Background
Tolosa-Hunt syndrome (THS) is characterized by unilateral orbital pain, ipsilateral oculomotor paresis and a prompt response to treatment with corticosteroids. Several reports have ...demonstrated that the clinical features of THS are not specific to one causal aetiology and can lead to misdiagnosis.
Case report
We report the case of a patient diagnosed with THS after an episode of unilateral orbital pain and diplopia with demonstration of granulomatous inflammation of both cavernous sinus on cerebral magnetic resonance imaging and an immediate response to treatment with corticosteroids. Progression of the disease over the following years, accompanied by increasing signs of inflammation on cerebral magnetic resonance imaging and cerebrospinal fluid pleocytosis, led to further diagnostic tests. Genetic analyses revealed a heterozygote low-penetrance mutation (Q703K) of the cryopyrin/NLRP3 gene compatible with a cryopyrin-associated periodic fever syndrome.
Discussion
This case report demonstrates that THS can be a central nervous system manifestation of cryopyrin-associated periodic fever syndrome, which therefore represents a differential diagnosis of THS, even in elderly patients.
Intraoperative stress may suppress the adaptive immune system. Abolished proinflammatory lymphocyte function is associated with higher risk of infection and postoperative complications. We ...hypothesized that thoracic epidural anaesthesia (TEA) reduces intraoperative stress and thus attenuates lymphocyte decrease and impairment of proinflammatory lymphocyte function.
Fifty-four patients undergoing major abdominal surgery who had a thoracic epidural catheter inserted were studied. In the TEA-I group, this catheter was used for intraoperative analgesia, whereas the TEA-P group received systemic opioids during surgery. In both groups, patient-controlled epidural analgesia was used for postoperative pain management. Blood samples for immune analyses were obtained before induction of anaesthesia, 2 h after skin incision, and at days 1 and 4 after surgery. Lymphocyte subpopulations, expression of human leucocyte antigen (HLA)-DR on monocytes, plasma concentrations of interleukin (IL)-10, interferon-γ (IFN-γ), and IL-12, and concanavalin-A-stimulated concentrations of IFN-γ and IL-10 were measured. Intraoperative data including bispectral index and plasma concentrations of epinephrine/cortisol were analysed; APACHE-II, SAPS II, and additional postoperative data were documented.
Plasma concentrations of epinephrine and cortisol were significantly lower in the TEA-I patients during surgery. IFN-γ/IL-10 ratio was significantly higher in the TEA-I group from 2 h after skin incision until day 1. Lymphocyte numbers and T-helper cells were significantly higher in the TEA-I group at day 1, whereas no significant differences were detected among IL-12, HLA-DR, and postoperative clinical course.
Intraoperative use of thoracic epidural catheter reduced stress response and prevented stress-induced perioperative impairment of proinflammatory lymphocyte function.
Therapy with antibiotics, dexamethasone, and supportive intensive care has improved the prognosis of pneumococcal meningitis, but mortality remains high. Here, we investigated an adjunctive ...combination therapy of the non-bacteriolytic antibiotic daptomycin plus several anti-inflammatory agents to identify the currently most promising adjunctive combination therapy for pneumococcal meningitis.
C57BL/6 mice were infected by injection of pneumococci into the cisterna magna. Treatment was begun 21 h after infection, and consisted of ceftriaxone plus (a) dexamethasone, (b) dexamethasone plus daptomycin, (c) daptomycin, (d) daptomycin plus an anti-IL1 antibody, (e) daptomycin plus roscovitine, or (f) daptomycin plus an anti-C5 antibody. Animals were followed until 45 h after infection. Furthermore, adjunctive daptomycin plus anti-C5 antibodies were assessed in a long-term follow-up.
Adjunctive treatment with daptomycin and an anti-C5 antibody was superior to adjunctive dexamethasone and reduced disease symptoms (clinical score 1.1 ± 1.1 versus 5.0 ± 2.7, p < 0.0083), improved explorative activity (open field test 17.8 ± 8.2 versus 7.4 ± 4.3 crossed fields/2 minutes, p < 0.0083), and reduced hearing impairment (thresholds for click stimulus 96.1 ± 14.7 versus 114.8 ± 9.3 dB SPL, p < 0.0083) in the acute stage. Furthermore, explorative activity (14.4 ± 7.3 crossed fields/2 minutes versus 6.3 ± 7.2, p < 0.05) and cognitive function (t-maze test, exploration time previously unknown alley 72.4 ± 14.3 versus 48.7 ± 25.6%, p < 0.05) was improved at 2 weeks after infection. Treatment with daptomycin plus an anti-IL-1β antibody or roscovitine was not of significant benefit in comparison to adjunctive therapy with dexamethasone.
An adjunctive combination of the non-lytic antibiotic daptomycin plus an anti-C5 antibody was superior to standard therapy with adjunctive dexamethasone in the treatment of pneumococcal meningitis.
Zusammenfassung
Wurzelförmige patientenindividuelle Implantate sind eine Alternative zu konventionellen Implantaten für den direkten Ersatz eines Wurzelrests. Diese Implantate erhalten das ...periimplantäre Weichgewebe nach der Zahnextraktion und haben eine vorhersehbare Ästhetik. Bei einer ausreichenden Compliance des Patienten und einer geeigneten Knochenkonfiguration bieten sie eine weitere Möglichkeit für den Ersatz eines Zahns. Der vorliegende Artikel beschäftigt sich mit der Herstellung und dem kompletten Behandlungsablauf. Anhand von 2 Patientenfällen wird das Vorgehen im Detail beschrieben. Auf die Unterschiede zu konventionellen Implantaten wird eingegangen und die Vor- und Nachteile diskutiert.
Zusammenfassung
Totalprothesen können mittels 3‑D-Druck hergestellt werden. Die möglichen Arbeitsabläufe der Fertigung mittels CAD/CAM („computer-aided design“/„computer-aided manufacturing“) sind ...dabei vielfältig. Die Herstellung ist effizient, kostengünstig und reproduzierbar. Dabei werden die Prothesenbasen gedruckt, für die Zähne können entweder konfektionierte Zahngarnituren verwendet oder individuelle Zahnkränze gedruckt werden. Anhand eines Fallbeispiels werden Entwurf und Fertigung einer Ober- und Unterkiefertotalprothese exemplarisch beschrieben.
Zusammenfassung
Operationen aus dem Fachgebiet der Hals-Nasen-Ohren-Heilkunde zählen zu den häufigsten operativen Eingriffen im Kindesalter. Die Tonsillenchirurgie mit oder ohne Adenotomie aufgrund ...einer adenotonsillären Hyperplasie mit Obstruktion der oberen Atemwege in Kombination mit oder ohne Belüftungsstörung des Mittelohrs ist bei diesen Eingriffen führend. Kinder mit obstruktiver Schlafapnoe (OSA) haben hierbei ein deutlich erhöhtes Risiko, perioperativ respiratorische Komplikationen zu erleiden. Es wurde über Todesfälle und bleibende neurologische Schäden aufgrund von Apnoe und einer erhöhten Opioidsensibilität berichtet. Die vorliegende Leitlinie stellt einen risikoadjustierten pragmatischen Ansatz dar. Patienten mit bestätigter oder vermuteter OSA sollen perioperativ entsprechend ihren individuellen Risiken und Bedürfnissen behandelt und überwacht werden, um schwere bleibende Schäden zu verhindern.
Experimental studies of nucleus-nucleus collisions in the whole SPS energy range are reviewed. Selected topics such as statistical properties of the hadronic phase, strangeness production, ...fluctuations and correlations are discussed with regard to information on the onset of deconfinement and the critical point of strongly interacting matter. In spite of the very interesting results obtained in particular at the low SPS energies, additional data including rare probes such as charmed particles and di-leptons are required for a precise understanding of the underlying physics. An outlook about prospects and capabilities of upcoming experiments in this interesting energy region at RHIC, SPS, and in particular with CBM at FAIR, is given.
At the future Facility for Antiproton and Ion Research in Darmstadt (FAIR) a dedicated heavy-ion experiment investigating the properties of highly compressed baryonic matter is proposed (CBM). Its ...goal will be to explore the QCD phase diagram in the region of moderate temperatures but very high baryon densities. Physics objectives, their experimental challenge, the resulting layout of the CBM detector, and first feasibility studies of key observables are discussed.
Abstract The production of $$\Sigma ^{0}$$ Σ 0 hyperons in proton proton collisions at a beam kinetic energy of 3.5 GeV impinging on a liquid hydrogen target was investigated using data collected ...with the HADES setup. The total production cross section is found to be $${\sigma (pK^{+}\Sigma ^{0}) = 17.7 \pm 1.7 (stat) \pm 1.6 (syst)}$$ σ ( p K + Σ 0 ) = 17.7 ± 1.7 ( s t a t ) ± 1.6 ( s y s t ) µb. Differential cross section distributions of the exclusive channel $${pp \rightarrow pK^{+}\Sigma ^{0}}$$ p p → p K + Σ 0 were analyzed in the center-of-mass, Gottfried–Jackson and helicity reference frames for the first time at the excess energy of 556 MeV. The data support the interplay between pion and kaon exchange mechanisms and clearly demonstrate the contribution of interfering nucleon resonances decaying to $$\textrm{K}^{+}\Sigma ^{0}$$ K + Σ 0 . The Bonn–Gatchina partial wave analysis was employed to analyse the data. Due to the limited statistics, it was not possible to obtain an unambiguous determination of the relative contribution of intermediate nucleon resonances to the final state. However nucleon resonances with masses around 1.710 $${\textrm{GeV}/\textrm{c}^{2}}$$ GeV / c 2 ( $${\textrm{N}^{*}(1710)}$$ N ∗ ( 1710 ) ) and 1.900 $${\textrm{GeV}/\textrm{c}^{2}}$$ GeV / c 2 ( $${\textrm{N}^{*}(1900)}$$ N ∗ ( 1900 ) or $${\Delta ^{*}(1900)}$$ Δ ∗ ( 1900 ) ) are preferred by the fit.
Background: This study investigates whether long‐term treatment with an angiotensin‐converting enzyme inhibitor (ACEI) impairs the haemodynamic regulation during total intravenous anaesthesia (TIVA) ...for minor surgery.
Methods: In a prospective, two‐armed observational study, 36 patients undergoing TIVA for minor surgery were studied. Seventeen were taking ACEIs regularly but no other antihypertensive medication (ACEI group); 19 patients without any cardiovascular medication served as controls (non‐ACEI group). Haemodynamic variables were measured every minute during induction and every 5 min during surgery. The plasma levels of renin, angiotensin II, vasopressin and catecholamines were measured before and 18 min after the induction of anaesthesia.
Results: The mean arterial pressure decreased to the same extent in both the groups during the induction of TIVA. There were also no differences between the groups regarding the heart rate, systolic and diastolic arterial pressure, as well as the use of vasoconstrictors, and fluids during induction and throughout surgery. In the ACEI group, the plasma renin concentration was higher at baseline and after the induction of anaesthesia presumably due to the interruption of the negative renin–angiotensin feedback loop (P<0.05). Angiotensin II increased only in the non‐ACEI group (6.2 ± 2.2 before vs. 9.6 ± 3.5 pg/ml after induction; P<0.05). In both groups, the plasma norepinephrine concentration decreased after the induction of TIVA (P<0.05). Plasma vasopressin and plasma epinephrine concentrations did not change in either group.
Conclusion: Long‐term ACEI treatment does not further aggravate the blood pressure decrease under TIVA during minor surgery, provided the induction procedure is slow, the patient is kept well hydrated and vasoconstrictors are promptly applied.
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