Diagnostic Dilemma in a Patient with Jaundice: How to Differentiate between Autoimmune Pancreatitis, Primary Sclerosing Cholangitis and Pancreas Carcinoma

A 68-year-old male patient was referred to our institution in May 2011 for a suspected tumor in the pancreatic head with consecutive jaundice. Using magnetic resonance imaging, further differentiation between chronic inflammation and a malignant process was not possible with certainty. Apart from cholestasis, laboratory studies showed increased values for CA 19-9 to 532 U/ml (normal <37 U/ml) and hypergammaglobulinemia (immunoglobulin G, IgG) of 19.3% (normal 8.0–15.8%) with an elevation of the IgG4 subtype to 2,350 mg/l (normal 52–1,250 mg/l). Endoscopic retrograde cholangiopancreatography revealed a prominent stenosis of the distal ductus hepaticus communis caused by pancreatic head swelling and also a bihilar stenosis of the main hepatic bile ducts. Cytology demonstrated inflammatory cells without evidence of malignancy. Under suspicion of autoimmune pancreatitis with IgG4-associated cholangitis, immunosuppressive therapy with steroids and azathioprine was started. Follow-up endoscopic retrograde cholangiopancreatography after 3 months displayed regressive development of the diverse stenoses. Jaundice had disappeared and blood values had returned to normal ranges. Moreover, no tumor of the pancreatic head was present in the magnetic resonance control images. Due to clinical and radiological similarities but a consecutive completely different prognosis and therapy, it is of fundamental importance to differentiate between pancreatic cancer and autoimmune pancreatitis. Especially, determination of serum IgG4 levels and associated bile duct lesions induced by inflammation should clarify the diagnosis of autoimmune pancreatitis and legitimate immunosuppressive therapy

Prenatal exposure to bisphenol A and/or diethylhexyl phthalate alters stress responses in rat offspring in a sex- and dose-dependent manner

Background: Prenatal exposures to endocrine disrupting chemicals (EDCs) are correlated with adverse behavioral outcomes, but the effects of combinations of these chemicals are unclear. The aim of this study was to determine the dose-dependent effects of prenatal exposure to EDCs on male and female behavior.Methods: Pregnant Sprague-Dawley rats were orally dosed with vehicle, bisphenol A (BPA) (5 μg/kg body weight (BW)/day), low-dose (LD) diethylhexyl phthalate (DEHP) (5 μg/kg BW/day), high-dose (HD) DEHP (7.5 mg/kg BW/day), a combination of BPA and LD-DEHP (B + D (LD)), or a combination of BPA and HD-DEHP (B + D (HD)) on gestational days 6–21. Adult offspring were subjected to the Open Field Test (OFT), Elevated Plus Maze (EPM), and Shock Probe Defensive Burying test (SPDB) in adulthood. Body, adrenal gland, and pituitary gland weights were collected at sacrifice. Corticosterone (CORT) was measured in the serum.Results: Female EDC-exposed offspring showed anxiolytic effects in the OFT, while male offspring were unaffected. DEHP (HD) male offspring demonstrated a feminization of behavior in the EPM. Most EDC-exposed male offspring buried less in the SPDB, while their female counterparts showed reduced shock reactivity, indicating sex-specific maladaptive alterations in defensive behaviors. Additionally, DEHP (LD) males and females and B + D (LD) females displayed increased immobility in this test. DEHP (LD) alone and in combination with BPA led to lower adrenal gland weights, but only in male offspring. Finally, females treated with a mixture of B + D (HD) had elevated CORT levels.Conclusion: Prenatal exposure to BPA, DEHP, or a mixture of the two, affects behavior, CORT levels, and adrenal gland weights in a sex- and dose-dependent manner

Coordination in climbing: effect of skill, practice and constraints manipulation

BACKGROUND: Climbing is a physical activity and sport involving many subdisciplines. Minimization of prolonged pauses, use of a relatively simple path through a route and smooth transitions between movements broadly define skilled coordination in climbing. OBJECTIVES: To provide an overview of the constraints on skilled coordination in climbing and to explore future directions in this emerging field. METHODS: A systematic literature review was conducted in 2014 and retrieved studies reporting perceptual and movement data during climbing tasks. To be eligible for the qualitative synthesis, studies were required to report perceptual or movement data during climbing tasks graded for difficulty. RESULTS: Qualitative synthesis of 42 studies was carried out, showing that skilled coordination in climbing is underpinned by superior perception of climbing opportunities; optimization of spatial-temporal features pertaining to body-to-wall coordination, the climb trajectory and hand-to-hold surface contact; and minimization of exploratory behaviour. Improvements in skilled coordination due to practice are related to task novelty and the difficulty of the climbing route relative to the individual's ability level. CONCLUSION: Perceptual and motor adaptations that improve skilled coordination are highly significant for improving the climbing ability level. Elite climbers exhibit advantages in detection and use of climbing opportunities when visually inspecting a route from the ground and when physically moving though a route. However, the need to provide clear guidelines on how to improve climbing skill arises from uncertainties regarding the impacts of different practice interventions on learning and transfer

Measuring the density of iodine depositions: Detecting an invisible residual tumor after conventional transarterial chemoembolization.

PURPOSE:The purpose of this study is to evaluate the use of density measurements in the diagnosis of an underlying residual tumor beyond iodine depositions after Lipiodol-based conventional transarterial chemoembolization (cTACE). METHOD AND MATERIALS:Thirty follow-up CT scans of 20 patients 6-12 weeks after Lipiodol-based cTACE, receiving a digital subtraction angiography at the same time, were analyzed. Reference for the detection of a residual tumor was the angiography, and a visible contrast enhancement was categorized as a residual tumor (n = 16 with residual tumor; n = 14 without residual tumor). The density of the iodine depositions was measured in all containing slices in non-contrast-, arterial- and portal venous-phase CT scans, with a slice thickness of 5.00 mm. The mean density of the iodine deposition during the portal venous phase was subtracted from the mean density of the arterial phase to calculate the density changes (a positive enhancement score represents washout in the portal venous phase). In addition, a quotient relating to the non-contrast measurement was evaluated. RESULTS:Patients with a residual tumor displayed significantly higher enhancement scores in favor of density reduction between the arterial and portal venous phases, compared to patients without a residual tumor (1.41 ± 3.59, n = 14 vs. -13.97 ± 2.88, n = 16; p-value < 0.01). Furthermore, 87.75% of patients with an enhancement score higher than -1.00 (n = 9) had a residual tumor, whereas 100.00% of patients with an enhancement score lower than -20.00 (n = 6) were shown to be tumor-free. The enhancement score quotient resulted in similar findings. CONCLUSION:After cTACE in patients with hepatocellular carcinoma (HCC), the presence of a viable tumor correlated with enhancement scores based on the density measurements of iodine depositions in different phases of the CT scan. Low enhancement scores were associated with completely treated tumors and can aid the decision process to avoid possibly unnecessary angiographies

The use of serum amylase and lipase in evaluating and managing blunt abdominal trauma

In order to determine the usefulness of serum amylase and lipase in the initial evaluation and subsequent management of blunt abdominal trauma (BAT) patients, we collected serum amylase and lipase on 85 consecutive BAT patients at admission, hospital day 1, hospital day 3, and hospital day 7. Only one patient had a pancreatic injury. A total of 45 patients (53%) had at least one enzyme abnormality during the study. There was no correlation between amylase or lipase values and age, sex, type of injury, diagnostic tests, operation, and outcome. In a control group of nonabdominal-trauma patients with admit studies only, all enzyme values were normal. We conclude that serum amylase and lipase are randomly elevated in patients with nonpancreatic-BAT both initially and during subsequent hospitalization and are not useful clinical tools in these patients

Innovative Praktiken mit Neuen Medien in Schulunterricht und -organisation (IPSO). Nationale Ergebnisse der internationalen IEA-Studie, SITES Modul 2 (Second Information in Education Study) Schlussbericht

With CD-ROMAvailable from TIB Hannover: F03B1531 / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekSIGLEBundesministerium fuer Bildung und Forschung, Berlin (Germany)DEGerman

Calcium phosphate/thermoresponsive hyaluronan hydrogel composite delivering hydrophilic and hydrophobic drugs

Background/Objective: Advanced synthetic biomaterials that are able to reduce or replace the need for autologous bone transplantation are still a major clinical need in orthopaedics, dentistry, and trauma. Key requirements for improved bone substitutes are optimal handling properties, ability to fill defects of irregular shape, and capacity for delivering osteoinductive stimuli. Materials and methods: In this study, we targeted these requirements by preparing a new composite of β-tricalcium phosphate (TCP) and a thermoresponsive hyaluronan (HA) hydrogel. Dissolution properties of the composite as a function of the particle size and polymeric phase molecular weight and concentration were analysed to identify the best compositions. Results: Owing to its amphiphilic character, the composite was able to provide controlled release of both recombinant human bone morphogenetic protein-2 and dexamethasone, selected as models for a biologic and a small hydrophobic molecule, respectively. Conclusion: The TCP–thermoresponsive HA hydrogel composite developed in this work can be used for preparing synthetic bone substitutes in the form of injectable or mouldable pastes and can be supplemented with small hydrophobic molecules or biologics for improved osteoinductivity