Spritzenabszesse bei intravenös Drogenabhängigen: Häufigkeit assoziierter Komplikationen in Abhängigkeit der Lokalisation

Zusammenfassung: Hintergrund: Haut- und Weichteilabszesse sind bei intravenös Drogenabhängigen der häufigste Hospitalisationsgrund. Zu den mit Spritzenabszessen assoziierten Komplikationen gehören septische Arthritiden, septische Thrombosen und Embolien, lokale Schädigung von umliegenden Strukturen, periphere Ischämie durch intraarterielle Injektion, Pseudoaneurysmata von Venen und Arterien und die nekrotisierende Fasziitis. Material und Methode: Wir führten eine retrospektive Studie von 108Hospitalisationen bei 85Patienten mit insgesamt 130Abszessen in Hinblick auf die aufgetretenen Komplikationen durch. Ergebnisse: Fünfundfünfzig Prozent der Abszesse waren an der unteren Extremität lokalisiert. Die Komplikationsrate an dieser Lokalisation war mit 12/71 (16,9%) signifikant höher (p=0,0005) als an der oberen Extremität mit 0/55. Abszesse an der unteren Extremität führten zu einer signifikant längeren Hospitalisationsdauer als solche an der oberen Extremität (8,5 vs. 4,2Tage, p=0,005) und damit zu höheren Kosten. Schlussfolgerung: Bei der Behandlung von Spritzenabszessen der unteren Extremität muss an das erhöhte Risiko assoziierter Komplikationen gedacht werden. In den Beratungsstellen durchzuführende präventive Maßnahmen könnten durch Vermeiden von Injektionen an den unteren Extremitäten zu einer Verminderung der durch den Drogenkonsum verursachten Kosten führe

PTP1B expression is an independent positive prognostic factor in human breast cancer

Protein tyrosine phosphatase 1B (PTP1B) is a non-transmembrane protein tyrosine phosphatase that has come into focus as a critical regulator of multiple signaling pathways. The role of PTP1B in breast cancer remains unclear with evidence suggesting that PTP1B can exert both tumor-suppressing and tumor-promoting effects. To better define the role of PTP1B in human breast cancer, and its relationship with HER2, we performed immunohistochemical studies on a large cohort of functionally annotated primary breast cancer specimens. 683 of 1,402 (49%) evaluable primary breast cancers are positive for PTP1B. There is no statistically significant association between PTP1B expression and age, tumor size, T stage, histologic grade, lymph node status, or histological subtype. Of note, there is no significant association between PTP1B expression and HER2 expression (PTP1B expression53.1% in HER2+ cancers vs. 47.5% in HER2− cancers, p=0.0985). However, PTP1B expression is significantly associated with estrogen receptor expression (PTP1B expression50.7% in ER+ cancers vs. 43.1% in ER− cancers, p=0.0137) and intrinsic molecular subtype (PTP1B expression53.9% in the luminal B HER2+ subtype and 37.9% in the basal-like subtype). Of note, multivariate analyses demonstrate that PTP1B is an independent predictor of improved survival in breast cancer (HR 0.779, p=0.006). Taken together, we demonstrate in the largest study to date that (1) PTP1B is commonly expressed in breast cancer, (2) there is no association or functional impact of PTP1B expression in HER2+ breast cancer, and (3) PTP1B expression in breast cancer is associated with significantly improved clinical outcome. Until additional studies are performed, caution should be exercised in using PTP1B inhibitors in human breast cance

Keine gewöhnliche perianale Fistel

Zusammenfassung: Wir präsentieren den Fall eines 63-jährigen Schweizer Staatsbürgers mit chronischer Diarrhö, Schleimabgang ab ano, analer Fistel und chronischem Analulkus bei anamnestisch bekannter Lungentuberkulose vor 56Jahren. Nach Bildgebung wurde klinisch und endoskopisch initial der Verdacht auf eine chronisch entzündliche Darmerkrankung geäußert. Erst eine gezielte Probenentnahme und Untersuchung mittels PCR konnte die Diagnose einer abdominalen Tuberkulose mit perianaler Manifestation sichern. Die differenzialdiagnostische Berücksichtigung der extrapulmonalen Tuberkulose ist wichtig bei der Abklärung chronisch abdomineller Symptome. Eine immunsuppressive Therapie bei ursprünglich vermuteter chronisch entzündlicher Darmerkrankung hätte zu einer Progression mit Gefahr der miliaren Tuberkulose führen könne

Evaluation of the prognostic relevance of the recommended minimum number of lymph nodes in colorectal cancer—a propensity score analysis

Purpose Nodal status in colorectal cancer (CRC) is an important prognostic factor, and adequate lymph node (LN) staging is crucial. Whether the number of resected and analysed LN has a direct impact on overall survival (OS), cancer-specific survival (CSS) and disease-free survival (DFS) is much discussed. Guidelines request a minimum number of 12 LN to be analysed. Whether that threshold marks a prognostic relevant cut-off remains unknown. Methods Patients operated for stage I–III CRC were identified from a prospectively maintained database. The impact of the number of analysed LN on OS, CSS and DFS was assessed using Cox regression and propensity score analysis. Results Of the 687 patients, 81.8% had ≥ 12 LN resected and analysed. Median LN yield was 17.0 (IQR 13.0–23.0). Resection and analysis of ≥ 12 LN was associated with improved OS (HR = 0.73, 95% CI: 0.56–0.95, p = 0.033), CSS (HR 0.52, 95% CI: 0.31–0.85, p = 0.030) and DFS (HR = 0.73, 95% CI: 0.57–0.95, p = 0.030) in multivariate Cox analysis. After adjusting for biasing factors with propensity score matching, resection of ≥ 12 LN was significantly associated with improved OS (HR = 0.59; 95% CI: 0.43–0.81; p = 0.002), CSS (HR = 0.34; 95% CI: 0.20–0.60; p < 0.001) and DFS (HR = 0.55; 95% CI: 0.41–0.74; p < 0.001) compared to patients with < 12 LN. Conclusion Eliminating biasing factors by a propensity score matching analysis underlines the prognostic importance of the number of analysed LN. The set threshold marks the minimum number of required LN but nevertheless represents a cut-off regarding outcome in stage I–III CRC. This analysis therefore highlights the significance and importance of adherence to surgical oncological standards

Diurnal variation of the potassium layer in the upper atmosphere

Measurements of the diurnal cycle of potassium (K) atoms between 80 and 110km have been made during October (for the years 2004–2011) using a Doppler lidar at Kühlungsborn, Germany (54.1°N,11.7°E). A pronounced diurnal variation is observed in the K number density, which is explored by using a detailed description of the neutral and ionized chemistry of K in a three-dimensional chemistry climate model. The model captures both the amplitude and phase of the diurnal and semidiurnal variability of the layer, although the peak diurnal amplitude around 90 kmis overestimated. Themodel shows that the total potassium density (≈K+K++KHCO3) exhibits little diurnal variation at each altitude, and the diurnal variations are largely driven by photochemical conversion between these reservoir species. In contrast, tidally driven vertical transport has a small effect at this midlatitude location, and diurnal fluctuations in temperature are of little significance because they are small and the chemistry of K is relatively temperature independent

Infantile-onset Pompe disease complicated by sickle cell anemia: Case report and management considerations

Infantile-onset Pompe disease (IOPD) is a rare, severe disorder of lysosomal storage of glycogen that leads to progressive cardiac and skeletal myopathy. IOPD is a fatal disease in childhood unless treated with enzyme replacement therapy (ERT) from an early age. Sickle cell anemia (SCA) is a relatively common hemoglobinopathy caused by a specific variant in the hemoglobin beta-chain. Here we report a case of a male newborn of African ancestry diagnosed and treated for IOPD and SCA. Molecular testing confirmed tw

EpCAM expression varies significantly and is differentially associated with prognosis in the luminal B HER2+, basal-like, and HER2 intrinsic subtypes of breast cancer

BACKGROUND: Epithelial cell adhesion molecule (EpCAM) is frequently expressed in breast cancer, and its expression has been associated with poor prognosis. Breast cancer can be subdivided into intrinsic subtypes, differing in prognosis and response to therapy. METHODS: To investigate the association between EpCAM expression and prognosis in the intrinsic subtypes of breast cancer, we performed immunohistochemical studies on a tissue microarray encompassing a total of 1365 breast cancers with detailed clinicopathological annotation and outcomes data. RESULTS: We observed EpCAM expression in 660 out of 1365 (48%) cases. EpCAM expression varied significantly in the different intrinsic subtypes. In univariate analyses of all cases, EpCAM expression was associated with a significantly worse overall survival. In the intrinsic subtypes, EpCAM expression was associated with an unfavourable prognosis in the basal-like and luminal B HER2(+) subtypes but associated with a favourable prognosis in the HER2 subtype. Consistently, specific ablation of EpCAM resulted in increased cell viability in the breast cancer cell line SKBR3 (ER(−), PR(−), and HER2(+)) but decreased viability in the breast cancer cell line MDA-MB-231 (ER(−), PR(−), and HER2(−) ). CONCLUSION: The differential association of EpCAM expression with prognosis in intrinsic subtypes has important implications for the development of EpCAM-targeted therapies in breast cancer

The intensification of metallic layered phenomena above thunderstorms through the modulation of atmospheric tides

We present a multi-instrument experiment to study the effects of tropospheric thunderstorms on the mesopause region and the lower ionosphere. Sodium (Na) lidar and ionospheric observations by two digital ionospheric sounders are used to study the variation in the neutral metal atoms and metallic ions above thunderstorms. An enhanced ionospheric sporadic E layer with a downward tidal phase is observed followed by a subsequent intensification of neutral Na number density with an increase of 600 cm−3 in the mesosphere. In addition, the Na neutral chemistry and ion-molecule chemistry are considered in a Na chemistry model to simulate the dynamical and chemical coupling processes in the mesosphere and ionosphere above thunderstorms. The enhanced Na layer in the simulation obtained by using the ionospheric observation as input is in agreement with the Na lidar observation. We find that the intensification of metallic layered phenomena above thunderstorms is associated with the atmospheric tides, as a result of the troposphere-mesosphere-ionosphere coupling