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Hintergrund: Für die Versorgung von Patientinnen mit unkompliziertem Harnwegsinfekt (HWI) stehen verschiedene Behandlungsoptionen zur Verfügung. Es ist nicht bekannt, inwieweit diese Optionen in der ärztlichen Praxis ausgeschöpft werden. Auch ist unklar, ob zwischen Management und[zum vollständigen Text gelangen Sie über die oben angegebene URL], 53. Kongress für Allgemeinmedizin und Familienmedizin

Hintergrund: Als Therapieoptionen bei unkompliziertem Harnwegsinfekt stehen Antibiotika, Schmerzmittel oder eine verzögerte Antibiotika-Verordnung (‚delayed prescription‘) zur Verfügung. Um die jeweils optimale Behandlungsstrategie zu finden und in kontrollierten Studien zu evaluieren,[zum vollständigen Text gelangen Sie über die oben angegebene URL], 50. Kongress für Allgemeinmedizin und Familienmedizin

In recent years delirium in the intensive care unit (ICU) has internationally become a matter of rising concern for intensive care physicians. Due to the design of highly sophisticated ventilators the practice of deep sedation is nowadays mostly obsolete. To assess a ventilated ICU patient for delirium easy to handle bedside tests have been developed which permit a psychiatric scoring. The significance of ICU delirium is equivalent to organ failure and has been proven to be an independent prognostic factor for mortality and length of ICU and hospital stay. The pathophysiology and risk factors of ICU delirium are still insufficiently understood in detail. A certain constellation of pre-existing patient-related conditions, the current diagnosis and surgical procedure and administered medication entail a higher risk for the occurrence of ICU delirium. A favored hypothesis is that an imbalance of the neurotransmitters acetylcholine and dopamine serotonin results in an unpredictable neurotransmission. Currently, the administration of neuroleptics, enforced physiotherapy, re-orientation measures and appropriate pain treatment are the basis of the therapeutic approach.

The Division of Evidence Based Medicine (dEBM), part of the Clinic for Dermatology, Venerology and Allergology, Charité - University Hospital Berlin, offers on a regular basis workshops focusing on different areas of aesthetic medicine. This year in cooperation with the Institute of Anatomy a joint course was designed and conducted. The course focused on the treatment with hyaluronic acids of different particle size for a new indication, hand augmentation. Fourteen physicians participated in this course. The evaluation of the course ranged between very good and good.

The Division of Evidence Based Medicine (dEBM), Clinic for Dermatology, Venerology and Allergology, Charité--Universitätsmedizin Berlin, offers on a regular basis workshops focusing on different areas of aesthetic medicine. Once a year a joint course is provided in cooperation with the Institute of Anatomy, offering the participants the possibility to improve their injection techniques as well as their knowledge on the facial anatomy. This course is focused on treatment with hyaluronic acids of different particle size. Besides the classical indications, it considers new indications such as correcting the shape of the nose or lacrimal groove. Thirteen physicians participated in the course, which was evaluated as very helpful as it improved not only the injection technique but also the knowledge of anatomy.

Although twin studies indicate that inherited genetic factors contribute to about 35% of colorectal cancers (CRC), the exact genetic background has currently been elucidated in only 5-10% of cases. These comprise several hereditary cancer predisposition syndromes that present with a high number of syn- or metachronous neoplasms within an affected person and/or family. Many of these tumors exhibit typical histopathological changes. In general, one should discriminate between cancer syndromes associated with adenomatous and non-adenomatous (i.e., hamartomatous) polyps, the latter being quite rare. The patient's age often serves as a substantial hint to hereditary cancer. The next step of diagnostic work-up includes analysis of microsatellite instability (MSI) together with immunohistochemical detection of a loss of expression in one of the most frequently affected mismatch repair genes (MSH2, MSH6; MLH1, PMS2). Finally, the molecular demonstration of a gene mutation in the blood or germline is the most expensive and tedious procedure. This requires a signed informed consent from the patient after appropriate genetic counseling.

Thirteen families were included in our HNPCC surveillance program, eight of which met strict and three incomplete Amsterdam criteria. Two index patients were younger than 35 years of age. Tumors of all index persons showed microsatellite instabilities in at least 50% of the ten markers studied. Immunohistochemical analysis of tumor sections was performed using antibodies against hMLH1 and hMSH2 proteins in order to identify the mutated gene, which is not expressed in the tumor. Coding regions of hMLH1 and hMSH2 genes were amplified by PCR from genomic DNA and sequenced. In nine families pathogenetic mutations all resulting in a truncated protein, could be identified. Furthermore, 21 intron and exon polymorphisms were found. Since July 1997 we have offered surgical and genetic counseling to families with hereditary cancer syndromes in a special outpatient clinic. In addition to 13 index patients three asymptomatic gene carriers were included and eight noncarriers were excluded from the HNPCC surveillance program, as recommended by the HNPCC study group of Germany. Molecular diagnosis has considerable clinical implication in hereditary nonpolyposis colorectal cancer (HNPCC) families with respect to family members who actually have the disease as well as gene carriers and noncarriers.

We analyzed the complete coding region with adjacent intron sequences of the BRCA1 gene in eight patients with hereditary and/or early-onset breast/ovarian cancer. We detected one germline mutation in exon 5 in a 35-year-old woman with early-onset breast and ovarian cancer and 10 polymorphisms, of which one has not been published so far. To determine whether certain BRCA1 polymorphisms are associated with an increased risk for breast cancer, we will compare genotype distributions of early-onset breast cancer populations with matched controls.

Legionella is a frequent etiologic agent in the development of both nosocomial and community acquired pneumonias. Involvement of the nervous system is common in Legionella infections. We present a case of Legionnaires' disease which illustrates distinctive neurologic findings including delirium and cerebellar dysfunction. Furthermore, this paper reviews the neurological and psychiatric features of 609 Legionella infected patients with involvement of the nervous system. The most common signs were disorientation (58%), headache (52.4%), and somnolence (39.7%). Less frequent or rare were: cerebellar dysfunction (11.2%), hallucinations (8.4%), agitation or stupor (4.1%), affective disorders (3.1%), peripheral neuropathy (2.8%), pyramidal disturbances (2.1%), memory loss (1.6%), seizures (1.5%), cranial nerve palsies (1.5%), incontinence (0.7%), and extrapyramidal disturbances (0.3%). Cranial CT scans, cerebrospinal fluid findings, and nerve and muscle biopsies were usually unremarkable. Neuropathologic examinations failed to demonstrate specific characteristics. Hyponatremia and serum CPK level elevation were present in up to 89% and 50% of patients, respectively. Prognosis of disturbances of the nervous system was mainly good. We conclude that in the presence of definite neurological findings, pulmonary infection, hyponatremia, and CPK elevation Legionella infection should be considered.

Im Rahmen der vorliegenden Arbeit wurden optochemische Sensoren (Optroden) zur Detektion der kationischen Spezies Quecksilber(II), Calcium(II) und zur Bestimmung von pH-Werten entwickelt und miniaturisiert. Der erste thematische Schwerpunkt der Arbeit widmet sich der Verbesserung der Stabilität von kationensensitiven Rezeptorschichten. Werden diese durch einfache Einkapselung von Indikatoren hergestellt, so wird die Stabilität der Schicht bedingt durch das Auswaschen des Farbstoffes auf etwa einen Tag begrenzt. Zur Unterdrückung dieses Farbstoffaustrages wurde eine neue Immobilisierungsmethode entwickelt und erprobt, die in der kovalenten Anbindung von Fluoreszenzindikatoren an das wasserlösliche Polysaccharid Dextran (70.000 g/mol) und der anschließenden Einkapselung der makromolekular gebundenen Indikatormoleküle in hydrophilen Matrices besteht. Als Matrices wurden anorganische Silikagele, die nach dem Sol-Gel-Verfahren hergestellt wurden, und das organische Hydrogel Polyhydroxyethylmethacrylat (PolyHEMA) eingesetzt. Die vorgestellte Immobilisierungsmethode weist gegenüber der direkten kovalenten Anbindung des Indikators an die Matrix eine deutlich erhöhte Flexibilität auf, was beispielhaft an drei Analyt-Rezeptor-Paaren dargestellt wird. Zur Herstellung von Quecksilber-sensitiven Schichten wurden zunächst Porphyrin-Dextrane synthetisiert und mittels spektroskopischer Methoden sowie durch Elektrophorese charakterisiert. Porphyrin-Dextran-dotierte, mesoporöse Silikagel- Schichten zeigten nach 40tägiger Lagerung in Meßpuffer noch 92% der anfänglichen Fluoreszenzintensität. Auf der Basis von Fluorescein-Dextran wurden pH-sensitive Silikagel- und PolyHEMA-Schichten hergestellt. Letztere zeigten einen Meßbereich von pH 5 bis 8 und Ansprechzeiten von 5 Sekunden/pH. Nach 18tägiger Lagerung in Meßpuffer zeigten die Sensoren noch über 95% der ursprünglichen Fluoreszenzintensitäten. Durch Coimmobilisierung von Calcium Green-Dextran und Texas Red-Dextran wurde ein Calcium-sensitiver Sensor mit interner Referenz hergestellt. Der Meßbereich des Sensors liegt zwischen 5 10-8 und 10-5 mol/l Ca(II) bei Ansprechzeiten von 5 Sekunden bis zum Erreichen des Sättigungswertes. Der Sensor erwies sich als sehr selektiv gegenüber Interferenzen von Na(I), K(I) und Mg(II). Durch die interne Referenzierung des Meßsignals läßt sich die Reproduzierbarkeit der Sensorsignale entscheidend verbessern. Als zweiter Schwerpunkt der Arbeit wurde in mehreren Schritten die Miniaturisierung der Calciumsensoren mit interner Referenz vorgenommen. Unter Verwendung von optischer Fasertechnik wurden Mikrosensoren mit Durchmessern von 600 bzw. 50 µm entwickelt. Basierend auf verjüngten Faserspitzen (Taper) mit Durchmessern von etwa 300 nm wurden die derzeit kleinsten faseroptischen Calciumsensoren (Nanosensoren) erhalten. Aufgrund der verbesserten Stabilität und der extremen Miniaturisierung der vorgestellten optischen Sensoren lassen sich in Zukunft neue analytische Aufgabenstellungen (z.B. Messung in biologischen Zellen) mit einer Ortsauflösung im Nanometerbereich bearbeiten.

Newborn male Wistar rats were subjected to early postnatal social and nutritional deprivation by separation of the pups from their mother animals from Day 3 to Day 14 for 16 hours daily. One group of the deprived animals was treated by daily injections of pyridostigmine (1 microgram/0.05 ml saline from Day 1 to Day 4, 5 micrograms/0.05 ml saline from Day 5 to Day 14). At the age of 14 days or 6 months, 5 deprived, 5 deprived and pyridostigmine treated rats and 5 controls were investigated. In the stratum radiatum of the hippocampal CA 1-region the vesicle population of axospinodendritic synapses was examined for quantitative ultrastructural changes using electron microscopic and morphometric methods. The vesicle density (number of vesicles/micron 2 terminal area) was determined in the whole presynaptic terminal as well as in distinct zones in the presynaptic terminal. 14 days of deprivation did not change the vesicle density in the whole presynaptic terminal, but did change the distribution of the vesicles. In 14 days old deprived rats the vesicle density was found to be decreased by about 10% in the presynaptic area bordering the synaptic contact zone (area 1), and it was increased by about 7% in the more distant area of the presynaptic terminal (area 2). Deprivation and simultaneous pyridostigmine treatment resulted in an elevated vesicle density in the whole presynaptic terminal by about 25%, in area 1 by about 8%, and in area 2 by about 30%. At the age of 6 months, the early postnatally deprived rats showed an increase in the vesicle density by about 8% in all areas of the presynaptic terminal when compared with the controls. Simultaneous pyridostigmine treatment led to a reduced vesicle density in the whole presynaptic terminal by about 5%, in area 1 by about 9%, and in area 2 by about 4%. The findings obtained following deprivation are interpreted as being the expression of an insufficient requirement of synaptic mechanisms caused by a lack of sensoric inputs during the early postnatal period. The results obtained in the neonatally pyridostigmine treated rats suggest permanent changes in the neurotransmitter metabolism following treatment with the psychotrophic drug. This may reflect a mechanism to compensate the effect of deprivation by neonatal pyridostigmine administration.

In this study dental plaster casts of 31 male and 45 female subjects were measured using the Berlin measurement system and evaluated with the aid of a computer. The parameters of subjects with class III malocclusion, crossbite, open bite and class II/1 malocclusion were compared. The changes were studied longitudinally in the main developmental stages, namely the deciduous, mixed and permanent dentitions. Significant differences were found also following treatment between the malocclusion groups.