[Diagnosis and treatment of interstitial cystitis (IC/PBS) : S2k guideline of the German Society of Urology]. / Diagnostik und Therapie der interstitiellen Zystitis (IC/BPS) : S2k-Leitlinie der Deutschen Gesellschaft für Urologie.

In this review article, the authors describe all relevant aspects of the new S2k guideline from the German Society of Urology (Deutschen Gesellschaft für Urologie, DGU) for the diagnosis and treatment of IC/PBS (interstitial cystitis/painful bladder syndrome). A list of necessary and optional examinations and the necessity of diagnosis of exclusion are summarized and evaluated. The treatment options listed (ranging from conservative, oral drug, and complementary medicine to interventional surgical procedures) also give the reader a good overview of the contents of the guideline and possible therapeutic approaches. Finally, the recommendations including consensus of the guideline group are also summarized in various information boxes.

Cytochrome P450 genotypes are not associated with refractoriness to antipsychotic treatment.

Evidence validating the influence of the cytochrome P450 (CYP) 2D6 and 2C19 enzymes genetic polymorphisms in the response to antipsychotics is scarce. We examined the hypothesis that a higher prevalence of CYP2D6 and/or CYP2C19 ultra rapid metabolizers might be found among refractory schizophrenia patients. Three groups were studied: refractory and non-refractory schizophrenia patients, and healthy controls. Participants were genotyped for CYP2D6 and CYP2C19 polymorphisms and classified in metabolic phenotypes. No between-group differences in the distribution of the phenotypes were found. Therefore, our findings do not support the CYPs 2D6 and 2C19 genotyping in the prediction of therapeutic response in schizophrenia.

Simultaneous double interphalangeal joints dislocation in a finger in a teenager.

ABSTRACT: The English literature reports a mere handful of cases involving simultaneous dislocation of two joints in the same finger. To our knowledge, all cases reported to date have been in skeletally mature individuals. We report a case of simultaneous proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints dislocations in one finger in a 14-year-old rugby player, managed by closed reduction and early mobilization, with excellent outcome. KEY WORDS: Proximal interphalangeal joint, Distal interphalangeal joint, Dislocation, Skeletally immature.

Human mastoid periosteum-derived stem cells: promising candidates for skeletal tissue engineering.

Currently, mesenchymal stem cells (MSCs) are considered as the most eligible cells for skeletal tissue engineering. However, factors such as difficult stimulation and control of differentiation in vivo hamper their clinical use. In contrast, periosteum or periosteum-derived cells (PCs) are routinely clinically applied for bone and cartilage repair. PCs have often been named MSCs but, although cells of osteochondrogenic lineages arise from MSCs, it is unclear whether periosteum really contains MSCs. Our aim was to investigate the MSC-like character of PCs derived from the periosteum of mastoid bone. Harvesting of periosteum from mastoid bone is easy, so mastoid represents a good source for the isolation of PCs. Therefore, we analysed the MSC-like growth behaviour and the expression of embryonic, ectodermal, endodermal and mesodermal markers by microarray and FACS technology, and the multilineage developmental capacity of human PCs. Regarding clinical relevance, experiments were performed in human serum-supplemented medium. We show that PCs do not express early embryonic stem cell markers such as Oct4 and Nanog, or the marker of haematopoietic stem cells CD34, but express some other MSC markers. Osteogenesis resulted in the formation of calcified matrix, increased alkaline phosphatase activity, and induction of the osteogenic marker gene osteocalcin. Staining of proteoglycans and deposition of type II collagen documented chondrogenic development. As shown for the first time, adipogenic stimulation of mastoid-derived PCs resulted in the formation of lipid droplets and expression of the adipogenic marker genes aP2 and APM1. These results suggest MSC-like PCs from mastoid as candidates for therapy of complex skeletal defects.

[Complications after lid loading. Is the platinum chain really effective?]. / Komplikationen nach Implantation von Lidgewichten. Ist die Platinkette wirklich effektiv?

INTRODUCTION: Numerous studies on the operative therapy for lagophthalmos exist. Reports about postoperative results, however, are rare and most studies include just a small number of patients. Additionally, since 1999a flexible platinum chains has been available as an alternative to the rigid gold implant. The authors are convinced that the platinum chain matches much more the anatomic prerequisites of the upper eye lid. Therefore, the aim of this study was to compare the complication rate of rigid gold implants with that of the flexible platinum chain. To increase the amount of patient data, a statistical meta-analysis after implantation of gold implants and the data form a survey of all surgeons who do implantations of the platinum chain have been compared. MATERIALS AND METHODS: To collect a greater number of patients a survey with focus on postoperative complications has been sent to all colleagues who perform implantations with the flexible platinum chain in patients with paralytic lagophthalmos. Complications included a corneal astigmatism, a migration of the implant, a bulging, an extrusion or an infection. In a further step the statistical comparison between the survey and the results of the meta-analysis about complications after application of rigid gold implants was performed. RESULTS: Through the survey, data for 212 implantations of the flexible platinum chains could be collected. The comparison showed a statistically significant lower rate of postoperative complications concerning astigmatism, bulging, and postoperative infections in the platinum chain group. Only the postoperative extrusion rates (6.8% after gold implantations and 3.3% after platinum chain implantations) showed no statistically significant difference (p=0.0612). In general, complications occurred in 45.1% of the cases after use of gold implants and in 12.8% after use of the platinum chain, respectively. CONCLUSION: Lid loading is a relatively simple and reversible procedure for the operative therapy of lagophthalmos. By using the platinum chain as an implant, postoperative complications can be decreased and thus the effectiveness of the treatment can be enhanced.

[Evaluation of a new lid implant for rehabilitation of the paralyzed eye]. / Evaluierung eines neuen Lidimplantates zur Therapie des Lagophthalmus. Ergebnisse einer Umfrage.

BACKGROUND: Since 1999 the platinum chain is being used as implant to correct lagophthalmos, which promises, due to its flexibility, lower postoperative complications. The lack of mandatory results reported in the literature, prompted us to survey all surgeons using the platinum chain in order to learn of the complications they had experienced. METHODS: A questionnaire was sent to 30 surgeons to survey results and complications associated with the implantation of the platinum chain to treat lagophthalmos. Complications like contouring, migration and extrusion of the implant occurred. RESULTS: Complications observed were bulging of the implant in 12 cases (5,7 %), 4 migrations of the implant (1,9 %), in 7 cases a frank extrusion (3,3 %), a ptosis of the upper eyelid in 8 cases (3,8 %), a corneal astigmatism in 3 cases (1,4 %) and in one case an infection of the upper eyelid (0,5 %). In 2 cases (0,9 %) the patients lamented a mechanical irritation of the upper eyelid. CONCLUSION: Implantation of eyelid weights is a straightforward and reversible procedure for the surgical therapy of lagophthalmos. Through the use of the platinum chain as implant the postoperative complications are to be regarded as small in total. With that the effectiveness of the procedure can be increased compared to rigid gold implants.

Current TNM classification of renal cell carcinoma evaluated: revising stage T3a.

PURPOSE: : Recent studies of rare cases of pT3a renal cell carcinoma extending directly into the adrenal gland showed worse survival than in other pT3a cases and recategorization as stage pT4 was suggested. We assessed the prognostic validity of a stage pT3a diagnosis based on perirenal fat infiltration. MATERIALS AND METHODS: : The records of 1,794 patients with renal cell carcinoma who underwent surgical resection between 1975 and 2000 at our institution were analyzed retrospectively. Focusing on pT3a tumors, as defined by perirenal fat infiltration, numerous clinical and histopathological parameters were investigated by univariate and multivariate statistical methods with cancer specific survival as the primary end point. RESULTS: : We identified 237 of 1,794 patients with perirenal fat infiltration, classified as having pT3a disease. In patients with pT3a tumors tumor size was a significant parameter predicting survival. The most significant cutoff value for tumor size in pT3a disease was 7 cm. Patients with distant metastasis had a worse prognosis independent of T classification. Therefore, to assess the prognostic value of the current T classification in regard to T3a tumors we excluded patients with tumor stage cM+ for further subgroup analysis. Survival comparison of pT1 pNall, cM0 (744 of 1,794 cases) and pT3a pNall, cM0 7 cm or less (100 of 237) as well as pT2 pNall, cM0 (265 of 1,794) and pT3a pNall, cM0 greater than 7 cm (93 of 237) yielded similar results. After splitting pT3a into a modified T1/T2 classification a significant difference in 5-year survival analysis for a modified T1/T2 stage was found (pT1 plus pT3a less than 7 cm 90% vs pT2 plus pT3a greater than 7 cm 73%, p <0.001). Subsequently multivariate analysis in all 1,794 patients showed that modified T stage was an independent significant predictor of cancer specific survival. CONCLUSIONS: : We suggest revising the current pT3a classification based on perirenal fat infiltration but rendering a modified pT1/pT2 classification, which resolves pT3a cases without the loss of prognostic validity. Perirenal fat infiltration should not be used to assign T category. Tumors directly infiltrating the adrenal gland should be reclassified as T4.

[Interstitial cystitis. Current aspects of diagnosis and therapy]. / Interstitielle Zystitis. Aktuelle Aspekte in der Diagnostik und Therapie.

Interstitial cystitis is a chronic, heterogeneous syndrome that is characterized by the classic symptoms of bladder pain, nycturia, and pollakiuria. Population studies have shown an increase in prevalence and incidence. Different hypotheses exist about the etiology and pathogenesis. Epithelial dysfunction and neuro-urothelial interaction are the most frequently used causal models. Utilization of the official diagnosis criteria of the NIDDK (National Institute of Diabetes, Digestive and Kidney Disease) should be flexible and individual in order not to overlook early forms of IC. Since there is no pathognomonic marker, diagnosis of IC is a combination of typical patient history and exclusion of differential diagnoses. Cystoscopy and biopsies are not specific; however, they can provide useful information on extent and aid in treatment choice. The effectiveness of conservative therapy has been increased by using electromotive drug administration (EMDA) in instillation therapy.

Nucleophilic aliphatic substitution reactions of propachlor, alachlor, and metolachlor with bisulfide (HS-) and polysulfides (Sn2-).

Reactions of bisulfide and polysulfides with alachlor, propachlor, and metolachlor were examined in aqueous solution to investigate the role reduced sulfur species could play in effecting abiotic transformations of chloroacetanilide herbicides. Experiments at 25 degrees C demonstrated that reactions were approximately first-order in HS- concentration and revealed that polysulfides are considerably more reactive than HS-. delta H not equal to values for reactions of the three chloroacetanilides with HS- are statistically indistinguishable at the 95% confidence level, as are delta S not equal to values, despite significant differences in second-order rate constants (kHS-). Transformation products were characterized by GC/MS (in some cases following methylation) and were found to be consistent with substitution of chlorine by the sulfur nucleophile. Products containing multiple sulfur atoms were observed for the reactions of chloroacetanilides with polysulfides, while products resulting from reaction with HS- only possessed a single sulfur atom. When second-order rate constants at 25 degrees C are multiplied by HS- and polysulfide concentrations reported in salt marsh porewaters, predicted half-lives range from minutes to hours. HS- and especially polysulfides could thus exert a substantial influence on the fate of chloroacetanilide herbicides in aquatic environments. Oxidation of the resulting sulfur-substituted products could generate ethane sulfonic acid derivatives, previously reported as prevalent chloroacetanilide degradates.

Human platelet supernatant promotes proliferation but not differentiation of articular chondrocytes.

The objective of the study was to evaluate the growth-promoting activity of human platelet supernatant on primary chondrocytes in comparison with fetal calf serum (FCS) supplemented cell culture medium. Furthermore, the differentiation potential of platelet supernatant was determined in three-dimensional artificial cartilage tissues of bovine articular chondrocytes. Proliferation of articular and nasal septal chondrocytes was assayed by incorporation of BrdU upon stimulation with ten different batches of human platelet supernatant. On bovine articular chondrocytes, all these batches were at least as growth-promoting as FCS. On nasal septal chondrocytes, nine out of ten batches revealed increased or equivalent mitogenic stimulation compared with medium supplemented with FCS. Three-dimensional culture and subsequent histological analysis of matrix formation were used to determine the differentiation properties of platelet supernatant on articular chondrocytes. Human platelet supernatant failed to induce the deposition of typical cartilage matrix components, whereas differentiation and matrix formation were apparent upon cultivation of articular chondrocytes with FCS. Proliferation assays demonstrated that human platelet supernatant stimulates growth of articular and nasal septal chondrocytes; however, platelet supernatant failed to stimulate articular chondrocytes to redifferentiate in three-dimensional chondrocyte cultures. Therefore platelet lysate may be suitable for chondrocyte expansion, but not for maturation of tissue-engineered cartilage.

Preparation of a pure autologous biodegradable fibrin matrix for tissue engineering.

Parallel to the growing role of tissue engineering, the need for cell embedding materials, which allow cells to stabilise in a three-dimensional distribution, has increased. Although several substances have been tested, fibrin is thus far the only one that permits the clinical application of cultured tissue. To date, autologous fibrinogen has usually been polymerised with bovine thrombin, which can cause severe immunological side effects. The objective of this study was to explore the practicability of obtaining autologous thrombin from a single patient in an adequate concentration and amount. Fibrinogen was cryoprecipitated from 200 ml of freshly-frozen plasma. Thrombin was isolated from the supernatant through ion-exchange chromatography. The thrombin was first bound to Sephadex A-50 and then eluated using 2 ml of a salt buffer (2.0 M NaCl in 0.015 M trisodiumcitrate, pH 7.0). The activity of the thrombin (51 NIH x ml(-1) to 414 NIH x ml(-1) reached levels comparable to those in commercially available fibrin glues (4-500 NIH x ml(-1)). The study has shown that it is possible to obtain a sufficient amount of autologous thrombin from a single donor to create a fibrin matrix of high efficiency without the risk of immunological and infectious side effects.