5-Oxoproline acidosis caused by acetaminophen and flucloxacillin treatment - a case report.

High anion gap metabolic acidosis (HAGMA) is a common diagnosis in the emergency department, which requires a systematic work-up in order to identify and treat the underlying cause. We present an unusual case of HAGMA due to 5-oxoproline accumulation caused by prolonged treatment with both acetaminophen (paracetamol) and flucloxacillin. This paper describes the diagnostic work-up of HAGMA and emphasizes on the approach and initial treatment in case the underlying etiology is unclear.

[Impending liver failure after chemoimmunotherapy-induced reactivation of hepatitis B - successful treatment with entecavir]. / Drohendes Leberversagen nach Chemoimmuntherapie-induzierter Reaktivierung einer Hepatitis B - erfolgreiche Therapie mit Entecavir.

HISTORY AND CLINICAL FINDINGS: An 83-year old woman had been treated with bendamustin and rituximab for prolymphocytic leukemia. Two weeks after cycle 6 of chemotherapy, signs and symptoms of a severe hepatitis occurred. INVESTIGATIONS: Highly elevated values for AST (1353 U/l) and bilirubin (27.8 mg/dl), impaired coagulation parameters (INR 1,68) and the detection of ascites led to the diagnosis of an impending liver failure induced by reactivation of a hitherto unknown hepatitis B (HBs antigen pos., HBe antigen pos., anti HBc IgG pos., HBV DNA 1,65 Mio copies/ml). TREATMENT AND COURSE: After an immediately started treatment with entecavir (0.5 mg/d po), symptoms and laboratory parameters rapidly improved. 4 months later liver chemistry was completely normal and HBV DNA was negative. After 8 months, a seroconversion to anti HBs was noted. CONCLUSION: In single cases, life threatening complications of chemotherapy induced reactivation of hepatitis B may be successfully treated by potent and stabile nucleosidanalogs.

Error analysis of a heterodyne submillimeter sounder for the detection of stratospheric trace gases.

Heterodyne submillimeter detection techniques represent an important development in the field of remote sensing of atmospheric composition. The disclosure of this wavelength region by new low-noise detectors and multichannel high-resolution spectrometers leads to expectations of improved accuracy and vertical resolution of the vertical composition profiles derived from these measurements. Because of the low-noise levels of newly developed receivers, special care is required to ensure that fundamental limitations of the components used do not contribute to systematic errors exceeding the random errors. Operated in an upward-looking geometry, the sensitivity of the retrieval algorithm to noise and instrumental errors can be rather high, and hence instrumental limitations could induce large uncertainties in the derived atmospheric information. Instrumental uncertainties typical for a passive heterodyne sounder are quantified, and their effects on the accuracy of the derived vertical mixing ratio profiles are presented.