[A rare case of birenal malacoplakia with renal failure]. / Seltener Fall einer birenalen Malakoplakie mit Nierenversagen.

HISTORY AND ADMISSION FINDINGS: A 45 year old man was admitted to our hospital because of fever, loss of appetite, and deterioration of general health. For two weeks the patient suffered from diarrhea which had resulted in moderate volume depletion. In addition, he complained of bilateral flank pain at the time of admission. Furthermore, the patient had a history of heavily drinking alcohol as well as cigarette smoking for many years. He had never attended a medical doctor before. INVESTIGATIONS: The patient presented with the clinical picture of acute renal failure and urosepticaemia which was caused by Escherichia coli. The kidneys were found to be at the upper limit of normal by sonography. Magnetic resonance imaging revealed signal-alterations in both kidneys with hyper- and hypointense zones in the renal parenchyma. DIAGNOSIS: To clarify the cause of rapid deterioration of renal function, we performed a renal biopsy. The histology of the renal specimen revealed an unusual type acute bacterial interstitial nephritis most likely due to an infection with E. coli. The clinical picture, the laboratory findings and renal histology, lead to the diagnosis of birenal malakoplakia. TREATMENT AND COURSE: After intravenous and subsequent oral antibiotic therapy the fever and the clinical signs of urosepticaemia subsided and renal function gradually improved. Antibiotic therapy and supplementation with vitamins were continued for 20 weeks. Five years after initial diagnosis, renal function was stable at a glomerular filtration rate of approximately 45 ml/min. CONCLUSIONS: Malakoplakia of the kidney is a rare form of bacterial interstitial nephritis and requires long-term antibiotic therapy.

[Does acupuncture influence the cardiac autonomic nervous system in patients with minor depression or anxiety disorders?]. / Beeinflusst Akupunktur die autonom kardiale Regulation bei Patienten mit leichten depressiven Episoden oder Angststörungen? Eine randomisierte, plazebokontrollierte Verlaufsstudie.

We undertook this study to evaluate the effects of needle acupuncture on cardiac autonomic nervous system (ANS) function in patients with minor depression or anxiety disorder. Patients (n = 36) were randomly distributed into a verum acupuncture (VA) group (needles were applied at classical acupuncture points, e. g. He7, Pe6, Du20, Bl62, Ex6) or a placebo (PL) group (needles were applied only epidermal at non-acupuncture points). Both groups underwent standardized measurements of the 5-minute resting heart rate variability (HRV), which were performed before the first and after the 9th acupuncture session of an acupuncture series, and also three times (before the start and 5, respectively, 15 minutes after needle application) during the third acupuncture session. Demographic data between the VA and PL group did not differ. Before the start of acupuncture there were also no significant differences in HRV data between these groups. Compared to PL the VA group showed a significant decrease of the mean resting heart rate both, 5 and 15 minutes after needle application, combined with a trend towards an increase of the high frequency (HF; 0.15 - 0.4 Hz) and a decrease of the low frequency (LF; 0.04 - 0.15 Hz) spectral power. The latter effects resulted in an overall significant decrease of the mean LF/HF ratio in VA compared to PL treated patients. This pattern of findings suggests that in patients with minor depression or anxiety only verum acupuncture 1.) leads to a relative increase of cardiovagal modulation of heart rate and 2.) facilitates the physiological regulatory ANS function in response to alterations of external or internal environment. Clinical implications of these findings are discussed.

[Treatment of perioperative anxiety in suspected breast carcinoma with a phytogenic tranquilizer]. / Zur Behandlung perioperativer Angste bei Mammakarzinomverdacht mit einem Phytotranquilizer.

OBJECTIVE: The present study examined the anxiolytic effect of the herbal preparation Kavosporal forte in 20 patients with situationally induced anxiety. MATERIAL AND METHODS: The degree of anxiety was acute in that the patients were waiting for the results of a histopathological diagnosis, carried out on account of suspect mammary findings, and therefore feared they were suffering from a mammary carcinoma. RESULTS: A significant reduction of anxiety compared with the placebo control was seen after a week's treatment with Kavosporal forte, levels of anxiety being measured a priori from the combined scores of two self-rating scales and one observer-rated scale. In addition, a significant increase was noted in alertness and a lessening of fatigue, introverted behavior and excitability as well as a reduction in levels of depression under the real therapeutic agent over the observation period. In none of the cases examined did any undesirable side effects occur, and the overall tolerance was also consistently good. CONCLUSIONS: It could therefore be concluded that the preparation under investigation is well suited of amelioration of the anxiety that arises regularly in connection with a mammary biopsy.

[Acupuncture in patients with minor depressive episodes and generalized anxiety. Results of an experimental study]. / Akupunktur bei leichten bis mittelschweren depressiven Episoden und Angststörungen. Ergebnisse einer experimentellen Untersuchung.

In a placebo-controlled, randomized, modified double-blind study we investigated the effects of body needle acupuncture (n = 10) in 43 patients with minor depression (ICD 10 F32.0, F32.1) and 13 patients with generalized anxiety disorders (ICD10 F41.1). The severity of the disease was assessed by the Clinical Global Impression Scale (CGI). Treatment response was defined as a significant improvement in CGI. An intent-to-treat analysis was performed to compare treatment responses between verum- and placebo acupuncture. After completing an total of 10 acupuncture sessions the verum acupuncture group (n = 28) showed a significantly larger clinical improvement compared to the placebo group (Mann-Whitney test, p < 0.05). There were significantly more responders in the verum-compared to the placebo group (60.7% vs. 21.4%; chi-square test, p < 0.01). In contrast, no differences in the response rates were evident just after 5 acupuncture sessions. A multivariate analysis with the independent factor acupuncture (verum vs. placebo) and the results of the results of the additional rating scales (total score of HAMA, HAMD, Bf-S, BL) as dependent variables (ANOVA, 1:54 D.F.) revealed a clear trend towards lower HAMA scores in the verum group after completing 10 acupunctures (F3.29, p = 0.075). This corresponds well to the high response rate of 85.7% in patients with generalized anxiety disorders, in whom verum acupuncture was applied. Our results indicate that needle acupuncture (Du.20, Ex.6, He.7, Pe.6, Bl.62) leads to a significant clinical improvement as well as to a remarkable reduction in anxiety symptoms in patients with minor depression or with generalized anxiety disorders. The total sum of acupuncture sessions and the specific location of acupuncture needle insertions might be important factors for bringing about therapeutic success.

Efficacy of a special Kava extract (Piper methysticum) in patients with states of anxiety, tension and excitedness of non-mental origin - A double-blind placebo-controlled study of four weeks treatment.

In a randomized, placebo-controlled double-blind study two groups of 29 patients each with anxiety syndromes not caused by mental disorders were treated for four weeks with three daily doses of 100 mg of Kava extract WS 1490 (Laitan®) from Piper methysticum rhizoma or a placebo preparation. Therapeutic efficacy was assessed by the Hamilton Anxiety Scale (main outcome variable), the Adjectives Check List and the Clinical Global Impression Scale (secondary target variables) after 1, 2, and 4 weeks of treatment. The HAMA overall score of anxiety symptomatology revealed a significant reduction in the drug group compared with the placebo group after one week of treatment. The difference between the two groups of patients increased during the course of the study. The results of the secondary target variables were in agreement with the HAMA score and demonstrated the efficacy of WS 1490 in patients with anxiety disorders. No adverse reactions caused by the medication were noted during the four weeks WS 1490 was administered.

The influence of thioctic acid on metabolism and function of the diabetic heart.

Streptozotocin-diabetes as a model for insulin-deficient Type 1 diabetes leads to cardiomyopathy, characterized by a 50% reduced glucose uptake (P < 0.001) and increased lactate and pyruvate levels (P < 0.001), i.e. a reduced glucose utilization by the heart. As thioctic acid (TA) has favourable effects on glucose metabolism, the influence of this drug at two different doses (0.1 mg/ml and 0.5 mg/ml, added to the perfusion medium) was investigated in the heart after 2 weeks of diabetes, using the working rat heart model at physiological workload about 45 min. TA at high doses led to a normalization of glucose uptake (P < 0.001) and glucose utilization, and consequently to a normalization of oxygen uptake (P < 0.001), myocardial ATP levels (P < 0.001) as well as cardiac output (P < 0.05). Whereas a low dose of TA resulted in a normalization of lactate and pyruvate production (P < 0.001), neither a normalization of glucose utilization nor of cardiac output was achieved by this low dosage. Additionally, TA improved at both doses utilization of endogenous glycogen in the diabetic heart (P < 0.001), the latter here already delivering 45% of the utilized glucose. TA acts especially by increasing glucose uptake, glycogen breakdown and glucose oxidation. Thus, metabolic and hemodynamic sequelae of insulin-deficiency in the heart can be corrected by TA. Due to its anti-diabetic effects on cardiac metabolism, TA could be considered an adjuvant therapy in diabetic cardiomyopathy.

[Effect of a special kava extract in patients with anxiety-, tension-, and excitation states of non-psychotic genesis. Double blind study with placebos over 4 weeks]. / Wirksamkeit eines Kava-Spezial-Extraktes bei Patienten mit Angst-, Spannungs-, und Erregungszuständen nicht-psychotischer Genese. Doppelblind-Studie gegen Plazebo über 4 Wochen.

Clinical Efficacy of a Kava Extract in Patients with Anxiety Syndrome/Double-blind placebo controlled study over 4 weeks. In a randomized, placebo-controlled double-blind study two groups each containing 29 patients with anxiety syndrome not caused by psychotic disorders were treated for a period of 4 weeks with kava extract WS 1490 (Laitan) 3 x 100 mg/day or a placebo preparation. Therapeutic efficacy was assessed by the Hamilton-Anxiety-Scale (main target variable), the Adjectives-List and the Clinical-Global-Impression-Scale (secondary target variables) after 1, 2 and 4 weeks of treatment. The HAMA overall score of anxiety symptomatology revealed a significant reduction in the drug receiving group already after one week of treatment. This difference between the two groups of patients increased in the course of the study. The results of the secondary target variables were in agreement with the HAMA-score and demonstrate the efficacy of WS 1490 in patients with anxiety disorders. No adverse experiences caused by the medication were noted during the 4 week administration of WS 1490.

In situ hybridization demonstrates vasopressin gene transcription in hypothalamic neurons of crossbred hypertensive x diabetes insipidus rats.

In situ hybridization, Northern blotting, and solution hybridization assay were used to examine vasopressin-gene messenger ribonucleic acid (mRNA) transcripts in hypothalamic tissue from five strains of rats: Long-Evans, Wistar-Kyoto, and diabetes insipidus (Brattleboro) rats, spontaneously hypertensive-stroke-prone rats, and cross-bred diabetes insipidus x spontaneously hypertensive-stroke-prone rats. A 290 base-pair, single-stranded RNA probe, with 221 bases complementary to exon C of the vasopressin gene was synthesized by the SP6 transcription vector system. This probe labeled appropriate neurohypophysial hypothalamic neurons, as well as suprachiasmatic nucleus cells, in tissue samples from all five strains of rats. Confirming other recent hybridization results with diabetes insipidus rat brain tissue, diabetic animals were found to transcribe their mutated vasopressin gene. In addition, this investigation found that the cross-bred diabetic-hypertensive rat also synthesizes a vasopressin-gene messenger ribonucleic acid transcript. Quantitative analyses of solution and in situ hybridization results suggested the cross-bred diabetic-hypertensive rat exhibits a level of vasopressin-gene messenger ribonucleic acid similar to diabetes insipidus rats. This observation is consistent with previous data on the cross-bred diabetic-hypertensive rat which suggests they inherit the mutant vasopressin gene from Brattleboro rats.

[Alternative therapy concept for the treatment of psychosomatic disorders. Controlled double-blind evaluation of fluspirilene versus bromazepam]. / Alternatives Therapiekonzept zur Behandlung psychosomatischer Beschwerden. Kontrollierte Doppelblind-Prüfung von Fluspirilen versus Bromazepam.

Today, Fluspirilene 1.5 mg i.m. (Imap 1,5 mg), is used to treat psychosomatic conditions, anxiety states and psychogenic disorders. The present article reports on clinical studies involving these indications. The efficacy of Fluspirilene 1.5 mg i.m. was demonstrated in patients with functional organic complaints, autonomic emotional symptom complexes, patients with anxiety, patients with functional heart complaints, and patients with functional gynaecological disorders. The results of a controlled study of 1.5 mg Fluspirilene i.m. and 6 mg Bromazepam are discussed. Forty-five patients from a neurologist's practice participated, all of whom had been classified as treatment-requiring patients with neurotic anxiety, on the basis of the physician's diagnosis and psychometric examination. Treatment lasted 42 days. The clinical assessment by the physician revealed that 1.5 mg Fluspirilene i.m. is significantly more effective than Bromazepam. The psychometric findings showed that patients with marked somatic anxiety treated with Fluspirilene showed greater improvement as expressed in a reduction in anxiety, lightening of mood, and increased activity, as compared with Bromazepam.

Polyunsaturation of subcutaneous fat and concentration of serum lipids of Israeli Beduin Arabs.

In 55 Israeli Beduin Arabs the ratio of polyunsaturated to saturated fatty acids in subcutaneous fat (which reflects the degree of unsaturation of dietary fat) and serum cholesterol and triglyceride concentrations were all significantly lower in men and women leading the typical seminomadic Beduin life than in men doing western-type work and in housewives of a fixed Beduin settlement. The values were 0.76, and 159 and 72 mg/dl, respectively, compared with 0.93, 187 and 108; P less than 0.001, less than 0.01 and less than 0.02, respectively. In the group as a whole there was a paradoxically positive correlation between P/S ratio and cholesterol (r = 0.37, Pr = 0.025) and P/S ratio and triglycerides (r = 0.46, Pr less than 0.01). The expected cholesterol-lowering effect of the polyunsaturated Israeli diet (P/S ratio about 1.0) was apparently swamped by other factors, dietary and/or non-dietary, involved in acculturation to a western life style of Beduin, among whom coronary heart disease has only recently begun to appear.