[Successful use of C1 esterase inhibitor in capillary leak syndrome]

This article reports the successful use of C1 esterase inhibitor in the treatment of capillary leak syndrome. The coincidence of exposure to latex during surgery and medication with ramipril led to prolonged shock complicated by secondary hyperfibrinolysis, capillary leak syndrome and multiple organ failure. Initial treatment according to relevant guidelines failed to stabilize the condition. Treatment was only successful after administration of 1,500 IU of human C1 esterase inhibitor.

The performance of organic and conventional cropping systems in an extreme climate year

The 1999 severe crop season drought in the northeastern US was followed by hurricane-driven torrential rains in September, offering a unique opportunity to observe how managed and natural systems respond to climate-related stress. The Rodale Institute Farming Systems Trial has been operating since 1981 and consists of three replicated cropping systems, one organic manure based (MNR), one organic legume based (LEG) and a conventional system (CNV). The MNR system consists of a 5-year maize–soybean–wheat–clover/hay rotation, the LEG of a 3-year maize–soybean–wheat–green manure, and the CNV of a 5-year maize-soybean rotation. Subsoil lysimeters allowed quantification of percolated water in each system. Average maize and soybean yields were similar in all three systems over the post-transition years (1985–1998). Five drought years occurred between 1984 and 1998 and in four of them the organic maize outyielded the CNV by significant margins. In 1999 all crop systems suffered severe yield depressions; however, there were substantial yield differences between systems. Organic maize yielded 38% and 137% relative to CNV in the LEG and MNR treatments, respectively, and 196% and 152% relative to CNV in the soybean plots. The primary mechanism of the higher yield of the MNR and LEG is proposed to be the higher water-holding capacity of the soils in those treatments, while the lower yield of the LEG maize was due to weed competition in that particular year and treatment. Soils in the organic plots captured more water and retained more of it in the crop root zone than in the CNV treatment. Water capture in the organic plots was approximately 100% higher than in CNV plots during September's torrential rains.

Changes in anticholinergic load from regular prescribed medications in palliative care as death approaches

Although there is an understandable emphasis on the side effects of individual medications, the cumulative effects of medications have received little attention in palliative care prescribing. Anticholinergic load reflects a cumulative effect of medications that may account for several symptoms and adverse health outcomes frequently encountered in palliative care. A secondary analysis of 304 participants in a randomised controlled trial had their cholinergic load calculated using the Clinician-Rated Anticholinergic Scale (modified version) longitudinally as death approached from medication data collected prospectively by study nurses on each visit. Mean time from referral to death was 107 days, and mean 4.8 visits were conducted in which data were collected. Relationships to key factors were explored. Data showed that anticholinergic load rose as death approached because of increasing use of medications for symptom control. Symptoms significantly associated with increasing anticholinergic load included dry mouth and difficulty concentrating (P < 0.05). There were also significant associations with increasing anticholinergic load and decreasing functional status (Australia-modified Karnofsky Performance Scale; and quality of life (P < 0.05). This study has documented in detail the longitudinal anticholinergic load associated with medications used in a palliative care population between referral and death, demonstrating the biggest contributor to anticholinergic load in a palliative care population is from symptom-specific medications, which increased as death approached.

Until the chemist opens - palliation from the doctor's bag

BACKGROUND

People with a life limiting illness may have unpredictable exacerbations of their symptoms requiring after hours care by general practitioners using medications that are readily accessible. All doctors are provided with injectable 'doctor's bag' emergency drugs for use in such a crisis.

OBJECTIVE

This article aims to: identify which medications from the doctor's bag can be used in the palliative care crises that are most frequently encountered, present the best possible evidence for these indications, and to provide GPs caring for palliative care patients after hours with management strategies so, whenever appropriate, they can continue to be managed at home.

DISCUSSION

The clinical context, including disease trajectory and patient and caregivers' wishes, must be assessed in palliative care crises. Having excluded reversible problems, symptoms can be treated using doctor's bag medications. Attention must be given to route of administration, duration of effect, and appropriate doses for effective palliation.

Bericht über das Auftreten einer hereditären Chondrodysplasie bei Jungschafen (Spider Lamb Syndrome)

Gegenstand und Ziel: Bei neonatalen Lämmern und Jungtieren einer Herde von Suffolk-Schafen traten plötzlich progressive skelettale Anomalien auf. Ziel dieser Untersuchung war, klinische und genetische Nachweise auf das Vorliegen einer hereditären Chondrodysplasie bei den Jungtieren durchzuführen. Falldarstellung: Vier betroffene Jungtiere, ein weibliches und drei männliche Lämmer im Alter von zwei bis vier Monaten, wurden zur Abklärung des Krankheitsgeschehens näher untersucht. Ergebnisse: Die Befunde der klinischen und röntgenologischen Untersuchung, die histologische Auswertung des unregelmäßigen Wachstums in den Röhrenknochen sowie der genetische Nachweis bestätigten das Vorliegen einer hereditären Chondrodysplasie, des so genannten “Spider Lamb Syndrome”. Klinische Relevanz: In der vorliegenden Arbeit werden die Befunde der klinischen, röntgenologischen, postmortalen und genetischen Untersuchungen präsentiert, der derzeitige Stand der Wissenschaft dokumentiert und die züchterischen Konsequenzen diskutiert.

[Cystic lesion of the dorsal mediastinum]

We present the case of a 52-year-old male who underwent thoracotomy for resection of a suspected bronchogenic cyst in the right posterior mediastinum. The size of the tumor had increased over years, according to repeated X-rays, and the cyst became symptomatic with obstruction of the right subclavian and jugular veins. To our surprise, histopathology revealed a hydatid cyst.

Magnetresonanztomographie in der Urologie

Due to low costs and common availability, ultrasonography and computed tomography still represent the most common diagnostic tools in uroradiology. However, magnetic resonance imaging (MRI) is gaining more and more importance since this imaging modality allows for a comprehensive examination of almost the complete spectrum of urologic diseases, including congenital malformations. The most important advantages of MRI are the free choice of slice orientation, high soft tissue contrast and high resolution as well as the lack of radiation. Technical progresses in hard and software components have led to a reduction in acquisition time, allowing for real-time imaging as well as MR angiography and MR urography with a significant reduction in motion artifacts. In addition, contrast enhanced MRI represents the imaging modality of choice in patients with reduced renal function or known allergy against iodinated contrast agent.

Lymphangioma of the pancreas and the duodenal wall: MR imaging findings

Pancreatic lymphangiomas are rare benign tumours with a histogenesis not yet completely understood. Predominantly the cystic aspect of this lesion can complicate the differentiation from other neoplastic and non-neoplastic cystic tumours of the pancreas. We present a case of a middle-aged woman with a lymphangioma involving the duodenal wall and the pancreatic head. With special regard to MR imaging findings differential diagnosis is discussed.