[Primary cutaneous cryptococcosis : Pigeons can carry more than letters !] / Primär kutane Kryptokokkose : Tauben können mehr als Briefe transportieren !

In the event of non-specific epidermal lesions, the importance of a comprehensive anamnesis becomes especially apparent. In the following, we report on a patient case in which only a focused anamnesis was able to bring light into the darkness of numerous differential diagnoses - and to produce the diagnosis of a rare but in this collective common illness: primary cutaneous cryptococcosis.

Corrected confidence bands for functional data using principal components.

Functional principal components (FPC) analysis is widely used to decompose and express functional observations. Curve estimates implicitly condition on basis functions and other quantities derived from FPC decompositions; however these objects are unknown in practice. In this article, we propose a method for obtaining correct curve estimates by accounting for uncertainty in FPC decompositions. Additionally, pointwise and simultaneous confidence intervals that account for both model- and decomposition-based variability are constructed. Standard mixed model representations of functional expansions are used to construct curve estimates and variances conditional on a specific decomposition. Iterated expectation and variance formulas combine model-based conditional estimates across the distribution of decompositions. A bootstrap procedure is implemented to understand the uncertainty in principal component decomposition quantities. Our method compares favorably to competing approaches in simulation studies that include both densely and sparsely observed functions. We apply our method to sparse observations of CD4 cell counts and to dense white-matter tract profiles. Code for the analyses and simulations is publicly available, and our method is implemented in the R package refund on CRAN.

[Peutz-Jeghers syndrome : not only a polyposis!]. / Peutz-Jeghers-Syndrom : Nicht immer nur eine Polyposis!

The clinical signs of the Peutz-Jeghers syndrome are often overlooked in daily clinical practice. Early diagnosis is enormously relevant for the patient's outcome. Therefore, it is very important not only to think of the well-known manifestation of the gastrointestinal polyposis but also to consider the various other processes which can influence the prognosis remarkably as for instance ovarian and testicular tumors when a mutation of the serine-threonine kinase gene STK11 (chromosome 19p13.3) is present.

Mortality due to myocardial infarction in the Bavarian population during World Cup Soccer 2006.

BACKGROUND: Previously, we had demonstrated that the World Cup Soccer 2006 provoked levels of emotional stress sufficient to increase the incidence of acute cardiovascular events. We sought to assess whether mortality was also increased as a result. METHOD: We analyzed daily data on mortality due to myocardial infarction (MI) and total mortality using data from the Bavarian State Office for Statistics. We retrospectively assessed study periods from 2006, 2005 and 2003. Quasi-Poisson regression with a log link to model the number of daily deaths was used. To be able to account for a possible delay, we also fitted a cubic distributed lag quasi-Poisson model for both 1 and 2 weeks post-exposure. RESULTS: A total of 6,699 deaths due to MI were investigated. No increase in death was found on days of World Cup matches either with or without German participation compared to the matched control periods. In addition, none of the analyses showed a significant effect of the (lagged) exposure to the risk period. Likewise, total mortality rates remained unchanged over the entire period of our analysis. CONCLUSION: During World Cup Soccer, the number of deaths due to myocardial infarction was not measurably increased compared to a matched control period. Thus, we could not demonstrate a translation of a stress-induced increase of cardiac morbidity into a noticeable increase in mortality. However, our findings are based on a public mortality registry, which may be flawed in many ways, regarding ascertainment of causes of death, in particular.

Pulsatile secretion of alpha-MSH and the differential effects of dexamethasone and haloperidol on the secretion of alpha-MSH and ACTH in dogs.

This study was performed to determine whether, in the dog, there is at any time pulsatile release of alpha-MSH and whether secretion of ACTH from the pars intermedia (PI) contributes to the circulating concentrations of ACTH. The 24-h secretory profiles of alpha-MSH, ACTH, and cortisol were determined in eight dogs. Plasma samples were obtained at 10-min intervals via an indwelling jugular catheter during two 12-h periods. Pulsatile secretion of alpha-MSH was found in all dogs, with wide variations in peak height. Plasma alpha-MSH levels were usually low (mean 15 pmol/l), but brief, distinct periods of increased plasma alpha-MSH concentrations as high as 489 pmol/l were found. Analysis of pulse frequency revealed a mean of 4.75 significant alpha-MSH peaks/24 h. The highest alpha-MSH peaks were associated with definite changes in the plasma concentrations of ACTH. In separate studies, the influence of dexamethasone on the 6-h secretory profiles and on the haloperidol-stimulated secretion of alpha-MSH, ACTH, and cortisol was investigated. In these two studies, plasma ACTH was measured by a highly sensitive immunoradiometric assay. Dexamethasone pretreatment significantly suppressed the plasma concentrations of ACTH, cortisol, and alpha-MSH to 10.3%, 3.9%, and 74.6% respectively. Dexamethasone pretreatment also significantly reduced the haloperidol-stimulated secretion of ACTH and cortisol, but had no influence on the haloperidol-stimulated secretion of alpha-MSH. After the administration of haloperidol to the dexamethasone-pretreated dogs, there were small increases in the plasma concentrations of ACTH and cortisol, the latter being significant. These data demonstrate that alpha-MSH is secreted spontaneously in a pulsatile manner in the dog and suggest that the canine PI contributes to circulating ACTH concentrations.