Search

Background: Endoscopic Ultrasound (EUS) and the EUS guided fine-needle Aspiration (EUS-FNA) increasingly plays an important role in the diagnostic evaluation of lesions or lymph nodes in the mediastinum and upper gastrointestinal tract of unknown origin. The objective of this study was to assess safety and accuracy of EUS-FNA in two secondary and tertiary health care providers., Methods: Prospectively, from Mai 2003 to June 2007, all patients underwent EUS with devices from Pentax (FG38UX, EC3830UT) with EUS-FNA (Cook or Mediglobe) at Johannes Gutenberg University and Catholic Hospital in Mainz. In all cases, cytology and extracted cells were histological examined by the same pathologists. In case of negative EUS results, patients were observed for at least 12 months after initial diagnosis later by reanalysis, CT-scan and follow-up clinical data to confirm the diagnosis., Results: In total, 776 patients with EUS and 167 EUS-FNA (21.5 %) could be evaluated. Median age was 62 years, 68 % of patients were male. Patients underwent EUS-FNA in the mediastinum (n = 54), pancreas (73), stomach (13), liver, adrenal glands and rectum (n = 6). The complication rate of EUS-FNA was very low with only 0.6 %, mainly consistent of one minor haemorrhage at the aspiration site. A clear histological diagnosis could not be achieved in 12.5 % (21/167). Statistical analyses of all EUS-FNA revealed a sensitivity of 77.8 % (95 %CI 67,2 - 86,3) and a specificity of 98.5 % (95 % CI 92,2 - 100), with a positive and negative predictive value of 98.4 % and of 78.1 %, respectively. The overall accuracy was 87 % (95 %CI 80,4 - 92,0)., Conclusion: EUS combined with FNA is a safe tool for first histological evaluation of unidentified lesions or lymph nodes in the mediastinum and upper gastrointestinal tract, indicative for gastrointestinal cancers., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: Spontaneous malignant transformation of laryngeal papillomatosis was in the past mostly negated, or the discussion in literature was rather toned down and reserved. Therefore, from a biological and prognostic point of view, HPV infection of the larynx seems to carry a different weight than a viral infection in genital region. According to general consensus, secondary, malignant transformation in juvenile papillomatosis occurs in irradiated patients and leads to the conclusion that radiation therapy of this disease is presently contraindicated. Because there is as yet no causal and curative treatment, repeated and frequent removal of papillomatous tissue by microlaryngoscopy may often be necessary to keep the airway patent., Patient, Method and Results: We diagnosed and treated an advanced laryngeal squamous cell carcinoma with lymphatic metastasis in a 50-year old male. Juvenile papillomatosis had been diagnosed already at the age of five, and at the patient's last presentation 5 years ago (age 45), typical clinical and histological features of laryngeal papillomatosis had been observed. Furthermore, virus infection of the papillomatous tissue (HPV-6/11) was proved by using the technique of in-situ hybridisation. Risk factors for malignant transformation, such as smoking, alcohol or radiation, were denied by the patient., Conclusions: From these aspects, a spontaneous, malignant transformation of laryngeal papillomatosis must be considered with regard to six similar observations in the German and English literature. In the reported case, a tumoural origin in the flat laryngeal mucosa in close neighbourhood to the former site of papillomas, is less probable, albeit not ruled out completely, since continuous changes from benign squamous papilloma to atypical, invasive tumour and a HPV-infection in the carcinomatous tissue could not be proved by in-situ hybridisation.

The paper gives a brief overview of five experimental approaches in which memory processes were studied by means of event-related brain potentials (ERPs). Some of the results were already published in English (Study 1), while others are new and will be reported in greater length as full paper elsewhere (Studies 2, 3, 4, and 5). Study 1 revealed that retrieval of information from episodic long-term memory is accompanied by a systematic slow negative potential. The topography of this slow wave depends on the quality of the reactivated information (spatial vs. verbal), and its amplitude reflects the difficulty of the retrieval process. In experiment 2 ERPs were recorded while subjects acquired either explicit or implicit knowledge about a sequential stimulus-response pattern. The data suggest that explicit learners who posses verbalizable knowledge about sequential dependencies have formed both perceptual and motor representations, while implicit learners have formed motor representations only. In study 3 fact retrieval in mental arithmetic was activated by a verification task. Incongruent solutions evoked an arithmetic N400-effect whose amplitude varied with the associative distance between an expected and an actually perceived solution to a multiplication problem. In study 4 ERPs were recorded during mental rotation tasks. A set of experiments revealed that mental rotation is always accompanied by a systematic negative variation over the parietal cortex. The amplitude of this "rotation specific negativity" increases with an increasing angular disparity between a perceived sign and its normal upright template. It was shown that this negativity is functionally distinct from a P300-complex which is often superimposed on it within the same latency window. Finally, study 5 examined ERPs in a sentence reading task in which grammatically legal but infrequent sentence constructions had to be processed. A left-anterior negativity was observed whenever an explicit case marker (the definite article in German) signalled a nominal phrase at a noncanonical position. The LAN phenomenon appears to be a manifestation of a syntax processor which performes a first-pass formal analysis of a sentence and which possibly allocates working memory resources whenever a word cannot be assigned immediately to an expected propositional role.

Nineteen congenitally blind subjects (Ss), eleven Ss who went blind later in their life, and 42 control Ss with normal vision were tested in a tactile version of a "mental rotation" task. A specially constructed tactile display was used which enabled a rotation of the alphanumeric symbols in multiples of 60 degrees without any form distortion. Ss had to compare two successively presented symbols regarding whether the second was just a rotated version or also a mirror image of the first. Decision latencies and errors were recorded. Neither of dependent variables reveal any differences between the three groups of subjects. Moreover, the well known linear increase of decision latency as a function of angular disparity could also be observed with the tactile stimuli in all three groups. Both results are consistent with the assumption that mental rotation effects are neither linked to the visual modality nor to a manipulation of visual-analog representations. If the task is solved by so called analog processes then these seem to operate with non-visual spatial representations.

With the help of immunohistochemical techniques and new antibodies developed in the last few years, we were able to identify 2 cases of nodular tumors of the skin as highly malignant Ki-1 lymphomas. The clinical course was characterized by the development of multiple skin tumors without any evidence of systemic involvement. After the excision of several skin tumors; we performed chemotherapy with the MACOP-B regimen. In one of our patients, however, this treatment could not prevent the occurrence of further tumors. Possibly, the cutaneous anaplastic Ki-1 lymphomas presented here are closely related to or even identical with mycosis fungoides d'emblée.

We examined the iron nutritional status of healthy term infants in a longitudinal study from 15 through 365 days of age. All infants were fed according to the present austrian recommendations. Serum hemoglobin (Hb) decreased from 15 through 122 days of age and remained constant thereafter. At 365 days of age, only 4.7% of the infants had hemoglobin levels below 11 g/dl, which is considered the borderline value for anemia. Mean corpuscular volume (MCV) of erythrocytes was changing during infancy. Free erythrocyte protoporphyrin (FEP) was constant from 122 days through 365 days of age. The upper normal value of 3 micrograms/gHb for infants older than 122 days of age corresponded to that for children older than one year and adults. Serum ferritin (SF) decreased from 15 through 183 days of age and remained constant thereafter. At 365 days of age, only 9.3% of the infants had SF below 10 micrograms/l, which is considered the borderline concentration for depletion of iron stores. We found no differences of iron nutritional status between infants who were breastfed longer than 122 days and infants who were breastfed shorter than 122 days or were fed formula. Our findings indicate that the prevalence of iron deficiency anemia and depletion of the iron stores is lower than in previous studies. Changes in infant nutrition during the last years resulted in higher iron intake and lower prevalence of iron deficiency.

Daily lead intake from drinking water was estimated on the basis of lead concentrations in running and boiled drinking water samples of 42 Viennese households and reported drinking water consumption of adults living in those households. Lead concentration (means, SD, median) in running water samples (15.3 (37.9) micrograms Pb/l, median 6.3) was significantly higher (p less than 0.005) than in boiled water samples (6.4 (11.1) micrograms Pb/l, median 4.1). The highest lead concentrations in running water samples were found in houses built before 1945. Reported drinking water consumption was 1306 (576) ml/day (median 1242); more than 70% of drinking water was consumed at home. Calculated lead intake from drinking water in Vienna was 11.8 (22) micrograms Pb/day (median 5.2). Lead intake from drinking water was highest (19.5 (31.3) micrograms Pb/day, median 7.3) in houses built before 1945. Lead intake with food was calculated using published data on lead concentrations in food items and on food intake and data from the present study. Calculated average lead intake with food (206 micrograms Pb daily) was far below the estimated safe lead intake proposed by WHO 1972. We conclude that lead intake from drinking water in Vienna is low in most households. However, lead intake may be close to toxic levels if persons living in houses built before 1945 are consuming extremely large amounts of drinking water.

Investigations were conducted on the composition of fatty acids in the fat of the embryo, the endosperm and several crush fractions of the maize kernel. The following results were obtained: 1. The embryo fat contained relatively lower contents of palmitin-, stearin- and linolenic acid, on the other hand higher contents of oleic- and linoleic acid in comparism to endosperm fat. 2. This result was identical to each one of the seven varieties examined. 3. The examined varieties presented clear differences both in the absolute contents of single fatty acids in the embryo and in the endosperm, as well as in the relationship between the components in the germ and in the endosperm. 4. The differences observed between the germ- and the endosperm fat in the crush fractions in some cases were clearly visible, while in other cases were not traceable.

In the past years the cultivation of maize in the Federal Republic of Germany has been intensified, and with the processing of localy bred maize a production of maize germ oil from German varieties could be expected. In order to maintain certain essential points about the amplitude of variations in the specimen of fatty acids in the localy bred maize, a greater number of maize samples from cultural practice trials (varieties, locations and fertilizer) were taken for the year 1971 and 1972 and their fatty acid composition was analysed. The following results were obtained: 1. Comparared to maize of foreign origin, processed in the Federal Republic of Germany, in most cases the localy bred, has higher contents of linoleic acid and lower contents of oleic acid. Thus the linoleic acid contents of the Germany maize varies between 54.3 and 68.8% while the foreign maize varies between 39.5 and 58.7%. 2. Great differences in quality exist between the local genotypes (varieties). Also clear, but not so great differences are induced by ecological factors, as locations, weather and nutrient supply. The differences of local environment in the linoleic acid content in case of variety "Inrakorn" varies between 60.8 and 64.5%.

The implementation of the recommended daily vitamin D and fluoride supplements for infants in Austria has been investigated during a nationwide infant nutrition survey (n = 1069). 93.9% of the infants received daily vitamin D supplements, whereas only 38% received fluroide. Rejection of fluoride supplemtation was most common among mothers aged between 30 and 45 years and mothers with university education. In Carinthia, Vorarlberg and Styria only 2 out of 10 infants received fluoride supplements. It seems necessary to reconsider the recommendations for fluoride supplementation in Austria.