[Unclear tetraparesis under immunosupression]. / Unklare Tetraparese unter Immunsuppression.

We report a case of a 69-year-old man who developed tetraparesis and muscular pain under the therapy of prednisolone for several months. Diagnosis was sepsis due to pyomyositis with multiple septic pulmonary staphylococcus aureus abscesses. Antibiotic therapy with piperacillin and tazobactam resulted in a decrease of the inflammatory factors and improvement of the tetraparesis. Pyomyositis, common in tropical areas, is a suppurative infection of striated muscle. Immunodeficiency has been implicated in the development of pyomyositis in temperate climates.

Psychological group treatment of obese essential hypertensives by lay therapists in rural general practice settings.

Two hundred and sixty-one obese essential hypertension patients from 15 rural general practices were assigned to either an experimental group (n = 155) or to waiting control group (n = 106). The experimental group underwent psychological group treatment aimed at weight reduction, improvement of stress coping, and reduction of salt-intake. Sixteen therapy sessions were conducted in each of the general practices by specifically trained lay therapists who applied a standardized, highly structured therapy programme. During the time of the study, both experimental group and waiting control group received intensified medical attention. After the 6-months therapy, health knowledge and health behaviour of the patients had improved. Mean weight reduction was 5.2 kg. Blood pressure had decreased by a mean of 14.4 mm Hg (systolic)/7.4 mm Hg (diastolic). After a follow-up period of four months, the beneficial effects of the group treatment were confirmed: Patients needed less anti-hypertensive medication and consistent reduction of body weight prevailed.

Psychological group treatment of essential hypertension in general practice.

One hundred and seven obese patients with essential hypertension from eight general practices received one of the following psychological group therapy procedures: (1) modification of nutritional patterns; (2) modification of nutritional patterns plus self-monitoring of blood pressure and training in social competence; (3) modification of nutritional patterns plus Jacobson's relaxation training; (4) information about the causes and consequences of high blood pressure. An approximately equal number of patients served as a waiting-control group. All patients had received pharmacological treatment for at least a year. Each procedure was administered by a psychologist with groups of up to 15 patients in 12 weekly sessions. The blood pressure values measured before and after intervention showed a clear reduction; this fall is greatest when the initial values were high. Even when the magnitude of the initial values was statistically controlled there was a distinctly greater reduction in blood pressure in the treatment groups than in the waiting-control group. No differential effect between the various therapy procedures could be demonstrated, however. The changes in general health behaviour of the treatment groups was statistically confirmed. In addition, there was a distinct reduction in body weight. Medication compliance also improved in the treatment groups. Since group procedures were accepted both by the doctors and the patients involved, they should be included to a great extent in the basic care of hypertensive patients in the future.

Splenic pseudocyst: preoperative diagnosis with ultrasonography.

Ultrasonography was used to establish the preoperative diagnosis of splenic pseudocyst in a 12-yr-old girl. This procedure was tried after the exact nature of the mass could not be determined from an intravenous pyelogram and a 99m Tc liver-spleen scan. The patient was successfully treated by splenectomy. The advantages of ultrasonography for detecting splenic cysts are emphasized.

The effect of different types of employment on quality of life.

BACKGROUND: Despite research that has investigated whether the financial benefits of open employment exceed the costs, there has been scant research as to the effect sheltered and open employment have upon the quality of life of participants. The importance of this research is threefold: it investigates outcomes explicitly in terms of quality of life; the sample size is comparatively large; and it uses an established and validated questionnaire. METHOD: One hundred and seventeen people with intellectual disability (ID) who were employed in either open or sheltered employment by disability employment agencies were interviewed. Quality of life was assessed using the Quality of Life Questionnaire. After making an initial assessment to see whether the outcomes achieved depended on type of employment, quality of life scores were analyzed controlling for participants' level of functional work ability (assessed via the Functional Assessment Inventory). RESULTS: The results showed that participants placed in open employment reported statistically significant higher quality of life scores. When the sample was split based upon participants' functional work ability, the type of employment had no effect on the reported quality of life for participants with a low functional work ability. However, for those participants with a high functional work ability, those in open employment reported statistically significantly higher quality of life. CONCLUSIONS: The results of this study support the placement of people with ID with high functional work ability into open employment. However, a degree of caution needs to be taken in interpreting the results presented given the disparity in income levels between the two types of employment.

Removal of arsenic from groundwater by zerovalent iron and the role of sulfide.

Several recent investigations have shown encouraging potential for the removal of arsenic (As) from groundwater by granular zerovalent iron (Fe0). In contrast to previous studies conducted, we have investigated the applicability of this method and the nature of As bonding under conditions with dissolved sulfide. Three column tests were performed over the period of 1 year using solutions with either As(V) or As(II) (2-200 mg/L) in the input solution. Arsenic outflow concentrations decreased from initially 30-100 microg/L to concentrations of below 1 microg/L with time. XANES (X-ray absorptions near edge structure) and EXAFS (expanded X-ray absorption fine structure) spectra indicated that As in the solid phase is not only directly coordinated with oxygen, as is the case in adsorbed or coprecipitated arsenite and arsenate. Samples with high sulfur content showed additional bonding, for which Fourier transformations of EXAFS data exhibited a peak between 2.2 and 2.4 A. This bonding most likely originated from the direct coordination of sulfur or iron with As, which was incorporated in iron sulfides orfrom adsorbed thioarsenites. The formation of this sulfide bonding supports the removal of As by Fe0 because sulfide production by microbial sulfate reduction is ubiquitous in permeable reactive barriers composed of Fe0.

[Intestinal hemorrhage due to multiple phlebectasias of the small intestine]. / Intestinale Blutungen infolge multipler Dünndarm-Phlebektasien.

A 37-year-old man had recurrent intestinal bleeding and resulting chronic anemia from multiple phlebectasias of the small intestine. Contrast medium studies and endoscopy of the intestine were negative. Abdominal angiography, however, demonstrated phlebectasias in the region supplied by the jejunal arteries. At operation and on examination of a resected portion of the jejunum, these multiple phlebectasias were demonstrated. Resection of the worst affected portion of the jejunum with end-to-end anastomosis was without complications postoperatively, the benzidine test on faeces was negative, and the blood-hemoglobin level gradually rose. Since radiological examination with contrast media and endoscopy are often negative in bleedings from vascular malformations of the intestine, abdominal angiography should be performed in case of intestinal bleedings not diagnosed by other methods.

[Acute mitral insufficiency in osteogenesis imperfecta]. / Akute Mitralinsuffizienz bei Osteogenesis imperfecta.

A 56-year-old woman with known osteogenesis imperfecta tarda but no obvious sign of cardiac disease developed increasing dyspnoea, eventually even at rest, with blood-streaked sputum over a period of 10 days. The chest radiograph demonstrated intraalveolar pulmonary oedema. Transthoracic echocardiography revealed as the likely cause of these signs chordal rupture of the anterior leaflet of the mitral valve with mitral regurgitation. After treatment of the cardiac failure with frusemide (up to 500 mg daily intravenously), nitrates and captopril (25 mg daily by mouth) the diagnosis was confirmed by transoesophageal echocardiography. Elective replacement of the mitral and aortic valves was performed 6 months later. Acid mucopolysaccharides were demonstrated histologically in the valvar stroma, a finding consistent with osteogenesis imperfecta. Echocardiography should be performed routinely in connective-tissue disease to reveal any possible cardiovascular involvement.