special site like the palms and soles. Therefore, alternative treatment options are needed to treat solitary lesions in the case of UMF or PR. Recently, topical photodynamic therapy (PDT) has been described to be an efficient and non-invasive therapeutical option with excellent clinical outcome. OBJECTIVE: The objective of this study was to report a 43-year-old woman with plantar UMF treated successfully with PDT, and to compare our findings with the data on PDT in UMF and PR reported in the literature. METHODS: The literature was analysed for articles on UMF and PR, respectively, treated with topical PDT. Various parameters including form of PDT and response to treatment were analysed and compared with our case. RESULTS: A total of 24 patients were documented with 24 lesions treated with PDT, either using aminolevulinic acid (ALA) or methylaminolevulinate (MAL). In average, a single lesion was treated 4 times with PDT. In 21 cases (88%), complete response could be achieved, whereas three cases (13%) showed partial remission. None of the cases showed stable or progressive disease. CONCLUSIONS: PDT is a safe, efficient and non-invasive therapeutical approach for the treatment of UMF and PR. It has no long-standing adverse events and therefore is of high therapeutic value especially in cases of UMF and PR located at special sites like the palms and soles. We propose to include topical PDT as therapeutic option for the treatment of UMF and PR in future guidelines on the management MF.

[Standardized telephone-assisted instructions on resuscitation by laypersons. Feasibility study using video-assisted quality analysis]. / Standardisierte Telefonanweisungen zur Wiederbelebung durch Laienhelfer. Videogestützte Qualitätsanalyse im Rahmen einer Machbarkeitsstudie.

BACKGROUND: Telephone-assisted instructions for cardiopulmonary resuscitation (T-CPR) are highly recommended by the current European Resuscitation Council (ERC) guidelines for resuscitation 2010. AIM: The aim of this study was to analyze the adherence of laypersons to T-CPR instructions given by dispatchers in a mock scenario. The dispatchers adapted international T-CPR instructions to local requirements. MATERIAL AND METHODS: An emergency "collapse in the office" with subsequent T-CPR was simulated for 10 volunteer, untrained administrative staff, as the only single emergency witness and 4 emergency medical service (EMS) dispatchers. Each volunteer was sent to a "colleague" who simulated a sudden cardiovascular event and collapsed unconscious during the description of symptoms. The local lay responder made an emergency call by landline telephone and was connected to the dispatcher. In the course of the simulation the "victim" was replaced by a CPR manikin. RESULTS: Every participant, i.e. 10 out of 10, assessed the victim, recognized the situation and telephoned for help. On the orders of the dispatchers 9 out of the 10 activated the loudspeaker of the telephone but 4 still continued to use the handset. The instructions for positioning were followed by all 10. Correct positioning of the victim required a median of 33[Symbol: see text]s with an interquartile range (IQR) of 30-39[Symbol: see text]s. Breathing control including instructions lasted a median of 54[Symbol: see text]s (IQR 49-60[Symbol: see text]s). Breathing was assessed by 8 out of 10 but only 2 out of 8 achieved a duration of 10[Symbol: see text]s as recommended by the ERC guidelines for resuscitation 2010. After a median of 202[Symbol: see text]s (IQR 196-241[Symbol: see text]s) chest compressions were started by 9 out of 10 and were performed for a median of 63[Symbol: see text]s (IQR 60-69[Symbol: see text]s). A correct technique was used by 7 but with a low rate of 80 compressions/min (IQR 72-86/min). The instructions for ventilation were understood by 9 out of 10. Mouth-to-mouth resuscitation was performed by 7 participants and technically correct by 5 of them. The ventilation cycle of the 7 active participants lasted for a mean of 25[Symbol: see text]s (IQR 24-30[Symbol: see text]s). The mean total duration of the timeframe analyzed was 340[Symbol: see text]s (IQR 334-368[Symbol: see text]s). CONCLUSION: The results demonstrate that the local T-CPR concept for untrained laypersons is feasible in a mock scenario. No substantial errors were observed for the majority of the untrained responders but the simulation also showed that not every emergency witness implemented the instructions according to the dispatcher's expectations. The T-CPR procedure was also more time-consuming than expected; therefore, every standardized T-CPR concept should be tested for local practicability. In accordance with current studies, the results suggest that the focus should be on compression-only CPR instructions in urban settings. Dispatcher education in T-CPR should incorporate videotaped mock-up scenarios with untrained local laypersons.

A large meteoritic event over Antarctica ca. 430 ka ago inferred from chondritic spherules from the Sør Rondane Mountains.

Large airbursts, the most frequent hazardous impact events, are estimated to occur orders of magnitude more frequently than crater-forming impacts. However, finding traces of these events is impeded by the difficulty of identifying them in the recent geological record. Here, we describe condensation spherules found on top of Walnumfjellet in the Sør Rondane Mountains, Antarctica. Affinities with similar spherules found in EPICA Dome C and Dome Fuji ice cores suggest that these particles were produced during a single-asteroid impact ca. 430 thousand years (ka) ago. The lack of a confirmed crater on the Antarctic ice sheet and geochemical and 18O-poor oxygen isotope signatures allow us to hypothesize that the impact particles result from a touchdown event, in which a projectile vapor jet interacts with the Antarctic ice sheet. Numerical models support a touchdown scenario. This study has implications for the identification and inventory of large cosmic events on Earth.

Corticosterone in feathers of laying hens: an assay validation for evidence-based assessment of animal welfare.

Studies indicate that the evaluation of animal welfare in birds may be carried out with the measurement of the stress-related hormone corticosterone in feathers. However a standardized procedure for corticosterone measurements in feathers is lacking, a validation needs to be carried out for each new species before implementation. The aim of the present study was to establish a valid method to measure corticosterone concentrations in feathers of laying hens in a precise and repeatable manner using an established and commercially available ELISA. Validation was performed with feather pools of tail and interscapular feathers of commercial Lohmann Brown laying hens. Assessment groups, consisting of 5 replicates, were created. All replicates of an assessment group were processed at the same time. Each replicate was run in 4 repetitions by ELISA. Intra-assay and interassay CV was 7.5 and 6.4%, respectively. The serial dilution showed linearity and parallelism. Examining the hormone extraction efficiency by using different methanol volumes resulted in no statistical differences (P > 0.05). Pulverized feathers showed higher corticosterone values than minced feathers (P > 0.05). Differences were shown between 2 feather types (tail vs. interscapular feathers; P < 0.05), as well as between vane and rachis (P < 0.05). Performance of a freeze-thaw cycle led to a decrease of corticosterone concentrations in the samples. A possible effect of UV-A radiation on the stability of corticosterone in the feathers was not found (P > 0.05). With the present study, a valid protocol, feasible for analyzing feather pools of laying hens, was developed. It may provide fundamentals for further investigations on corticosterone in feathers as a noninvasive indicator to evaluate aspects of animal welfare.

Effect of pH-lowering litter amendment on animal-based welfare indicators and litter quality in a European commercial broiler husbandry.

Several studies have shown that litter moisture is a major reason for foot pad lesions (FPD) and promotes microbial growth of nitrifying bacteria. The aim of the current study was to determine the possible effects of a sodium bisulfate complex (SBS) as a litter additive on FPD, hock burn (HB), and litter parameters. Two application rates of SBS were examined in 2 experiments on a commercial farm. Two groups of about 30,000 broiler chicks each were introduced on spelt granulate spread at 700 g/m² and kept for 36 d. In the first experiment (TRT1), 250 g/m² SBS was spread on top of litter 20 h before chick placement; in the second experiment (TRT2), SBS was reduced to 150 g/m². Each experiment consisted of 1 treatment group (SBS) and a control group without treatment (CON). Both experiments were repeated once. Litter parameters (pH, percentage of dry matter), foot pad, hock condition and body weight of randomly sampled birds (n = 60 per group) were recorded weekly. Mortality rate was higher in SBS groups compared to CON groups (TRT1 2.79 vs. CON 2.03%, TRT2 2.88 vs. CON 2.27%). SBS had no effect on body weight averaged over the whole production period (P > 0.05). Incidence of FPD was significantly reduced in both groups treated with SBS compared to CON (P < 0.05), with group TRT1 showing the best results. Incidence of HB was not affected by SBS (P > 0.05) but by dry matter content (P < 0.05). At the beginning, SBS reduced litter pH to 1.7 and 2.0 in TRT1 and TRT2, respectively, compared to 6.5 and 6.7 in CON. Litter pH in TRT groups increased over time and approached pH of control groups by day 15. Results of the current study indicate that SBS treatment may be beneficial regarding foot pad health in broilers. However, further studies are needed to investigate alternative SBS application rates, and to verify the results.

Enzymatic hydrolysis of PTT polymers and oligomers.

Oligomers and polymers (film, fabrics) of the linear aromatic polyester poly(trimethylene terephthalate) (PTT) were treated with polyesterases from Thermomyces lanuginosus, Penicillium citrinum, Thermobifida fusca and Fusarium solani pisi. The cutinase from T. fusca was found to release the highest amounts of hydrolysis products from PTT materials and was able to open and hydrolyse a cyclic PTT dimer according to RP-HPLC-UV detection. In contrast, the lipase from T. lanuginosus also showed activity on the PTT fibres and on bis(3-hydroxypropyl) terephthalate (BHPT) but was not able to hydrolyse the polymer film, mono(3-hydroxypropyl) terephthalate (MHPT) nor the cyclic dimer of PTT. As control enzymes inhibited with mercury chloride were used. Surface hydrophilicity changes were investigated with contact angle measurements and the degree of crystallinity changes were determined with DSC.

The effect of change in a stimulus sequence on P300.

In past studies, the P300 amplitude of the ERP has been found to be enhanced for infrequent, unpredictable and/or task-relevant eliciting events. A fourth factor, namely the physical change between two consecutive stimuli in event sequences used, has often been confounded with frequency, predictability and relevance. The current study examined whether change also increases the P300 amplitude. Fourteen adults viewed sequences of slides in which predictability, task (counting) and change varied within subject. ERP was recorded at Cz, Pz, Oz and Fz. P300 amplitudes were significantly larger: (1) for unpredictable than for predictable events, (2) for counted than for non-counted stimuli, and (3) for stimulus change rather than no stimulus change. The change effect interacting with counting suggested that P300 amplitude may be particularly increased by stimulus changes imbedded within only certain cognitive tasks.

Comparison of gadolinium-DTPA and macromolecular gadolinium-DTPA-polylysine for contrast-enhanced pulmonary time-of-flight magnetic resonance angiography.

RATIONALE AND OBJECTIVES: The authors investigated the enhancing effect of low-dose administration of the macromolecular, paramagnetic contrast medium gadolinium (Gd)-DTPA-polylysine (average molecular weight, 40,000-50,000 dalton [D]) compared with Gd-DTPA (molecular weight, 547 D) in time-of-flight magnetic resonance angiography of unilaterally damaged sheep lungs. MATERIALS AND METHODS: Thirteen heart-lung preparations were examined in the head coil of a 1.5-tesla imager (Magnetom SP, Siemens, Erlangen, Germany). The authors performed time-of-flight angiograms (coronal; repetition time, 35 mseconds; echo time, 6 mseconds; 20 degrees flip angle; pixel size 1.0 x 1.0 x 1.5 mm3) before and after application of the contrast agents. Gadolinium-DTPA-polylysine was used in a dose of 0.027 mmol/kg body weight while Gd-DTPA was injected in variable doses. RESULTS: After Gd-DTPA-polylysine, signal intensity increased by 118% in pulmonary arteries in healthy lungs and by 121% in damaged lungs (P < 0.001). In addition, the contrast-to-noise ratio measured between pulmonary arteries and perivascular parenchyma increased significantly (P < 0.01). On three-dimensional angiograms, two more generations of vascular branches could be detected. A dose of Gd-DTPA 6.1 times higher than the Gd-DTPA-polylysine dose was necessary to obtain the same contrast enhancing effect as Gd-DTPA-polylysine in healthy lungs. In damaged lungs, none of the administered doses of Gd-DTPA reached the average contrast enhancement of Gd-DTPA-polylysine. CONCLUSIONS: The authors' measurements demonstrate significant improvement of time-of-flight angiograms by low-dose administration of Gd-DTPA-polylysine.

A new class of potent antiproliferative glycolipids.

The synthesis and biological activities of a new class of antiproliferative glycolipids with an unexpected broad spectrum of activity, including a human multidrug resistant cell line, are described. Chemically these compounds are glycolipids derived from N-acetyl-D-glucosamine and glycyrrhetinic acid (beta-aglycone). Peptidation of the glucoacids allyl 3 beta-[[2-acetamido-3-O-[(R)-1-carboxyethyl]- 2-deoxy-4,6-O-isopropylidene-beta-D-glucopyranosyl]oxy]-11-oxo-12- oleanen-30-oate and (R,S)-2-methoxy-3-(octadecyloxy)propyl-2-acetamido-3-O-[(R)-1-carb oxyethyl]- 2-deoxy-4,6-O-isopropylidene-beta-D-glucopyranoside was successfully achieved after activation with O-benzotriazolyl-N,N,N',N' -tetramethyluronium hexafluorophosphate.

[Magnetic resonance imaging of the degree of pulmonary edema using a macromolecular contrast medium]. / Kernspintomographische Quantifizierung des Lungenödemgrades mit Hilfe eines makromolekularen Kontrastmittels.

PURPOSE: Development and experimental validation of a method tor the quantification of pulmonary oedema by measurement of total lung water and intravascular lung water and by calculation of extravascular lung water. MATERIAL AND METHODS: Isolated sheep lung preparations with unilateral pulmonary oedema were perfused (pulsatile pump) and examined under ventilatory arrest and during ventilation. Total lung water was calculated from proton density obtained from a multi-spin echo sequence and gravimetrically (reference method). Pulmonary intravascular volume was calculated from signal intensity histograms obtained from 3D-TOF MR-angiograms before and after application of the macromolecular contrast medium gadolinium-DTPA-polylysine. The reference method was a dye-dilution technique. Extravascular lung water was calculated as the difference between total lung water and pulmonary intravascular volume. RESULTS: Under ventilatory arrest, the magnetic resonance technique for the measurement of extravascular lung water correlated well with the reference technique (r = 0.89, n = 42 lungs). In 10 lungs the correlation coefficients were r = 0.95 (ventilatory arrest) and r = 0.92 (ventilated lungs). CONCLUSION: The results demonstrate that magnetic resonance imaging enhanced by a macromolecular contrast medium may be applicable for quantification of pulmonary oedema.

Radiologic anatomy of ventricular assist devices.

Ventricular assist devices (VAD) allow for long-term circulatory support of patients with end-stage heart failure. With the increasing duration of circulatory support, diagnostic imaging plays an important role in the management of patients on a VAD. The aim of our review was to analyze the radiologic features of different VADs. From 1987 to 1996, 319 patients (mean age 42 years, range 3 to 74 years) were treated with a VAD. A Berlin Heart VAD was implanted in 263 of the patients, the univentricular Baxtor Novacor was implanted in three patients, and the univentricular CI Heartmate was implanted in 19 patients. All patients were studied by serial chest radiographs. In addition, 70 patients underwent computed tomography (CT), and five patients underwent electron beam CT. The Berlin Heart VAD was used as a biventricular support system in 218 patients. In all cases, the position of the wire-directed cannulae was identified on the chest radiographs, while the exact position of the cannula tip could be visualized by CT only. The plastic cannulae of both the Novacor and the Heartmate were not discernible on radiographs, but required CT for evaluation. Computed tomography also resolved the metal components of the pumps. The titanium-made pump housing of the Heartmate caused beam-hardening artefacts that might conceal fluid accumulations in the pump pocket. Computed tomography is the standard of reference for examinations of cannula position, pump position, and pump components of ventricular assist devices.

Outcome of patients with ventricular assist devices and acute renal failure requiring renal replacement therapy.

The significance of acute renal failure (ARF) for patients treated with a ventricular assist device (VAD) is uncertain. There is little information on the outcome of patients who require renal replacement therapy during treatment with a VAD. A retrospective review was undertaken to evaluate the impact of renal failure requiring renal replacement therapy on such patients. Studied were 227 patients who were supplied with a VAD at the German Heart Institute Berlin. Fifty-five patients required renal replacement therapy during treatment with a VAD. These were compared with patients not needing renal replacement therapy (ARF and non-ARF groups). Significant differences for the end points of survival, heart transplantation, and discharge from hospital were observed in patients with ARF (p < 0.01). Survival was then analyzed according to indications for treatment with a VAD (bridge to transplantation or cardiac recovery after cardiotomy, transplantation, myocardial infarction, myocarditis, and endocarditis). Survival for bridge-to-transplantation patients was clearly influenced in a negative way by ARF (p < 0.01). For cardiac recovery patients, only a small difference in survival was observed (p = 0.05). We conclude that ARF is a negative predictor for bridge-to-transplantation patients. For cardiac recovery patients the impact of ARF on survival is marginally significant.

Induction of ovulation in gonadotropin treated gilts with synthetic gonadotropin releasing hormone.

Four consecutive trials were conducted to investigate the possibility of controlling the time of ovulation in prepuberal gilts pretreated with PMS and HCG. In trial 1 it was shown that the GnRH analog Hoe 766 was superior to other compounds tested. The following trial revealed that 10 mug of that analog is the optimal dose to elicit an ovulatory response. In trial 3 it was found that the majority (73%) of gilts had started ovulating by 39 h after Hoe 766 injection. Individual gilts started ovulating up to 4 h sooner or up to more than 5 h later. Apparently the ovulatory process of an individual gilt extends over a period of 4 - 5 h. Double insemination of 9 gilts at 34 and 41 h after Hoe 766 resulted in fertilization rates and litter sizes that compared favourably with those of corresponding gilts treated with HCG.