A close look at autoimmune muscle disorders: association of Lambert–Eaton myasthenic syndrome with dermatomyositis

Dermatomyositis/polymyositis (DM/PM) and Lambert-Eaton myasthenic syndrome (LEMS) are two autoimmune disorders that have very rarely been reported to occur together in the same patient. We report on two patients with DM who were later diagnosed with concomitant LEMS, and point out diagnostic challenges in identifying LEMS in patients with DM/PM. As specific treatment for LEMS is available, it is important to identify those DM/PM patients who suffer from concomitant LEMS.

[A new gene locus for an autosomal-dominant non-syndromic hearing impairment (DFNA 33) is situated on chromosome 13q34-qter]

By investigation of a German family pedigree with non-syndromic hearing impairment of early onset and autosomal-dominant mode of inheritance, linkage to known DFNA loci was excluded, and the existence of a new locus (DFNA33) was revealed. In a subsequent genomic scan the phenotype was mapped to a 6 cM interval on chromosome 13q34-qter. A maximum two-point lod score of 2.96 was obtained for the marker D13S285 with a maximum lod score in the multipoint analysis of 3.28 at 124.56 cM.

[Obstructive pulmonary diseases and pulmonary hypertension]

Pulmonary hypertension is a frequent complication of chronic obstructive pulmonary disease. Especially in patients with concurrent sleep apnoe syndrome (so called "overlap syndrome"), the risk for pulmonary hypertension is high. Pathophysiologically, both toxic effects (cigarette smoke) and alveolar hypoventilation can induce dysfunction of the pulmonary endothelium. Genetic factors and cytokines/growth factors released by inflammatory cells may induce remodeling of the pulmonary vessels. Pulmonary hypertension results, which is initially reversible, but gradually worsens over time. At present, therapeutic options include long term oxygen in addition to the treatment of the underlying disease. A subgroup of patients may profit of a specific therapy with sildenafil and other new substances. However, studies that define these subgroups need to be performed.

Multi-level partnerships to promote health services among internally displaced in eastern Burma

Ethnic populations in eastern Burma are the target of military policies that result in forced labour, destruction of food supplies, and massive forced displacement. Despite international assistance to Burmese refugees along the Thai-Burma border, traditional humanitarian models have failed to reach these internally displaced persons (IDPs) within Burma. Nevertheless, through the cultivation of a model (cross border local-global partnerships) 300,000 IDPs in eastern Burma now receive critical health services where, otherwise, there would be none. We describe key elements of the partnership model's genesis in eastern Burma. The role of the local partner, Backpack Health Worker Team (BPHWT), is highlighted for its indigenous access to the IDP populations and its maintenance of programmatic autonomy. These local elements are potentiated by international support for technical assistance, training, resources, and advocacy. International policy and investment should prioritize support of locally-driven health initiatives that utilize local-global partnerships to reach not only IDPs but also other war-torn or traditionally inaccessible populations worldwide.

[Necrotizing fasciitis--a rare complication of laparoscopic appendectomy]

Necrotizing fasciitis is a bacterial infectious disorder affecting the fascia and the dermis, however sparing the muscle layer. Initial, difficult to detect, fast-progressing subcutaneous spread with rapid progression to shock, conduces to the high mortality rates of the disorder. In risk patient groups, such as in diabetes patients, immunocompromized patients or the elderly, the mortality rate even exceeds 80%. The majority of infections is caused by common skin, rectal or urethral bacteria. The commonest paths of entry into the body include minor skin lesions, including surgical wounds. Fever, pain, skin redness and edema, crepitus and, later even skin necrosis mimicking grade III burns, are the symptoms suggestive of necrotizing fasciitis. Among depicting methods, CT examination is irreplacable. Only early and sufficiently radical surgical management with adjunctive antibiotic therapy may result in successful outcomes. The authors present a rare case of necrotizing fasciitis, which developed as a complication of laparoscopic appendectomy in a young healthy subject. Considering the rarity of the complication, a summary of available medical literature data related to the problematics is included in this presentation.

Participatory prevention research model promotes environmental change for healthier schools

Barriers exist to healthy eating and physical activity for children in the school environment. Modifiable school environmental factors have led to the development of the Nutrition Friendly Schools and Communities (NFSC) model to prevent the development of overweight in school children and adolescents. The design of the NFSC environmental intervention is to actively engage the school community to prevent overweight in school-aged children. This article presents data measuring the environmental changes achieved by the Los Angeles Unified School District (LAUSD) elementary schools participating in a 3-year participatory research pilot study funded by the Centers for Disease Control and Prevention (CDC). An objective of the pilot study is to determine whether any or all of the 15 steps developed for the NFSC model could be implemented. Further, researchers want to know if any of the study schools could implement the NFSC model as a whole during the allotted time of the pilot study.

[Unusual combination of clinical forms in a young man. Atypical pityriasis rosea]

Uncommon forms of pityriasis rosea (PR) are found in a not inconsiderable proportion of patients (totaling approximately 20%) and predominantly affect children and young adults. They are characterized by atypical morphology and distribution of the primary medallion or also of the subsequent exanthematous individual lesions. The etiology of PR is not yet known. It is possible that the underlying cause of PR is viral in origin.

[Treatment of multiple angiomatosis involving the skeleton and the abdominal and thoracic cavities with interferon alpha, thalidomide and zoledronate]

Multiple angiomatosis is a very rare disease formed by histologically benign angiomas spreading beyond single organ or tissue. In the case reported herein, hemangiomas affected several vertebrae of a young man and spread through his peritoneal cavity projecting to his stomach and causing recurrent hematemesis. Also affected was the mediastinum. The patient suffered from bone pain and digestive problems. Initial treatment involved 2 drugs with antiangiogenic effect: interferon alpha (initial dose of6 million units 3 times a week, later reduced to 3 million units 3 times a week due to adverse effects) and zoledronate (4 mg i.v. every 28 days). Even though the therapy eliminated bone pain after 2 months, CT check at a later stage showed but little regression of the mass of the angiomas in the abdominal cavity and the mediastinum. Substantial reduction in the mass of the angiomas to merely residual quantity, i.e. partial remission of the disease, was achieved only after the addition of 100 mg/day thalidomide (Myrin) to the above mentioned doses of interferon and zoledronate administered on a regular basis. However, the disease recurred after the therapy was interrupted, and the above triple combination therapy has had to be restored. Maintenance therapy will succeed to repeated achievement of remission of angiomas. A very good therapeutic effect was recorded for combined interferon alpha, thalidomide and zoledronate in this specific case of multiple angiomatosis.

[A new locus for an autosomal dominant, non-syndromic hearing impairment (DFNA57) located on chromosome 19p13.2 and overlapping with DFNB15]

BACKGROUND

Non-syndromic hearing loss is the most genetically heterogeneous trait known in humans. To date, 54 loci for autosomal dominant non-syndromic sensorineural hearing loss (NSSHL) have been identified by linkage analysis.

METHODS

In this study a German pedigree has been identified segregating a progressive bilateral loss of lower and middle frequencies.

RESULTS

A genome-wide screening and linkage analysis revealed the existence of a new NSSHL locus (DFNA57). The phenotype was mapped to a 10 degrees Mbp interval on chromosome 19p13.2 from 7.8 to 18.2 degrees Mbp, a maximum 2-point LOD score of 3.08 was obtained for the marker D19S586. The region overlaps with the recessive locus DFNB15.

CONCLUSION

The results underline the heterogeneity of hereditary hearing disorders. Identification of genes can help to reach a better understanding of the molecular mechanism of hearing.

The regulatory T-cell phenotype in progressive mycosis fungoides

In early stages mycosis fungoides (MF) often runs an indolent course. Nevertheless a small but significant part of these patients develop an aggressive, life threatening course. These patients usually were immunocompromised. In most of those cases the lymphoma cells express CD25. This raised the question if those lymphomas may express a regulatory phenotype. Recently a couple of in vitro and in vivo studies analyzed this issue with different methods. This review discusses the recent developments in this highly topical area of research.

Importance of changes in gastric emptying for postprandial plasma glucose fluxes in healthy humans

OBJECTIVE

Regulation of postprandial (pp) plasma glucose excursions is complex. Insulin and glucagon are thought to play the predominant role. Nevertheless, only 50% of the variation in pp plasma glucose excursions is explained by variations by the latter. Theoretically, gastric emptying (GE) should be another important factor. However, its impact on pp glucose homeostasis is unknown.

RESEARCH DESIGN AND METHODS

We examined the consequences of pramlintide-induced delay in GE on pp glycemia and glucose fluxes, determined isotopically. GE was recorded by scintigraphy. Fourteen healthy subjects (8 men, 6 women; age 40 +/- 3 yr, body mass index 27.8 +/- 1.1 kg/m2) ate a mixed meal, and 30 microg of pramlintide (PRAM) or placebo (PBO) were injected subcutaneously.

RESULTS

At 60 min, greater proportions of the initial gastric contents remained in the stomach (PBO vs. PRAM). Thereafter, GE slopes paralleled until 240 min. Fifty percent retention times were lower when PBO was given (P < 0.001). GE was greater from 240 min to the end of the PRAM experiments, so that only slightly greater proportions of the meal remained in the stomach at 330 min. Reductions of GE lowered pp glucose (7.5 +/- 0.3 vs. 6.0 +/- 0.2 mmol/l, P < 0.001), even though plasma insulin was lower with PRAM (164 +/- 13 vs. 138 +/- 13 pmol/ml, both P < 0.01). Reduction in total glucose appearance (P < 0.001) was due to reduced meal-derived glucose appearance (10.2 +/- 0.5 vs. 7.0 +/- 0.4 micromol.kg(-1).min(-1), P < 0.001). Endogenous glucose appearance was greater with PRAM (P < 0.001). Splanchnic glucose uptake was greater with PRAM (26.5 +/- 1.6 vs. 32.5 +/- 2.1%, P = 0.014).

CONCLUSIONS

These data support the concept that GE is an important physiological regulator of pp glucose homeostasis in humans.

Acroangiodermatitis Mali resulting from arteriovenous malformation: report of a case of Stewart-Bluefarb syndrome

We describe the rare Stewart-Bluefarb syndrome in a 15-year-old boy. This syndrome presents as a congenital arteriovenous malformation of the lower leg with multiple arteriovenous shunts accompanied by the benign acroangiodermatitis of Mali (pseudo-Kaposi's sarcoma). The clinical features of this disorder and the treatment options are reviewed.

A school salad bar increases frequency of fruit and vegetable consumption among children living in low-income households

OBJECTIVE

To measure change in fruit and vegetable (F&V) consumption among elementary-school children after the introduction of a salad bar programme as a lunch menu option in the US Department of Agriculture's (USDA) reimbursable lunch programme in Los Angeles Unified School District (LAUSD).

DESIGN

A cross-sectional sample of children was interviewed before and after a salad bar intervention (1998 and 2000, respectively) utilising a 24-hour food recall questionnaire. Frequencies of F&V consumption were calculated.

SETTING

The evaluation took place in three LAUSD elementary schools participating in the salad bar programme and the USDA reimbursable lunch programme.

SUBJECTS

Three hundred and thirty-seven children in 2nd-5th grade (7-11 years old).

RESULTS

After the salad bar was introduced, there was a significant increase in frequency (2.97 to 4.09, P < 0.001) of F&V consumed among the children studied. The increase in frequency of F&V consumed was almost all due to an increase during lunch (84%). Mean energy, cholesterol, saturated fat and total fat intakes were significantly lower in the children after the salad bar was introduced in the schools compared with the intakes in the children before the salad bar was introduced.

CONCLUSION

A salad bar as a lunch menu option in the USDA reimbursable lunch programme can significantly increase the frequency of F&V consumption by elementary-school children living in low-income households.

[Dronabinol for supportive therapy in patients with malignant melanoma and liver metastases]

BACKGROUND

Loss of appetite and nausea can reduce the quality of life of patients with malignant melanoma and liver metastases. Often established antiemetic drugs fail to bring relief. Tetrahydrocannabinol (THC, Marinol), which is the active agent of Indian hemp, has been used successfully in this situation for other malignant tumors.

PATIENTS AND METHODS

We treated 7 patients with hematogenous metastatic melanoma and liver metastases suffering from extensive loss of appetite and nausea supportively with dronabinol (Marinol. All of these patients had previously received standard antiemetic therapy without adequate relief. Dronabinol is a synthetic Delta-tetrahydrocannabinol. The drug was administered in capsule form. We evaluated the palliative effects of dronabinol with a special patient evaluation form, which was filled out at the beginning of the therapy and again after 4 weeks.

RESULTS

The majority of patients described a significant increase in appetite and decrease in nausea. These effects remained for some weeks, but then decreased as metastases progressed and the general condition worsened. All of the patients experienced slight to moderate dizziness, but it was not sufficiently troubling to cause interruption or termination of therapy.

CONCLUSION

Loss of appetite and nausea due to liver metastases of malignant melanoma can be treated in individual cases supportively with Dronabinol.

Konduktives Knochenersatzmaterial mit variabler Antibiotikaversetzung

BACKGROUND

A new bone substitute, consisting of hydroxylapatite and calcium sulphate, was prepared in two formulations and analysed for its mechanical strength and antibiotic elution.

MATERIAL AND METHODS

The bone substitute PerOssal has osteoconductive and degradable properties. The material has a built-in capillary structure, which results in an immediate fluid uptake. Antibiotics absorbed to the bone substitute resulted in a prolonged release rate. Mechanical strength was investigated by an unconfined compression test up to failure under both wet and dry conditions for both formulations of the bone substitute. Antibiotic release was analysed microbiologically for two antibiotics, vancomycin and gentamicin, over an elution period of 10 days using the agar diffusion method.

RESULTS

The drug release analysis resulted in a prolonged release rate of both antibiotics over 10 days. In vitro the amount of gentamicin and vancomycin eluted at day 10. From one pellet still exceeded the minimal inhibitory concentration of most aetiologically important pathogens. Formulation two of the present bone substitute is significantly harder in both wet and dry conditions when compared to formulation one. Both formulations lose strength in the wet condition relative to their performance in the dry condition. However, formulation two is as hard under wet conditions as formulation one is when dry.

CONCLUSION

PerOssal is a suitable new degradable osteoconductive bone substitute that can be loaded with antibiotic solutions, which are released in effective doses over 10 days. The mechanical strength of PerOssal is sufficient to support cancellous bone defects in non-weight-bearing areas or in combination with osteosynthesis.