Primary antifungal prophylaxis in acute myeloblastic leukemia and myelodysplastic syndrome--still an open question?

In this review, we aim to compare different early treatment strategies of invasive fungal diseases in patients undergoing induction chemotherapy for acute myelogenous leukemia or myelodysplastic syndrome. Three treatment approaches--prophylactic, empiric, and preemptive treatment--are subject to continuous discussion among physicians treating patients at risk. Considering the available clinical basis of evidence, we opt for antifungal prophylaxis with posaconazole 200 mg tid po as our primary prophylactic strategy, while the employment of preemptive treatment should be delayed until more accurate diagnostic tools become available.

Mechanographic analyses in pediatrics: allometric scaling of 'peak jump force' and its relationship to 'maximal isometric grip force' in childhood and adolescence.

Background: Kinetic analyses of the neuromuscular system have become an important part in the diagnostics of metabolic bone disorders in pediatrics because of the relevance of the 'Functional Muscle-Bone Unit'. Because muscle function is associated with muscle metabolism, it is suggested that the association of maximal forces with anthropometric variables (e. g.

Diagnosis and treatment of fungal infections in allogeneic stem cell and solid organ transplant recipients.

Importance Of The Field: Invasive fungal diseases (IFD) are severe complications in patients receiving immunosuppression after solid organ or allogeneic stem cell transplantation. Extensive study has been conducted on therapeutic strategies for IFD in neutropenic patients, mostly those with hematological malignancy. There is an ongoing discussion on whether these studies may be applied to transplant patients as well.

Value of a new fixed-combination pack of bisphosphonate, calcium and vitamin D in the therapy of osteoporosis: results of two quantitative patient research studies.

Background: Osteoporotic patients with insufficient calcium intake and/or vitamin D insufficiency need adequate calcium and vitamin D supplementation with their bisphosphonate treatment. However, consistent intake and, therefore, the effectiveness of calcium/vitamin D supplementation may be impaired by several factors in the individual patient: low prescription rate or lack of advice to purchase calcium/vitamin D; reduced compliance because of the complexity of the regimen; or incorrect intake. There is a need to provide patients with a better way of taking bisphosphonate treatment with their calcium/vitamin D supplementation.

Secondary endovascular and conversion procedures for failed endovascular abdominal aortic aneurysm repair: can we still be optimistic?

The purpose of this study was to evaluate the incidence, etiology, and outcome of secondary endovascular and "open" conversion procedures after failed endovascular abdominal aortic aneurysm repair (EVAR). From January 1997 until December 2005, 625 patients with an infrarenal abdominal aortic aneurysm were treated by elective EVAR, with 98.7% (n = 617) primary EVAR success.

Ribavirin priming in patients with chronic hepatitis C and normal ALT: a pilot study.

Background/aims: Ribavirin has favorable immune-modulating effects in patients with hepatitis C. Therefore, a ribavirin monotherapy preceding the combination of peginterferon plus ribavirin may be beneficial. We conducted a pilot study with a sequential regimen using a reduced dosage of peginterferon-alfa 2b in patients with chronic hepatitis C and normal transaminases.

Patients at high risk of invasive fungal infections: when and how to treat.

When and how to treat invasive fungal infections (IFIs) is discussed in this review, with a focus on the two most prevalent non-endemic IFIs, namely invasive aspergillosis and invasive candidiasis. Early treatment initiation in patients with IFIs has a profound impact on mortality rates, but reliable diagnostic measures are lacking. This situation has led to the parallel use of different treatment strategies, e.

Sustained efficacy of risedronate in men with primary and secondary osteoporosis: results of a 2-year study.

The aim of this study was to assess the effect of treatment with risedronate 5 mg daily relative to control in men with primary or secondary osteoporosis over 2 years. Osteoporosis is a common condition in men that can have serious clinical consequences. In an earlier interim report, we found that 1 year of risedronate therapy resulted in significant increases in bone mineral density (BMD) and a significant reduction in vertebral fractures compared to control in men with osteoporosis.

Insulin binding to antibodies is a risk factor for inexplicable severe hypoglycaemia in children with type-1 diabetes mellitus.

Background: Type-1 diabetic individuals differ with regard to both, the formation of circulating insulin antibodies, and the incidence of severe hypoglycaemia.

Aim Of The Study: To assess the association of insulin binding to antibodies with the incidence of severe hypoglycaemia.

Patients And Methods: In a cross sectional study, 73 children with type-1 diabetes mellitus (median age 14 years, duration of diabetes 6 years) were investigated, 22 of whom had experienced severe hypoglycaemia during the past 18 months, and 51 had never experienced severe hypoglycaemia.

Endovascular treatment of iatrogenic and traumatic carotid artery dissection.

This paper reports on the early and midterm results of endovascular treatment of acute carotid artery dissections, its specific problems, and its limitations. We encountered seven patients with symptomatic extracranial carotid artery dissection, three cases of which occurred after carotid endarterectomy, two after carotid angioplasty and stenting, and two after trauma. Balloon-expandable and self-expanding stents were placed using a transfemoral approach.

Acute effects of treatment for prodromal symptoms for people putatively in a late initial prodromal state of psychosis.

Background: People in a putatively late prodromal state not only have an enhanced risk for psychosis but already suffer from mental and functional disturbances.

Aims: To evaluate the acute effects of a combined supportive and antipsychotic treatment on prodromal symptoms.

Method: Putatively prodromal individuals were randomly assigned to a needs-focused intervention without (n=59) or with amisulpride (n=65).

Effect of an antiretroviral regimen containing ritonavir boosted lopinavir on intestinal and hepatic CYP3A, CYP2D6 and P-glycoprotein in HIV-infected patients.

This study aimed to quantify the inhibition of cytochrome P450 (CYP3A), CYP2D6, and P-glycoprotein in human immunodeficiency virus (HIV)-infected patients receiving an antiretroviral therapy (ART) containing ritonavir boosted lopinavir, and to identify factors influencing ritonavir and lopinavir pharmacokinetics. We measured activities of CYP3A, CYP2D6, and P-glycoprotein in 28 patients before and during ART using a cocktail phenotyping approach. Activities, demographics, and genetic polymorphisms in CYP3A, CYP2D6, and P-glycoprotein were tested as covariates.

Assessment of urinary mephenytoin metrics to phenotype for CYP2C19 and CYP2B6 activity.

Objectives: (S)-Mephenytoin is selectively metabolised to (S)-4'-hydroxymephenytoin by CYP2C19. The urinary excretion of 4'-hydroxymephenytoin reflects the activity of individual enzymes. We evaluated fractioned urinary collection and beta-glucuronidase pre-treatment in order to determine the optimal CYP2C19 metrics.

Prospective evaluation of the pharmacodynamics of piritramide in neonates and infants.

Piritramide is a synthetic opioid commonly used in Germany and Austria for the analgesia of pediatric patients. Little pharmacokinetic and pharmacodynamic data for the pediatric population is available. The aim of this investigation was to gain pharmacodynamic data on postsurgical analgesia and the side effects of piritramide.

Combined endovascular stent-graft repair and adjunctive visceral vessel reconstruction for complex thoracoabdominal aortic aneurysms.

Aim: This study demonstrates the therapeutic value of the hybrid open and endovascular procedure in anatomically challenging thoracoabdominal aortic aneurysms (TAAAs) in high-risk patients.

Methods: Between January 2000 and February 2006, 8 patients were treated with open visceral vessel revascularization and endovascular repair for TAAAs. Patient data were available from medical records.

Identification of the endogenous key substrates of the human organic cation transporter OCT2 and their implication in function of dopaminergic neurons.

Background: The etiology of neurodegenerative disorders, such as the accelerated loss of dopaminergic neurons in Parkinson's disease, is unclear. Current hypotheses suggest an abnormal function of the neuronal sodium-dependent dopamine transporter DAT to contribute to cell death in the dopaminergic system, but it has not been investigated whether sodium-independent amine transporters are implicated in the pathogenesis of Parkinson's disease.

Methodology/principal Findings: By the use of a novel tandem-mass spectrometry-based substrate search technique, we have shown that the dopaminergic neuromodulators histidyl-proline diketopiperazine (cyclo(his-pro)) and salsolinol were the endogenous key substrates of the sodium-independent organic cation transporter OCT2.

Determination of absorbed dose to water for high-energy photon and electron beams-comparison of the standards DIN 6800-2 (1997), IAEA TRS 398 (2000) and DIN 6800-2 (2006).

For the determination of the absorbed dose to water for high-energy photon and electron beams the IAEA code of practice TRS-398 (2000) is applied internationally. In Germany, the German dosimetry protocol DIN 6800-2 (1997) is used. Recently, the DIN standard has been revised and published as Draft National Standard DIN 6800-2 (2006).

Recombinant activated factor seven in acute life-threatening bleeding in neonates: report on three cases and review of literature.

Introduction: Acute bleeding of different genesis can be a severe, life-threatening problem in neonatology. Recombinant factor seven (rFVIIa) is known to have unique hemostatic properties in adults and older children.

Case Presentation: Three cases of acute life-threatening peri- and postnatal hemorrhage were successfully controlled after the application of fFVIIa.

Deletion of Lys224 in regulatory domain 4 of Factor H reveals a novel pathomechanism for dense deposit disease (MPGN II).

We report a novel pathomechanism for membranoproliferative glomerulonephritis type II (MPGN II) caused by a mutant Factor H protein expressed in the plasma. Genetic analyses of two patients revealed deletion of a single Lys residue (K224) located within the complement regulatory region in domain 4 of Factor H. This deletion resulted in defective complement control: mutant protein purified from the plasma of patients showed severely reduced cofactor and decay-accelerating activity, as well as reduced binding to the central complement component C3b.

Examining the developing skeletal muscle: Why, what and how?

This review focuses on methodological concepts in the evaluation of skeletal muscle function, taking into account classical muscle physiology, the developing motor system in children and anthropometric parameters. Thereby, the classical concept of kinetic and thermodynamic description of muscle function is discussed in relation to data pertaining to human physiology. Emphasis is given to the specific problems that arise when assessing muscle function during development.

Speed of sound: relation to geometric characteristics of bone in children, adolescents, and adults.

Objectives: To investigate the relation between volumetric bone mineral density (vBMD) and speed of sound (SOS).

Study Design: Total and trabecular vBMD were measured by peripheral quantitative computed tomography at the forearm in a population of 216 individuals of a pediatric outpatient clinic. Moreover, SOS was measured by a quantitative ultrasound device (QUS) at the thumb, patella, and os calcis.

The role of epidural spinal cord stimulation in the treatment of Buerger's disease.

Purpose: This clinical, retrospective study is evaluated the effect of epidural spinal cord stimulation (SCS) in the treatment of Buerger's disease.

Methods: The clinical criteria of Shionoya were used to diagnose 29 patients (22 men, 7 women; mean age 33.7 years) with Buerger's disease.

Successful plasma therapy for atypical hemolytic uremic syndrome caused by factor H deficiency owing to a novel mutation in the complement cofactor protein domain 15.

Quantitative or functional deficiency of complement factor H results in uncontrolled complement activation. This leads to thrombotic microangiopathy and finally causes renal failure (atypical hemolytic uremic syndrome [aHUS]). By regular analysis of factor H in patients with aHUS, the authors found a complete factor H deficiency in an infant in whom aHUS developed at 8 months of age.

Acute effects of glucose and insulin on vascular endothelium.

Aims/hypothesis: Chronic exposure to high concentrations of glucose has consistently been demonstrated to impair endothelium-dependent, nitric oxide (NO)-mediated vasodilation. In contrast, several clinical investigations have reported that acute exposure to high glucose, alone or in combination with insulin, triggers vasodilation. The aim of this study was to examine whether elevated glucose itself stimulates endothelial NO formation or enhances insulin-mediated endothelial NO release.