Successful treatment of glandular tularemia with azithromycin in a pregnant woman in Austria.

Treatment of tularemia during pregnancy is challenging due to toxicity of standard treatment regimens. Here, we report a 31-year-old woman with glandular tularemia who was successfully treated with intravenous azithromycin. Follow-up examinations over a 6-month period showed a sustained response to treatment. She later gave birth to a healthy child.

Microparticle-associated tissue factor activity in patients with pancreatic cancer: correlation with clinicopathological features.

BACKGROUND: Patients with pancreatic cancer have an unfavourable prognosis. A central role in pancreatic cancer progression has been suggested for tissue factor (TF), the main initiator of the blood coagulation cascade. We hypothesized that elevated levels of plasma microparticle (MP)-associated TF activity might indicate the presence of poorly differentiated pancreatic cancer, disease dissemination and infiltration of peripancreatic vessels. METHODS: MP-TF activity was measured in 73 pancreatic cancer patients and 22 healthy controls. Abdominal computerized tomography (CT) scans performed at study inclusion were investigated for probability of tumoural vascular invasion. In addition, intratumoural TF expression, D-dimer and CA 19-9 levels were determined. RESULTS: MP-TF activity (pg/mL) was significantly higher in patients (median: 0·37 [range: 0·00-11·91]) than in controls (median: 0·05 [range: 0·00-0·76]; P < 0·001). When pancreatic cancer patients were compared with regard to stage and grade, significantly elevated levels of MP-TF activity were only present in those with poorly differentiated metastatic nonresectable tumours (n = 11, median: 2·95 [range: 0·25-11·91]). In three patients with poorly differentiated tumours, a high probability of vascular invasion was found (MP-TF activity in these cases: 2·95, 7·00 and 10·34). MP-TF activity correlated strongly with CA 19-9 (r = 0·60) and weakly with D-dimer (r = 0·33) levels. Immunohistochemical staining for TF was positive in 14 of 15 resected tumours. MP-TF activity was associated with an increased risk of mortality (HR: 1·8 per doubling in MP-TF activity, [95% CI: 1·4-2·4, P < 0·001]). CONCLUSION: MP-TF activity might represent a biomarker for a poorly differentiated and invasive pancreatic cancer phenotype and poor survival.

Three-dimensional fracture visualisation of multidetector CT of the skull base in trauma patients: comparison of three reconstruction algorithms.

The purpose of this study was to retrospectively assess the detection rate of skull-base fractures for three different three-dimensional (3D) reconstruction methods of cranial CT examinations in trauma patients. A total of 130 cranial CT examinations of patients with previous head trauma were subjected to 3D reconstruction of the skull base, using solid (SVR) and transparent (TVR) volume-rendering technique and maximum intensity projection (MIP). Three radiologists independently evaluated all reconstructions as well as standard high-resolution multiplanar reformations (HR-MPRs). Mean fracture detection rates for all readers reading rotating reconstructions were 39, 36, 61 and 64% for SVR, TVR, MIP and HR-MPR respectively. Although not significantly different from HR-MPR with respect to sensitivity (P = 0.9), MIP visualised 18% of fractures that were not reported in HR-MPR. Because of the relatively low detection rate using HR-MPRs alone, we recommend reading MIP reconstructions in addition to the obligatory HR-MPRs to improve fracture detection.

Very good partial response in a patient with MALT-lymphoma of the lung after treatment with low-dose thalidomide.

Pulmonary MALT lymphoma is a rare disease entity and generally follows an indolent clinical course. Due to scarce information from randomized prospective trials, no standardized therapy protocols exist. Besides irradiation and chemotherapy, novel biological agents such as the anti CD20-antibody rituximab and thalidomide constitute a promising new approach. In this report we demonstrate the case of a 52-year-old male patient with extra-intestinal MALT lymphoma of the lung. After 10 months of treatment with low dose thalidomide (100mg/d), very good partial response of the intrapulmonary lesions was achieved.

Effects of progressive strength training on muscle mass in type 2 diabetes mellitus patients determined by computed tomography.

OBJECTIVE: To examine the effect of a 4-month progressive strength training program on muscle and fat mass assessed by computed tomography (CT) in type 2 diabetes mellitus (T2DM) patients, and to assess the relationships of changes in muscle cross-section area (CSA) with glycaemic control. METHODS: Twenty adults (mean age +/- SE: 56.4 +/- 0.9 a) with T2DM participated in a supervised strength training program for 4 months 3 days/week. Muscle and fat areas of the quadriceps muscle were estimated by CT volumetry before and immediately after the training. Glycaemic (HbA1c) and anthropometric (BMI, skinfolds) measurements were assessed at 0 and 4 months, respectively. RESULTS: After strength training, muscle strength increased significantly in all measured muscle groups. Quadriceps size (CSA of the muscle) was increased by 2.4% (from 7.99 +/- 0.3 cm(3) to 8.18 +/- 0.3 cm(3), p = 0.003) for the right extremity, 3.9% (from 8.1 +/- 0.4 cm(3) to 8.41 +/- 0.5 cm(3), p = 0.04) for the left side. Fat tissue CSA reduced from 0.66 +/- 0.1 cm(3) to 0.56 +/- 0.12 cm(3) for the right leg (15.3% reduction) and from 0.58 +/- 0.12 cm(3) to 0.37 +/- 0.13 cm(3) for the left leg (35.8% reduction), resulting in a mean fat CSA reduction of 24.8%. Fat mass assessed by skin folds was significantly reduced and lean body mass was significantly increased. The change in muscle CSA was not correlated with the changes in HbA1c or muscle strength. CONCLUSIONS: Strength training significantly improves both muscle mass and the muscle to fat ratio in T2DM. However, changes in muscle observed with computed tomography were not related to changes observed in HbA1c with training.

The relative benefits of endurance and strength training on the metabolic factors and muscle function of people with type 2 diabetes mellitus.

OBJECTIVE: To compare the effects of a 4-month strength training (ST) versus aerobic endurance training (ET) program on metabolic control, muscle strength, and cardiovascular endurance in subjects with type 2 diabetes mellitus (T2D). DESIGN: Randomized controlled trial. SETTING: Large public tertiary hospital. PARTICIPANTS: Twenty-two T2D participants (11 men, 11 women; mean age +/- standard error, 56.2+/-1.1 y; diabetes duration, 8.8+/-3.5 y) were randomized into a 4-month ST program and 17 T2D participants (9 men, 8 women; mean age, 57.9+/-1.4 y; diabetes duration, 9.2+/-1.7 y) into a 4-month ET program. INTERVENTIONS: ST (up to 6 sets per muscle group per week) and ET (with an intensity of maximal oxygen consumption of 60% and a volume beginning at 15 min and advancing to a maximum of 30 min 3x/wk) for 4 months. MAIN OUTCOME MEASURES: Laboratory tests included determinations of blood glucose, glycosylated hemoglobin (Hb A1c), insulin, and lipid assays. RESULTS: A significant decline in Hb A1c was only observed in the ST group (8.3%+/-1.7% to 7.1%+/-0.2%, P=.001). Blood glucose (204+/-16 mg/dL to 147+/-8 mg/dL, P<.001) and insulin resistance (9.11+/-1.51 to 7.15+/-1.15, P=.04) improved significantly in the ST group, whereas no significant changes were observed in the ET group. Baseline levels of total cholesterol (207+/-8 mg/dL to 184+/-7 mg/dL, P<.001), low-density lipoprotein cholesterol (120+/-8 mg/dL to 106+/-8 mg/dL, P=.001), and triglyceride levels (229+/-25 mg/dL to 150+/-15 mg/dL, P=.001) were significantly reduced and high-density lipoprotein cholesterol (43+/-3 mg/dL to 48+/-2 mg/dL, P=.004) was significantly increased in the ST group; in contrast, no such changes were seen in the ET group. CONCLUSIONS: ST was more effective than ET in improving glycemic control. With the added advantage of an improved lipid profile, we conclude that ST may play an important role in the treatment of T2D.