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Zusammenfassung. Anorektalen Schmerzen liegen meistens organische Erkrankungen im Sinne einer Analfissur, Perianalvenenthrombose, Proktitis, Hämorrhoidalleiden oder gar einer Neoplasie zu Grunde. Die digital rektale Untersuchung wird leider oft vernachlässigt, obwohl anhand dieser die Problematik häufig eingegrenzt werden kann. Allzuoft wird jedoch kein klinisches Korrelat für die Schmerzen gefunden. Spätestens dann kommen, nach Ausschluss einer relevanten Pathologie in der apparativen Diagnostik, die Differentialdiagnosen der funktionellen anorektalen Schmerzen und Pathologien des Beckenbodens mit Ausstrahlung ins Perineum ins Spiel. Namentlich handelt es sich um die Proctalgia fugax, das Levator-ani-Syndrom, die Coccygodynie, die chronische Prostatitis und die interstitielle Zystitis. Die Proctalgia fugax dauert max. 30 min an und die Diagnose stellt sich anhand der Anamnese. Die Therapie ist supportiv (Massage, Sitzbäder, Analdilatation, Vasodilatatoren). Das Levator-ani-Syndroms ist durch eine Schmerzdauer über 30 Minuten und einer schmerzhaften Abtastung der Puborektalschlinge charakterisiert. Durch eine Biofeedbacktherapie, Sitzbäder, Massage oder Neurostimulation kann eine Symptomlinderung erreicht werden. Die neuropathischen und urogenitalen Schmerzbilder mit perinealer Schmerzausstrahlung werden konservativ mit Analgetika, schmerzmodulierenden Antidepressiva oder Antikonvulsiva behandelt. Alternativ kann eine Infiltrationstherapie der Triggerpunkte vorgenommen werden. Die Coccygodynie zählt nicht zu den funktionellen Erkrankungen. Durch gezielte Manipulationen des Steissbeines kann teils eine rasche Beschwerdebesserung erreicht werden.

Anorectal and perineal pain

Accidental hypothermia could be listed as an ‘orphan disease,’ since mild hypothermia is common but has no severe medical consequences, whereas severe hypothermia is rare and life-threatening. In order to increase our knowledge, find new outcome predictors, and propose better guidelines for the treatment of deep accidental hypothermia victims, we created the International Hypothermia Registry (IHR: https://www.hypothermia-registry.org ), which will allow us to gather a large number of cases in order to achieve statistical significance and issue evidence-based recommendations.

Background: Lung transplantation (LT) is a recognized treatment for end-stage pulmonary disease. Bacteria from the recipient nasopharynx seed the new lungs leading to infections and allograft damage. Understanding the characteristics and topological variations of the microbiota may be important to apprehend the pathophysiology of allograft dysfunction. Objectives: To examine the characteristics and relationship of bacterial compositions between conducting and respiratory zones of the allograft. Methods: We performed 16S rRNA gene sequencing on bronchial aspirates (BAs) and bronchoalveolar lavages (BALs) collected in pairs in 19 patients at several time-points post-LT. Results: The respiratory zone was characterized independently of the time post-LT by a higher bacterial richness than the conducting zone (p = 0.041). The phyla Firmicutes and Proteobacteria dominated both sampling zones, with an inverse correlation between these two phyla (Spearman r = -0.830). Samples of the same pair, as well as pairs from the same individual clustered together (Pseudo-F = 3.8652, p < 0.01). Microbiota of BA and BAL were more closely related in samples from the same patient than each sample type across different patients, with variation in community structure being mainly inter-individual (p < 0.01). Both number of antibiotics administered (p < 0.01) and time interval post-LT (p < 0.01) contributed to the variation in global microbiota structure. Longitudinal analysis of BA-BAL pairs of two patients showed dynamic wave like fluctuations of the microbiota. Conclusions: Our results show that post-transplant respiratory zones harbor higher bacterial richness, but overall similar bacterial profiles as compared to conductive zones. They further support an individual microbial signature following LT.

There are conflicting data on the role of the lectin pathway of complement activation and its recognition molecules in acute rejection and outcome after transplantation. To help resolve this we analyzed polymorphisms and serum levels of lectin pathway components in 710 consecutive kidney transplant recipients enrolled in the nationwide Swiss Transplant Cohort Study, together with all biopsy-proven rejection episodes and 1-year graft and patient survival. Functional mannose-binding lectin (MBL) levels were determined in serum samples, and previously described MBL2, ficolin 2, and MBL-associated serine protease 2 polymorphisms were genotyped. Low MBL serum levels and deficient MBL2 diplotypes were associated with a higher incidence of acute cellular rejection during the first year, in particular in recipients of deceased-donor kidneys. This association remained significant (hazard ratio 1.75, 95% confidence interval 1.18-2.60) in a Cox regression model after adjustment for relevant covariates. In contrast, there was no significant association with rates of antibody-mediated rejection, patient death, early graft dysfunction or loss. Thus, results in a prospective multicenter contemporary cohort suggest that MBL2 polymorphisms result in low MBL serum levels and are associated with acute cellular rejection after kidney transplantation. Since MBL deficiency is a relatively frequent trait in the normal population, our findings may lead to individual risk stratification and customized immunosuppression.

BACKGROUND Transient ischemic attacks (TIA) are stroke warning signs and emergency situations, and, if immediately investigated, doctors can intervene to prevent strokes. Nevertheless, many patients delay going to the doctor, and doctors might delay urgently needed investigations and preventative treatments. We set out to determine how much general practitioners (GPs) and hospital physicians (HPs) knew about stroke risk after TIA, and to measure their referral rates. METHODS We used a structured questionnaire to ask GPs and HPs in the catchment area of the University Hospital of Bern to estimate a patient's risk of stroke after TIA. We also assessed their referral behavior. We then statistically analysed their reasons for deciding not to immediately refer patients. RESULTS Of the 1545 physicians, 40% (614) returned the survey. Of these, 75% (457) overestimated stroke risk within 24 hours, and 40% (245) overestimated risk within 3 months after TIA. Only 9% (53) underestimated stroke risk within 24 hours and 26% (158) underestimated risk within 3 months; 78% (473) of physicians overestimated the amount that carotid endarterectomy reduces stroke risk; 93% (543) would rigorously investigate the cause of a TIA, but only 38% (229) would refer TIA patients for urgent investigations "very often". Physicians most commonly gave these reasons for not making emergency referrals: patient's advanced age; patient's preference; patient was multimorbid; and, patient needed long-term care. CONCLUSIONS Although physicians overestimate stroke risk after TIA, their rate of emergency referral is modest, mainly because they tend not to refer multimorbid and elderly patients at the appropriate rate. Since old and frail patients benefit from urgent investigations and treatment after TIA as much as younger patients, future educational campaigns should focus on the importance of emergency evaluations for all TIA patients.

Die haufigste Ursache einer Zwerchfellhernie stellt ein stumpfes Abdominaltrauma dar. Atraumatisch spontane Diaphragmahernien im Erwachsenenalter sind sehr rar.

Background: Years since onset of sexual intercourse (YSSI) is a rarely used variable when studying adolescents' sexual outcomes. The aim of this study is to evaluate the influence of YSSI on the adverse sexual outcomes of early sexual initiators. Methods: Data were drawn from the 2002 Swiss Multicenter Adolescent Survey on Health database, a nationally representative cross-sectional survey including 7429 adolescents in post-mandatory school aged 16-20 years. Only adolescents reporting sexual intercourse (SI) were included (n = 4388; 45% females) and categorised by age of onset of SI (early initiators, age

The relative role of plasmalemmal and mitochondrial ATP-sensitive K+(KATP) channels in calcium homeostasis of the atrium is little understood. Electrically triggered (1 Hz) cytoplasmic calcium transients were measured by 340-to-380-nm wavelength fura 2 emission ratios in cultured rat atrial myocytes. CCCP, a mitochondrial protonophore (100–400 nmol/l), dose dependently reduced the transient amplitude by up to 85%, caused a slow rise in baseline calcium, and reduced the recovery time constant of the transient from 143 to 91 ms ( P < 0.05). However, neither 5-hydroxydecanoate, a mitochondrial KATPchannel blocker, nor diazoxide (500 μmol/l) affected the amplitude, baseline, or time constant in CCCP-treated cells. HMR-1098 (30 μmol/l), a plasmalemmal KATPchannel blocker, and glibenclamide (1 μmol/l) increased the amplitude in CCCP-treated myocytes by 69–82%, sharply elevated the calcium baseline, and prolonged the recovery time constant to 181–193 ms ( P < 0.01). Thus opening of plasmalemmal but not mitochondrial KATPchannels reduces the calcium overload in metabolically compromised but otherwise intact atrial myocytes. Mitochondrial KATPchannels probably operate through a different mechanism to afford ischemic protection.

Stretch-induced atrial natriuretic factor (ANF) secretion was studied in cultures of neonate atrial appendage myocytes. Stretch, applied for 40 min by hypotonic swelling, increased the mean area of 44 individually imaged myocytes by 4.8–8.8% ( P < 0.0001) at 6 min and by 2.3–6.2% ( P < 0.05) at 35 min. Stretch increased immunoreactive ANF release by 42% ( P < 0.05) from a baseline of 315 pg/ml. The ATP-sensitive K+(KATP)-channel blocker tolbutamide (100 μmol/l) increased the stretch-stimulated release to 84% ( P < 0.01) over baseline, whereas lower concentrations (1, 10, and 30 μmol/l) had no stimulatory effect. The KATP-channel opener diazoxide (0.1, 1, 10, 30, and 100 μmol/l) inhibited stretch- plus tolbutamide-stimulated ANF release in a concentration-dependent manner, with IC50 = 2.2 μmol/l, although 100 μmol/l diazoxide did not reduce the increase in mean cell area. The stretch-stimulated KATP current, monitored in 82 whole cell recordings with sulfonylurea receptor (SUR) ligands, was inversely correlated with the stretch-induced ANF release ( r 2 = 0.79, P < 0.0001). In the absence of stretch, the KATP current had no relationship with baseline ANF release, and baseline ANF release was not affected by the KATP-channel modulators. The results show that SUR ligands that open KATP channels inhibit stretch-induced ANF release in atrial myocytes, in correlation with the stretch-activated KATP current. The subcellular site of action of the SUR ligands—plasmalemma or intracellular organelles—remains to be determined.

In Switzerland, organ procurement is well organized at the national-level but transplant outcomes have not been systematically monitored so far. Therefore, a novel project, the Swiss Transplant Cohort Study (STCS), was established. The STCS is a prospective multicentre study, designed as a dynamic cohort, which enrolls all solid organ recipients at the national level. The features of the STCS are a flexible patient-case system that allows capturing all transplant scenarios and collection of patient-specific and allograft-specific data. Beyond comprehensive clinical data, specific focus is directed at psychosocial and behavioral factors, infectious disease development, and bio-banking. Between May 2008 and end of 2011, the six Swiss transplant centers recruited 1,677 patients involving 1,721 transplantations, and a total of 1,800 organs implanted in 15 different transplantation scenarios. 10 % of all patients underwent re-transplantation and 3% had a second transplantation, either in the past or during follow-up. 34% of all kidney allografts originated from living donation. Until the end of 2011 we observed 4,385 infection episodes in our patient population. The STCS showed operative capabilities to collect high-quality data and to adequately reflect the complexity of the post-transplantation process. The STCS represents a promising novel project for comparative effectiveness research in transplantation medicine. Electronic supplementary material The online version of this article (doi:10.1007/s10654-012-9754-y) contains supplementary material, which is available to authorized users.