Skin diseases are more common than we think: screening results of an unreferred population at the Munich Oktoberfest.

BACKGROUND: Skin diseases are ranked as the fourth most common cause of human illness, resulting in an enormous non-fatal burden. Despite this, many affected people do not consult a physician. Accordingly, the actual skin disease burden might be even higher since reported prevalence rates are typically based on secondary data that exclude individuals who do not seek medical care. OBJECTIVE: The aim of the study was to investigate the prevalence of skin diseases in an unreferred population in a real-life setting. METHODS: A cross-sectional study of 9 days duration was performed in 2016 at the 'Bavarian Central Agricultural Festival', which is part of the Munich Oktoberfest. As part of a public health check-up, screening examinations were performed randomly on participating visitors. All participants were 18 years or older and provided written informed consent. RESULTS: A total of 2701 individuals (53.5% women, 46.2% men; mean age 51.9 ± 15.3 years) participated in the study. At least one skin abnormality was observed in 1662 of the participants (64.5%). The most common diagnoses were actinic keratosis (26.6%), rosacea (25.5%) and eczema (11.7%). Skin diseases increased with age and were more frequent in men (72.3%) than in women (58.0%). Clinical examinations showed that nearly two-thirds of the affected participants were unaware of their abnormal skin findings. CONCLUSION: Skin diseases might be more common than previously estimated based on the secondary data of some sub-populations. Further information and awareness campaigns are needed to improve people's knowledge and reduce the global burden associated with skin diseases.

Microcystic adnexal carcinoma (MAC)-like squamous cell carcinoma as a differential diagnosis to Bell´s palsy: review of guidelines for refractory facial nerve palsy.

BACKGROUND: Bell´s palsy is the most common cause of facial paralysis worldwide and the most common disorder of the cranial nerves. It is a diagnosis of exclusion, accounting for 60-75% of all acquired peripheral facial nerve palsies. Our case shows the first case of a microcystic adnexal carcinoma-like squamous cell carcinoma as a cause of facial nerve palsy. CASE PRESENTATION: The patient, a 70-year-old Caucasian male, experienced subsequent functional impairment of the trigeminal and the glossopharyngeal nerve about 1½ years after refractory facial nerve palsy. An extensive clinical work-up and tissue biopsy of the surrounding parotid gland tissue was not able to determine the cause of the paralysis. Primary infiltration of the facial nerve with subsequent spreading to the trigeminal and glossopharyngeal nerve via neuroanastomoses was suspected. After discussing options with the patient, the main stem of the facial nerve was resected to ascertain the diagnosis of MAC-like squamous cell carcinoma, and radiochemotherapy was subsequently started. CONCLUSION: This case report shows that even rare neoplastic etiologies should be considered as a cause of refractory facial nerve palsy and that it is necessary to perform an extended diagnostic work-up to ascertain the diagnosis. This includes high-resolution MRI imaging and, as perilesional parotid biopsies might be inadequate for rare cases like ours, consideration of a direct nerve biopsy to establish the right diagnosis.

Newly acquired kiwi fruit allergy after bone marrow transplantation from a kiwi-allergic donor.

BACKGROUND: The phenomenon of allergy transfer from an allergic donor to a non-allergic recipient via hematopoietic cell transplantation has been described by several reports. However, it could not yet been conclusively shown that allergic reaction of the recipient is elicited by the donor's cells. OBJECTIVES: In the case of a 46-year-old male patient who - for the first time in his life - had two episodes of oral allergic syndrome upon kiwi consumption after having received myeloablative hematopoietic stem cell transplantation (HCT) from his kiwi-allergic sister, we aimed to clarify the origin of allergen reactive cells in the donor. We not only intended to demonstrate if allergy was transferred by HCT but also to present an experimental workup for the analysis of allergy transfer by HCT. METHODS: Allergic sensitization to kiwi in recipient and donor was proven by ImmunoCAP. Furthermore, origin of peripheral blood mononuclear cells (PBMCs) was analyzed by chromosomal fluorescence in situ hybridization (FISH). To confirm allergic reaction and activation of hematopoietic cells by customized kiwi extract, we performed basophil activation test from whole blood as well as T cell proliferation assays from purified PBMCs of both recipient and donor. RESULTS: Basophil activation upon kiwi extract was demonstrated in both recipient and donor. Besides, we showed proliferation of CD4(+) T cells after incubation with kiwi extract. FISH analysis proved that hematopoietic cells of the male recipient completely originated from the female donor. CONCLUSION: Exemplified in this patient, we show for the first time that allergy transfer is mediated by the donor's cells. Moreover, our experimental approach using customized kiwi extract to prove contribution of kiwi-specific T and B cells in both kiwi-allergic recipient and donor could serve as a model approach for future studies.

Intramural hematoma of the aorta: delayed pericardial tamponade.

Intramural hematoma of the aorta is a fatal disorder that remains poorly characterized. Recently, it has been accepted as a variant form of aortic dissection, where blood accumulates within the aortic media without the presence of an intimal tear. Clinically, it may present somewhat similar to dissection, and although optimal therapy remains controversial, current opinion supports surgery as the preferred method of treatment for intramural hematomas that involve the ascending aorta and aortic arch.

Central mechanisms of experimental and chronic neuropathic pain: findings from functional imaging studies.

Over the last few years remarkable efforts have been made using functional imaging studies to unravel brain processing of pain and decipher underlying neuronal mechanisms. Cerebral processing in experimental pain models, especially those provoking hyperalgesia, and its pharmacological modulation will form the first part of this review. In a second part we will address central mechanisms of clinical neuropathic pain. Up to now, there are at least six main mechanisms involved in the chronification of neuropathic pain: (i) activity increase in areas of the pain neuromatrix, (ii) recruitment of additional cortical areas beyond the classical pain neuromatrix, (iii) cortical reorganization and maladaptive neuroplasticity, (iv) alterations in neurochemistry (v) structural brain changes and (vi) disruption of the brain default mode network. In a third part of this review we discuss mechanisms of endogenous pain modulation.

In vivo detection of hepatitis C virus (HCV) RNA in the brain in a case of encephalitis: evidence for HCV neuroinvasion.

We report here a 27-year-old woman who presented with encephalitis of unknown origin. Magnetic resonance imaging (MRI) of the brain revealed leukoencephalopathy, cerebrospinal fluid showed signs of inflammation. Serum and brain biopsy tissue was tested positive for hepatitis C virus (HCV). Neuropathological investigation supported the hypothesis of viral encephalitis. C3, C4 and cryoglobulins as well as cerebral MR-angiography were normal. Neurological complications of HCV infection other than hepatic encephalopathy are generally attributed to parainfectious phenomena. This is the first case of HCV-RNA detection in vivo in human brain in literature and it raises the possibility that HCV is able to induce encephalitis caused by neurotrophism. This is supported by the fact that there is a growing body of literature on HCV-induced cerebral dysfunction and laboratory findings indicating HCV neuroinvasion.

[Retropharyngeal tendinitis. Differential diagnosis in the management of acute neck pain]. / Retropharyngeale Tendinitis. Differenzialdiagnose des akuten Zervikalsyndroms.

Neck pain is frequent and can be a symptom of numerous differential diagnoses with quite different diagnostic and therapeutic consequences. A 37-year-old woman reported acute neck pain aggravated by movements of the cervical spine and head and by swallowing. Clinical examination showed pronounced neck stiffness. T2-weighted MRI demonstrated high-intensity edema and effusion localized prevertebrally in the area of the superior part of the longus colli muscle. Computed tomography of this region demonstrated prevertebral calcification leading to the diagnosis of retropharyngeal tendinitis. Nonsteroidal antiphlogistic drugs led to rapid improvement of clinical signs and symptoms. Retropharyngeal tendinitis should be considered in patients with acute neck pain.

Performance and use of current sheet antennae for RF-hyperthermia of a phantom monitored by 3 tesla MR-thermography.

Several MR-compatible current sheet antennae (CSA) of different height (h) (16 cm (l) x 8 cm (w) x 1-5 cm (h)) were built for simulated RF (96 MHz) hyperthermia of a medium-sized (12l) tissue-equivalent phantom inside a 3 tesla whole body tomograph. Prior to use, efficiencies of the CSA were determined by network analysis and by calorimetry. Depending on the height h of the CSA and on the thickness d(bolus) of the water bolus used for RF-coupling of the CSA to the lossy medium, their efficiency varied between 20-70% and the CSA with h = 3 cm was selected for simulated RF hyperthermia. During heating, spatial temperature distributions (20-42 degrees C) of five slices (voxel size 2 x 2 x 10mm(3)) were recorded intermittently within 4 s/slice by measuring the temperature dependent shift of the (1)H resonance frequency (125.32 MHz). A phased array consisting of two identical CSA produced distinctly different spatial temperature distributions at 0 and 180 degrees phase difference between both RF channels feeding the antennae. Within a one-dimensional heat diffusion model, the specific absorption rate (SAR) of the electromagnetic wave generated by a single antenna was deduced from the experimental data resulting in a penetration depth (1/e(2)) of approximately 4 cm.

[Therapy of active Crohn disease with Boswellia serrata extract H 15]. / Therapie des aktiven Morbus Crohn mit dem Boswellia-serrata-Extrakt H 15.

BACKGROUND: The purpose of this clinical trial was to compare efficacy and safety of the Boswellia serrata extract H15 with mesalazine for the treatment of active Crohn's disease. PATIENTS AND METHODS: Randomised, double-blind, verum-controlled, parallel group comparison for which 102 Patients were randomised. The per protocol population included 44 patients treated with H15 and 39 patients treated with mesalazine. As primary outcome measure the change of the Crohn Disease Activity Index (CDAI) between the status of enrolment and end of therapy was chosen. H 15 was tested on non-inferiority compared to standard treatment with mesalazine. RESULTS: The CDAI between the status of enrolment and end of therapy after treatment with H15 was reduced by 90 and after therapy with mesalazine by 53 scores in the mean. In this non-inferiority-trial the test hypothesis was confirmed by the statistical analysis. The difference between both treatments could not be proven to be statistically significant in favor to H15 for the primary outcome measure. The secondary efficacy endpoints confirm the assessment of the comparison of H15 and mesalazine. The proven tolerability of H15 completes the results of the shown clinical efficacy. CONCLUSIONS: The study confirms that therapy with H15 is not inferior to mesalazine. This can be interpreted as evidence for the efficacy of H15 according to the state of art in the treatment of active Crohn's disease with Boswellia serrata extract, since the efficacy of mesalazine for this indication has been approved by the health authorities. Considering both safety and efficacy of Boswellia serrata extract H15 it appears to be superior over mesalazine in terms of a benefit-risk-evaluation.

Coronary and carotid operations under prospective standardized conditions: incidence and outcome.

BACKGROUND: No randomized trial has yet evaluated the hypothetical benefit of carotid endarterectomy with coronary artery bypass grafting. This prospective review was undertaken to determine the differences between observed and predicted complication rates, as well as to define new predictors and assess costs in a standardized population. METHODS: A prospective nonrandomized study was undertaken over a 4-year period involving all coronary artery bypass graftings done at one institution. Operative procedure was standardized. All patients underwent preoperative screening for carotid disease. If 80% or more stenosis was present, combined coronary artery bypass grafting and carotid endarterectomy was performed. RESULTS: Of 2,071 patients, 1,987 had coronary artery bypass grafting only. In that group there were 34 strokes (1.7%) and 41 deaths (2.0%). Eighty-four patients underwent combined coronary artery bypass grafting/carotid endarterectomy and in that group there were four strokes (4.7%) and five deaths (5.9%). Independent risk factors for postoperative stroke were age (odds ratio 1.09; 95% confidence interval 1.04, 1.3), hypertension (odds ratio 2.67; 95% confidence interval 1.22, 5.23), extensively calcified aorta (odds ratio 2.82; 95% confidence interval 1.34, 5.97), and bypass time (odds ratio 1.01; 95% confidence interval 1.00, 1.02). Cost of a stroke was significant (p < 0.05) in both groups. CONCLUSIONS: Patients with carotid disease fall into a higher risk group than patients without it. This increased risk is not because of carotid disease alone. Patients without significant carotid disease, who suffered a perioperative stroke, fell into an even higher risk category. Furthermore, carotid endarterectomy was not a significant risk factor by either the univariate or the multivariate analysis.

Cell cycle effects of thaliblastine.

The non-myelotoxic antitumor drug thaliblastine (thalicarpine, NSC-68075, CAS-5373-42-21) has a novel chemical structure; it is a complex dimeric-type aporphine benzylisoquinoline alkaloid possessing antiproliferative and antitumor activities in experimental and clinical studies. In this study the effect of this drug on the cell cycle progression of ovarian tumor line O-342 and its cisplatin-resistant subline O-342/DDP was evaluated. As assessed by flow cytometric analysis, thaliblastine affected the cell cycle progression. In both lines, a comparable pattern of cell cycle arrest was found. Within the first 5 h of thaliblastine exposure, a G2/M block was observed; thereafter cell-cycle arrest in G1 became prominent, while S-phase cells finished DNA replication.

Initial clinical experience with rectus sheath grafts in congenital heart defects.

This study reports on the initial clinical experience using anterior rectus sheath as potentially growing graft material in congenital heart lesions. The first seven patients with complex congenital lesions requiring a rectus sheath graft because of inadequate available pericardium are reviewed. The initial operations were: TOF (unicusp pulmonary valve) (re-op), two Konno procedures (one VSD and one RV patch), two arterial switch procedures for TGA (neoaortic augmentation), two Fontan (re-op) atrial augmentation patch and pulmonary arterioplasty (re-op). Ages ranged from 1 week to 15 years. Follow-up ranged from 1 to 72 months and included open visual inspection at reoperation in 5 cases, angiography in 3 cases, and echocardiography in 4 cases. One early respiratory death occurred in the fourth postoperative week. So far no early bleeding from rectus sheath patches, infection, aneurysmal dilatation, or scar contraction was observed. No manifestation of peripheral emboli was seen. Hernias of the harvest site were absent. We concluded that in absence of pericardium and in areas where future cicatrization or aneurysmal dilatation is undesirable, anterior rectus sheath appears to be a reasonable alternative.

Autologous whole plasma fibrin gel. Intraoperative procurement.

Fibrin glue is a relatively recent addition to the armamentarium of hemostatic agents for surgical use. Its efficacy has been repeatedly demonstrated in almost all surgical disciplines and subspecialties. Its use in the United States has been limited because of the risk of viral transmission associated with the use of human plasma. Previous authors have described techniques that limit this risk, but they are frequently impractical, expensive, or cumbersome. We describe the use of patients' own fresh plasma to make fibrin gel at the operative field. It provided hemostasis at least as good as that from heterologous plasma glue in 40 cardiac surgical patients. Autologous whole plasma fibrin gel is inexpensive and safe and eliminates the risk of viral transmission associated with glue derived from heterologous donor plasma.

Ventricular reconstruction with vascular prosthesis after aneurysmectomy. Ability to defibrillate and utilize the automatic internal cardioverter defibrillator.

Adjunct surgical procedures for patients with malignant ventricular tachyarrhythmias who require the automatic internal cardioverter defibrillator include aortocoronary artery bypass graft surgery, valvular repair or replacement, subendocardial resection, and aneurysmectomy. Ventricular reconstruction and its compatibility with the AICD are described in a 64-year-old man who required treatment of refractory ventricular tachycardia as well as resection of a large anteroapical aneurysm. Reconstruction using a dacron patch preserved left ventricular geometry but did not adversely affect the ability to defibrillate and allowed successful utilization of the automatic defibrillator.

Sensing aberration by the automatic implantable cardioverter defibrillator during intraoperative testing.

A 50-year-old man underwent replacement of his automatic implantable cardioverter defibrillator (AICD) because a magnet test revealed severe battery depletion. He had had his unit implanted 18 months previously after an episode of sudden cardiac death. He had documented torsades de pointes and inducible ventricular tachycardia, confirmed by electrophysiologic study. Before a new unit was implanted thresholds were measured by an external cardioverter defibrillator. Ventricular fibrillation (VF) was induced by alternating current through a standard, line-operated battery charger with stimulation delivered to the epicardium via rate-sensing electrodes. VF was allowed to continue for 10 seconds before shock was delivered. Termination of VF required 15 joules, which was higher than that required at initial implantation 18 months earlier. The new pulse generator was activated for testing and VF was again induced. The AICD discharged after 12.3 seconds. Prior to wound closing, the AICD was deactivated by magnet. Instead of R-wave synchronous beeping tones during deactivation, double beeping tones were heard. Electrogram recordings revealed abnormalities of the T-wave and ST segment of the rate-sensing electrodes, which were the cause of the tone irregularities. Stabilization of the T-wave and ST segment occurred within 8 minutes and the tones became normal. The procedure was then completed.