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[Subjective sequelae of splenectomy].

111 of 806 former patients splenectomized at the Würzburg university hospital during the years 1968-1983 were interviewed for their complaints since their operation. Investigations included the use of Beck's inventory for measuring depression and the Giessen questionnaire for the evaluation of general complaints used in psychosomatic medicine. There was a significant increase of symptoms after splenectomy as compared to the normal population. A special list of 18 questions to investigate typical postsplenectomy complaints was answered by 95 of these 111 persons and by a control group of "statistical twins" with similar upper abdominal surgery without splenectomy. The leading difference was the highly significant increase of the susceptibility to infections after splenic loss followed by accelerated exhaustion and increased physical and mental weakness. The distribution of other complaints like for instance the intolerance to alcohol hitherto judged as typical sequelae of splenectomy was not statistically different in both splenectomy was not statistically different in both groups. Since the symptoms listed above as significantly increased in the splenectomized patient were closely correlated with the susceptibility to infection they seem to be rather the expression of the decreased resistance than direct consequences of the loss of the spleen.

Adolescent↗

Main stem bronchial occlusion in a neonate.

In recent years it has become evident that partial obstruction of bronchi can be acquired postnatally secondary to mechanical trauma caused during prolonged endotracheal intubation. In the presented case, a complete obstruction of the right main stem bronchus developed during the neonatal period despite a relatively short time of intubation. The etiological background is discussed.

Bronchi↗

[Dorso-posterior extraperitoneal pelviscopy (DEP). From experiment to initial clinical application].

BACKGROUND: Dorsoposterior and/or perineal access to pelvic connective tissue spaces has lost its importance due to improved transabdominal techniques. Because of the development of minimally invasive surgery towards "soft-tissue endoscopy" we were interested in whether the video-assisted technique could give new impetus to the perineal approach. Successful experiments on corpses were followed by the first clinical application. METHODS: After the dilation of the retrorectal, rectovaginal and rectoprostatical spaces with a dissecting balloon, pneumoextraperitoneum was established and all extraperitoneal structures of the pelvis could be dissected. RESULTS: In the experimental and in the clinical situation the spaces could be perfectly surveyed. EXPERIMENTALLY: Complete, circular preparation of the rectum was achieved. Parts of the bladder, vagina and prostate were visualized ventrally. Laterally both ureters and the paraproctal and iliacal vessels could be dissected. In the clinical application the retrorectal space could be dilated without problems and it could be rinsed and drained. Postoperatively no complications were recorded. The patient could be discharged on the 17th postoperative day. CONCLUSION: The described method is suitable for clinical use. Besides the described indication, further surgical applications exists.

Diverticulitis, Colonic↗

Review of Clostridium difficile-associated diseases.

Clostridium difficile has recently become recognized as an important nosocomial pathogen. This review summarizes what is known about the isolation of the organism, the spectrum of clinical disease, virulence factors, treatments, and methods of prevention. Risk factors for C. difficile disease are also discussed. The most important risk factor is the use of certain antibiotics (ampicillin, cephalosporins, and clindamycin). C. difficile is associated with 96% to 100% of cases of pseudomembraneous colitis, 60% to 75% of antibiotic-associated cases of colitis, and 11% to 33% of antibiotic-associated cases of diarrhea. Other risk factors include gastrointestinal manipulations, advanced age, female sex, inflammatory bowel disease, cancer chemotherapy, and renal disorders. Hospital outbreaks of C. difficile disease are examined. Data from nosocomial outbreaks support transmission of C. difficile by contaminated fomites and hand carriage by hospital personnel.

Age Factors↗

Autoimmunity as a secondary phenomenon in scleroderma (and so-called human adjuvant disease).

Autoantibodies form under diverse circumstances. Some autoantibodies are clearly secondary phenomena in response to tissue injury. When there is defective microdebridement, tissue antigens will persist and will produce even more autoantibody. Scleroderma is classified as an autoimmune disease but autoantibodies are not always present. There is extensive literature on the early role of vascular changes and the presence of connective tissue active substances. There are clinical cases of scleroderma following implants of silicone, paraffin injections, and occupational silica or polyvinyl chloride exposure. It would be hard to describe a worse group of nondegradable substances capable of overloading the debridement system. It has been demonstrated that macrophages that ingest silica release factors that increase biosynthesis by fibroblasts. There may be many methods of arriving at the clinical pattern of scleroderma. Elimination of autoantibodies as a primary etiologic consideration will allow concentration on the other known physiologic factors. There is, in some cases, a secondary injury of the kidney from immune complexes. Autoimmunity, when it occurs, is a secondary phenomenon in scleroderma, or so-called 'human adjuvant disease'.

Adjuvants, Immunologic↗

Hair deformities.

To be able to treat the wide spectrum of hair deformities, a surgeon must possess a wide spectrum of skills in HRS, cosmetic surgery, and reconstructive surgery. Specific education and training in HRS is not a traditional part of formal surgical training, although much information is available through several national and international organizations. Being sensitive to the unique variables associated with HRS increases the chances of achieving a superior functional and cosmetic result when treating significant hair deformities.

Adult↗

Humanized knock-in mice expressing chimeric prion protein showed varied susceptibility to different human prions.

Mice to which human prions efficiently transmit in short incubation periods are valuable not only as research tools of human prions but also as reliable diagnostic tools. We recently produced a line of knock-in mouse expressing a unique human-mouse chimeric PrP (Ki-ChM mouse), which has mouse-specific residues practically only at the C-terminal part after posttranslational modification, and here we attempted transmission of various human prions to assess the susceptibility profile of the mouse. Susceptibility varied considerably depending on prions inoculated: highly susceptible to MM1 and MV1 types of sporadic Creutzfeldt-Jakob disease (CJD), developing disease within approximately 150 days, familial CJD with M232R mutation, and dura graft-associated CJD (dCJD) without amyloid plaque; less susceptible to MM2-type sporadic CJD and variant CJD, with some mice lacking any sign of transmission; and totally resistant to VV2 type sporadic CJD and dCJD with amyloid plaque. The rather short incubation time achieved by Ki-ChM mice suggests new approaches to produce mice that develop prion disease with very short incubation periods. We compared the characteristic susceptibility profile of Ki-ChM with those of other precedent transgenic mice and discussed, including the prospects in developing genetically engineered mice susceptible to human prions.

Animals↗

Pulmonary complications of radiation therapy.

There have been important developments in understanding the difference in pathogenesis and clinical significance between acute or sporadic pneumonitis and late radiation fibrosis. Corticosteroid therapy and other forms of therapy are useful in the treatment of acute pneumonitis. Late radiation fibrosis is refractory to treatment; therefore, minimizing the likelihood of developing it is particularly important. Baseline lung assessments are appropriate in patients who are clinically at risk. A new development is the use of the DVH to compare radiation treatment plans to minimize the volume of normal lung irradiated in patients who are at risk. It is hoped that the study of mechanisms that lead to the development of radiation fibrosis will point the way to possible future therapies. Patients who are included in studies of novel irradiation treatments for lung cancer need, in particular, to be monitored for late radiation lung toxicity.

Breast Neoplasms↗

The urogenital and rectal pain syndromes.

Pain syndromes of the urogenital and rectal area are well described but poorly understood and underrecognized focal pain syndromes. They include vulvodynia, orchialgia, urethral syndrome, penile pain, prostatodynia, coccygodynia, perineal pain, proctodynia and proctalgia fugax. The etiology of these focal pain syndromes is not known. A specific secondary cause can be identified in a minority of patients, but most often the examination and work-up remain unrevealing. Although these patients are often depressed, rarely are these pain syndromes the only manifestation of a psychiatric disease. This review article presents an overview of the neuroanatomy of the pelvis, which is a prerequisite to trying to understand the chronic pain syndromes in this region. We then discuss the clinical presentation, etiology and differential diagnosis of chronic pain syndromes of the urogenital and rectal area and review treatment options. The current knowledge of the psychological aspects of these pain syndromes is reviewed. Patients presenting with these pain syndromes are best assessed and treated using a multidisciplinary approach. Currently available treatment options are empirical only. Although cures are uncommon, some pain relief can be provided to almost all patients using a multidisciplinary approach including pain medications, local treatment regimens, physical therapy and psychological support, while exercising caution toward invasive and irreversible therapeutic procedures. Better knowledge of the underlying pathophysioloigical mechanisms of the urogenital and rectal pain syndromes is needed to allow investigators to develop treatment strategies, specifically targeted against the pathophysiological mechanism.

Chronic Disease↗

Fetal arrhythmias.

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Arrhythmias, Cardiac↗

Schizophrenia, antipsychotics and diabetes: Genetic aspects.

The relatively high comorbidity of type 2 diabetes and schizophrenia may suggest a shared biological susceptibility to these two conditions. Family studies have demonstrated an increased risk of diabetes in unaffected relatives of patients with schizophrenia, consistent with a heritable susceptibility trait. Linkage analyses have identified several loci that are associated with schizophrenia and some of these, notably those on chromosomes 2p22.1-p13.2 and 6g21-824.1 have also been observed in linkage studies in type 2 diabetes. In addition, the dopamine D5 receptor on chromosome 5 and the tyrosine hydroxylase gene on chromosome 11 have both been suggested as candidate genes in schizophrenia and may also be implicated in susceptibility to poor glycaemic control. In addition, an increased rate of type II diabetes has been observed in some patients treated with antipsychotics. Potential neurochemical substrates of this effect include the histamine H1 receptor, the 5-HT2C serotonin receptor or the beta3 adrenoreceptor. However, the search for a genetic basis to the association between diabetes and schizophrenia is still in its infancy, and much further work needs to be performed, including the systematic screening of all confirmed susceptibility loci and quantitative trait locus mapping of glycaemic control.

Chromosomes, Human, Pair 11↗

Sudden deafness following chromic acid application to a perforation of the tympanic membrane.

It is current practice in the treatment of many ear diseases to instil locally into the ear potentially ototoxic agents. It is now becoming increasingly clear that some of these agents may pass from the middle to the inner ear despite the presence of intact labyrinthine windows and hence produce deafness. This paper reports a case of severe sensorineural deafness which developed following the application of chromic acid to a perforation of the tympanic membrane--a hitherto unrecognized complication. Therefore, the risks outlined above should be carefully considered prior to local therapy with any such agents and they should be applied with extreme caution.

Adult↗