Dyspnoe: Objektivierung des Subjektiven oder die Quadratur des Zirkels

Zusammenfassung: Die Dyspnoe wird definiert als "subjektiv unangenehme Wahrnehmung des Atmens, die sich aus qualitativ umschriebenen Empfindungen von unterschiedlicher Intensität zusammensetzt". Dyspnoe ist wohl eines der häufigsten und gleichzeitig eines der schwierigsten sowie am wenigsten verstandenen klinischen Symptome. Erst seit Kurzem wird die Atemnot - analog den schon vor Jahrzehnten erarbeiteten Konzepten bezüglich des Symptoms Schmerz - in differenzierter Art und Weise betrachtet. Die Modalitäten umfassen neben der Intensität auch den Grad des Missempfindens und die emotionale Reaktion, d.h. sensorische und affektive Dimensionen. Dazu kommen Angst, Depression und andere psychologische Faktoren, ausgelöst nicht nur durch die Symptome der Dyspnoe sondern auch durch die vielfältigen Aspekte der zugrunde liegenden Krankheit. Diese multidimensionalen Aspekte sollten heute unbedingt mit krankheitsspezifischen Lebensqualitätsfragebögen erfasst werde

Schlüssel zur Diagnostik in der Pneumologie: Anamnese und klinische Untersuchung

Zusammenfassung: Im Zeitalter der hoch technisierten Medizin werden Anamnese und klinische Untersuchung zunehmend in den Hintergrund gedrängt. Es ist aber eine Tatsache, dass damit auch heute noch 80% aller Diagnosen gestellt werden können. Falls überhaupt notwendig, dienen weitere, zumeist apparative Tests nur noch der Bestätigung der Diagnose. Eine kompetente Anamnese und klinische Untersuchung machen nicht selten teure und/oder zeitaufwendige Explorationen unnötig. Vor allem gilt es zu betonen, dass die aufgrund des klinischen Eindrucks gewonnene subjektive Einschätzung der Vortest-Wahrscheinlichkeit für das Vorliegen einer Krankheit eine unabdingbare Voraussetzung für die Bewertung weiterer Testresultate is

Ankylosing spondylitis and sarcoidosis — Coincidence or association?

We report a 25-year-old woman presenting with sarcoidosis and bilateral sacroiliitis. Her sarcoidosis related symptoms (malaise, cough and dyspnoea) improved dramatically under treatment with steroids but severe back pain persisted. Only seven similar cases have been described over the last 40 years and the question of a possible association between the two diseases has been raised. However, prevalence data from the literature and the apparent lack of genetic links are better arguments for coincidence than for association

Activity of oxantel pamoate monotherapy and combination chemotherapy against Trichuris muris and hookworms : revival of an old drug

BACKGROUND: It is widely recognized that only a handful of drugs are available against soil-transmitted helminthiasis, all of which are characterized by a low efficacy against Trichuris trichiura, when administered as single doses. The re-evaluation of old, forgotten drugs is a promising strategy to identify alternative anthelminthic drug candidates or drug combinations. METHODOLOGY: We studied the activity of the veterinary drug oxantel pamoate against Trichuris muris, Ancylostoma ceylanicum and Necator americanus in vitro and in vivo. In addition, the dose-effect of oxantel pamoate combined with albendazole, mebendazole, levamisole, pyrantel pamoate and ivermectin was studied against T. muris in vitro and additive or synergistic combinations were followed up in vivo. PRINCIPAL FINDINGS: We calculated an ED50 of 4.7 mg/kg for oxantel pamoate against T. muris in mice. Combinations of oxantel pamoate with pyrantel pamoate behaved antagonistically in vitro (combination index (CI) = 2.53). Oxantel pamoate combined with levamisole, albendazole or ivermectin using ratios based on their ED50s revealed antagonistic effects in vivo (CI = 1.27, 1.90 and 1.27, respectively). A highly synergistic effect (CI = 0.15) was observed when oxantel pamoate-mebendazole was administered to T. muris-infected mice. Oxantel pamoate (10 mg/kg) lacked activity against Ancylostoma ceylanicum and Necator americanus in vivo. CONCLUSIONSIGNIFICANCE: Our study confirms the excellent trichuricidal properties of oxantel pamoate. Since the drug lacks activity against hookworms it is necessary to combine oxantel pamoate with a partner drug with anti-hookworm properties. Synergistic effects were observed for oxantel pamoate-mebendazole, hence this combination should be studied in more detail. Since, of the standard drugs, albendazole has the highest efficacy against hookworms, additional investigations on the combination effect of oxantel pamoate-albendazole should be launche

Testing an optimality-based model of rooting zone water storage capacity in temperate forests

Rooting zone water storage capacity Sr is a crucial parameter for modeling hydrology, ecosystem gas exchange and vegetation dynamics. Despite its importance, this parameter is still poorly constrained and subject to high uncertainty. We tested the analytical, optimality-based model of effective rooting depth proposed by Guswa (2008, 2010) with regard to its applicability for parameterizing Sr in temperate forests. The model assumes that plants dimension their rooting systems to maximize net carbon gain. Results from this model were compared against values obtained by calibrating a local water balance model against latent heat flux and soil moisture observations from 15 eddy covariance sites. Then, the effect of optimality-based Sr estimates on the performance of local water balance predictions was assessed during model validation.The agreement between calibrated and optimality-based Sr varied greatly across climates and forest types. At a majority of cold and temperate sites, the Sr estimates were similar for both methods, and the water balance model performed equally well when parameterized with calibrated and with optimality-based Sr. At spruce-dominated sites, optimality-based Sr were much larger than calibrated values. However, this did not affect the performance of the water balance model. On the other hand, at the Mediterranean sites considered in this study, optimality-based Sr were consistently much smaller than calibrated values. The same was the case at pine-dominated sites on sandy soils. Accordingly, performance of the water balance model was much worse at these sites when optimality-based Sr were used. This rooting depth parameterization might be used in dynamic (eco)hydrological models under cold and temperate conditions, either to estimate Sr without calibration or as a model component. This could greatly increase the reliability of transient climate-impact assessment studies. On the other hand, the results from this study do not warrant the application of this model to Mediterranean climates or on very coarse soils. While the cause of these mismatches cannot be determined with certainty, it is possible that trees under these conditions follow rooting strategies that differ from the carbon budget optimization assumed by the model.</p

Solar activity during Skylab: Its distribution and relation to coronal holes

Solar active regions observed during the period of Skylab observations (May 1973-February 1974) were examined for properties that varied systematically with location on the sun, particularly with respect to the location of coronal holes. Approximately 90 percent of the optical and X-ray flare activity occurred in one solar hemisphere (136-315 heliographic degrees longitude). Active regions within 20 heliographic degrees of coronal holes were below average in lifetimes, flare production, and magnetic complexity. Histograms of solar flares as a function of solar longitude were aligned with H alpha synoptic charts on which active region serial numbers and coronal hole boundaries were added

Valaciclovir for Chronic Hepatitis BVirus Infection after Lung Transplantation

Abstract. : We report on a chronic asymptomatic hepatitis B surface antigen (HBsAg) carrier who developed an increase in aminotransferase and HBsAg levels 1 year after lung transplantation. During treatment for cutaneous herpes simplex virus (HSV) infection with oral valaciclovir there was a marked decrease in replicating hepatitis B virus (HBV)-DNA and aminotransferase levels, which was sustained for 9 months by continuing low-dose valaciclovir. A second rise in aminotransferase levels again responded to a valaciclovir dose increase and the HBV-DNA levels declined further. Although we cannot exclude a spontaneous variation of the serologic parameters, our observation suggests that valaciclovir may represent a valuable therapeutic option in the treatment of chronic hepatitis B after lung transplantatio

Central Venous Catheter Infection with Brevibacterium sp. in an Immunocompetent Woman: Case Report and Review of the Literature

Brevibacterium spp. were considered apathogenic until a few reports of infections in immunocompromised patients were published. Herein, we present a case of a catheter-related septicemia with Brevibacterium casei in an immunocompetent patient receiving continuous iloprost infusion for pulmonary arterial hypertension and review the clinical presentation of this mainly emerging opportunistic pathoge