[Management of Orbital Complications]. / Diagnostik und Therapie bei orbitalen Komplikationen.

OBJECTIVE: Orbital complications of sinusitis represent serious diseases. In clinical practice, the term "orbital phlegmon" is often used, although this most serious expression of orbital infection is very rarely seen. However, a correct classification in each stage of orbital complications and resulting treatment recommendations are crucial for the prognosis of the patient. MATERIAL AND METHODS: Data from 49 patients who underwent treatment for orbital complications from 01/01/2000 until 31/12/2010 were retrospectively analysed. In particular, data on the epidemiology, diagnostic procedures and treatment methods were analyzed. RESULTS: From the observation period 109 patient records with the diagnosis "orbital affections" (ICD-10 H05) could be identified. Overall, data from 49 patients (36 male and 13 female) with orbital complications of sinusitis could be analyzed. 53.1% of the patient population were children and adolescents aged 1-20 years. Orbital complications were classified using the classification according to Chandler. The group I and II according to Chandler emerged most frequently. 26 patients (53.1%) showed a preseptal cellulitis (group I) and 11 patients (22.4%) had an orbital cellulitis (group II). Patients from group III or higher according to Chandler received a combined medical and surgical treatment. CONCLUSIONS: Orbital complications of sinusitis mostly seem to arise in infancy and adolescence. With prompt identification of the orbital complications in stage I and II of Chandler, conservative therapy only could be successful. From the third stage up, sinus surgery needs to be considered. The classification of Chandler allows a correct recommendation of therapy.

Inhibitors of 20-hydroxyeicosatetraenoic acid reduce renal vasoconstrictor responsiveness.

20-Hydroxyeicosatetraenoic acid (20-HETE) is a cytochrome P450-derived constrictor eicosanoid produced by the preglomerular vasculature where it contributes to regulation of tone. Removal of the tonic inhibitory influence of nitric oxide (NO) has been reported to increase renal 20-HETE release. Because inhibition of NO synthesis enhances responses to vasoconstrictor agents, we examined a contribution for increased 20-HETE generation. In the rat kidney perfused with Krebs' buffer, responses to U46619 (9,11-dideoxy-9alpha,11alpha-methanoepoxy PGF2alpha), a thromboxane A2 mimetic, were compared before and after 50 microM L-nitroarginine (L-NA) to inhibit NO synthase. L-NA raised perfusion pressure (PP) from 79 +/- 3 to 190 +/- 7 mm Hg and enhanced constrictor responsiveness to U46619. U46619 (10, 30, 100, and 300 ng) increased PP by 7 +/- 1, 17 +/- 2, 50 +/- 7, and 67 +/- 7 mm Hg, respectively, before L-NA and 15 +/- 1, 37 +/- 7, 68 +/- 10, and 85 +/- 11 mm Hg, respectively, after L-NA, which did not increase 20-HETE efflux from the kidney. Nonetheless, an inhibitor of omega-hydroxylase, dibromododecencyl methylsulfonimide (DDMS), which reduced 20-HETE release, normalized the enhanced responsiveness to U46619. When PP was elevated with phenylephrine, vasoconstrictor responses to U46619 were similarly enhanced, an effect that was also prevented by DDMS. DDMS and an antagonist of 20-HETE, 20-HEDE [20-hydroxyeicosa-6(Z), 15(Z)-dienoic acid], also reduced vasoconstrictor responses to U46619 in the absence of elevation of PP. Because 20-HETE inhibits K+ channels, we examined the effects of K+ channel inhibitors on vasoconstrictor responses and showed that both tetraethylammonium (TEA) and charybdotoxin enhanced renal vasoconstrictor responses to U46619. However, the inhibitory effects of 20-HEDE on vasoconstrictor responses remained after treatment with TEA. These results support a role for 20-HETE vasoconstrictor responses but suggest an action independent of K+ channels.

Toxoplasmic lymphadenitis--clinical and serologic profile.

OBJECTIVE: To study the serologic profile of several types of test for toxoplasmosis, in order to contribute to the interpretation of antibody kinetics. METHODS: The clinical and serologic features of 120 cases of lymphadenopathy with known time of clinical onset were studied during 18 months postinfection. Antibody kinetics was determined by Sabin-Feldman dye test, complement fixation with light antigen, IgM immunofluorescent antibody test, and IgM immunosorbent agglutination assay (IgM-ISAGA). Cell-mediated immunity was evaluated by the toxoplasmin skin test. RESULTS: Seventy-five female patients aged 11-54 years (median 27 years) and 45 male patients aged 3-59 years (median 17 years) were studied, 85% of whom were under 30 years of age. Cervical lymph nodes were involved throughout, generally on both sides, with more than one affected ganglion group in 88%. The predominant symptom was asthenia (69%), which persisted in some cases for several months. A negative Sabin-Feldman dye test in a lymphadenopathy with more than three weeks' evolution excludes a toxoplasma etiology. A positive Sabin-Feldman dye test with negative IgM-ISAGA almost invariably excludes recent infection. The Sabin-Feldman dye test was positive in 94% of patients with titers higher than 1 : 16 000 within the first three months. The IgM-ISAGA yielded 98% of positive results, of which 94% were high titers. Titers >/= 1 : 160 in the IgM immunofluorescent antibody test and complement fixation were found to be highly indicative of recent infection, since 87% and 91%, respectively, were found within the first three months. A negative skin test plus positive serology values indicates recent infection. CONCLUSION: Our results indicate that estimation of time of infection on the basis of serologic results is improved by the simultaneous application of several tests, and correlates closely with the presence of clinical lymphadenitis.

Photoinduced electron-transfer reactions with quinolinic and trimellitic acid imides: experiments and spin density calculations(1)

The regioselectivity of photoinduced electron-transfer (PET) reactions of unsymmetrical phthalimides is controlled by the spin density distribution of the intermediate radical anions. ROHF ab initio calculations were found to be most suitable for atomic spin density analysis. Intramolecular PET reactions of quinolinic acid imides were studied with the potassium butyrate and hexanoate 1a,b and a cysteine derivative 3. The photocyclizations products 2a,b and 4 were formed with moderate regioselectivities (68:32, 57:43, and 81:19) showing preferential ortho cyclization. The intermolecular reaction of potassium propionate and potassium isobutyrate with N-methylquinolinic acid imide (5) yielded as addition products the dihydropyrrolo[3,4-b]pyridines 6a,b with slight ortho regioselectivity (55:45). In contrast to these low regioselectivities, the PET reaction of potassium propionate with the methyl ester of N-methyltrimellitic acid imide (9) yielded solely the para addition product 10. Likewise, the intramolecular photoreaction of the cysteine derivative 7 gave a 75:25 (para/meta) mixture of regioisomeric cyclization products 8. The regioselectivity originates from donor-acceptor interactions prior to electron transfer and differences in spin densities in the corresponding imide radical anions. The results of DFT and ab initio calculations for the radical anions of the quinolinic acid imide (11(*)(-)) and the methyl ester of trimellitic acid imide (12(*)(-))( )()were in agreement with the latter assumption: spin densities in 11(*)(-) were higher for the imido ortho carbon atoms (indicating preferential ortho coupling); for 12(*)(-) the spin densities were higher for the imido para carbon atoms (indicating preferential para coupling). These correlations became more significant when the additional spin densities at the carbonyl oxygen and the adjacent carbon atoms were taken into account. The cyclization selectivities for 2, 4, and 8 deviate from the intermolecular examples probably because of ground-state and solvent effects.

Richness and diversity of parasite communities in European eels Anguilla anguilla of the River Rhine, Germany, with special reference to helminth parasites.

A total of 121 European eels (Anguilla anguilla) from 2 sampling sites on the River Rhine were investigated in respect of their parasite communities. Special attention was given to the swim bladders, intestines, gills and fins of the fish. Twelve different parasite species were found to live in and on the eels. Data from each sampling site were kept separate. Parasites found in descending order of prevalence were: Anguillicola crassus, Trypanosoma granulosum, Myxobolus sp., Paratenuisentis ambiguus, Pseudodactylogyrus sp., Bothriocephalus claviceps, Myxidium giardi, Pomphorhynchus laevis, Trichodina sp., Raphidascaris acus, Acanthocephalus lucii and Acanthocephalus anguillae. Significantly different prevalences were reported for L3 larvae of A. crassus, adult P. ambiguus, B. claviceps and Myxobolus sp. at the 2 sampling sites. The highest number of parasite species was recorded from the intestine, which contained up to 6 different helminths. The coexistence of the acanthocephalans P. laevis and P. ambiguus, which showed clear patterns of distribution within the intestine of the respective hosts, was reported for the first time. Up to 3 different helminth species were found in the intestine of individual fish. Among those, acanthocephalans were the most prevalent worms with the eel-specific parasite P. ambiguus as the dominant species not only of the intestinal but also of the total component communities. Both infra and component communities exhibited low diversity and were dominated by this single species. The evenness reached only approximately 50% or less and it remained unclear why the helminth communities of the eels from the River Rhine with its huge catchment area exhibit such a low parasite diversity and high dominance.

Hepatitis toxoplásmica / Hepatic toxoplasmic

Con el objeto de valorar el compromiso hepático en el curso de una toxoplasmosis aguda adquirida, se efectúo punción biopsia hepática a 9 pacientes adultos: 8 con linfadenitis y con meningoencefalitis el caso restante. Todos los pacientes alcanzaron títulos de Sabin-Feldman de 1:64.0000 y con la reacción de fijación de complemento superaron la dilución de 1:80. Presentaron hepatomegalia 7 de 9 pacientes. El hepatograma mostró una ASAT con una media de 30 UI/L (VR:20), una ALAT de 51 UI/L (VR:20), fosfatasa alcalina de 68 UI/L (VR:10-50) y GGT de 75 UI/L (VR:5-35). El cuadro histológico consistió en una hiperplasia e hipertrofia kupfferiana difusa con tendencia a conformar acúmulos focales en dos casos. No se observaron granulomas ni colestasis. La necrosis hepatocítica fue muy frecuente (6 de 9 casos) siempre focal y de poca monta y mostró en algún caso tendencia a localizarse en la zona centrolobulillar. El infiltrado portal fue constante en todos los casos a predominio neto de células mononucleares, pero sin tendencia a la destrucción de la lámina hepatocítica limitante. En tres casos se observaron francos signos de regeneración con abundantes hepatocitos binucleados y en un caso mitosis. La imagen histológica resultante es la de una hepatitis reactiva inespecífica. El sustrato morfológico explica la escasa repercución clínica y bioquímica que se observa en estos pacientes. La necrosis focal parece ser el hallazgo más constante junto a la hiperplasia kupfferiana difusa o focal

Hepatitis toxoplásmica / Hepatic toxoplasmic

Con el objeto de valorar el compromiso hepático en el curso de una toxoplasmosis aguda adquirida, se efectúo punción biopsia hepática a 9 pacientes adultos: 8 con linfadenitis y con meningoencefalitis el caso restante. Todos los pacientes alcanzaron títulos de Sabin-Feldman de 1:64.0000 y con la reacción de fijación de complemento superaron la dilución de 1:80. Presentaron hepatomegalia 7 de 9 pacientes. El hepatograma mostró una ASAT con una media de 30 UI/L (VR:20), una ALAT de 51 UI/L (VR:20), fosfatasa alcalina de 68 UI/L (VR:10-50) y GGT de 75 UI/L (VR:5-35). El cuadro histológico consistió en una hiperplasia e hipertrofia kupfferiana difusa con tendencia a conformar acúmulos focales en dos casos. No se observaron granulomas ni colestasis. La necrosis hepatocítica fue muy frecuente (6 de 9 casos) siempre focal y de poca monta y mostró en algún caso tendencia a localizarse en la zona centrolobulillar. El infiltrado portal fue constante en todos los casos a predominio neto de células mononucleares, pero sin tendencia a la destrucción de la lámina hepatocítica limitante. En tres casos se observaron francos signos de regeneración con abundantes hepatocitos binucleados y en un caso mitosis. La imagen histológica resultante es la de una hepatitis reactiva inespecífica. El sustrato morfológico explica la escasa repercución clínica y bioquímica que se observa en estos pacientes. La necrosis focal parece ser el hallazgo más constante junto a la hiperplasia kupfferiana difusa o focal (AU)

Effects of monophosphoryl lipid A on myocardial ischemia/reperfusion injury in dogs.

We wished to determine if the previously observed cardioprotective effects of monophosphoryl lipid A (MLA, 65 micrograms/kg intravenously, i.v.), an endotoxin derivative, were time related and mediated by an enhancement of antioxidant defense mechanisms, i.e., myocardial catalase and superoxide dismutase (SOD) activities and neutrophil infiltration as assessed by myeloperoxidase (MPO) activity. We also wished to study the effect of pretreatment with MLA on vascular endothelial and smooth muscle function in vivo and in vitro. Barbital-anesthetized dogs were subjected to 60-min left circumflex coronary artery (LCX) occlusion followed by 5-h reperfusion. Myocardial catalase, SOD, and MPO activities were measured at the end of 5-h reperfusion. Pretreatment with MLA 24 h before ischemia produced a significant reduction in myocardial infarct size as measured by triphenyltetrazolium staining (15.3 +/- 4.4 vs. 30.9 +/- 5.2% in controls, p < 0.05), but 1-h pretreatment with MLA had no protective effect. MLA pretreatment for 24 h resulted in marked reduction (p < 0.05) in MPO activity in the border zone surrounding the infarct. Although a trend indicated an increase in catalase activity in the 24-h pretreatment group, no significant changes were observed in either catalase or SOD activities among the three groups. The cardioprotection produced by MLA was independent of differences in collateral blood flow to the ischemic region assessed by radioactive microsphere technique, systemic hemodynamics, myocardial oxygen demand, and ischemic bed size. Responses of the LCX bed to intracoronary acetylcholine (ACh) or nitroglycerin (NTG) in vivo and responses of isolated femoral artery rings to the endothelium-dependent vasodilators, ACh, A23187, bradykinin, or the nonendothelium-dependent vasodilator, sodium nitroprusside (SNP) in vitro were significantly decreased in the MLA 1-h pretreatment group but not in the 24-h pretreatment group. Incubation of the femoral artery rings from the MLA 1-h pretreatment group with 3 mM L-arginine for 1 h reversed the decreased endothelium-dependent responses to ACh and A23187, but not those to bradykinin. These results indicate that (a) the MLA-induced myocardial infarct size reduction was pronounced when MLA was administered for 24 h but was not evident at 1-h pretreatment; (b) a decrease in neutrophil infiltration into the site of ongoing tissue damage might be partially responsible for the protection; (c) vascular endothelial and/or smooth muscle function were transiently decreased by MLA administration and returned to nearly normal levels 24 h after treatment; and (d) the effect of MLA on endothelium-dependent responses might be mediated by the L-arginine/nitric oxide (NO) pathway.

Growth hormone response to clonidine in neuroleptic-free patients with multidagnostically defined schizophrenia.

The role of alpha 2-adrenergic receptor sensitivity in schizophrenia was examined by measuring growth hormone (GH) response after the intravenous administration of clonidine (1.3 micrograms/kg) in 26 healthy control subjects and 26 neuroleptic-free, acutely psychotic patients with at least 1 out of 11 possible diagnoses of schizophrenia derived from a multidiagnostic psychopathological assessment. GH responses were significantly (0.01) lower than control values in schizophrenias defined by E. Bleuler, M. Bleuler, Schneider, Langfeldt, Taylor and Abrams, and Cloninger, but not in DSM-III, World Health Organization, Feighner, Kraepelian, and Research Diagnostic Criteria (RDC) schizophrenias. Eight patients with RDC schizoaffective disorder also had a blunted response. However, there were no correlations with any symptom measures. There were no differences between paranoid and nonparanoid patients, although there was a significant difference between nonparanoid patients and control subjects. These findings support the presence of noradrenergic dysfunction in some patients within the schizophrenia syndrome, possibly those whose illnesses have an affective component. The study also illustrates the need for simultaneous investigation of several different sets of diagnostic criteria for schizophrenia in neurobiological research.