Amination of Arenes through Electron-Deficient Reaction Cascades of Aryl Epoxyazides

[reaction: see text] Aryl epoxyazides undergo efficient electron-deficient reaction cascades mediated by Lewis acids, leading to regiospecific amination of the aromatic ring.

Cognitive processing in completely paralyzed patients with amyotrophic lateral sclerosis

Cognitive functions have never been studied before in completely paralyzed patients, probably due to the lack of the appropriate method. In this study, three male patients in the last stage of amyotrophic lateral sclerosis (ALS) are examined. They were totally locked-in, i.e., incapable of any voluntary response including eye movements. Given this complete lack of motor expression, the method of event-related brain potentials (ERPs) was used. The ERP recording was carried out at the patients' bedside. In one patient indications of preserved cognitive abilities including adequate language comprehension were obtained. The data of the second patient also demonstrate a high degree of intactness of complex cognitive functions, but some ERP phenomena were consistently abnormal, which may be interpreted as a consequence of disease-related degenerative processes. In the third patient no electrocortical response which might indicate higher cortical processing was found. This first ERP study of totally paralyzed patients shows that some of them can possess high, perhaps even normal, information processing capacity after a long period of severe immobility and artificial ventilation.

Genotypic and phenotypic properties of coagulase-negative staphylococci causing dialysis catheter-related sepsis

Sixty coagulase-negative staphylococcus (CNS) isolates were recovered from the blood cultures or peritoneal dialysate effluent of 43 patients on renal dialysis. The patients had either renal dialysis catheter-related sepsis (CRS) or continuous ambulatory peritoneal dialysis (CAPD)-associated peritonitis. Isolates were characterized by biotyping, and genotyped by pulsed-field gel electrophoresis (PFGE). Phenotypic properties of the strains were also investigated. Several genotypes were identified with no one specific strain of CNS being associated with CRS. However, closely related strains were isolated from several patients within the units studied, suggesting horizontal transfer of micro-organisms. Genotypic macro-restriction profiles did not concur with phenotypic profiles or biotypes, confirming that genotyping is required for epidemiological studies. All staphylococcal strains were investigated for the production of phenotypic characteristics. Significant differences were predominantly seen in the production of lipase, esterase and elastase in strains isolated from the renal patients with CRS and CAPD-associated peritonitis, compared with a non-septic control group. These phenotypic characteristics may therefore have a role in the maintenance of CRS in renal patients.

The microbial diagnosis of infective endocarditis

This review suggests an evidence-based algorithm for sequential testing in infective endocarditis. It discusses blood culture and the merits and drawbacks of serology in making the diagnosis. Newer techniques are briefly reviewed. The proposed algorithm will complement the Duke criteria in clinical practice.

Observer variability in the Goseki grouping of gastric adenocarcinoma in resection and biopsy specimens

AIMS

The Goseki grouping of gastric adenocarcinoma has been suggested as a possible prognostic factor. In those centres where it is used, it may be valuable to assess the Goseki grouping of a tumour on the initial diagnostic biopsy as well as on the resection specimen since it may in theory influence management. We examined the robustness of Goseki grouping of gastric adenocarcinoma in representative sections from resection and biopsy specimens in order to assess the consistency of agreement among a group of pathologists.

METHODS

A single representative block from 100 gastric resection specimens was studied using a haematoxylin and eosin and mucin (alcian blue/periodic acid-Schiff) stain. These were circulated in batches to members of a group of 12 pathologists who each completed a simple proforma confirming the presence of carcinoma and assigning a Goseki group. In a second circulation the diagnostic biopsy specimen taken prior to resection was examined in the same way. This allowed comparison of the Goseki group of the biopsy and resection specimens.

RESULTS

In both studies kappa statistics showed good agreement on tubular differentiation of the carcinoma, but only moderate agreement for the intracellular mucin production, resulting in moderate agreement for the final Goseki group. Correlation between the Goseki group assigned on the biopsy and resected specimens was seen in 62% of the cases. However, the reproducibility was low (kappa 0.375).

CONCLUSIONS

The Goseki grouping of resected gastric adenocarcinoma is reproducible and can be used in prognostication. Goseki grouping of biopsy specimens is of limited value in predicting the Goseki group assigned to the resected carcinoma.

[The Knee Injury and Osteoarthritis Outcome Score--a multifunctional questionnaire to measure outcome in knee arthroplasty]

AIM

It was the purpose of this investigation to create a German version of the Knee Injury and Osteoarthritis Outcome Score (KOOS) and to test its appropriateness in patients with advanced gonarthritis.

METHOD

Reliability (test-retest reliability, internal consistency), validity (convergent construct validity and divergent construct validity), sensitivity to change as well as practicability and acceptance of this questionnaire were tested in 90 patients.

RESULTS

The test-retest reliability was acceptably high for all subscales, it ranged between r = 0.65 and 0.78 and the questionnaire showed a high internal consistency in almost all of the subscales. The comparison to the results of the questionnaire "Short Form-12" (SF-12) as well as to the patients self-assessment of health status showed high concordance in nearly all subscales, however it was only moderate for the symptom scale. Furthermore the KOOS was able to show significant differences between patients and healthy controls. When testing the sensitivity to change, the KOOS could demonstrate significant improvements within 3 months and the instrument has shown to be practicable with a high acceptance by the patients.

CONCLUSION

With the German version of the Knee Injury and Osteoarthritis Outcome Score a multidimensional instrument is available now to measure health status as well as therapeutic effects in patients with knee problems. Modifying the subscale "symptoms" could further optimize this questionnaire in patients with advanced gonarthritis.

Immune restoration in head and neck cancer patients via cyclooxygenase inhibition: an update

Most carcinomas overexpress cyclooxygenase, especially COX-2, thus secreting large amounts of immunosuppressive prostaglandins. Epidemiological data and animal models have provided evidence that inhibition of cyclooxygenase and thus prostaglandin E2 synthesis via non-steroid antiinflammatory drugs (NSAIDs) inhibits tumor growth in vitro and in vivo. Moreover, it could be demonstrated that chemoprevention, i.e. the long-term use of NSAIDs, significantly reduced the risk of developing certain types of cancer. However, the molecular mechanisms underlying these antineoplastic effects are not entirely understood. This review focuses on prostaglandin-mediated immunosuppressive mechanisms in head and neck cancer and presents immunorestorative strategies via cyclooxygenase inhibition in vitro and in vivo with special emphasis on COX-2. A better understanding of the interaction of tumors with the immune system and how the process of carcinogenesis can be antagonized by selectively modulating the activity of specific enzymes such as COX-2 will provide the rationale for the use of NSAIDs for chemoprevention or immunoadjuvant cancer therapies.

Haemophilus paraphrophilus prosthetic valve endocarditis

We report a case of prosthetic, aortic valve, infective endocarditis caused by Haemophilus paraphrophilus. There are no other cases described in the available literature where this microorganism has caused prosthetic valve endocarditis and no other case reported involving only the aortic valve.

Effects of mobile phone radiation on UV-induced skin tumourigenesis in ornithine decarboxylase transgenic and non-transgenic mice

PURPOSE

The effects of low-level radiofrequency radiation (RFR) on ultraviolet (UV)-induced skin tumorigenesis were evaluated in ornithine decarboxylase (ODC) and non-transgenic mice.

MATERIALS AND METHODS

Transgenic female mice over-expressing the human ODC gene and their non-transgenic littermates (20 animals in the cage control group, and 45-49 animals in the other groups) were exposed for 52 weeks to UV radiation or a combination of UV radiation and pulsed RFR. The UV dose was 240 Jm(-2) (1.2 x human minimum erythemal dose) delivered three times a week. One group of animals was exposed to Digital Advanced Mobile Phone System (DAMPS)-type RFR, the other group to Global System for Mobile (GSM)-type RFR at a nominal average specific absorption rate of 0.5 W kg(-1), 1.5 h day(-1), for 5 days a week. The skin was carefully palpated weekly for macroscopic tumours. Histopathological analyses of all skin lesions and of a specified dorsal skin area were performed on all animals.

RESULTS

UV exposure resulted in development of macroscopic skin tumours in 11.5 and 36.8% of non-transgenic and transgenic animals, respectively. The RFR exposures did not give a statistically significant effect on the development of skin tumours in either transgenic or non-transgenic animals, or in combined analysis, but tumour development appeared slightly accelerated especially in non-transgenic animals. No effects of RFR exposures were found on excretion of 6-hydroxymelatonin sulphate into urine or on polyamine levels in dorsal skin.

CONCLUSION

RFR exposures did not significantly enhance skin tumourigenesis. However, the slightly accelerated tumour development may warrant further evaluation.

Mupirocin and Staphylococcus aureus: a recent paradigm of emerging antibiotic resistance

OBJECTIVES

To describe trends in mupirocin resistance among Staphylococcus aureus in New Zealand (NZ), following the availability of mupirocin in 1986.

PATIENTS AND METHODS

Data from a variety of sources were used for this study: susceptibility data collected annually from diagnostic laboratories throughout NZ; a local survey of mupirocin-resistant S. aureus in the Auckland area in 1997; a national survey of S. aureus antimicrobial susceptibility in 1999; and the national methicillin-resistant S. aureus (MRSA) surveillance programme.

RESULTS

All data sources show that there was a steady increase in mupirocin resistance among S. aureus throughout the 1990s, and rates in NZ are now markedly higher than those reported in most other comparable countries. By 1999, resistance averaged 28%, with higher rates among community-acquired compared with hospital-acquired isolates, and with a wide geographical variation in resistance. Resistance was more common among S. aureus generally than MRSA.

CONCLUSION

We postulate that the steady rise in mupirocin resistance among S. aureus in NZ throughout the 1990s may be due, at least in part, to the over the counter availability of mupirocin from 1991 to 2000. The current patterns of mupirocin consumption need to be reviewed and its use rationalized to maximize the chances of this antibiotic retaining beneficial antistaphylococcal activity.

Eikenella corrodens infective endocarditis in a previously healthy non-drug user

Reported here is a case of Eikenella corrodens aortic valve infective endocarditis presenting as a stroke in a previously healthy 31-year-old man. The patient had no evidence of structural heart disease and reported no history of intravenous drug use or recent dental treatment. There are no other cases reported in the available literature in which this microorganism has caused endocarditis in the absence of recognised risk factors.

[Giant Madelung's disease. Report of a case and review of the literature]

Madelung's disease, also known as benign symmetrical lipomatosis, is a rare proliferative disorder of unknown etiology that was first mentioned by Brodie in 1846. Characterized by multiple symmetrical deposits of unencapsulated fat in the head and neck region, the disease is most common in middle-aged men with a history of alcohol abuse. The only effective therapy in cases of dyspnea and dysphagia, indicating the necessity of treatment, is the surgical resection of the adipose tissue. The authors report on the evaluation and therapy in a case of giant Madelung's disease.

[Osteosarcoma and Ewing's sarcoma--The most frequent malignant bone tumors in children--therapy and outcome]

BACKGROUND

Osteosarcoma and Ewing's sarcoma are the most frequent malignant bone tumors in children and young adults with relatively poor overall survival rates.

METHODS

Between January 1980 and December 1994, 175 children with osteosarcoma and 64 children with Ewing's sarcoma were treated at the author's institution. 22 children had synchronous metastases, 19 patients had a pathologic fracture. Both groups were treated systemically with chemotherapy regimens (COSS and CESS). Local therapy was amputation or tumor resection and endoprosthetic replacement or biological reconstruction with wide or radical resection margins. In case of Ewing's sarcoma in 35 patients postoperative radiation therapy was done.

RESULTS

Five-year overall survival rate for osteosarcoma and Ewing's sarcoma patients is about 63 %, ten-year survival rate for osteosarcoma patients is 60.2 %, for Ewing's sarcoma patients 54.5 %. Prognostic factors significantly influencing overall survival rates are tumor response to chemotherapy (p values = 0.0056 and 0.013, respectively), surgical treatment with adequate resection margins (p value = 0.0001 for osteosarcoma patients) and development of postoperative metastases (p value = 0.0001 for both groups).

CONCLUSION

For both groups of malignant bone tumors systemic chemotherapy as well as adequate surgical therapy are necessary to reduce the rates of local recurrences and to achieve better survival rates.

Determination of bone and tissue concentrations of teicoplanin mixed with hydroxyapatite cement to repair cortical defects

A highly specific and sensitive isocratic reversed-phase high performance liquid chromatography (HPLC) method for the determination of the major component of teicoplanin in tissue is reported. Comparing fluorescamine and o-phthalaldehyde (OPA) as derivatizing agents, the derivative formed with the latter exhibits superior fluorescence intensity allowing detection of femtomole quantities. Pretreatment for tissue samples is by solid-phase extraction which uses Bakerbond PolarP C(18) cartridges and gives effective clean up from endogenous by-products. Linearity was given from 0.6 to 100 ng per injection. The coefficient of variation did not exceed 5.8% for both interday and intraday assays. It was found that when bone defects are repaired with a hydroxyapatite-teicoplanin mixture, the antibiotic does not degrade, even when it is in the cement for several months. The stability of teicoplanin in bone cement was determined fluorodensitometrically.

Alkanotrophic Rhodococcus ruber as a biosurfactant producer

In this report we examined the structure and properties of surface-active lipids of Rhodococcus ruber. Most historical interest has been in the glycolipids of Rhodococcus erythropolis, which have been extensively characterised. R. erythropolis has been of interest due to its great metabolic diversity. Only recently has the metabolic potential of R. ruber begun to be explored. One major difference in the two species is that most R. ruber strains are able to oxidise the gaseous alkanes propane and butane. In preparation for investigation of the effects of gas metabolism on biosurfactant production, we set out to characterise the biosurfactants produced during growth on liquid n-alkanes and to compare these with R. erythropolis glycolipids.

[The expression of zeta-chain of the T cell receptor as prognostic marker for patients with head and neck cancer]

INTRODUCTION

The zeta-chain as an important component of the T cell receptor (TCR) is involved in the transduction of intracellular signals and is therefore critical for T cell activation and subsequent induction of an anti-tumor response. In patients with squamous cell carcinoma of the head and neck (SCCHN) several mechanisms of immune suppression have been described. The expression of the TCR zeta-chain of both peripheral blood lymphocytes (PBLs) and tumor infiltrating lymphocytes (TILs) has been analysed in patients with SCCHN and correlated to clinical data.

METHODS

TIL and PBL from 47 patients with SCCHN were obtained. To determine expression of the zeta-chain in both PBLs and TILs, double immunostaining with mAbs and flow cytometric analysis was performed. The technique combined an intracellular staining with a surface staining.

RESULTS

As compared to healthy controls (n = 23), zeta-chain expression was significantly reduced (p < 0.002) in patients with SCCHN (n = 23) with lowest expression in those with UICC VI disease. Our results show a tight correlation between the loss of zeta-chain expression and the clinical aggressiveness of the tumor. Higher tumor stages frequently show a higher loss of the zeta-chain. In 11 patients zeta-chain expression of the PBL could be compared with TIL. Independent of the tumor stage the loss of the zeta-chain expression is much higher in TIL than in PBL. The loss of the zeta-chain expression also correlates with the progression of the disease. Patients with a high loss of the zeta-chain expression develop a recurrence more frequently.

CONCLUSION

The loss of the zeta-chain documents a systemic immune defect, which even occurs in early tumor stages. Additionally to locoregional approaches future therapeutic strategies should also focus on systemic immunomodulation.

[Clinical and epidemiological data of patients with malignomas of the head and neck]

BACKGROUND

The present study describes clinical and epidemiological data of patients with malignomas of the head and neck documented in the Munich Cancer Register.

PATIENTS AND METHODS

Data of head and neck cancer patients treated at four departments of head and neck surgery and one of oral-maxillo-facial surgery in the area of Munich from 1978 up to now are reported.

RESULTS

Incidence and mortality as a function of age, sex, and tumor localization are described in comparison to clinical and epidemiological data as specified in tumor registers of the Saarland and the USA. Moreover, TNM stages, survival, recurrence, and metastasis rates are presented.

CONCLUSION

Based on the documentation of the Munich Cancer Register our study is the first to present a detailed description of clinical and epidemiological data of patients suffering from head and neck malignomas.

[Correlation of FDG-PET and MRI/CT with histopathology in primary diagnosis, lymph node staging and diagnosis of recurrency of head and neck cancer]

AIM

Correct staging of head and neck cancer is important for the patient's prognosis and further therapeutic strategies. Aim of the present study was to investigate the diagnostic value of FDG-PET regarding the pre-surgical diagnosis of primary tumor and cervical lymph node metastases, the diagnosis of tumour recurrence, and the localisation of unknown primary, further to compare the results to those of morphological imaging modalities (CT/MRI) and to correlate the results of both methods with histopathological findings.

PATIENTS/METHODS

115 patients (pts) (72 x primary diagnosis, 37 x recurrence, and 6 x unknown primary) underwent FDG-PET (ECAT EXACT HR+) and CT or MRI. Results were correlated with histopathological findings in terms of detection of primary and recurrent tumors as well as lymph node metastases.

RESULTS

Regarding the pre-surgical diagnosis, sensitivity and specificity for identifying primary tumors were 85 % and 100 % for PET and 88 % and 75 % for CT/MRI, respectively. Accuracy was 86 % for PET and 87 % for CT/MRI. Sensitivity and specificity for detecting primary lymph node involvement were 71 %/86 % for PET and 74 %/57 % for CT/MRI, resulting in an accuracy of 77 % with PET and 68 % with morphological imaging. In 23 pts histopathology revealed pT1 stages with tumor diameters < 12 mm. In 8 pts CT/MRI and in 10 pts PET failed to identify these small primary lesions. Detecting tumor recurrence (n = 37) PET showed a higher sensitivity (83 %), specificity (76 %) and accuracy (78 %) compared to CT/MRI (sensitivity: 67 %; specificity: 52 %; accuracy: 57 %). In 4/6 pts with unknown primary, imaging was able to identify a primary lesion (3/4 in FDG-PET, 2/4 in CT/MRI), in 2/6 patients even in the follow-up no primary tumor was found.

CONCLUSIONS

FDG-PET provides only minor additional information to morphological imaging concerning diagnosis of primary tumors. At a similar level of sensitivity, however, it seems to be more specific regarding the lymph node involvement. PET seems to be superior to CT/MRI in detecting tumor recurrence as well as occult primary tumors in pts with known cervical lymph node metastases.