Carpal enchondroma.
Chondromas in the carpal bones are uncommon. A review of carpal bone cysts treated in this institution between 1983 and 1993 revealed three cases. We present these cases and a review of the literature.
Adult↗
Biomedical subjects
A Berger
Publications and source records attributed to A Berger.
Cystic retroperitoneal lymphangiomas in adults.
Lymphangioma (LA) is a rare benign tumour of the lymphatic tissue, most common in the neck and head, and clinically manifests itself mostly in childhood. Within this group, intra-abdominal and retroperitonal LA are the rarest tumours, especially when occurring in adults. We report four LAs localized in the retroperitoneum of patients aged between 28 and 72 years. One of these tumours infiltrated the transverse mesocolon and greater omentum, others were situated in the left retroperitoneum and retroperitoneally at the duodeno-jejunal flexure, and in the retrosplenal and retropancreatic area. Diagnosis was made by light microscopy supported by immunohistochemistry. In three cases the tumour could be removed by radical surgery and none of these patients had a recurrence (median follow-up time: 4 years). The tumour could not be removed completely from one patient with pre-operative chylascos. Six months after diagnosis of LA this patient died of cardiopulmonary failure due to progressive tumour chylascos. Isolation and ligation of the cystic LA's peduncle as well as ligation of lymph channels can prevent recurrences and chylascos.
Adult↗
Emerging viral pathogens in long-term expatriates (II): Dengue virus.
Dengue virus infections have been well known for many years; still dengue virus is regarded as an 'emerging' pathogen, as the disease profile is changing. Its geographical range and overall incidence, and the incidence of the associated complications, dengue haemorrhagic fever (DHF) and dengue shock syndrome (DSS), are on the increase. Modern-day travel and increasing urbanization seem to be the main contributing factors. In order to estimate the risk of infection during long-term stays in dengue-endemic countries, we tested sera obtained from 323 development aid workers and their family members who had spent on average 9.8 years in dengue-endemic regions for the presence of dengue virus antibodies. Dengue virus antibody screening was done by a commercially available immunofluorescence test (IF). Reactive samples were re-tested by an in-house IF and also tested for cross-reactivity to yellow fever virus using yellow fever IF and neutralization test (NT). Evaluation of the results revealed that the screening test has a specificity of at least 63.2%. In 12 of 19 initially positive cases crossreacting antibodies against yellow fever virus could be ruled out. Three cases remained indeterminable, whereas four of the reactive and 10 (out of 12) of the borderline reactive cases showed crossreactivity with yellow fever virus, probably due to previous vaccination. We found seroprevalence rates of 4.3% with no significant differences related to gender or area of upbringing. Seroprevalence rates were evaluated according to region of suspected or confirmed infection. In two cases the dengue infection had taken a classical clinical course; in another three cases an extraordinary febrile illness was reported in the history. None of the other seropositive individuals had a history of an illness possibly attributable to dengue virus infection. Our results show that there definitely is a risk for long-term expatriates to acquire (mostly non- or oligo-symptomatic) dengue infection, which might be important especially in the light of the supposed aetiology of DHF or DSS as a secondary infection with another dengue virus serotype.
Adolescent↗
Opaque enema CT scan allows early diagnosis of non-occlusive right colonic ischaemia in dialysis patients.
Explore the source record for details and available documents.
Adult↗
Postoperative blood flow monitoring after free-tissue transfer by means of the hydrogen clearance technique.
The hydrogen clearance technique was introduced for monitoring postoperative blood flow after free-tissue transfer in this prospective clinical study. This technique allows unlimited repeatable quantitative measurements of tissue blood flow in milliliters per minute per 100 gm of tissue at any site including buried flaps. In this study a real-time blood flow measuring system (Ameflow, Ameda, Switzerland) was employed. Two thousand eight hundred and twenty-three blood flow measurements were carried out on 72 free-tissue transfers, which were performed on 71 patients. Nine of these 72 flaps showed vascular complications (12.5 percent), including arterial thrombosis in 6.9 percent (n = 5), hematoma in 4.2 percent (n = 3), and venous thrombosis in 1.4 percent (n = 1). Complications as well as uneventful postoperative cases were monitored correctly by the hydrogen clearance technique in all cases, reaching sensitivity and specificity values of 1.0 for this technique in our study. Furthermore, all complications could be detected earlier by the hydrogen clearance technique than by clinical monitoring alone, which allowed flap salvation in 7 of 9 cases and a resulting permanent failure rate of free-tissue transfer of 2.8 percent (n = 2). From our data we conclude that the hydrogen clearance technique is a promising tool for postoperative blood flow monitoring after free-tissue transfer. For experimental pathophysiologic and pharmacologic studies of tissue blood flow in flaps, further evaluation of our measuring device including comparative studies with other established techniques is highly recommended.
Adolescent↗
Replantation of the complete external genitals.
Most cases of genital amputation represent an isolated penile amputation; the combined amputation of both penile and testes is reported very seldom. We describe a case of complete amputation of the external genitals with successful replantation and good functional outcome. The problem is analyzed with respect to operative strategy, ischemic periods, postoperative management, and psychiatric background. For the replantation of the testes, time frames are comparable to those for macroreplantations.
Adult↗
The fasciocutaneous supraclavicular artery island flap for releasing postburn mentosternal contractures.
Mentosternal contractures represent a surgical challenge to the plastic and reconstructive surgeon. We add the supraclavicular artery island flap to the armamentarium of surgical procedures to improve the function and cosmesis of disfigured patients. Since July of 1994, the supraclavicular artery island flap has been used at our institution for releasing postburn mentosternal contractures in eight patients. The flap was planned to be 4 to 10 cm in width and 20 to 30 cm in length with the supraclavicular vessels running axially. All donor defects could be closed primarily without significant postoperative complications in seven of the eight patients. All flaps healed primarily, achieving a good functional result by complete removal of contracting scar tissue for all patients; one donor site healed by secondary intention. We found the supraclavicular artery island flap both reliable and safe for immediate resurfacing after resection of cervical scars. The anatomy, operative procedure, and postoperative results of the supraclavicular artery island flap are outlined in this paper.
Adult↗
Emerging viral pathogens in long-term expatriates (I): Hepatitis E virus.
Hepatitis E virus (HEV) is one of the so-called 'emerging' viral pathogens, whose role is increasingly being recognized. To estimate the risk of HEV infection during long-term stays in HEV-endemic countries, 500 serum samples obtained from development aid workers and their family members who had spent on average 9 years in HEV-endemic regions were tested for antibodies against HEV by ELISA and Immunoblot. We found seroprevalence rates of 5-6% with no significant differences related to gender or area of upbringing (raised in an HEV-endemic vs. nonendemic region). Seroprevalence rates did not increase with increasing number of stays or number of expatriate years. None of 77 children and adolescents tested was positive for anti-HEV. The Indian subcontinent showed the highest seropositive rate with 10%. In subjects returning from West and Central Africa, East Africa, South-east Asia and Latin America seroprevalence rates were around 7%. We found a comparatively low seroprevalence rate of 2.1% for the Arab countries and the Middle East. Our results show that there definitely is a risk for long-term expatriates to acquire HEV infection; however, in most of our cases infection seems to have been non- or oligo-symptomatic.
Adolescent↗
Rapid diagnosis of enterovirus infection by a new one-step reverse transcription-PCR assay.
The AMPLICOR Enterovirus Test was evaluated with 103 cerebrospinal fluid (CSF) specimens. Twenty-seven CSF specimens were culture positive. With the AMPLICOR test, enterovirus RNA was detected in 34 specimens. Compared with culture, the AMPLICOR test gave a sensitivity of 96.3% and a specificity of 100%. The sensitivity of culture was 79.4% in comparison with the AMPLICOR test.
Enterovirus↗
Use of the Stroop phenomenon as a diagnostic tool for malingering.
AIMS: To assess a computerised version of the Stroop test for detection of malingering of cognitive deficit. METHODS: Sixty subjects were assessed using this test. Twenty had cognitive deficits due to brain damage of miscellaneous aetiologies. Ten were healthy, not acquainted with the test, and were asked to simulate cognitive impairment. Another 10 simulators were psychology students trained in the use of the test. Twenty healthy subjects served as controls. Results were analysed for reaction time, error percentage, and the Stroop effect. RESULTS: There was a significant difference in reaction time among groups, showing a direct relation of age among control subjects, and also longer reaction time in patients with brain damage than in controls. Controls and patients with brain damage showed a clear Stroop effect. Simulators had a significantly prolonged reaction time, increased error percentage, and inverted or absent Stroop effect. This alteration of the Stroop effect is never present in organic cognitive deficits and seems to be a characteristic pattern of feigning, independently of knowledge of the test. CONCLUSION: This technique is recommended as a valuable tool to detect feigned cognitive impairment.
Adult↗
Timing of free microsurgical tissue transfer for the acute phase of hand injuries.
Because of favourable survival rates in replantation surgery and a high standard of free tissue transfer the interval between injury and microsurgical reconstruction has become gradually shorter. The acute phase can be defined as the interval ranging from emergency procedures within 24 hours to urgent procedures done within 72 hours. Bearing in mind the infection rates that have been reported of 1.5% for the acute phase and 17.5% for the late phase, we should encourage emergency reconstructions. However, in most cases of upper extremity injuries, reconstruction with conventional flaps is possible. Between 1981 and 1995 we did 72 acute post-traumatic free tissue transfers to the upper extremity in our unit within 72 hours (urgently). There were no significant differences in the incidence of infections when acute were compared with urgent procedures. As a result we support the concept of urgent operations. The following advantages are to be considered: urgent operations allow a second look operation, the viability of the extremity can be assessed, and the reconstructive procedure can be planned more precisely. Last but not least, the procedure is done during the day time with better operating conditions.
Hand Injuries↗
Weighted logrank tests to detect a transient improvement in survivorship.
In investigating whether an intervention has an effect on survival, we exploit the flexibility of weighted logrank tests for constructing optimal tests sensitive to specified patterns of changes in the ratios or differences of the hazards as a function of time. The tests presented seem appropriate if either the intervention on trial imposes changes in life style, such as a diet modification or an exercise regimen, or if the effect of therapy itself is limited in duration, such as in the case of drugs for AIDS that may induce drug resistant viruses. For such problems, we postulate no difference between the hazards of the two groups initially, increased discrepancies as time goes on, and an eventual leveling-off of the discrepancies in hazards perhaps due to compliance problems or to adoption of the behavior change under study by individuals in the control group. We suggest a quadratic weight function for such problems and show how to evaluate the power of the proposed tests as well as their efficiency relative to other logrank tests. Other uses of quadratic weight functions, for example for evaluating effects with lag times, and for some parametric procedures are also described. Additive and multiplicative models are presented and both discrete and continuous times are considered.
Acquired Immunodeficiency Syndrome↗
[Rare differential diagnosis of breast tumor. Giant cell tumor of the ribs].
We report a case of a breast tumor. As carcinoma of the breast was suspected, a biopsy was taken and a very rare osteoclastoma originating in the rib was identified. Semimalignant bone tumors tend to recur locally. The symptoms are nonspecific; the initial diagnosis is often made late. To differentiate the diagnosis, one should think about primary and secondary bone diseases and tumors of the organs of the thorax. In our case, the tumor was completely resected, including the ribs, and the defect was covered with a corium plasty. In this way, we are able to save the breast. We discuss different methods for covering chest wall defects.
Bone Neoplasms↗
Alcohol withdrawal.
There are three concurrent processes involved in the withdrawal from alcohol in an alcohol-dependent person. The first process is the hippocampal calcium channel mechanism diagnosed by the coarse tremor leading, sometimes precipitously, to convulsions. The second process is commonly referred to as alcoholic hallucinosis, and involves the psychoactive biogenic amine, harmine. The third process involves the locus coeruleus and presents as irritability, a fine tremor, autonomic storm, and diaphoresis. Magnesium and phenobarbital are usually sufficient to treat the syndrome of alcohol withdrawal, although neuroleptics may be required.
Alcoholism↗
Follow-up of four HIV-infected individuals after administration of hepatitis C virus and GBV-C/hepatitis G virus contaminated intravenous immunoglobulin: evidence for HCV but not for GBV-C/HGV transmission.
In 1994, hepatitis C virus (HCV) infection was transmitted to four HIV seropositive patients attending the Department of Angiology, University Clinics, Frankfurt am Main, by the administration of Gammagard. The patients were suffering from thrombocytopenia and received betweeen 20 and 30 g of the contaminated lot 93F21AB11. GBV-C/HGV RNA could be amplified from the Gammagard lot 93F21AB11 using 5'NCR and NS5 primer pairs. All the four patients were negative in the GBV-C/HGV RT-PCR prior to therapy and until the end of the follow-up period. GBV-C/HGV IgG antibodies to the putative envelope (E2) were detected using the E2 HGV-env kit (Boehringer-Mannheim, Germany) in Gammagard lot 93F21AB11 and in one patient before donation of immunoglobulin. Anti-E2 seroconversion was observed in one recipient, the other two patients remained anti-E2 seronegative until the end of the observation period. It is concluded that there is no direct evidence for transmission of GBV-C/HGV by contaminated intravenous immunoglobulin since GBV-C/HGV RNA was not detected in the recipients up to 1 year after administration.
Adult↗
Cytokines as prognostic and therapeutic tools in human cancer.
Explore the source record for details and available documents.
Biomarkers, Tumor↗
Sequence analysis of hepatitis C virus variants producing discrepant results with two different genotyping assays.
Methods for identifying the genotype of hepatitis C virus (HCV) in clinical specimens are frequently based upon the direct characterisation of viral RNA sequences by polymerase chain reaction (PCR) amplification, or by serologically based methods, in which the infecting genotype is inferred from the pattern of antibody reactivity to type-specific peptides or recombinant proteins used as antigens in an Enzyme Linked Immunosorbent Assay (ELISA). Although genotyping by direct, PCR-based methods show generally highly concordant results with the genotype inferred from serological typing assays (> 95% agreement), there exist a small number of samples that produce discrepant results. To investigate the underlying reasons for the discrepancies, we obtained eleven samples from haemophiliacs and four samples from patients with chronic hepatitis C that produced discordant results between a PCR based assay (InnoLipa I and II) and a serotyping assay (Murex HC02). Nucleotide sequences in the 5'noncoding region (5'NCR), core, and NS4 region were used to identify the genotype of the circulating virus and to identify amino acid changes in NS4 that might alter antigenicity. In 14 samples, sequence analysis of all three regions was concordant with the results of the InnoLipa assay. There were few if any amino acid substitutions in NS4 that might have accounted for the discrepant serotyping results, which were found predominantly in samples from individuals with a history of multiple exposure to HCV. It remains unclear whether the detection of antibody in such discrepant samples corresponds to previous expression of a different genotype than detected by PCR, or whether the virus population in plasma is more restricted in genotype diversity than the population in the liver or at other sites of viral replication.
Amino Acid Sequence↗
SNAP-25 can self-associate to form a disulfide-linked complex.
SNAP-25 is expressed in neurons and endocrine cells and is essential for exocytosis of neurotransmitters and peptide hormones. It has been shown to be involved in several interactions with other proteins of the secretion machinery. Here we show that SNAP-25 can self-associate to form a disulfide-linked complex. Complex formation is facilitated in vitro (in concentrated extracts or by immunoprecipitation). SNAP-25 complexes, however, also form when intact cells are treated with a membrane-permeable crosslinker indicating that SNAP-25 molecules exist in close proximity in vivo and could form complexes spontaneously. We also show that monomeric SNAP-25 and disulfide-linked SNAP-25 complexes are palmitoylated and that both can be cleaved by botulinum neurotoxin E.
Animals↗