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Zwischen einem Krankenhaus in Tansania und einem deutschen Institut fur Pathologie wurde 2007 eine Telepathologieverbindung eingerichtet. Uber die internetbasierte Plattform iPath wurden Falle anhand statischer histologischer Bilder begutachtet. Die Arbeit soll das diagnostische Spektrum bei einem Hilfsprojekt in einem afrikanischen Land skizzieren. Analysiert wurden 5230 Diagnosen, darunter Falle, die erst bei einer Zweitbegutachtung in Deutschland am ubersandten Paraffinblock geklart werden konnten. Es wurden von insgesamt 17 anatomischen Entnahmelokalisationen die fuhrenden Diagnosen in den 5 fallzahlstarksten Gruppen betrachtet. Ferner wurden Falle von Kindern/Jugendlichen und besondere Erkrankungen bewertet. Diagnostiziert wurden 2934 (56,1 %) benigne und 2134 (40,8 %) maligne Erkrankungen. Fur eine Zweitbegutachtung mussten 734 (14 %) Falle nach Deutschland geschickt werden. Die haufigsten Lokalisationen waren Cervix uteri (n = 1211), Prostata (n = 728), Haut (n = 626), Mamma (n = 524) und Lymphknoten (n = 340). In 504 Falle (9,6 %) waren Kinder/Jugendliche betroffen. Afrikatypische Erkrankungen kamen selten vor. Mittels Telepathologie konnten histopathologische Diagnosen zeitnah zur Verfugung gestellt werden. Probleme ergaben sich vor allem durch die instabile personelle Situation vor Ort. Die Materialqualitat entsprach oft nicht den Anforderungen fur eine weiterfuhrende Zweituntersuchung. Es wurde deutlich, dass im Rahmen dieses Hilfsprojektes nicht vordergrundig mit exotischen Krankheiten, sondern mehrheitlich mit Standardbefunden aus der Tumor- und Infektionspathologie zu rechnen ist.

Muscle atrophy is a physiological response to disuse and malnutrition, but hibernating bears are largely resistant to this phenomenon. Unlike other mammals, they efficiently reabsorb amino acids from urine, periodically activate muscle contraction, and their adipocytes differentially responds to insulin. The contribution of myocytes to the reduced atrophy remains largely unknown. Here we show how metabolism and atrophy signaling are regulated in skeletal muscle of hibernating grizzly bear. Metabolic modeling of proteomic changes suggests an autonomous increase of non-essential amino acids (NEAA) in muscle and treatment of differentiated myoblasts with NEAA is sufficient to induce hypertrophy. Our comparison of gene expression in hibernation versus muscle atrophy identified several genes differentially regulated during hibernation, including Pdk4 and Serpinf1. Their trophic effects extend to myoblasts from non-hibernating species (including C. elegans), as documented by a knockdown approach. Together, these changes reflect evolutionary favored adaptations that, once translated to the clinics, could help improve atrophy treatment.

Extranodal lymphomas occurring in the head and neck region account for 12-15% of all malignant tumors of this locality. Classical Hodgkin lymphoma (cHL) is a rare subtype, representing around 1% of all lymphomas in Waldeyer's ring. Cases diagnosed in the Reference Centre for Lymph Node Pathology at the Pathological Institute of the University of Würzburg were further analyzed in this study.Histological subtype and EBV association of 21 cases were reviewed in conjunction with clinical data.Data of 12 male and 9 female patients with an average age of 51 years (median 45; 35-72) were reviewed. All samples were taken from the lymphatic tissue of the Waldeyer's ring (nasopharynx n = 15, palatine tonsils n = 5, lingual tonsils n = 1). The most common symptoms leading to a consultation with an otorhinolaryngologist were otalgia, swelling, or impaired nasal breathing. Only four patients showed typical B‑symptoms. In 6 cases (29%), an isolated extranodal manifestation was found, 15 patients (71%) showed simultaneous infiltration of cervical lymph nodes during staging, and 6 cases (29%) were EBV positive.An exclusively extranodal manifestation of cHL in Waldeyer's ring is rare, whereas infiltration of extranodal tissue in the case of a primary manifestation of lymphoma in cervical nodes can occur more frequently and may often remain undiagnosed. Therefore, a specialized ENT consultation could be a reasonable complementary module in tumor staging to determine the correct tumor extent.

A collaboration between a hospital in Tanzania and a German institute for pathology was initiated in 2007 with the aim of establishing a working telepathological connection using the internet-based platform iPath to transmit static histological images.This study aimed to describe the diagnostic spectrum evaluated in the course of an aid project in a developing country in Africa.A total of 5230 diagnoses were analyzed, including cases that could only be definitively concluded after a second analysis of the paraffin-embedded material in Germany. The most frequent diagnoses in the five largest diagnostic groups from 17 different anatomical locations were surveyed. In addition, cases sampled from children/young adults and rare diagnoses were assessed separately.Altogether we diagnosed 2934 (56.1%) benign and 2134 (40.8%) malignant diseases. The number of cases sent to Germany for a second opinion was 734 (14%). The five most common anatomical locations were the uterine cervix (n = 1211), the prostate (n = 728), skin (n = 626), breast (n = 524), and lymph nodes (n = 340). Children comprised 504 cases (9.6%). Typical tropical diseases were only rarely seen in the whole collective of cases.By means of telepathology histopathological diagnoses can be supplied in a short period of time. Difficulties occurred mainly due to the unstable staff situation on site and because the quality of sampled biopsy material was not always sufficient for further investigations. Furthermore, it became clear in the course of this aid project that a predominance of standard diagnostic findings routinely seen in the pathology of tumors and infections can be anticipated rather than exotic diseases.

Tumors of the pancreatic head commonly consist of carcinomas whereas other entities are rare exceptions. Extrapulmonary sarcoidosis is well-known but is extremely rare when detected as a mass in the pancreatic head. In general the diagnosis of sarcoidosis requires histologic examination with verification of non-caseous, epithelioid cell-like granulomas. Systemic therapy consists of steroids when the patient exhibits symptoms or in the case of progression of the disease. However, in some cases extended abdominal resections are also required to confirm the diagnosis and/or to treat symptoms.

Backround. Pressure relief is an important factor to determine the quality of antidecubitus devices. Many studies have been carried out to measure the interface pressure, but because the results differed markedly, we made a study to assess the measurement devices. Methods. Thesystems FSA, a device for internal use in the Luck company, the X-Sensor and an invasive subcutaneous pressure measurement over the os sarcum (COACH: piezoelectric probe, MIPM) were tested on 20 healthy volunteers (average age 27 years, average BMI 21.8). Results. The values of interface measurement showed obvious deviations from subcutaneous pressure in two cases (FSA +1.8%, Luck -33%, X-Sensor +65%) and some results showed extreme variations (FSA +18 mmHg, Luck -21 mmHg, X-Sensor +27 mmHg). Conclusions. The interface pressure measurement (with a few volunteers) is not suitable for a correct assessment of antidecubitus devices. Furthermore, the use of this method is not necessary to monitor pressure relief in intensive care patients. These systems can, however be useful in the training of nursing staff.

Simultaneous measurement of intramuscular pressure (IMP), tissue oxygen partial pressure (pO(2)) and EMG fatigue parameters in the multifidus muscle during a fatigue-inducing sustained muscular contraction. The study investigated the following hypotheses: (1) Increases in IMP result in tissue hypoxia; (2) Tissue hypoxia is responsible for loss of function in the musculature. The nutrient supply to muscle during muscle contraction is still not fully understood. It is assumed that muscle contraction causes increased tissue pressure resulting in compromised perfusion and tissue hypoxia. This tissue hypoxia, in turn, leads to muscle fatigue and therefore to loss of function. To the authors' knowledge, no study has addressed IMP, pO(2) and EMG fatigue parameters in the same muscle to gain a deeper sight into muscle perfusion during contraction. As back muscles need to have a constant muscular tension to maintain trunk stability during stance and locomotion, muscle fatigue due to prolonged contraction-induced hypoxia could be an explanation for low back pain. Sixteen healthy subjects performed an isometric muscular contraction exercise at 60% of maximum force until the point of localized muscular fatigue. During this exercise, the individual changes of IMP, pO(2) and the median frequency (MF) of the surface EMG signal of the multifidus muscle were recorded simultaneously. In 12 subjects with a documented increase in intramuscular pressure, only five showed a decrease in tissue oxygen partial pressure, while this parameter remained unchanged in six other subjects and even increased in one. A fall in tissue pO(2) was associated with a drop in MF in only five subjects, while there was no correlation between these parameters in the other 11 subjects. To summarize, an increase in IMP correlated with a decrease in pO(2) and a drop in MF in only five out of 16 subjects. High intramuscular pressure values are not always associated with a hypoxia in muscle tissue. Tissue hypoxia is not automatically associated with a median frequency shift in the EMG signal's power spectrum.

In this study the influence of soft-care systems on subcutaneous tissue pressure and pO2 has been examined. In 14 volunteers 3 probes were implanted over the os sacrum for measurement during the 20-minute periods. Then the probands were asked to lie on a standard mattress, on 8 static beds of various kind and on 3 dynamic soft-care systems. The clinical mattress pressure values amounted to 25.5 mm Hg (± 5.2; n = 14). The gell-cushion showed increased values (26.9 ± 9.5 mm Hg; n = 5). Compared to the standard mattress the other systems showed reductions in pressure from 32.7 % to 83.1 %. The lowest pressure was recorded with an air-supported mattress (8.3 ± 2.3 mm Hg; n = 5). The pO2 initial values before lying down varied greatly from individual to individual (26.9–71.3 mm Hg). In the course of the 20-minute periods the pO2 value sometimes remained constant, sometimes increased and at other times it decreased. Under extrem conditions (with 8 probands asked to lie on the floor) a correlation (r = –0.787) between pressure and pO2 was observed (pressure values between 20.6 and 192.9 mm Hg). The results indicate the use of modern soft-care systems depending on the individual risk of pressure sores.

Fragestellung und Ziel der Studie: Ziel der Arbeit ist, durch Messung des intramuskularen Sauerstoffpartialdrucks den kritischen Bereich des pneumatischen Drucks der Antischockhose (ASH) zu definieren, ab dem sich eine Muskelischamie an der unteren Extremitat entwickelt. Bei gleichzeitiger intrakompartimenteller Druckmessung sollte neben der Gewebeoxygenation auch die auf Druck empfindlich reagierende Impulsfortleitung im N. peronaeus profundus beurteilt werden. Methodik: Bei 22 normotensiven gesunden Freiwilligen wurden mit einem ASH-Beinsegment im M. tibialis anterior Druckwerte zwischen 0 und 100 mm Hg erzeugt. Uber einen Zeitraum von bis zu 6 h erfolgte die Messung des Muskelgewebedrucks, der Sauerstoffspannung und des Muskelsummenaktionspotentials (MSAP) des N. peronaeus profundus. Ergebnisse: Ausgangsdruckwert im M. tibialis anterior im Median 12,0 mm Hg (Q25%/Q75%: 8,9/17,3), pO2: 14,8 mm Hg (Q25%/Q75%: 11,5/22,0). Ubertragung des pneumatischen Drucks zu 97,7% (Q25%/Q75%: 89,2/99,8) auf den Extremitatenmuskel. Bereits bei niedrigen ASH-Druckwerten (20–40 mm Hg) trat im Einzelfall eine schwere Hypoxie auf. Eine Reduktion des MSAP war ab einem ASH-Druck von 10 mm Hg zu beobachten. ASH-Druckwerte von 60 mm Hg (n = 6) fuhrten in 5 Fallen innerhalb von 5–20 min zum Abfall des pO2 auf pathologische Werte. Inflationsdruckwerte uber 60 mm Hg resultierten nahezu ausnahmslos in einer Anoxie des Muskels und im Verlust des MSAP. Schlusfolgerungen: Der Einsatz der ASH sollte nur mit Modellen erfolgen, bei denen der Inflationsdruck manometrisch kontrolliert werden kann. Der ASH-Einsatz erscheint dann gerechtfertigt, wenn bei einem Polytraumatisierten im schweren hamorrhagischen Schock das Risiko einer sich auch systemisch auswirkenden lokalen Gewebeischamie bewust in Kauf genommen werden mus.

INTRODUCTION A body stalk anomaly is a rare congenital defect. The anomaly is one of the anterior abdominal wall defects. It is characterized by severe clefts of the abdominal wall with absence of or very small, umbilical cord. CASE REPORT We report on a patient in the 21st week of gestational age with the ultrasonographic findings of multiple fetal anomalies including a singular umbilical artery and an ahydramnion. She was sent to hospital for termination of the pregnancy. The karyotype was normal (46 XX). Ultrasonographic evaluation of the fetal anterior abdominal wall was impossible due to ahydramnion. Clinical examination showed an omphalocoele with herniation of the stomach, the small intestine, the liver and the spleen. A very short umbilical cord was observed which was attached to the omphalocoele. The lower limbs were deformed. Furthermore, anal atresia with an extroverted coele was found. Autopsy confirmed the clinical diagnosis of a body stalk anomaly. DISCUSSION It is important to distinguish a body stalk anomaly from other types of anterior abdominal wall defects because of their prognosis and an appropriate medical management. A body stalk anomaly is a sporadic defect and not associated with chromosomal abnormalities. This congenital defect is invariably lethal.

Within seven years our patient developed a granulosa cell tumor of the ovary which initially was treated surgically. Histologically, the initial finding as well as the first recurrence showed a low proliferation rate (Ki67 30%) in the second recurrence. After surgical treatment of this second recurrence we started a chemotherapy with carboplatine, epirubicine and cyclophosphamide. For monitoring treatment and detecting recurrence we used inhibin as tumor marker.

Previous studies reported correlations of CAG repeat length with sex hormone serum concentrations and cardiometabolic risk factors, but were limited by small cross-sectional samples. We used data of 1859 men aged 20-79 years from the population-based Study of Health in Pomerania (SHIP) to investigate the direct and modulating effects of CAG repeat length on androgen action and cardiometabolic risk factors. We performed cross-sectional and longitudinal linear and Poisson regression models adjusted for age, smoking, physical activity, alcohol consumption and body mass index. The CAG repeat length was categorized into quartiles and low total testosterone (TT) defined according to the age-specific (by decades) 10th percentile, respectively. Age-adjusted cross-sectional linear regression models showed a positive association between CAG repeat length and serum testosterone concentrations [β coefficient for TT, 0.099 (p = 0.028) and for free T, 0.002 (p = 0.001), respectively]. After a 5.0 year median follow-up period, men with CAG repeat length in the lowest quartile had an increased risk of incident low TT concentrations [relative risk (RR), 2.31; 95% confidence interval (CI), 1.18-4.55]. We found no direct association between CAG repeat length and cardiometabolic risk factors in cross-sectional and longitudinal multivariable linear regression analyses; whereas men with longer CAG repeat length and low TT concentrations showed the highest risk of incident MetS (RR, 1.51; 95% CI, 1.05-2.16). CAG repeat length is a risk factor of incident low TT concentrations and a contributing factor of testosterone-related cardiometabolic effects. The added clinical value of a combined assessment of CAG repeat length and serum TT concentrations merits further investigation.

Systemic sarcoidosis is an autoimmune disease with a prevalence of 40 per 100,000 people and which mostly affects young adults. It is characterized by non-caseous granulomatous changes of interstitial tissue, predominantly in the lungs. Extrapulmonal sarcoidosis has been described in every organ, but is present only in 1-5% with pancreatic involvement. Furthermore, sarcoidosis leading to a symptomatic mass in the pancreas is extremely rare and must then be differentiated in particular from cancer and pancreatitis. For therapy, it is crucial to find the right diagnosis before planning an operation--otherwise overtreatment by surgery may be an unwanted consecution.

Tumors of the pancreatic head commonly consist of carcinomas whereas other entities are rare exceptions. Extrapulmonary sarcoidosis is well-known but is extremely rare when detected as a mass in the pancreatic head. In general the diagnosis of sarcoidosis requires histologic examination with verification of non-caseous, epithelioid cell-like granulomas. Systemic therapy consists of steroids when the patient exhibits symptoms or in the case of progression of the disease. However, in some cases extended abdominal resections are also required to confirm the diagnosis and/or to treat symptoms.

We report the case of multiple midgut carcinoids causing segmental intestinal ischaemia in a 77-year-old man. He was admitted to our hospital because of a 2-month history of postprandial abdominal pain with nausea / vomiting and anaemia. The extensive diagnostic examinations (blood tests, ultrasound, computed tomography, hydro magnetic resonance) did not reveal any pathological findings. The small-bowel capsule endoscopy demonstrated multiple areas of bleeding. A laparotomy showed a local ischaemia of the small bowel, a segmental resection of the jejunum / ileum was performed. There were no signs of occlusion of the mesenteric artery. The pathological examination revealed 8 carcinoids of the midgut (jejunum / ileum). Immune histology demonstrated serotonin-synaptophysin-chromogranin-producing carcinoids. The patient was re-operated because of suspected ongoing mesenteric ischaemia, but no further pathologies were found. The postoperative course was uneventful. A subsequent octreotide scan was negative for metastases.Carcinoids may become symptomatic mimicking intestinal ischaemia. Although this coincidence is considered to be typical, it is still a rare event. The diagnosis is often delayed. EVS ("elastic vascular sclerosis") of the mesenteric artery is pathognomonic for these carcinoids but, as our case demonstrates, not mandatory. According to the literature, the stage of the disease corresponds to the extent of the intestinal ischaemia.

Adenomas/carcinoid tumors of the middle ear are very rare tumors of young to middle aged patients. The terms adenoma and carcinoid tumor of the middle ear can be used as synonyms, with the WHO favouring the term middle ear adenoma (MEA). These tumors usually present with unspecific clinical symptoms and a long case history. They are classified as benign tumors with only very few reported cases of regional metastasis after years of disease. According to recent literature, the clinical course is usually uncomplicated with complete surgical excision being adequate therapy.This study describes the clinical course and the diagnostic challenges in four cases of this rare tumor entity.The selected patients (2 males, 2 females, 25-38 years old) showed very similar clinical findings with decreased hearing acuity, tinnitus and sometimes pain. After the primary surgical excision up to 10 further operations were necessary, this being in contrast to the usual clinical course as described in the literature. In two cases a tumor recurrence was documented with one case recurring six times. In this case adjuvant radiotherapy (70 Gy) was performed. The histological differential diagnosis can also be problematic; in one case with a highly atypical morphology it was impossible to arrive at a definite diagnosis during the analysis of a frozen section.Adenomas of the middle ear can have a much more complicated clinical course than is suggested by the recent literature. The presented cases in this study and the analysis of previously published cases shows that the typical progression described by the current WHO-classification with unproblematic surgical management of the tumor and an uncomplicated further clinical course does not always correspond to reality. The main reason for this is the difficulty in obtaining a complete surgical excision. Therefore, a well-planned and comprehensive surgical management with a high frequency of follow-up examinations should be chosen. In complicated individual cases adjuvant radiotherapy can be helpful.

A subset of advanced laryngeal squamous cell carcinomas (SCC) does not metastasize in regional lymph nodes (pN0). However, more than 30 % of tumors without signs of metastasizing in the clinical examination (cN0) show occult metastases. The guidelines of the German ENT-Society intend the extent of neck dissection (ND) depending on clinical stage of tumor and lymph nodes. If laryngeal surgery is followed by an adjuvant radiation/chemotherapy, ND is not always necessary. Histomorphological, immunohistochemical, or molecular parameters with predictive value for nodal metastasizing could support the planning for ND, especially in patients with cN0.Within the last 20 years there were many publications concerning this problem. Herein, we analyzed the results of 455 publications. We have chosen studies regarding the predictive value of tumor stage, grading, peritumorous inflammation, invasion of lymphatic vessels, angioneogenesis, proliferation, overexpression of p53 or cyclin D1, inhibitors of cyclin-dependent kinases, growth factors, apoptosis, cell-adhesion, nm23, metalloproteinases, DNA/ploidy as well as tumor genetics.All examined parameters did not allow a fail-safe prediction of the risk for nodal metastasizing.Up to now, reliable predictors do not exist. The investigation of above mentioned parameters in pre-operative tumor biopsies is not helpful for the planning of ND in the stage cN0 (out of T1).

1. Hintergrund: Die Neurofibromatose (NF) Typ 1 (M. Recklinghausen) ist eine autosomal-dominant vererbte Multisystem-Erkrankung, die sich auch am Gefassystem manifestieren kann. Jede 3000. Schwangerschaft ist davon betroffen. 2. Fall: Wir berichten uber eine 33-jahrige Erstgravida mit kutaner Manifestation einer bereits seit der Pubertat bestehenden NF. Der Schwangerschaftsverlauf war zunachst unauffallig. Es kam zu keiner Verschlimmerung der NF assoziierten Symptome. Bei der Erstvorstellung in der 34+0 SSW bestand noch keine ausgepragte Wachstumsretardierung. Im weiteren Verlauf entwickelte sich jedoch eine fetale Wachstumsretardierung (samtliche Grosenparameter des Feten waren unter der 5. Perzentile), so dass mit 39+1 SSW bei zusatzlichem Oligohydramnion die Indikation zur Geburtseinletung mit Prostaglandingel gestellt wurde. Die Geburt verlief komplikationslos. Es wurde ein lebensfrischer Knabe geboren (2720g

A body stalk anomaly is a rare congenital defect. The anomaly is one of the anterior abdominal wall defects. It is characterized by severe clefts of the abdominal wall with absence of or very small, umbilical cord.We report on a patient in the 21st week of gestational age with the ultrasonographic findings of multiple fetal anomalies including a singular umbilical artery and an ahydramnion. She was sent to hospital for termination of the pregnancy. The karyotype was normal (46 XX). Ultrasonographic evaluation of the fetal anterior abdominal wall was impossible due to ahydramnion. Clinical examination showed an omphalocoele with herniation of the stomach, the small intestine, the liver and the spleen. A very short umbilical cord was observed which was attached to the omphalocoele. The lower limbs were deformed. Furthermore, anal atresia with an extroverted coele was found. Autopsy confirmed the clinical diagnosis of a body stalk anomaly.It is important to distinguish a body stalk anomaly from other types of anterior abdominal wall defects because of their prognosis and an appropriate medical management. A body stalk anomaly is a sporadic defect and not associated with chromosomal abnormalities. This congenital defect is invariably lethal.

Pressure relief is an important factor to determine the quality of anti-decubitus devices. Many studies have been carried out to measure the interface pressure, but because the results differed markedly, we made a study to assess the measurement devices.The systems FSA, a device for internal use in the Lück company, the X-Sensor and an invasive subcutaneous pressure measurement over the os-sacrum (COACH: piezoelectric probe, MIPM) were tested on 20 healthy volunteers (average age 27 years, average BMI 21.8).The values of interface measurement showed obvious deviations from subcutaneous pressure in two cases (FSA +1.8%, Lück -33%, X-Sensor +65%) and some results showed extreme variations (FSA +18 mmHg, Lück -21 mmHg, X-Sensor +27 mmHg).The interface pressure measurement (with a few volunteers) is not suitable for a correct assessment of anti-decubitus devices. Furthermore, the use of this method is not necessary to monitor pressure relief in intensive care patients. These systems can, however be useful in the training of nursing staff.

A 58 years old male patient presented with a left cervical metastasis of a poorly differentiated squamous cell carcinoma, which was diagnosed by fine needle aspiration cytology. Clinical examination, MRT scans and panendoscopy did not detect the primary tumour site. The positron emission tomography localized an uptake of FDG in the left sided base of the tongue. The patient underwent an ipsilateral modified radical neck dissection and a lateral pharyngotomy. In the left tongue base an induration was palpable which was resected with security distance. The histopathological examination showed a poorly differentiated squamous cell carcinoma with a largest extension of 5 mm x 10 mm.

A new process of polarization-anisotropic photo-induced light scattering is observed in thin crystals of Fe-doped LiNbO3. The characteristic features, such as its dependence on the crystal thickness, on the pump beam wavelength and on the read-out configuration as well as the kinetics for its appearance, are investigated and analyzed in detail. We present an Ewald sphere and discuss possible mechanisms to explain the appearance of the new scattering phenomenon.

Proteomics relying on two-dimensional (2-D) gel electrophoresis of proteins followed by spot identification with mass spectrometry is an excellent experimental tool for physiological studies opening a new perspective for understanding overall cell physiology. This is the intriguing outcome of a method introduced by Klose and O'Farrell independently 25 years ago. Physiological proteomics requires a 2-D reference map on which most of the main proteins were identified. In this paper, we present such a reference map with more than 300 entries for Bacillus subtilis proteins with an isoelectric point (pI) between 4 and 7. The most abundant proteins of exponentially growing cells were compiled and shown to perform mainly housekeeping functions in glycolysis, tricarboxylic acid cycle (TCC), amino acid biosynthesis and translation as well as protein quality control. Furthermore, putative post-translational modifications were shown at a large scale, with 47 proteins in total forming more than one spot. In a few selected cases evidence for phosphorylation of these proteins is presented. The proteome analysis in the standard pI range was complemented by either stretching the most crowded regions in a narrow pH gradient 4.5-5.5, or by adding other fractions of the total B. subtilis proteome such as alkaline proteins as well as extracellular proteins. A big challenge for future studies is to provide an experimental protocol covering the fraction of intrinsic membrane proteins that almost totally escaped detection by the experimental procedure used in this study.

Acute compartment syndrome of the leg is to be regarded as a traumatological emergency. Most specialists already agree that only a timely operative decompression of the afflicted compartment can prevent serious tissue damage. What still remains subject to discussion, however, is the precise tissue pressure above which the operation becomes imperative. Experimental human studies focusing on tissue pressure and muscle oxygenation have not yet been carried out. It was thus the aim of the present study to analyze oxygen partial pressure of the anterior tibial muscle and peroneal action potential in a model compartment syndrome in man.In 22 healthy, normotensive volunteers, constant pressure values from 0 to 100 mmHg were induced in the anterior tibial muscle with antishock trousers. Over a period of up to 6 h measurements were made of (1) tissue pressure, (2) intramuscular oxygen partial pressure (pO2), and (3) muscle response potential (MRP) of the n. peroneus profundus by electroneurography.We achieved a 97.7% (Q25%/Q75%: 89.2/99.8) transfer of the pneumatic pressure to the lower leg. Already at intramuscular tissue pressures of 30-40 mmHg, hypoxia and reduction of MRP appeared. A reduction of the MRP to zero and pO21 mmHg was observed from a pressure of 50 mmHg. Tissue pressure values of over 75 mmHg resulted almost without exception in anoxia of the muscle.Even under normal perfusion conditions, already slight increases in pressure of above 30 mmHg lead to reduced tissue oxygenation and neural function. We have to consider that with additionally traumatized muscle the ischemic tolerance is markedly reduced and due to unknown influences such as local vasoreactivity and capacity of autoregulation the nutritive perfusion cannot be determined. In the case of a severely injured muscle, to be on the safe side decompressive fasciotomy should therefore be carried out if pressure values remain above 30 mmHg.

One of the strongest and most noticeable responses of a Bacillus subtilis cell to a range of stress and starvation conditions is the dramatic induction of a large number of general stress proteins. The alternative sigma factor sigma B is responsible for the induction of the genes encoding these general stress proteins that occurs following heat, ethanol, salt or acid stress, or during energy depletion. sigma B was detected more than 20 years ago by Richard Losick and William Haldenwang as the first alternative sigma factor of bacteria, but interest in sigma B declined after it was realized that sigma B is not involved in sporulation. It later turned out that sigma B, whose activity itself is tightly controlled, is absolutely required for the induction of this regulon, not only in B. subtilis, but also in other Gram-positive bacteria. These findings may have been responsible for the recent revival of interest in sigma B. This chapter summarizes the current information on this sigma B response including the latest results on the signal transduction pathways, the structure of the regulon and its physiological role. More than 150 general stress proteins/genes belong to this sigma B regulon, which is believed to provide the non-growing cell with a non-specific, multiple and preventive stress resistance. sigma B-dependent stress proteins are involved in non-specific protection against oxidative stress and also protect cells against heat, acid, alkaline or osmotic stress. A cell in the transition from a growing to a non-growing state induced by energy depletion will be equipped with a comprehensive stress resistance machine to protect it against future stress. The protection against oxidative stress may be an essential part of this response. In addition, preloading of cells with sigma B-dependent stress proteins, induced by mild heat or salt stress, will protect cells against a severe, potentially lethal, future stress. Both the specific protection against an acute emerging stress, as well as the non-specific, prospective protection against future stress, are adaptive functions crucial for surviving stress and starvation in nature. We suggest that the sigma B response is one essential component of a survival strategy that ensures survival in a quiescent, vegetative state as an alternative to sporulation. The role of sigma B in related Gram-positive bacteria (including cyanobacteria) with special emphasis on pathogenic bacteria is discussed.

With an incidence of between 3 and 34%, decubitus ulcers are common chronic wounds, many of which can be avoided by prophylactic measures. The most effective preventive measure is relieving pressure on the endangered part of the body, and this is most easily achieved by regularly changing the patient's position in bed. Since, however, this is not always possible for staff-shortage or illness-related (e.g. fractures of the spine) reasons, modern pressure-relieving systems are being increasingly used. The range of options extends from simple foam plastic underlays to water-filled cushions to pneumatic cushions or beds filled with tiny glass beads. Selection of the most appropriate system is often difficult. For effective prophylaxis, determination of the individual risk of developing a bedsore with the aid of special scales makes good sense. In this way, the measures required can be adapted to the particular needs of the individual patient. New approaches to decubitus ulcer prevention and wound management may help to ensure effective care of the endangered or affected patient.

BACKGROUND AND CASE REPORT: We report on a case of fetal Listeriosis in a dichorionic twin pregnancy where both placentae, but only one of the twins were infected. While the firstborn child showed no infection and remained healthy until today, the other newborn had all clinical signs of granulomatosis infantiseptica and died despite of immediate resuscitation immediately after delivery.This discrepant course with Listeriosis in twins underlines, that fetal factors influence the clinical outcome in placental Listeriosis. The reasons for the infection of only one twin and the avoidance of the other twin remain unclarified. We speculate that immunologic mechanisms or the presence of meconium-stained amniotic fluid may play an important role for intrauterine infection with Listeriosis.

In this study the influence of soft-care systems on subcutaneous tissue pressure and pO2 has been examined. In 14 volunteers 3 probes were implanted over the os sacrum for measurement during the 20-minute periods. Then the probands were asked to lie on a standard mattress, on 8 static beds of various kind and on 3 dynamic soft-care systems. The clinical mattress pressure values amounted to 25.5 mm Hg (+/- 5.2; n = 14). The gell-cushion showed increased values (26.9 +/- 9.5 mm Hg; n = 5). Compared to the standard mattress the other systems showed reductions in pressure from 32.7% to 83.1%. The lowest pressure was recorded with an air-supported mattress (8.3 +/- 2.3 mm Hg; n = 5). The pO2 initial values before lying down varied greatly from individual to individual (26.9-71.3 mm Hg). In the course of the 20-minute periods the pO2 value sometimes remained constant, sometimes increased and at other times it decreased. Under extreme conditions (with 8 probands asked to lie on the floor) a correlation (r = -0.787) between pressure and pO2 was observed (pressure values between 20.6 and 192.9 mm Hg). The results indicate the use of modern soft-care systems depending on the individual risk of pressure sores.

The chronic exertional compartment syndrome of the musculus tibialis anterior is thought to be responsible for a major part of complaints of the lower leg among active sportsmen. There is an important role of tissue pressure measurement in diagnosing chronic anterior compartment syndrome during muscular activity. However, there is a controversial debate about the relevant parameters.Metaanalysis of all the 21 studies (1979-1998) measuring intracompartmental pressures during muscular activity. Parameters of analysis: type of exercise, catheter technique, recommendations of diagnostic criteria.Analysis of literature shows that there has been no standardisation concerning the type of muscular exertion (isometrics for 5-10 min, exercise on the treadmill between 3.2 and 12 km/h). In 8 of the 21 studies the results have been attained through the unsuitable Wick-catheter-technique. In the overall view none of the suggested criterions for diagnosis is taken up by other teams. There are considerable variations up to 500% regarding the recommended parameters.From all studies no uniform recommendation for parameters of diagnostic relevance can be derived. On this background it should be demanded that future research is conducted by a uniform regimen for examination and modern technique of measuring with a high temporal resolution. Under these standardised conditions the investigated parameters of the intracompartmental pressure curve should be reconsidered once more regarding diagnostic predictability by calculations of specifity and sensitivity.

Die definitive Diagnose des chronisch-funktionellen Kompartmentsyndroms des musculus tibialis anterior basiert heute ubereinstimmend neben der Anamneseerhebung and korperlichen Untersuchung auf der invasiven Messung des intrakompartimentellen Druckes [2–4, 6]. Kontrovers wird in der Literatur jedoch die diagnostische Aussagekraft der aus Muskeldruckverlaufskurven abgeleiteten Diagnosekriterien diskutiert [8]. Die Diskrepanz beruht auf dem Einsatz vollkommen verschiedener Provokationstests and der Anwendung unterschiedlicher, teilweise obsoleter oder ungeeigneter Mestechnik. Diese uneinheitlichen Untersuchungsbedingungen fuhrten dazu, das sich die eine Arbeitsgruppe bei der Diagnosefindung auf Ruhedruckmessungen stutzte, die andere auf wahrend der Belastung gemessene Druckwerte, wahrend wieder andere Autoren sich in ihrer Entscheidung auf die Druckwerte der Erholungsphase konzentrierten. Daruber hinaus differierte auch die Hohe der empfohlenen Druckwerte. So schwanken die in den letzten beiden Jahrzehnten publizierten Richtwerte sowohl bei Probanden, als auch bei Patienten in einem so ausgepragten Mase, das bei kritischer Betrachtung keine eindeutige Empfehlung abgeleitet werden kann [8]. Einigkeit bestand bisher nur darin, das bei Patienten mit einem chronisch funktionellen Kompartmentsyndrom wahrend muskularer Beanspruchung infolge einer Muskelvolumenvermehrung vergleichsweise hohe Druckwerte auftreten [3, 5–7]. Die belastungsinduzierte Erhohung des Gewebedruckes reduziert im betroffenen Kompartment die Gewebeperfusion und fuhrt uber eine nachfolgende Permeabilitatsstorung und interstitiellem Odem zur Verminderung der Gewebeoxygenierung und funktioneller Einschrankung der nutritiv-abhangigen Strukturen.