The spreading process of Ehrlichia canis in macrophages is dependent on actin cytoskeleton, calcium and iron influx and lysosomal evasion.

Ehrlichia canis is an obligate intracellular microorganism and the etiologic agent of canine monocytic ehrlichiosis. The invasion process has already been described for some bacteria in this genus, such as E. muris and E. chaffeensis, and consists of four stages: adhesion, internalisation, intracellular proliferation and intercellular spreading. However, little is known about the spreading process of E. canis. The aim of this study was to analyse the role of the actin cytoskeleton, calcium, iron and lysosomes from the host cell in the spreading of E. canis in dog macrophages in vitro. Different inhibitory drugs were used: cytochalasin D (actin polymerisation inhibitor), verapamil (calcium channel blocker) and deferoxamine (iron chelator). Our results showed a decrease in the number of bacteria in infected cells treated with all drugs when compared to controls. Lysosomes in infected cells were cytochemically labelled with acid phosphatase to allow the visualisation of phagosome-lysosome fusion and were further analysed by transmission electron microscopy. Phagosome-lysosome fusion was rarely observed in vacuoles containing viable E. canis. These data suggest that the spreading process of E. canis in vitro is dependent on cellular components analysed and lysosomal evasion.

Long-term follow-up after incisional hernia repair: are there only benefits for symptomatic patients?

INTRODUCTION: Incisional hernias are among the most frequent complications in visceral surgery and are currently considered to be an indication for surgery in all cases, regardless of the patient's symptoms. However, it still remains unclear to what extent surgery actually results in improvement according to objective (e.g., less pain or dysesthesia) or subjective criteria (e.g., less discomfort or better cosmetic result). The purpose of this prospective study was to identify patients who derive objective and subjective benefit from surgical repair. MATERIALS AND METHODS: This prospective study included patients who underwent open incisional hernia repair with mesh implantation from December 2006 to April 2009. Data were collected before and 18 months after surgery. Pain intensity was rated on the numerical analog scale (NAS) pre- and postoperatively. Patients were divided into oligosymptomatic (NAS 0-3) and symptomatic (NAS 4-10) groups based on their preoperative pain level, and the postoperative outcome of the two groups was compared by standardized questionnaire. RESULTS: Ninety patients were prospectively enrolled, 45 (50 %) of each gender. Prior to surgery, 43 patients (47.8 %) were oligosymptomatic, and 47 (52.2 %) reported clinically relevant pain. Eighteen months after surgery, 7.5 % of the oligosymptomatic patients complained of clinically relevant pain; its rate remained unchanged. The symptomatic group showed a significant reduction in clinically relevant pain from 100 % to 14.0 %, (p < 0.001). The percentage of patients with clinically relevant dysesthesia was 12.5 % in the oligosymptomatic and 20.9 % in the symptomatic group 18 months postoperatively. The overall recurrence rate was 13.3 % after 18 months without difference in both groups. A reduction in discomfort in the surgical area was reported by 77.5 % of the oligosymptomatic and 79.1 % of the symptomatic patients. CONCLUSIONS: Symptomatic patients definitely profit from surgical repair in the long-term course. However, the notable postoperative rate of clinically relevant pain and dysesthesia in oligosymptomatic patients and their high recurrence rate cast doubt on whether they really benefit from surgical repair. The remarkable degree of subjective satisfaction in oligosymptomatic patients should not be underestimated.

Diagnostic considerations and treatment approaches to underlying anxiety in the medically ill.

Autonomic and somatic manifestations of anxiety are common in medically ill patients. When anxiety symptoms occur in such patients, the psychiatrist's ability to rapidly identify anxiety and perform a proper differential diagnosis is important, and can be life-saving. For example, a patient with deteriorating cardiac or pulmonary function may be misidentified as primarily "anxious" and referred to the psychiatrist. The change in the patient's medical status is missed until the situation becomes critical. Medication side effects can also cause anxiety symptoms in the medically ill patient. It is important for the psychiatrist to have knowledge of medications commonly associated with such side effects. Diagnosing primary anxiety disorders, such as generalized anxiety disorder, panic disorder, or posttraumatic stress disorder, can be difficult in medically ill patients, but it is an important skill for the consulting psychiatrist. Anxiety can occur secondary to the stress or fear associated with illness, particularly serious illness. This presentation will discuss all of the aforementioned aspects of anxiety in the patient with concomitant medical illness.