Search

30 minutes after drinking half a cup of rat poison a 16-year-old girl was admitted to hospital. In addition to various enteric detoxification measures forced dialysis was instituted and, after the urinary thallium level had become known (9 mg/l), haemodialysis was begun and ferric ferrocyanide (Prussian blue) administered (0.5 mg daily for six days). She had no symptoms at any time. After 10 days she was discharged. Five days after discharge she was again admitted, with colic-like abdominal pain, vomiting, paraesthesias of the hands and feet, and in a state of agitation. She had once again ingested rat poison, about one cup. Physical examination revealed little of consequence, except diffuse alopecia. Urinary thallium concentration was 37 mg/l. In the electrocardiogram the P-R interval was shortened to 0.11 s and T waves inverted in leads III and V1. Electronmicroscopy of cardiac and skeletal biopsies revealed lipid droplets, increased sarcoplasm and widening of some of the tubules. Treatment consisted of haemodialysis, forced diuresis (1 l urine/h), administration of ferric ferrocyanide, orthograde intestinal infusions and potassium substitution (serum level: 5 mmol/l). After 28 days the patient was discharged into psychiatric care.

Mykosen im Anogenitalbereich sind haufige Krankheitsbilder in der dermatologischen Praxis. Wahrend Dermatophytosen bei Mannern haufiger nachzuweisen sind, sind genitale Candidosen insbesondere bei Frauen problematisch. Hier findet sich zudem ein Anstieg von Non-albicans-Spezies (insbesondere C. glabrata, C. krusei, C. guilliermondii), die aufgrund ihrer Resistenzentwicklung gegenuber Azol-Praparaten fur ein Therapieversagen verantwortlich sein konnen. Die meisten superfiziellen Infektionen sprechen jedoch zufrieden stellend auf eine topische antimykotische Behandlung an, insbesondere wenn Pradispositionsfaktoren und die Moglichkeit einer sexuellen Ubertragung berucksichtigt werden. Ausgedehnte Infektionen durch Dermatophyten, Hefen und naturlich systemische Infektionen erfordern eine systemische antimykotische Therapie.

Das Internet bietet eine Vielzahl von Informationen rund um die medizinische Mykologie. Oft erfordert es einen erheblichen Zeitaufwand, den „fungal jungle“ bei der Online-Recherche mit Suchmaschinen zu durchqueren und die fur den eigenen Bedarf geeignete Webseite zu finden. Dieser Beitrag soll den Zugang zu mykologischen Informationen erleichtern und stellt eine Auswahl an deutsch- und englischsprachigen Webseiten zusammen. Dabei wurden die Seiten primar fur dermatomykologisch tatige und interessierte Arzte, Naturwissenschaftler und Studenten ausgewahlt; auf den meisten Seiten werden aber auch relevante Mykosen anderer Fachbereiche behandelt.

The spatial heterogeneity of myocardial perfusion and metabolism was studied in 11 anaesthetized dogs under resting conditions. In each heart local myocardial blood flow was assessed using the tracer microsphere technique in 256 samples (mean mass: 83.1 mg) taken from the left anterior ventricular wall. In the same samples, the following biochemical parameters were determined: accumulation of [3H]-deoxyglucose (a measure of glucose uptake), free cytosolic adenosine (S-adenosylhomocysteine accumulation technique, a measure of tissue oxygenation and a possible mediator of blood flow regulation), and the specific activities of oxidative (citrate synthase, cytochrome-c-oxidase) and glycolytic (hexokinase, phosphoglycerate kinase) enzymes. Capillary density and mitochondrial and myofibril volume densities were determined by morphometry. Myocardial perfusion in each sample (average 0.77 ml min−1 g−1) varied between 0.1 and 2.5 times the mean (coefficient of variation 0.30±0.02). [3H]-deoxyglucose was deposited locally in proportion to perfusion. Samples showing low flow (< 0.2 ml min−1 g−1) did not exhibit increased levels of cytosolic adenosine. The specific activities of the oxidative and glycolytic enzymes, however, were uniformly distributed between low and high flow areas. Furthermore, capillary density and mitochondrial and myofibril densities were similar in high and low flow regions. The results show firstly that local glucose metabolism in the heart occurs in proportion to local blood flow, suggesting that high flow regions have a higher than average metabolic rate. Secondly, regions of low flow are not compromized by critical oxygenation and most likely have a lower than average oxygen demand and finally, the homogeneous distribution of oxidative and glycolytic enzymes, as well as the homogeneous myocardial ultrastructure, suggest that areas with high and low blood flow under resting conditions may increase their metabolic rate to similar levels when required.

The present report describes the case of a 57-year-old patient with malignant fibrous histiocytoma of the left atrium operated on for a suspected atrial myxoma. Surgery was performed as radically as possible and included resection of the atrial wall. Clinical investigation and echocardiography performed 29 months after surgery revealed no signs of tumor recurrence. Diagnostic procedures, topography, pathohistology as well as options for therapy are discussed with regard to the latest literature. A radical surgical approach represents the only effective therapeutic measure. Owing to a lack of sufficient experience, there is no additional therapeutic recommendation on hand. Neither radiation nor chemotherapeutic treatment concepts have proved efficient. Echocardiography represents the best examination procedure for both diagnosis and follow-up in patients with cardiac tumor.

Different kinds of cell motility are reviewed in this paper with special regard to development and ultrastructure. The variety of animal cell motility types can be reduced to three principles : ciliary and ameboid movements and muscle contraction. The ultrastructure of all kinds of cilia is very similar from single cell organisms to highly specialized cells of the human body e.g., ciliary respiratory epithelium. As a rule, ciliary movement is caused by minimal sliding of the nine double tubules consisting of tubulin, a protein differing from myosin and actin. Ameboid movement and muscle cell contraction are based on the sliding filament mechanism of actin and myosin. Although the principles of this mechanism have not changed during evolution some differences in the structure and arrangement of actin and myosin filaments occurred. Obviously, the high degree of order of the myofibrils of vertebrate heart and skeletal muscle cells has developed from loose and rapid changing arrangement of contractile filaments in ameboid cells. There are some changes of residues in the actin and myosin molecules during the development of the intracellular contractile system. Finally, some peculiarities of the myocardium, its special arrangement of muscle cells and some disturbances of the contractile filaments under pathologic conditions are discussed.

In 300 human hearts of all age groups (pre-natal to senescence) postmortem angiographs were performed under a pressure of 100 mmHg. The largest diameters of the three coronary arteries (i.e. the right coronary artery, the left descending and the left circumflex branch) were determined.

Previous clinical studies in patients with hypertrophic cardiomyopathies predominantly comprised patients with typical subaortic HOCM and in many other studies patients with ‘hypertrophic’ cardiomyopathies were investigated; i.e. no distinction was made between patients with the typical obstructive, the atypical obstructive and the non-obstructive forms of hypertrophic cardiomyopathy. In addition, in the more differentiated studies, the differential diagnosis between HOCM and HNCM was based mainly on the presence and absence of the subaortic pressure gradient. This is also true for the clinical characterization of both types of hypertrophic cardiomyopathy. Finally, diagnostic descriptions of atypical (mid-ventricular) HOCM exist only in the form of case reports, i.e. they are not based on observations in a large number of patients. Therefore a comparative study in 353 patients with hypertrophic cardiomyopathies was designed to characterize the clinical picture of patients with HNCM and with atypical HOCM in relation to typical HOCM with special reference to the differential diagnosis. The study revealed a profoundly different diagnostic profile of the three subsets of hypertrophic cardiomyopathies. The distinction between the three subsets may serve as a more differentiated basis for clinical studies related to diagnosis, therapeutic approaches, long-term follow-up observations and prognostic evaluation of patients with hypertrophic cardiomyopathies.

Much has been learned in the past twenty years about the biologic changes occurring in zones of acute myocardial ischemic injury. Almost all of this information has come from studies of regional ischemia in dogs or other experimental animals. In this paper, the changes which occur when myocardium is made acutely and severely ischemic by sudden occlusion of a major branch of a coronary artery in the dog will be reviewed with special attention to those changes which are associated with irreversible (lethal) injury.