[Confusion, tachypnea, and tachycardia in a 71-year-old man with type 2 diabetes mellitus]. / Bewusstseinsstörung, Tachypnoe und Tachykardie bei einem 71-jährigen Patienten mit Diabetes mellitus Typ 2.

Patients with type 2 diabetes who present with confusion and/or abdominal pains should be screened for sodium-glucose cotransporter 2 (SGLT-2)-induced diabetic ketoacidosis. Severe acidosis was diagnosed despite only moderately increased blood sugar levels. If so, immediate ICU treatment is essential.

What is the preferred concentration of ethanolamine oleate for sclerotherapy of oral vascular anomalies?

BACKGROUND: This study compared three different concentrations of EO (1.25%, 2.5% and 5%) for the treatment of oral vascular anomalies (OVAs). MATERIAL AND METHODS: This was a retrospective comparative analysis of patients with OVAs treated with EO. Anomalies smaller than 20 mm were included. The patients were treated with 1.25% (G1), 2.5% (G2), and 5% (G3) and clinical data were obtained. The number of sessions, the final volume and dose of EO were statistically analyzed to verify effectiveness and safety of the treatment. The different concentrations of EO were compared considering the number of sessions, the final volume and total dose of EO. Analysis of covariance (ANCOVA) was used to evaluate the influence of covariates on the outcomes. A p-value < 0.05 was considered significant. RESULTS: Nineteen women and 11 men with a median age of 54 years were included. The OVAs were most frequent in the lip (n=14) and cheek (n=9). All lesions exhibited complete clinical healing within 28 days. Patients of G3 required fewer sessions than those of G2 (p=0.017), a lower final volume compared to the other groups (p<0.001), and a lower total dose than G1 (p<0.001). Patients of G1 used a lower total dose than G2 (p=0.003). CONCLUSIONS: The concentration of 5% EO performed better than 1.25% and 2.5% for sclerotherapy of OVAs measuring up to 20 mm. This preliminary result should be the preferred concentration of EO to provide an effective and safe treatment of OVAs.

[Procalcitonin in the intensive care unit : Differential diagnostic and differential therapeutic possibilities]. / Prokalzitonin auf der Intensivstation : Differenzialdiagnose und Differenzialtherapie.

Procalcitonin (PCT) is formed in IL6-mediated, IL8-mediated, and TNFα-mediated systemic inflammation conditions, in multiple organs and structures of the body. In patients with sepsis, significantly increased PCT levels are found. The PCT levels are highly correlated with the severity of the illness, and decreased PCT levels under therapy correlates with a better prognosis. In the differential diagnosis, measuring the PCT level helps differentiate between bacterial and viral infections. Noninfectious inflammatory reactions can, however, show moderately increased PCT levels. Cut-off values depend on renal and hepatic function. A therapeutic algorithm using PCT levels could be used for determining duration of a course of antibiotics, which can reduce antibiotic usage. In this paper, the differential diagnostic and differential therapeutic possibilities of PCT levels for critically ill patients are discussed.

Effectiveness and safety of foam sclerotherapy with 5% ethanolamine oleate in the treatment of low-flow venous malformations in the head and neck region: a case series.

The aim of this study was to evaluate the effectiveness and safety of 5% ethanolamine oleate (EO) foam in the treatment of low-flow venous malformations in the head and neck region. Seventeen consecutive patients (six male, 11 female) and 34 low-flow venous malformations were enrolled. The vascular anomalies ranged between 20mm and 80mm in size. The typical clinical indication was a swelling (88.2%) with a purple colour (85.3%); the most frequent location was the tongue (23.5%). Ethanolamine oleate foam was produced via the Tessari method and applied at 10mg per 1cm to the vascular anomalies. This process resulted in the highest clinical healing score in 64.7% of cases, and half of the patients reported a high level of satisfaction (score >9). In the majority of cases (88.2%), the patients reported that the pain immediately postoperative was mild or moderate. There were direct relationships between vascular anomaly size and the volume of EO applied, the number of sessions, and healing (P<0.05). No recurrence was observed during 6 months of follow-up. This case series showed the effectiveness and safety of 5% EO foam for the treatment of venous malformations in the head and neck region.

The role of toxicokinetics in xylene-induced ototoxicity in the rat and guinea pig.

In the rat, some aromatic solvents cause a high level of ototoxicity that is characterized by damage to outer hair cells in the cochlea, which results in irreversible hearing loss. However, there is a vast difference in their potency. Among the three isomers of xylene, only para-xylene has been shown to be ototoxic in the rat. Moreover, all the species do not show the same susceptibility to ototoxic solvents, the rat being the most susceptible and the guinea pig seeming resistant to this ototoxic effect. The objective of the study was to determine whether toxicokinetic factors could explain the differences in ototoxicity observed among the three isomers of xylene in the rat and the species-dependent ototoxicity in the rat and the guinea pig. Blood and brain concentrations of each isomer were monitored in Sprague-Dawley rats treated orally by gastric intubation with a single dose or a 10 day-repeated treatment of 8.47 mmol/kg (an ototoxic dosage for para-xylene) of each isomer. Moreover, histology of the cochlea was carried out and the toxicokinetics of meta-xylene was monitored in rats treated with a single dose or a 10 day-repeated treatment of 16.94 mmol/kg meta-xylene, a non-ototoxic isomer. Similarly, histology of the cochlea was carried out and the toxicokinetics of para-xylene was followed in guinea pigs treated by gavage with a single dose or a 10 day-repeated treatment of 8.47 mmol/kg para-xylene. Finally, the blood and brain concentrations of para-xylene were measured in both the rats and the guinea pigs after a 4-h exposure to 1800 ppm of para-xylene. Among the three isomers studied, para-xylene yielded the highest blood and brain concentrations in the acutely and repeatedly exposed rats. When given a high dosage of meta-xylene (16.94 mmol/kg), the rats showed blood and brain concentrations of meta-xylene in the same order as those obtained with 8.47 mmol/kg para-xylene, but no outer hair cell loss was observed. No outer hair cell loss was observed in the guinea pigs treated with para-xylene. Whatever the exposure pattern, the blood and brain concentrations of para-xylene in the rats were 3.1-9.5 times higher than those measured in the guinea pigs. These results indicate that toxicokinetic factors cannot explain the differences in ototoxicity observed with the three isomers in the rat. However, they suggest that the differences in susceptibility to para-xylene observed between the rats and the guinea pigs might be due to toxicokinetic factors.

Different transcriptional activity and in vitro TNF-alpha production in psoriasis patients carrying the TNF-alpha 238A promoter polymorphism.

Genes encoded on chromosome 6 within the major histocompatibility complex region are thought to play an important role in the pathogenesis of psoriasis. A potential candidate gene is tumor necrosis factor alpha. The tumor necrosis factor alpha promoter contains several polymorphisms including two G-->A transitions at position -308 and -238, which are the most common in Caucasian populations. The TNF238.2 (-238A) allele has been strongly associated with psoriasis. We have investigated the effect of the -238 and -308 variants on transcription of the tumor necrosis factor alpha gene in luciferase reporter gene assays. In addition, peripheral blood mononuclear cells of 47 patients with psoriasis and 43 controls were stimulated with different antigens and mitogens (streptococcal sonicate and superantigen, lipopolysaccharide, phorbol-12-myristate, phytohemagglutinin, CD3 antibodies) and tumor necrosis factor alpha production was measured in supernatants by enzyme-linked immunosorbent assay. The psoriasis-associated tumor necrosis factor alpha promoter allele TNF238.2 showed a significantly decreased transcriptional activity. Peripheral blood mononuclear cells carrying this allele produced significantly less tumor necrosis factor alpha after stimulation with T cell mitogens and streptococcal antigens in comparison to controls. The promoter allele TNF238.2 seems to influence tumor necrosis factor alpha production; a possible role in the pathogenesis of psoriasis has to be further evaluated.

Epidemiology of anorexia nervosa in a defined region of Switzerland.

The authors conducted a retrospective study of the incidence of anorexia nervosa in the industrialized canton of Zurich, Switzerland, during three randomly selected sampling periods from 1956 to 1975. The data were derived from case histories from nearly all medical, pediatric, and psychiatric clinics in this region. The incidence of anorexia nervosa increased significantly, from .38/100,000 for 1956-1958 to .55/100,000 for 1963-1965 to 1.12/100,000 for 1973-1975. This increase was not due to the fact that nowadays anorectic patients are hospitalized earlier or that they are hospitalized for less severe illness.

Maxwell's Demon at work: Two types of Bose condensate fluctuations in power-law traps.

After discussing the idea underlying the Maxwell's Demon ensemble, we employ this ensemble for calculating fluctuations of ideal Bose gas condensates in traps with power-law single-particle energy spectra. Two essentially different cases have to be distinguished. If the heat capacity is continuous at the condensation point, the fluctuations of the number of condensate particles vanish linearly with temperature, independent of the trap characteristics. In this case, microcanonical and canonical fluctuations are practically indistinguishable. If the heat capacity is discontinuous, the fluctuations vanish algebraically with temperature, with an exponent determined by the trap, and the micro-canonical fluctuations are lower than their canonical counterparts.

Dementia in rural primary care practices in Lake County, Oregon.

Procedures used in assessing patients with dementia in rural settings are little studied. Among all patients aged 65 years and older in the four primary care practices in Lake County, Oregon, dementia cases were identified from computerized office databases using preselected International Classification of Diseases, Ninth Edition, codes. A semi-structured chart review determined (1) a dementia diagnosis, (2) cognitive and functional domains assessed, and (3) diagnostic studies performed. Of 1540 available records, 30 had dementia. Nineteen of them met National Institute of Neurological and Communicative Diseases and Stroke-Alzheimer's Disease and Related Disorders Association criteria for Alzheimer's disease (AD). Cognitive impairment was documented in 73% of the 51 identified charts and all with AD. Laboratory studies were recorded in 33% overall and in 42% with AD. Neuroimaging was documented in 18% overall and in 16% with AD. The prevalence of documented dementia in these rural practices may be low, possibly because cases of mild dementia may not be labeled as such. Laboratory studies were performed in a minority of cases of dementia.

Scaling hypothesis leading to extended self-similarity in turbulence.

A scaling hypothesis leading to extended self-similarity (ESS) for structure functions (the qth order moments of the magnitude of the longitudinal component velocity differences) in isotropic, homogeneous turbulence is proposed. This is done by generalizing the scale variable r to rg(r/L), with a crossover function g. By extending the refined self-similarity, it is shown that the presented scaling also leads to ESS for structure functions of the energy dissipation rate fluctuations, and to ESS bridging relations between velocity and dissipation rate moments. Extended self-similarity on the basis of a universal crossover function g strictly holds toward the outer scale (L) range only. Yet we find at least approximate ESS toward the viscous, inner scale (l) range. Furthermore, the probability densities for the velocity differences and the energy dissipation rate fluctuations which are compatible with this ESS are offered.

Postradiation pleomorphic malignant fibrous histiocytoma of the breast.

A case of primary malignant fibrous histiocytoma (MFH) of the breast occurring two years after surgical excision and radiation therapy for a carcinoma of the left breast is reported. Fine needle aspiration was positive for malignant cells, consistent with a pleomorphic sarcoma. Cytologic examination revealed giant cells with marked pleomorphism. Some cells showed single large nuclei with cytoplasmic vacuoles while others revealed multinucleation with foamy cytoplasm, phagocytosed erythrocytes and cellular debris. These findings are considered useful in the cytologic diagnosis of the pleomorphic variant of MFH.

Test-retest reliability of psychological and neurobehavioral tests self-administered by computer.

A series of 12 psychological and 7 neurobehavioral performance tests were administered twice to a nonclinical normative sample with 1 week between administrations. The tests were presented in a self-administered computerized format. One week test-retest reliabilities were comparable to conventional administration formats. The results suggest that individual test reliability is not affected when tests are administered as part of an extensive multi-measure battery. Computer administered test reliability coefficients also were compared to a Mixed Format (computer-conventional) administration with mixed format reliabilities generally similar to the reliabilities of published conventional tests but also generally lower than same format testing. Compared to psychological test reliability, neurobehavioral test reliability appeared more vulnerable to decreases with mixed format testing. These conclusions should not be generalized to all computer implemented tests as the qualities of the test implementation will affect the outcome.

[After-care in surgical replacement of the ligaments of the knee joint]. / Nachbehandlung bei operativem Bandersatz am Kniegelenk.

Reconstructive surgery of ligamentous injuries of the Knee Joint is often associated with a considerable impairment of its integrity and requires a high standard of surgical technique. The postoperative course, aiming towards normal function, is demanding and bound to biomechanical and biological principles. It therefore has to be built up gradually and lasts basically 12 months - with an individual variety. Up to the 6th postoperative week the healing process is in the foreground. During the second phase, up to the 12th week careful rehabilitation is aimed to improve muscle strength, increase weight bearing and optimize mobility. In the third phase, from the 12th week on, the patient regains full strength, range of motion as well as coordination, and an integrated sport rehabilitation is started.