7. Bioethik-Symposium : Medizin im Wandel – Individualisierte Medizin auf der Basis humangenetischer Diagnostik

Die rasant wachsenden Möglichkeiten der Gendiagnostik in der Klassifizierung, Therapie und Prognostik von Krankheiten bringen dem Grundlagenf orscher und dem in der Versorgungsmedizin tätigen Arzt wie der nationalen und internationalen Jurisprudenz und dem Medizinethiker eine Fülle von Aufgaben, die nicht allein aus der je fachspezifischen Sicht sondern nur in interdisziplinärer Kooperation zu leisten sind. Auch bedarf es der kritischen Information und der wertorientierten Einbeziehung der Gesellschaft in die Reflexion der rasch fortschreitenden Entwicklung. Dem war das 7. Bioethik-Symposium der BWG in Kooperation mit der Akademie für Ethik in der Medizin, Göttingen, unter der Überschrift "Gen-diagnostisch gestützte individualisierte Medizin" im Haus der Wissenschaft Braunschweig gewidmet. Es knüpfte an der Thematik des Vorjahr-Symposiums an

8. Bioethik-Symposium Braunschweig : „Selbstbestimmtes Leben im Alter – Informatik als Segen oder Bedrohung?“

„Selbstbestimmtes Leben im Alter – Informatik als Segen oder Bedrohung?“ – so das Thema des 8. Bioethik-Symposiums der Braunschweigischen Wissenschaftlichen Gesellschaft in Kooperation mit der Akademie für Ethik in der Medizin, Göttingen, am 8.2.2012. Wieder ein zunehmend wichtiges Problemfeld angesichts der wachsenden medizin-technischen Möglichkeiten assistierter Gesundheitsüberwachung einerseits und der steigenden Zahl bedürftiger Menschen, denen solche Technologien zugute kommen können

Anisotropy of quasiparticle lifetimes and the role of disorder in graphite from ultrafast time-resolved photoemission spectroscopy

Femtosecond time-resolved photoemission of photoexcited electrons in highly oriented pyrolytic graphite (HOPG) provides strong evidence for anisotropies of quasiparticle (QP) lifetimes. Indicative of such anisotropies is a pronounced anomaly in the energy dependence of QP lifetimes between 1.1 and 1.5 eV—the vicinity of a saddle point in the graphite band structure. This is supported by recent ab initio calculations and a comparison with experiments on defect-enriched HOPG which reveal that disorder, e.g., defects or phonons, increases electron energy relaxation rates

Small Is Beautiful: Why Profundaplasty Should Not Be Forgotten

Background: Surgical profundaplasty (SP)is used mainly as an adjunct to endovascular management of peripheral vascular disease (PAD) today. Results from earlier series of profundaplasty alone have been controversial, especially regarding its hemodynamic effect. The question is: Can profundaplasty alone still be useful? Our aim was to evaluate its role in the modern management of vascular patients. Methods: This was a retrospective outcome study. A consecutive series of 97 patients (106 legs) from January 2000 through December 2003 were included. In 55 (52%) legs, the superficial femoral artery was occluded. These patients were included in the current analysis. Of these patients 14 (25%) were female. Mean age was 71 ((11) years. Nineteen (35%) were diabetic. The indication for operation was claudication in 29 (53%), critical leg ischemia (CLI) in 26 (47%), either with rest pain in 17 (31%), or ulcer/gangrene in 9 (16%). Endarterectomy with patch angioplasty with bovine pericardium was performed in all cases. Mean follow-up was 33(14 months. Mean preoperative ankle brachial index (ABI) was 0.6. Sustained clinical efficacy was defined as upward shift of 1 or greater on the Rutherford scale without repeat target limb revascularization (TLR) or amputation. Mortality, morbidity, need for TLR, or amputation were separate endpoints. Results: Postoperatively, ABI was significantly improved (mean=0.7), in 24 (44%) by more than 0.15. At three years, cumulative clinical success rate was 80%. Overall, patients with claudication had a better outcome than those with CLI (p=0.04). Two (4%) major amputations and 2 (4%) minor ones were performed, all in patients with CLI. None of the 9 (16%) ulcers healed. Conclusion: Profundaplasty is still a valuable option for patients with femoral PAD and claudication without tissue loss. It is a straightforward procedure that combines good efficacy with low complication rates. Further endovascular treatment may be facilitated. It is not useful for patients with the combination of critical ischemia and tissue los

Two Novel Mutations Identified in an African-American Child with Chediak-Higashi Syndrome

Background. Chediak-Higashi syndrome (CHS) is a rare, autosomal recessive disorder characterized by oculocutaneous albinism, immunodeficiency, coagulopathy and late-onset, progressive neurological dysfunction. It also has an “accelerated phase” characterized by hemophagocytic lymphohistiocytosis (HLH). The disease is caused by mutations in the CHS1/LYST gene located on chromosome 1, which affects lysosome morphology and function. We report the case of an African-American child with CHS in Case. This 16-month old African-American girl presented with fever and lethargy. The proband had pale skin compared to her parents, with light brown eyes, silvery hair and massive hepatosplenomegaly. Her laboratory evaluation was remarkable for pancytopenia, high serum ferritin and an elevated LDH. Bone marrow aspirate revealed large inclusions in granulocytes and erythrophagocytosis consistent with HLH. Genetic evaluation revealed two novel nonsense mutations in the CHS1 gene: c.3622C > T (p.Q1208X) and c.11002G > T (p.E3668X). Conclusions. Our patient is one of the few cases of CHS reported in the African American population. We identified 2 nonsense mutations in the CHS1 gene, the first mutation analysis published of an African-American child with Chediak-Higashi Syndrome. These two mutations predict a severe phenotype and thus identification of these mutations has an important clinical significance in CHS

Novel pathogenic COX20 variants causing dysarthria, ataxia, and sensory neuropathy.

COX20/FAM36A encodes a mitochondrial complex IV assembly factor important for COX2 activation. Only one homozygous COX20 missense mutation has been previously described in two separate consanguineous families. We report four subjects with features that include childhood hypotonia, areflexia, ataxia, dysarthria, dystonia, and sensory neuropathy. Exome sequencing in all four subjects identified the same novel COX20 variants. One variant affected the splice donor site of intron-one (c.41A>G), while the other variant (c.157+3G>C) affected the splice donor site of intron-two. cDNA and protein analysis indicated that no full-length cDNA or protein was generated. These subjects expand the phenotype associated with COX20 deficiency

Cystinosis: practical tools for diagnosis and treatment

Cystinosis is the major cause of inherited Fanconi syndrome, and should be suspected in young children with failure to thrive and signs of renal proximal tubular damage. The diagnosis can be missed in infants, because not all signs of renal Fanconi syndrome are present during the first months of life. In older patients cystinosis can mimic idiopathic nephrotic syndrome due to focal and segmental glomerulosclerosis. Measuring elevated white blood cell cystine content is the corner stone for the diagnosis. The diagnosis is confirmed by molecular analysis of the cystinosin gene. Corneal cystine crystals are invariably present in all patients with cystinosis after the age of 1 year. Treatment with the cystine depleting drug cysteamine should be initiated as soon as possible and continued lifelong to prolong renal function survival and protect extra-renal organs. This educational feature provides practical tools for the diagnosis and treatment of cystinosis