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  • 1
    ISSN: 1432-1440
    Keywords: Aerosolized pentamidine ; Fansidar ; Pneumocystis carinii pneumonia ; Prophylaxis ; Pyrimethamine/sulfadoxine ; Toxoplasma gondii ; Toxoplasmic encephalitis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The incidence of Pneumocystis carinii pneumonia (PCP) and toxoplasmic encephalitis (TE) was analyzed in 83 human immunodeficiency virus (HIV)-infected patients who inhaled aerosolized pentamidine (AP) either for primary prophylaxis (group la) or secondary prophylaxis (group IIa) of PCP. These cohorts were compared with two historical groups of patients who took Fansidar (pyrimethamine/sulfadoxine) for primary prophylaxis (group lb) or secondary prophylaxis (group IIb) of PCP. The follow-up was 3—41 months (median 8 months). PCP did not occur in group la but was seen in 1 patient of group Ib (5%). TE was observed in 3 patients of group Ia (7.3%) and in 1 patient of group Ib (5%). PCP relapses were seen in 5 patients of group IIa (11.9%) and in 3 patients of group Ilb (6.9%), whereas TE occurred in 13 patients of group IIa (30.9%) and in 1 patient of group IIb (2.3%). 20.3% of patients with CD4+ counts 〈 100/μl and only 7.7% of those with CD4+ counts 〉 100/μl developed toxoplasmosis. In conclusion, Fansidar rather than AP prophylaxis should be recommended for patients with a history of PCP or toxoplasmosis and for all HIV-infected patients with CD4+ counts ≤ 100/μl. In patients with CD4+ lymphocyte counts between 100 and 200/μl, AP prophylaxis appears appropriate.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1432-1084
    Keywords: Key words: Human immunodeficiency virus ; Bowel disease ; CT ; AIDS ; Cytomegalovirus ; Colitis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. Intestinal symptoms affect most AIDS patients at some point in their disease. The purpose of this study was to evaluate the use of CT in this setting. A total of 339 abdominal CT exams were reviewed for signs of intestinal disease. Abdominal CT scans of 45 patients with intestinal symptoms were compared with colonoscopy and histologic data. The CT results were correlated with CD4 + T-lymphocyte counts and patient survival. More than 14 % of all abdominal CT exams displayed signs of enteric disease. Of the 45 patients studied with both CT and colonoscopy, 35 (78 %) had signs of intestinal disease by CT. Of these 35 patients, colonoscopic signs of an intestinal lesion were found in 29 and histologic proof of disease was established in 30 cases. Colonoscopy and histology detected 8 lesions missed by CT. There were 14 cases of unspecific colitis, 15 cases of cytomegalovirus (CMV) colitis, and 4 cases of enteric tuberculosis as per biopsy. Five patients presented with Kaposi's sarcoma and 1 with a non-Hodgkin's lymphoma. Neither colonoscopic nor CT signs of intestinal disease did reliably distinguish between histologic subgroups. Specifically, CMV colitis could not be distinguished from unspecific colitis. CD4 + T-lymphocyte counts for histologic subgroups were not significantly different, either. No colonoscopic or histologic feature predicted survival, whereas low CD4 counts and ascites on CT indicated a poor prognosis. Whereas CT detects signs of intestinal disease in most AIDS patients, these signs remain largely unspecific. Colonoscopy and biopsies provide no consistently valid standard with which to compare CT because of controversial sensitivity and specificity of these methods. The CT technique detects small bowel as well as extraintestinal disease. Therefore, CT is an important diagnostic modality in abdominal disease of immunocompromised patients.
    Type of Medium: Electronic Resource
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  • 3
    Electronic Resource
    Electronic Resource
    Springer
    European food research and technology 180 (1985), S. 357-368 
    ISSN: 1438-2385
    Source: Springer Online Journal Archives 1860-2000
    Topics: Process Engineering, Biotechnology, Nutrition Technology
    Description / Table of Contents: Zusammenfassung Die Lebensmittelbestrahlung ist auch in der Bundesrepublik Deutschland durch Anträge auf Ausnahmegenehmigungen für die versuchsweise Bestrahlung von Gewürzen wieder aktuell geworden. Nachdem die Frage nach der gesundheitlichen Unbedenklichkeit bis zu einer die Pasteurisierung einschließenden Dosis geklärt ist, steht mit der Bestrahlung eine Methode zur Verfügung, die vor allem für die Desinfestation von Früchten, die Dekontamination von gefrorenen Produkten und die Hygienisierung von trockenen Lebensmitteln interessant ist. Zur gesetzlichen Regelung dieses Verfahrens sind von Codex Alimentarius Standards entwickelt worden, die sich auch mit Kontrolle und Dosimetrie befassen, und die in die nationalen Gesetzgebungen übernommen werden sollten. Die meisten der bisherigen Zulassungen auch im Bereich der E.G. machen hiervon allerdings noch keinen Gebrauch. Was die industrielle Anwendung betrifft, so ist die Bestrahlungstechnik erprobt; verschiedene industrielle Lebensmittelbestrahlungsanlagen in unterschiedlichen Ländern sind bereits in Betrieb und in begrenztem Umfang kann vor allem im Bereich der E.G. auf vorhandene Lohnbestrahlungsanlagen zurückgegriffen werden. Über die zu erwartende Reaktion des Verbrauchers besteht noch weitgehend Unklarheit; eine Kennzeichnung der bestrahlten Produkte wird es ihm ermöglichen, selbst über den Konsum bestrahlter Lebensmittel zu entscheiden.
    Notes: Summary Food irradiation has become a matter of topical interest also in the Federal Republic of Germany following applications for exemptions concerning irradiation tests of spices. After risks to human health by irradiation doses up to a level sufficient for product pasteurization were excluded, irradiation now offers a method suitable primarily for the disinfestation of fruit and decontamination of frozen and dried food. Codex Alimentarius standards which refer also to supervision and dosimetry have been established; they should be adopted as national law. However, in the majority of cases where individual countries including EC member-countries so far permitted food irradiation, these standards were not yet used. Approved irradiation technique for industrial use is available. Several industrial food irradiation plants, partly working also on a contractual basis, are already in operation in various countries. Consumer response still is largely unknown; since irradiated food is labelled, consumption of irradiated food will be decided upon by consumers.
    Type of Medium: Electronic Resource
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  • 4
    Electronic Resource
    Electronic Resource
    Springer
    Der Unfallchirurg 103 (2000), S. 401-404 
    ISSN: 1433-044X
    Keywords: Schlüsselwörter Koxitis ; Tuberkulose ; Endoprothetischer Hüftgelenksersatz ; Key words Coxitis ; Tuberculosis ; Hip arthroplasty
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract The possibility of a specific origin of joint infection should be considered in finding the diagnosis. This is demonstrated in a case of tuberculosis of the hip treated in the Dept. of Trauma Surgery in collaboration with the Medical Dept. of the Klinikum Minden. Microbiological and imaging examinations are essential to plan and perform a combined therapy of hip arthroplasty and concomittant medical antituberculous therapy. In accordance to a literature review, this procedure proved successful for both eliminating the local infection and the functional outcome of the operation.
    Notes: Zusammenfassung Die Möglichkeit einer spezifischen Genese von Gelenkinfekten und Spondylitiden ist in die differentialdiagnostischen Überlegungen einzubeziehen. Dies wird anhand eines Falls einer Coxitis tuberculosa demonstriert, welcher in Zusammenarbeit der unfallchirurgischen mit der medizinischen Klinik des Klinikums Minden therapiert wurde. Ein differenziertes diagnostisches Vorgehen mit bildgebenden und mikrobiologischen Methoden erlaubt eine gezielte Planung und Durchführung einer kombinierten Therapie aus operativem endoprothetischen Hüftgelenkersatz und antituberkulöser Chemotherapie. Nach kritischer Bewertung des Therapieergebnisses und Diskussion der Literatur ist das präsentierte Vorgehen erfolgreich, sowohl die lokale Sanierung des Infekts, als auch das funktionelle Ergebnis betreffend.
    Type of Medium: Electronic Resource
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  • 5
    Electronic Resource
    Electronic Resource
    Springer
    Journal of molecular medicine 69 (1991), S. 446-448 
    ISSN: 1432-1440
    Keywords: Pneumocystis carinii pneumonia ; Aerosolized pentamidine ; Relapse
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary A patient with a history ofPneumocystis carinii pneumonia (PCP) inhaled aerosolized pentamidine (AP) for secondary prophylaxis of PCP. Nine months after the first PCP episode he presented with pulmonary upper-lobe infiltrations demonstrated by chest x-ray, and bronchoalveolar lavage confirmed the diagnosis of PCP. The clinical course and possible explanations for this unusual form of PCP are presented. The case emphasizes the importance of clinical controls for early diagnosis of relapse of PCP in patients inhaling aerosolized pentamidine. Monitoring of serum lactate dehydrogenase levels appeared to be important in the follow-up of the patient described.
    Type of Medium: Electronic Resource
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  • 6
    ISSN: 1435-4373
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The efficacy and safety of 25 mg pyrimethamine plus 500 mg sulfadoxine given twice a week in preventing relapses of AIDS-related toxoplasmic encephalitis was evaluated in an open study. The 56 HIV-infected patients evaluated had responded to intensive treatment with pyrimethamine/clindamycin prior to starting the present prophylactic regimen. Four patients (7 %) experienced relapse while on pyrimethamine/sulfadoxine. The probability of freedom from relapse was 〉90 % for 12 months and 〉80 % for 24 months. Side effects comprised mild or moderate allergic reactions which occurred in 23 patients (41 %), leading to discontinuation in four patients (7%). Forty-nine of the 56 patients did not have a history ofPneumocystis carinii pneumonia and did not receive antiparasitic prophylaxis other than pyrimethamine/sulfadoxine; two of them (4 %) developed pneumocystosis. The probability of freedom from pneumocystosis was about 90 % for 24 months. Pyrimethamine/sulfadoxine twice a week appears to be a promising regimen for prevention of toxoplasmic encephalitis, and also appears to provide protection againstPneumocystis carinii pneumonia. Although allergic reactions are usually mild and disappear on continuation, they may limit the value of this regimen.
    Type of Medium: Electronic Resource
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  • 7
    ISSN: 1434-9949
    Keywords: Anticardiolipin Antibodies ; Monitoring Disease Activity ; Rheumatic Diseases ; SLE
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The prevalence of anticardiolipin antibodies in active systemic lupus erythematosus (SLE) was compared with that in inactive SLE and other rheumatic and non-rheumatic diseases to determine the value of these autoantibodies in monitoring rheumatic diseases. Pairs of IgG- and IgM-aCL were measured by ELISA in 173 consecutive hospitalised patients, including 141 with rheumatic diseases (18 active SLE, 21 inactive SLE, 19 rheumatoid arthritis, 13 reactive arthritis, 7 other spondyloarthropathies, 16 vasculitis, 47 other autoimmune diseases) and 32 non-rheumatic controls. A further 101 aCL pairs were determined during follow-up in 19 patients with SLE. Serum concentrations were analysed with respect to SLE activity and compared between the different patient groups. IgG- and IgM-aCL levels in excess of 10 GPL and 9 MPL respectively were considered positive. 30.6% of all patients (53/173) were found to be positive for IgG-aCL, as against only 9.8% (17/173) for IgM-aCL. IgG-aCL serum levels in active SLE differed significantly from all other groups, including inactive SLE (all p〈0.005). Median IgM-aCL levels were below the cut off point in all groups, although measurable values were obtained almost exclusively in active SLE and RA. In this study IgM-aCL measurement was of less value in monitoring rheumatic diseases. IgG-aCL positivity in SLE was associated with a significantly higher odds ratio (OR) for active disease (OR 16.0, 95% confidence interval: 2.8–90.0). The results show that disease activity in SLE was accompanied by significantly increased IgG-aCL, whereas no elevation was found in other diseases. This parameter may therefore be useful in monitoring SLE activity.
    Type of Medium: Electronic Resource
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  • 8
    ISSN: 1437-1588
    Keywords: Schlüsselwörter Tropenkrankheiten ; Virale hämorrhagische Fieber ; Lassa-Fieber ; Infektionsschutz ; Quarantäne ; BSL4 ; Seuchenhygiene ; Öffentliches Gesundheitswesen ; Rettungswesen ; Krankentransport ; Krankenpflege ; Schutzkleidung ; Kontaktpersonen ; Keywords Tropical Diseases ; Viral Haemorrhagic Fever ; Lassa-Fever ; Epidemic Control ; Preparedness Plans ; Quarantine ; BSL4 ; Patient Isolation ; Barrier Nursing ; Protective Equipment ; Contact Tracing
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Patients infected with viral haemorrhagic fevers (VHF), pneumonic plague or zoonotic orthopoxvirus infections usually require intensive care and a special isolation. Contact persons must be traced and monitored. Last year our working group published a concept for the management and control of these life-threatening highly contagious diseases. Now the principles of our plan have been accepted. The development of guidelines for rapid reaction to those communicable diseases is an important task for all EU Member States. In Germany microbiological diagnosis is performed by a diagnostic centre (Biosafety-Level BSL4) and supported by a corresponding confirmation laboratory. At present four high security infectious disease units for patient care (HSIU) are available in Munich, Leipzig, Hamburg and Berlin. Another one located in Frankfurt will be functional by 2001. In addition to the HSIU a corresponding number of centres of competence shall be established in order to support and advise the hospitals initially treating the patients as well as the local public health officer. The risk categorisation for contact persons, which has been developed by our working group, has proved to be very useful in practice. Ambulances should be used for transfer of patients to the HSIU. So-called transport-isolators are not suitable for patients who are seriously ill. Air-based transport without using an isolator is a problem, since no decontamination procedure exists. As soon as the last HSIU in the Rhine Main area is working the centres of competence will be established. This will provide competent health care for VHF-patients and a convincing management for these kinds of threats to public health everywhere in Germany.
    Notes: Zusammenfassung Verschiedene virusbedingte hämorrhagische Fieber (VHF), Pocken (humane Affenpocken) sowie Lungenpest erfordern besondere Maßnahmen zum Schutz des Krankenhauspersonals und anderer Personen vor Ansteckung. Kontaktpersonen müssen ermittelt und überwacht werden, um eine Ausbreitung zu verhindern. Ein im Mai 1999 veröffentlichtes Konzept zum Management und zur Kontrolle dieser lebensbedrohenden hochkontagiösen Infektionskrankheiten wurde inzwischen mit Fachöffentlichkeit und Gesundheitsbehörden diskutiert. Bei den zwischenzeitlich aufgetretenen Fällen bestätigte sich das vorgeschlagene Vorgehen : In Deutschland werden die mikrobiologische Diagnostik und Differentialdiagnostik zentral von einem Zentrum der biologischen Sicherheitsstufe BSL4 und einem entsprechenden Bestätigungslabor vorgenommen. Für Isolierung und klinische Behandlung der Patienten stehen vier Behandlungszentren zur Verfügung, ein fünftes soll im nächsten Jahr betriebsbereit sein. Die zunehmende Inanspruchnahme zeigt, dass sich die vorgesehene Schwerpunktversorgung durchsetzt. Handelsübliche Transportisolatoren sind für schwer kranke Personen nicht geeignet. Ohne deren Verwendung können Luftfahrzeuge jedoch nicht regelrecht dekontaminiert werden. Transporte sollen daher grundsätzlich auf dem Landweg erfolgen. Zur Unterstützung und Beratung der erstversorgenden Krankenhäuser und der örtlich zuständigen Amtsärzte sollen um die Behandlungszentren sog. Kompetenzzentren entstehen. Der Personal- und Platzbedarf bei der Versorgung eines an einem VHF Erkrankten in fortgeschrittenem Stadium ist höher als erwartet. Die adäquate Versorgung von Kranken in sog. Bettisolatoren ist nicht möglich. Routinelaboruntersuchungen müssen in der Behandlungseinheit erfolgen. Maßnahmen zur Verhinderung der Weiterverbreitung müssen stärker koordiniert werden. Die von uns vorgeschlagene Einteilung der Kontaktpersonen wird um eine Auflistung der empfohlenen Maßnahmen ergänzt.
    Type of Medium: Electronic Resource
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