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Visceral hypersensitivity of the lower gastrointestinal tract, defined as an increased response to colorectal distension, frequently prompts episodes of debilitating abdominal pain in irritable bowel syndrome (IBS). Although the pathophysiology of IBS is not yet fully elucidated, it is well known that stress is a major risk factor for development and acts as a trigger of pain sensation. Stress modulates both immune responses as well as the gut microbiota and vice versa. Additionally, either microbes themselves or through involvement of the immune system, activate or sensitize afferent nociceptors. In this paper, we review current knowledge on the influence of stress along the gut-brain-microbiota axis and exemplify relevant neuroimmune cross talk mechanisms in visceral hypersensitivity, working toward understanding how gut microbiota-neuroimmune cross talk contributes to visceral pain sensation in IBS patients.

Fecal microbiota transplantation (FMT) has the potential to restore (bacterial and fungal) microbial imbalance in ulcerative colitis (UC) patients and contribute to disease remission. Here, we aimed to identify fecal fungal species associated with the induction of clinical remission and endoscopic response to FMT for patients with mild-to-moderate ulcerative colitis. We analyzed the internal transcribed spacer 1 (ITS1)-based mycobiota composition in fecal samples from patients (

Due to rapid digitalization, an increasing amount of data is available in healthcare settings; big data and artificial intelligence (AI) have also made their appearance.To provide insight into various ethical dilemmas that need to be considered when applying big data in clinical practice.Description and analyses of the ethical aspects associated with the use of clinical data in the context of psychiatric care.Various ethical aspects play a role in four phases; data collection, analysis, dissemination and application of results. In order to use clinical data and AI in a responsible manner, these aspects must be taken into account.The use of big data and AI in healthcare should aim to stimulate learning and improving care together with patients and professionals. Big data and AI should not be seen as the holy grail, but as a supporting tool in healthcare - a field in which many of the aspects that play a role in clinical care cannot be converted into measurable data.

Background Cutaneous leishmaniasis (CL) is frequent in travellers and can involve oro-nasal mucosae. Clinical presentation impacts therapeutic management. Methodology Demographic and clinical data from 459 travellers infected in 47 different countries were collected by members of the European LeishMan consortium. The infecting Leishmania species was identified in 198 patients. Principal findings Compared to Old World CL, New World CL was more frequently ulcerative (75% vs 47%), larger (3 vs 2cm), less frequently facial (17% vs 38%) and less frequently associated with mucosal involvement (2.7% vs 5.3%). Patients with mucosal lesions were older (58 vs 30 years) and more frequently immunocompromised (37% vs 3.5%) compared to patients with only skin lesions. Young adults infected in Latin America with L. braziliensis or L. guyanensis complex typically had an ulcer of the lower limbs with mucosal involvement in 5.8% of cases. Typically, infections with L. major and L. tropica acquired in Africa or the Middle East were not associated with mucosal lesions, while infections with L. infantum, acquired in Southern Europe resulted in slowly evolving facial lesions with mucosal involvement in 22% of cases. Local or systemic treatments were used in patients with different clinical presentations but resulted in similarly high cure rates (89% vs 86%). Conclusion/Significance CL acquired in L. infantum-endemic European and Mediterranean areas displays unexpected high rates of mucosal involvement comparable to those of CL acquired in Latin America, especially in immunocompromised patients. When used as per recommendations, local therapy is associated with high cure rates., Author summary Cutaneous and muco-cutaneous leishmaniasis (CL and MCL) are disfiguring diseases caused by a worldwide distributed parasite called Leishmania and its 20 species. Clinical manifestations span a wide continuum from single nodular lesion to disseminated form with mucosal involvement. No randomized clinical trial has ever been done exclusively in travellers and medical management is poorly evidence-based or based very predominantly on data obtained in endemic countries. Articles and reviews almost invariably propose a dichotomic view, with Old World CL described as a benign disease in contrast to New World CL strongly associated with destructive mucosal lesions. Our study is the first prospective clinical study providing a detailed description of the clinical presentation and risk of mucosal involvement in CL in several hundreds of patients, with frequent formal identification of the infecting Leishmania species. The harmonized data collection in patients infected in many transmission foci worldwide enabled direct comparisons of clinical patterns induced by different Leishmania species, and on the outcome following treatment with either local or systemic regimens. The study is based on an international harmonized data collection that allowed a wide capture of parasitologically confirmed cases. In striking contrast with previous assumptions, the study shows that CL acquired in Europe displays unexpected high rates of mucosal involvement comparable to those of CL acquired in Latin America, especially in immunocompromised travellers. It also shows that when used as per recommendations, local therapy is associated with high cure rates.

Irritable bowel syndrome (IBS) is a heterogenic, functional gastrointestinal disorder of the gut-brain axis characterized by altered bowel habit and abdominal pain. Preclinical and clinical results suggested that, in part of these patients, pain may result from fungal induced release of mast cell derived histamine, subsequent activation of sensory afferent expressed histamine-1 receptors and related sensitization of the nociceptive transient reporter potential channel V1 (TRPV1)-ion channel. TRPV1 gating properties are regulated in lipid rafts. Miltefosine, an approved drug for the treatment of visceral Leishmaniasis, has fungicidal effects and is a known lipid raft modulator. We anticipated that miltefosine may act on different mechanistic levels of fungal-induced abdominal pain and may be repurposed to IBS. In the IBS-like rat model of maternal separation we assessed the visceromotor response to colonic distension as indirect readout for abdominal pain. Miltefosine reversed post-stress hypersensitivity to distension (i.e. visceral hypersensitivity) and this was associated with differences in the fungal microbiome (i.e. mycobiome). In vitro investigations confirmed fungicidal effects of miltefosine. In addition, miltefosine reduced the effect of TRPV1 activation in TRPV1-transfected cells and prevented TRPV1-dependent visceral hypersensitivity induced by intracolonic-capsaicin in rat. Miltefosine may be an attractive drug to treat abdominal pain in IBS.

A persisting leishmania parasite

In Nederland komen slangenbeten zelden voor. Ze verlopen meestal mild, maar als het een geimporteerde slang betreft kunnen ze gevaarlijk zijn. De huisarts is uitstekend in staat een eerste evaluatie uit te voeren – algemene beoordeling van de patient, immobilisatie van de aangedane extremiteit, achterhalen van de soort en de giftigheid van de slang. Manipulatie van het gebeten gebied wordt sterk ontraden. Bij twijfel moet de patient naar de spoedeisende hulp verwezen worden.

Hintergrund Lamellierende Endotheltransplantationen (Descemetʼs stripping automated endothelial keratoplasty [DSAEK] und Descemet membrane endothelial keratoplasty [DMEK]) haben sich zur Standardtherapie bei Erkrankungen des Hornhautendothels entwickelt. Im Vergleich zur perforierenden Keratoplastik (PKP) gehen sie mit einer schnelleren visuellen Erholung und einem wesentlich geringeren Komplikationsrisiko einher, zudem ist der perioperative Kontroll- und Behandlungsaufwand der meist alteren Patienten weniger aufwendig. Im Hinblick auf die Indikationsstellung zur Operation wie auch fur die optimale Betreuung der Patienten nach DSAEK oder DMEK ist die Kenntnis der haufigsten Komplikationen wichtig.

Gewrichtsaandoeningen na een bezoek aan de tropen die zich presenteren als pijn (artralgie) of zwelling (artritis) van een of meerdere gewrichten, kunnen het gevolg zijn van een breed scala aan pathogenen. Zij worden vooral veroorzaakt door virale en in mindere mate door bacteriele micro-organismen. Infecties door schimmels en parasieten leiden zelden tot klachten van de gewrichten bij de doorsnee tropenreiziger. De pathogenese van elk van deze micro-organismen is anders, maar de prognose is vrijwel altijd gunstig met een herstel zonder restverschijnselen. In vele gevallen is uitsluitend symptomatische behandeling beschikbaar. Patienten zijn vaak bang dat er een reumatische aandoening speelt. Daarom is een diagnose via goede anamnese en kennis van de epidemiologie, naast lichamelijk onderzoek, belangrijk voor de prognose en ter geruststelling. Daar veel patienten nogal eens na langere tijd de huisarts consulteren, is het belangrijk dat deze hulpverlener op de hoogte is welke importziekten zich langere tijd na de reis kunnen manifesteren. Een aantal niet-infectieuze oorzaken van gewrichtsklachten in relatie tot reizen zullen ook besproken worden.

Background Leptospirosis is a potentially fatal zoonotic disease that is prevalent in travellers. Here, we describe epidemiological and diagnostic characteristics of all returning travellers diagnosed with leptospirosis in the Netherlands between 2009 and 2016. Furthermore, we present a detailed clinical case series of all travellers with leptospirosis who presented at the Academic Medical Center (AMC) in the same period. Method We extracted data from the records of the Dutch Leptospirosis Reference Center (NRL) of all cases of leptospirosis in travellers in the Netherlands from 2009 to 2016. Patients who presented at the AMC were identified and clinical data were extracted from the hospital records. Results 224 cases of travel-related leptospirosis were included. An increase of cases was observed from 2014 onwards. The majority of cases were male (78.1%), and had travelled to South-East Asia (62.1%). Of 41 AMC cases, 53.7% were hospitalised, but most patients had a relatively mild disease course, with no fatalities. A longer delay in diagnosis and treatment initiation existed in hospitalised compared to non-hospitalised patients, suggesting a benefit of early recognition and treatment. Conclusions Leptospirosis was increasingly observed in returning travellers in the Netherlands, and is a diagnosis that should be considered in any returning febrile traveller.

Background Miltefosine (Profounda, FL) is an oral alkylphospholipid drug which is approved by the Food and Drug Administration for the treatment of some species of New World cutaneous leishmaniasis. The maximal daily recommended dosage is 50 mg t.i.d for 28 days; yet there is some evidence that doses Methods We used a miltefosine dose escalation of 50 mg t.i.d (1.28 mg/kg/day) for days 1–5 with fatty food, increasing to 50 mg. q.i.d. (1.71 mg/kg/day) for days 6–15. For days 16–28, the patient received 250 mg daily (2.13 mg/kg/day). Weekly blood testing was done for complete blood count, metabolic panel, and miltefosine pharmacokinetics. Plasma concentrations were assayed using a validated liquid chromatography coupled to tandem mass spectrometry methodology. Results The patient experienced a good clinical result with his two ulcerative lesions on the left leg healing with full epithelialization by day 28. He tolerated miltefosine well until he escalated to 250 mg daily when he noted 2 hours of fatigue and dizziness after the dose, nausea and after the fourth day he developed epididymitis. His serum creatinine was elevated (1.4 mg/dL). The epididymitis resolved after approximately a week, his other symptoms resolved soon after completing the day 28 dose. Serial miltefosine plasma levels accumulated during treatment to 30, 34, 44, and 53 μg/mL on days 7, 14, 21, and 27 after the start of treatment (dropping to 27 μg/mL 8 days post), with an apparent distribution half-life of 7 days. Conclusion Miltefosine yielded healing of recalcitrant L. tropica infection but was associated with adverse effects at the 250 mg daily dose that severely limited the activity of the patient for the final 8 days of therapy; however, they were not dose-limiting. Miltefosine accumulation appeared to be dose-proportional compared with reported concentrations with a median 1.8 mg/kg/day dose in Dutch cutaneous leishmaniasis patients (median weight 85 kg). Disclosures All authors: No reported disclosures.

Rabies is a deadly disease, and current preexposure vaccination schedules are lengthy and expensive. We identified nine studies investigating abbreviated schedules. Although initial responses were lower, accelerated adequate immune responses were elicited after booster vaccinations. Lower-dose (and therefore cheaper) vaccination schedules may constitute a valid alternative to current vaccination schedules.

Background The 17D-yellow fever (YF) vaccination is considered contraindicated in immune-compromised patients; however, accidental vaccination occurs. In this population, measuring the immune response is useful in clinical practice. Methods In this study we compare two antibody tests (the Immune Fluorescence Assay and the Plaque Reduction Neutralization Test) in a group of Dutch immune-compromised travellers with a median of 33 days (IQR [28–49]) after primary YF vaccination. Results We collected samples of 15 immune-compromised vaccinees vaccinated with the 17D yellow fever vaccine between 2004 and 2012. All samples measured in the plaque reduction neutralization test yielded positive results (>80% virus neutralization with a 1:10 serum dilution). Immune Fluorescence Assay sensitivity was 28% (95% CI [0.12–0.49]). No adverse events were reported. Conclusions All immune-compromised patients mounted an adequate response with protective levels of virus neutralizing antibodies to the 17-D YF vaccine. No adverse effects were reported. Compared to the plaque reduction neutralization test, the sensitivity of the Immune Fluorescence Assay test was low. Further research is needed to ascertain that 17D vaccination in immune-compromised patients is safe.

Resume L’evolution rapide de la pratique de la chirurgie dentaire durant ces dernieres decennies doit amener les praticiens a se poser des questions quant a leur exercice, notamment eu egard aux normes et aux protocoles qui sont crees pour les rehabilitations esthetiques du sourire. En effet, les patients montrent un engouement reel pour l’esthetique dentaire, un enthousiasme permis par l’evolution des techniques attenantes a la dentisterie, et largement relayees par les medias. On observe ainsi une culture du sourire (comme une branche de la culture de l’image), et les chirurgiens-dentistes s’engagent dans la course a la standardisation du sourire en y repondant par l’etablissement de normes et de lignes-guides. Il est important de se demander jusqu’ou va cette normalisation, et si des limites permettraient d’y incorporer de la prudence. C’est d’autant plus necessaire que certaines pratiques ont – deja – cours dans certains pays, comme l’Afrique du Sud. La normalisation du sourire risque bien d’aller a l’encontre de l’ethique si ce n’est pas deja fait.

This review addresses the question of whether the risk of developing mucosal leishmaniasis (ML) warrants systemic treatment in all patients with New World cutaneous leishmaniasis (CL) or whether local treatment might be an acceptable alternative. The risk of patients with New World CL developing ML after the initial infection has been the main argument for systemic treatment. However, this statement needs re-evaluation and consideration of all the available data. The putative benefit of preventing ML should outweigh the toxicity of systemic antileishmanial therapy. To assess the need for and risk of systemic treatment the following factors were reviewed: the incidence and prevalence of ML in endemic populations and in travellers; the severity of mucosal lesions; the efficacy of current options to treat ML; the toxicity and, to a lesser extent, the costs of systemic treatment; the risk of developing ML after local treatment; and the strengths and limitations of current estimates of the risk of developing ML in different situations. Local treatment might be considered as a valuable treatment option for travellers suffering from New World CL, provided that there are no risk factors for developing ML such as multiple lesions, big lesions (>4 cm(2)), localisation of the lesion on the head or neck, immunosuppression or acquisition of infection in the high Andean countries, notably Bolivia.

We encountered a case of severe murine typhus complicated by acute respiratory distress syndrome. To determine worldwide prevalence of such cases, we reviewed the literature and found that respiratory symptoms occur in ≈30% of murine typhus patients. In disease-endemic areas, murine typhus should be considered for patients with respiratory symptoms and fever.

Zusammenfassung In seiner grosen “Monographic der Medusen” hat Haeckel (1880) bei der Aufstellung seiner neuen Familie Flosculidae mit den Gattungen Floscula und Florescu festgestellt, das wir die Bildung eines Gastrovascularsystems mit unverzweigten Radiarkanalen und einfachem Ringkanal bei jugendlichen Larven der Ulmariden (“und wahrscheinlich aller Rhizostomeen”) finden. Nach dem biogenetischen Grundgesetz durften wir daher annehmen, das die Flosculidae die Vorfahren der Ulmariden und Rhizostomeen darstellen. Inzwischen hat Thiel (1970) gezeigr, das das Kanalsystem der Kolpophorae Stiasnys ohne Bildung eines Ringkanales zentrifugal vom Magenrand, bei den Dactyliophorae jedoch von einem vorher in der Nahe des Schirmrandes gebildeten Ringkanal entsteht. Diese zentripetalen Auswuchse verzweigen sich im Laufe der ontogenetischen Entwicklung mehr und mehr und anastomo-sieren sich untereinander und weiterhin auch mit den Radiarkanalen in verschiedener Weise. Die Entwicklung zeigt so in der Tat - wie Haeckel vermutet hat - von einer Flosculu-ahnlichen Form ausgehend eine fortschreitende Kornplizierung des Gastrovascularsystems. Stiasny (1921) hat die verschiedenen Typen dieser Kornplizierung nach den Gattungen, bei denen sie vorkommen, benannt und unterscheidet den Lychnorhiza-Typ mit ein oder mehreren unverzweigten oder nur wenig ver-zweigten intrazirkularen Auswuchsen, den Crambione-Typ mit untereinander, aber nichr mit den Radiarkanalen anastomisierenden Auswuchsen, den Acromitus-Typ mit untereinander und nur mit den rhopalaren Radiarkanalen, den Acromitoides-Typ mit untereinander und nur mit den interrhopalaren Radiarkanalen anastomisierenden Auswuchsen und schlieslich den Catostylus-Typ, in dem die Gefasnetze sowohl mit den rhopalaren als auch den interrhopalaren Radiarkanalen anastomisieren, weiter den Lobonemoides-Typ, der wie der Acromitus-Typ Anastornosen mit den rhopalaren, und den Lobonema-Typ, der wie bei Catostylus mit den beiderseitigen Radiarkanalen anastomosiert, wahrend er bei Stomolophus nur allgemein von einem sehr breiten Anastomosennetz schreibt. Ebenso gibt er bei Rhizistoma und Rhopilema keine nahere Beschreibung ihres Typs. Bei der ersteren bleibt das Gastro-vascularsystem zeitlebens auf dem Crambione-Typ, bei der letzteren auf dem Acromitus-Typ stehen. Dabei treten die einzelnen aufgefuhrten Stadien (das Floscula-, Lychnorhiza-, Crambione, Acromitus-, Acromitoides- und Catostylus-Stadium) in der ontogenetischen Entwicklung in der genannten Reihen-folge nacheinander auf, je nachdem, um welche Gattung es sich jeweils handelt, bis das Endstadium dieser Form erreicht ist. Es finder hier also irn Laufe der Entwicklung in den Postephyren eine Wieder-holung der genannten Reihe statt, wenn sie nicht groser sind als 25–27 mm, wahrend die ausgewach-senen Tiere bis zu 350 mm und mehr erreichen konnen. Tatsachlich finder hier also wahrend dieser Entwicklung eine Wiederholung der einzelnen phylogenetischen Sradien sratt, wie es das biogenetische Grundgesetz fordert. Diese Entwicklung wird anhand von Photographien von mit Haematoxilin injizierten Praparaten Stiasnys zur Anschauung gebracht. - Zum Schlus gibt der Verfasser ein neues Schema der phylogenetischen Beziehungen der Gattungen der Rhizostornida, das auf der Ausbildung der Stadien des Gastrovascularsystems beruht. Summary In his compenduous “Monograph of the Acraspeda” E. Haeckel (1880) has pointed out, that we find the formation of a gastrovascular system with unbranched radial canals and a ring canal in the larval stages of the Ulmaridae (and probably also of all Rhizostomidae) and on account of the biological foundamental law we may therefore suppose that the family Flosculidae with the genera Floscukz and Floresca represents the ancestors of the Ulmaridue and Rhizostomidue. In the meantime, however, Thiel (1970) has shown, that in the UO. Kolpophorue the gastrovascular network originates without a ring canal centrifugally from the rim of the stomach. In the Dactyliophorae however, it is formed from a previously produced ringcanal on the margin of the umbrella by unbranched zentripetally outgrowths. These later on more and more ramify and in different modes anastomose with each other and the radial canals. Thiel (1970) established therefore the new orders Cepheida and Rhizostomida, of which only the latter have a ring canal. They show, in fact, a development as Haeckel has supposed from a Floscula-like form, first with a ringcanal without any zentripetal outgrowths, then with simple unbranched, not anastomosing zentripetal canals, the Lychnorhizidae. These are followed by on its ends joined, not with one of the radial canals communicating zentripetal canals (Crarnbione-Typ), later on by forms which are in communication with the rhopalar- resp. interrhopalar radial canals (the Acromitus- resp. the Amomitoides-Typ. Finally we find the Catostylus-Typ, in which the intracirkular network is in communication with both the rhopalar- and the interrhopalar canals, which is also the case in Stomolophus. These differently named states (the Floscula-, Lychnorhiza-, Crambione-, Acromitus-, Acromitoides-and Catostylus stages) appear in the ontogenetical development after each other in the denominate succession till the adult stage of the genus is reached. The genus Rhizostoma reaches its completion already in the Crambzone-, the genus Rhopilemu in the Acromitus-state. In the individual development these stages appear after each other in the early youth until ca. 25 mm diameter. On this way they reprresent a repetition of phylogenetical stages as the genetical foundamental law necessitates. This development in the young individuals is represented by injection of the gastrovascularsystem with Delafields Haematoxilin by Stiasny in several photographs, which are republished in the present work. - At last the author gives a new diagrammatical representation of the possible phylogenetical relations of the genera of the Rhizostomida on account of this formation of the gastrovascularsystem.

Summary Background. Current diagnostic methods for cutaneous leishmaniasis (CL) have low sensitivity or are not useful for treatment follow-up. We previously described the quantitative nucleic acid sequence-based amplification (QT-NASBA) method as a sensitive and specific assay for detection and quantification of Leishmania parasites in skin biopsies. This assay could be a valuable instrument for monitoring response to treatment of CL and identifying treatment failures at an early stage. Aim. QT-NASBA results of skin biopsies at the end and 6 weeks after treatment from patients with proven CL on various treatment regimens were compared with clinical outcome. Methods. The QT-NASBA assay measured the parasite load in skin biopsies before, at the end and 6 weeks after treatment. The results were compared with treatment outcome (clinical cure, delayed healing response or treatment failure) up to 6 months after treatment. Results. In total, 137 skin biopsies were obtained from 53 patients. A positive QT-NASBA result 6 weeks after treatment was significantly associated with treatment failure/delayed healing up to 6 months (P

Lamellar keratoplasties, e.g. Descemet's stripping automated endothelial keratoplasty (DSAEK) and Descemet membrane endothelial keratoplasty (DMEK) are considered the procedures of choice for corneal endothelial diseases. In comparison to penetrating keratoplasty (PK) they are associated with faster visual rehabilitation, a lower risk of complications and a decreased necessity for follow-up visits, which reduces the burden on quality of life in elderly patients. In order to advise patients regarding the indications for surgery and to facilitate the follow-up management, it is important to know the most important complications associated with these keratoplasty techniques.The most important preoperative complication is a delayed indication for the operation. In contrast to PK, DSAEK and DMEK surgery should be provided at an earlier stage of disease as chronic edema alters the stroma and reduces the speed of visual recovery. The most important complications during or early after surgery are detached lamellae, pupillary blocks with increased pressure or air bubbles in the vitreous cavity in patients with previous vitrectomy. The main long-term complications include chronic increased intraocular pressure and immune-mediated graft rejections in DSAEK patients after reducing or stopping topical corticosteroid therapy. This article describes the potential complications of endothelial keratoplasty and provides a detailed explanation of strategies to avoid these complications.

Background Adenoviral conjunctivitis causes high socioeconomic costs due to high contagiousness and therefore the need for extended quarantine. To date the only potentially active, topical antiviral agent is povidone-iodine (PVI). The aim of this study was to investigate the effect of diluted PVI on free adenovirus and adenoviral infected cells as well as to evaluate the cellular toxicity of PVI on non-infected cells. Material and methods PVI was diluted to a final concentration of 0.0008 %. Virucidal activity was measured IN VITRO using adenovirus 8 and A549 human epithelial cell cultures. Cytotoxicity effects on healthy cells after short- and long-term exposure to diluted PVI were measured in A549 cell cultures. Results Exposure to PVI at a concentration of 1:10 (0.8 %) completely extinguishes infectivity of free adenovirus after an exposure time of 10 minutes. PVI is less effective against intracellular adenovirus resulting in a decreased infectivity and viral activity for approximately one day with a narrow spectrum between toxicity and virucidal activity. Healthy epithelial cells can be exposed to PVI for up to 6 hours without a cytotoxic effect. Conclusions PVI is highly effective against free adenovirus but less effective against intracellular adenoviral particles in already infected cell. Short- and long-term exposure of PVI causes little cytotoxicity for healthy cells. Therefore, administration of diluted PVI at a concentration of 1:10 is a potential option to reduce contagiousness in cases of adenoviral infections.

BACKGROUND Povidone-iodine alone or in combination with antibiotics is commonly used for presurgical disinfection in cataract surgery. In spite of the use of the combination Povidone-iodine and ofloxacin, the rate of ocular contamination as assessed from surgical knives was reported to be as high as 26 %. The aim of this study was to investigate the efficacy of diluted Povidone-iodine alone for surgical disinfection. PATIENTS AND METHODS 126 consecutive patients undergoing elective cataract surgery with a conjunctival wound and a scleral tunnel received prior to surgery a disinfection with diluted Povidone-iodine eye drops (Braunol 1:10 diluted = 0.8 % Povidone-iodine, 3 times every 5 min). To assess residual bacteria on the ocular surface after disinfection, the surgical knives for the side ports and the scleral tunnel were cultured in thioglycolate broth. RESULTS In 8 out of 126 (6 %) patients the culture from the surgical knives revealed a positive result (89 % coagulase negative Staphylococci). Four of these 8 cases occurred during a single list. All control cultures remained negative. CONCLUSION Diluted Povidone-iodine eye drops alone are highly effective for bacterial disinfection when applied properly. The rate of contamination using 0.8 % Povidone-iodine in our series was considerably lower as compared to that of other studies.

BACKGROUND: A wide variety of pepper sprays is currently available and gaining increasing popularity among both professional guardians and amateurs. Adverse side effects to the anterior segment of the eye are known but underestimated. HISTORY AND SIGNS: We present two cases with severe corneal and conjunctival damage after accidental self injury by a pepper spray (Jet Protector Guardian Angel), benzyl alcohol 90.1 %, capsaicinoids 2.6 %). THERAPY AND OUTCOME: Despite immediate and intensive irrigation, a complete epithelial defect, extensive ischemia to the limbus and the conjunctiva and a circular conjunctival chemosis were diagnosed. After slow re-epithelialization in both cases, a neurotrophic superficial keratitis, a reduced corneal sensibility and in one case deep stromal scarring were noted. CONCLUSIONS: Pepper spray application to the eye might result in severe and permanent damage to the corneo-conjunctival tissue which is not adequately addressed in the current literature. From the present case reports arise the discussion whether the irritative and lipophilic capsacin/benzyl alcohol mixture or the pyrotechnical additives nitrocellulose und sinoxide are responsible for the anterior segment injuries. Language: de

Travellers to tropical destinations who seek medical attention after returning to their home country often present with fever, frequently as a result of an imported infectious disease. For this reason, clinicians initially focus on an infectious cause when a clear relationship in time exists between travel and disease onset. We present a case of a patient, who developed fever 2 weeks after his return from Ghana and who was finally diagnosed with an auto-immune disease: arteritis of the large arteries. This case illustrates that broad differential diagnostic thinking is paramount in the assessment of returned travellers.

Adult expatriates in countries where hepatitis B virus (HBV) is highly endemic have an increased risk of HBV infection but little is known about risks to their children or about patterns of spread. The epidemiology of HBV infection was studied among 124 unvaccinated Dutch missionaries and family members who lived in a rural area of Nigeria. Antibodies to hepatitis B core antigen were found in 5 (9.8%) of 51 adults (incidence rate 1.7 per 1000 person-months at risk [PMAR]) and 9 (12.3%) of 73 children (incidence rate 2.8 per 1000 PMAR). Vertical transmission of HBV was a likely source of infection in 1 child and was a possible source of infection in 2 others. The prevalence of HBV infection showed strong family clustering (P

Die Wirksamkeit der eingesetzten therapeutischen Methoden steht in enger Beziehung zu den Rahmenbedingungen. Gerade die Frage nach dem richtigen Zeitpunkt des Therapiebeginns ist in der Behandlung des fruhen kindlichen Stotterns ein wichtiger Aspekt. Therapeutische Grundhaltungen sind konzeptubergreifende Faktoren, die aufgrund der starken systemischen Komponente des Stotterns in Kap. 7 ebenso Beachtung finden wie der Umgang mit dem Stottern selbst. Die beschriebenen organisatorischen Rahmenbedingungen wie ambulante oder stationare Behandlungen, Intensiv- und Intervalltherapien schaffen unterschiedliche Arbeitsgrundlagen.

In Kap. 8 werden Bausteine der Stottertherapie losgelost von bestehenden therapeutischen Konzepten vorgestellt. Ziel ist die individuelle Anpassung der Therapie an das Alter, die Symptomatik, Umweltfaktoren sowie die Ressourcen des Kindes und seiner Familie. Die Therapieelemente werden in ihrer konkreten praktischen Umsetzung mit vielen Ubungsvorschlagen veranschaulicht. Neben der Beschreibung von Gruppensettings als Ort des sozialen und kommunikativen Lernens werden Vorschlage zur Zusammenstellung und inhaltlichen Planung von Gruppen gemacht. Auf die Therapie des Polterns als komorbid auftretende Storung wird abschliesend eingegangen.

Die Zusammenarbeit mit den Eltern spielt in der Behandlung des kindlichen Stotterns aufgrund der starken psychischen und systemischen Dynamik eine wichtige Rolle. Die unterschiedlichen Ebenen der Zusammenarbeit in Form von Information, Beratung und Training werden in Kap. 9 mit grosem Praxisbezug ausgefuhrt.

Ein Thema, das sowohl Wissenschaftler und Therapeuten als auch die Eltern stotternder Kinder sehr beschaftigt, ist die Frage nach der Ursache fur die Entstehung von Stottern. Gleichzeitig ist von grosem Interesse, ob es Kriterien oder Faktoren gibt, die daruber entscheiden, wie sich das Stottern bei den individuell betroffenen Kindern entwickeln wird, die also von prognostischer Relevanz sind. In Kap. 2 sind Erkenntnisse bezuglich dieser Fragen zusammengestellt. Vorgeschlagen wird eine am individuellen Patienten orientierte Gegenuberstellung von Forderfaktoren und Defiziten, sodass einem multifaktoriellen Ansatz bezuglich verursachender und aufrechterhaltender Faktoren konkret und einzelfallorientiert entsprochen werden kann.

Stottern ist kein einheitliches Krankheitsbild, sondern ein Syndrom, das sich aus individuell sehr unterschiedlichen sprachlichen, motorischen und psychosozialen Symptomen zusammensetzt. Die Redewendung „Wenn zwei das Gleiche tun, ist es noch lange nicht dasselbe“ hat fur das Storungsbild Stottern grose Gultigkeit. Kapitel 1 bildet mit der Beschreibung von Symptomen und Regelhaftigkeiten des Stotterns sowie der Abgrenzung zu anderen Storungen des Redeflusses die Grundlage der Diagnostik und der am Einzelfall orientierten Therapieplanung.

The number of patients with chronic inflammatory diseases who have been travelling to the tropics or subtropics has been rising. Use of immunomodulating drugs increases the risk for infectious diseases and may reduce seroprotection rates following vaccination. In addition, live vaccines, such as the yellow fever vaccine, are contra-indicated. Patients and their physicians are not always aware of the consequences of the use of immunomodulating drugs for travel and this may lead to undesirable situations, including last-minute cancellation of the trip. Informing and vaccinating patients early after the diagnosis of the inflammatory disease may prevent these undesirable situations.