A case of repetitive myocardial infarction with unobstructed coronaries due to Churg-Strauss syndrome

© The Author(s) 2019. Published by Oxford University Press on behalf of the European Society of Cardiology.BackgroundMyocardial infarction is most commonly caused by thrombosis occurring on a background of coronary atherosclerosis, resulting in reduced coronary flow. Less often, myocardial infarction can occur in the absence of coronary disease. The pathomechanism of myocardial infarction in such patients is heterogeneous and more challenging to diagnose and treat. European Society of Cardiology published a position paper on myocardial infarction in patients with non-obstructive coronary disease, with definitions and recommendations for investigations, in what has hitherto been an under-recognized and under-investigated Cinderella-like condition. However, the importance of obtaining a diagnosis is all the more important, since one treatment approach with revascularization and antithrombotic treatment does not ‘fit all’.Case summaryA 70-year-old male patient presented with chest pain at rest, associated with rise in troponin and without ECG changes. A diagnosis of non-ST elevation myocardial infarction was made. Coronary angiography showed a smooth stenosis which resolved with administration of intracoronary nitrate. A diagnosis of coronary artery spasm was made, and treatment initiated. After 18 months, the patient had recurrent chest pains at rest, unresponsive to glyceryl trinitrate (GTN). Cardiac magnetic resonance revealed extension of subendocardial infarction, without inducible ischaemia. CT coronary angiogram (CTCA) showed non-obstructive coronaries. Blood tests showed significant eosinophilia, raised troponin, and C-reactive protein (CRP) that fluctuated without correlation with symptoms or any ECG changes. A diagnosis of Churg–Strauss syndrome was made, and immunosuppression commenced.DiscussionChurg–Strauss syndrome is an autoimmune vasculitis in patients with history of atopy or late-onset asthma which when involving coronary arteries can lead to myocardial injury mimicking acute coronary syndrome (ACS). Identification is important to allow initiation of immunosuppression which can prevent development or progression.Peer reviewedFinal Published versio

Zufällige binäre Bäume : Algorithmen, Asymptotik und Statistik

[no abstract

Informed speculation and the organisation of financial markets.

The thesis deals with several aspects of the impact of informed speculation on financial markets. It consists of four chapters. Chapter 1 gives a general discussion of the welfare effects of insider trading, and investigates whether insider trading should be prohibited. The following chapters are concerned with more specific questions of the organisation and regulation of financial markets. Chapter 2 investigates the performance of dealership markets in the presence of informed speculation. It is shown that informed trading creates externalities which might render markets with several competing market makers less liquid than a market with a monopolist specialist. Chapter 3 deals with a different effect of insider trading on secondary markets. It is argued that insider trading influences the allocation of risk between different classes of investors. The premature resolution of uncertainty due to insider trading makes prices more volatile and more informative. The effects of these two opposed effects on ex-ante investment are ambiguous: both more and less investment may occur. Chapter 4 investigates a dynamic asset pricing model with informed speculation and noise trading. The properties of the steady state equilibria in a overlapping generations economy with infinite horizon are characterized. It is shown that noise trading leads to feedback effects of the kind that expectations of a high price volatility become self-stabilizing. The effects of asymmetric information and the early release of information are discussed and related to the results of the preceding chapters

"Männer müssen lernen, mehr aus dem Bauch raus zu machen, und Frauen, den Kopf mit zu gebrauchen": Geschlechterkonstruktionen durch ÄrztInnen

"Studien konnten zeigen, dass das Geschlecht von PatientInnen medizinische Entscheidungsprozesse in ärztlichen Konsultationen beeinflusst. Wenig im Fokus stand jedoch bisher, wie Geschlecht in medizinischen Settings produziert und konstruiert wird. Diese Pilotstudie hat die Geschlechterkonstruktionen von niedergelassenen ÄrztInnen in ihren Erzählungen zur Empfehlung des Nahrungsergänzungsmittels Selen an KrebspatientInnen untersucht. Es wurden zwei Fokusgruppendiskussionen durchgeführt und mit Elementen der dokumentarischen Methode sowie mittels qualitativer Inhaltsanalyse ausgewertet. Die ÄrztInnen stellten 'Geschlecht' als einen spezifischen, auf der PatientInnenseite lokalisierten Komplex von Verhalten und Befinden dar, wobei Männer als zu rigide und simplizistisch und Frauen als naiv und zu emotional geschildert wurden. Ihre Empfehlung von Selen sahen ÄrztInnen als Versuch, als problematisch empfundene geschlechtsspezifische Verhaltensweisen abzuschwächen." (Autorenreferat)"Studies have shown that a patient's gender is an important factor in physician-patient encounters and in influencing medical decisions. The question of how gender is produced and constructed in medical settings has received little attention so far. This pilot study investigated physicians' constructions of gender in their accounts of recommending the nutritional supplement selenium to cancer patients. Two focus group discussions with physicians were conducted and analyzed using elements of the documentary method and qualitative content analysis. Physicians depicted 'gender' as a specific complex of behavior and feeling which can be attributed to the patients. Men were described as too rigid and simplistic, while women were seen as naive and too sensitive. When recommending selenium, physicians tried to attenuate gender-specific behavior which is regarded as problematic." (author's abstract

Akustisch-physiologische Untersuchungen und Studien, verwerthet für die praktische Ohrenheilkunde

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On the subtree size profile of binary search trees

For random trees T generated by the binary search tree algorithm from uniformly distributed input we consider the subtree size profile, which maps k ∈ ℕ to the number of nodes in T that root a subtree of size k. Complementing earlier work by Devroye, by Feng, Mahmoud and Panholzer, and by Fuchs, we obtain results for the range of small k-values and the range of k-values proportional to the size n of T. In both cases emphasis is on the process view, i.e., the joint distributions for several k-values. We also show that the dynamics of the tree sequence lead to a qualitative difference between the asymptotic behaviour of the lower and the upper end of the profile. Copyright © 2010 Cambridge University Press

Biochemical analysis of CTLA-4 immunoreactive material from human blood

<p>Abstract</p> <p>Background</p> <p>CTLA-4 was initially described as a membrane-bound molecule that inhibited lymphocyte activation by interacting with B7.1 and B7.2 molecules on antigen presenting cells. Alternative splicing of mRNA encoding the CTLA-4 receptor leads to the production of a molecule (sCTLA-4) that lacks a membrane anchor and is therefore secreted into the extracellular space. Despite studies finding that people with autoimmune disease more frequently express high levels of sCTLA-4 in their blood than apparently healthy people, the significance of these findings is unclear.</p> <p>Methods</p> <p>Molecules isolated from blood using CTLA-4 specific antibodies were analyzed with ligand binding assays, mass spectroscopy, and biochemical fractionation in an effort to increase our understanding of CTLA-4 immunoreactive material.</p> <p>Results</p> <p>Mass spectroscopy analysis of the molecules recognized by multiple CTLA-4-specific antibodies failed to identify any CTLA-4 protein. Even though these molecules bind to the CTLA-4 receptors B7.1 and B7.2, they also exhibit properties common to immunoglobulins.</p> <p>Conclusion</p> <p>We have identified molecules in blood that are recognized by CTLA-4 specific antibodies but also exhibit properties of immunoglobulins. Our data indicates that what has been called sCTLA-4 is not a direct product of the CTLA-4 gene, and that the CTLA-4 protein is not part of this molecule. These results may explain why the relationship of sCTLA-4 to immune system activity has been difficult to elucidate.</p