Acute otitis. Etiology, diagnosis, treatment

Glutaraldehyde is an antibacterial and antiviral agent commonly used for cleaning and disinfection of endoscopic equipment. The accepted glutaraldehyde air-concentration is 0.2 ppm. The irritant action, allergic potential and possible neurotoxicity of glutaral have been reported. Red eyes, cough, headache and running nose are most frequent symptoms of glutaral activity. The incidence of bronchial asthma and contact dermatitis has also been reported. In order to avoid occupational hazards of glutaraldehyde closed washing-disinfection systems, proper ventilation (20 cycles per hour), vapour recovery safety nozzle and neutralizing agent should be used.     

Acute pancreatitis. Classification, diagnosis, therapy

Acute pancreatitis is a multietiologic entity with rather diverse clinical courses. Whereas edematous pancreatitis has a mortality of less than 1%, nowadays; still approximately 20% of all patients with the necrotizing form succumb to the disease. To further improve therapeutic results a standardized approach should be used. For effective treatment the differentiation between edematous and necrotizing pancreatitis is crucial. All patients with signs of pancreatic necroses during abdominal ultrasound and patients with organ insufficiencies should undergo a CT-scan to define exactly the nature and the extent of the disease. Primarily all patients are treated conservatively. Main indications for operative intervention are signs for infection of pancreatic necroses and an acute abdomen due to local complications of acute pancreatitis. In cases of biliary origin an elective cholecystectomy has to be performed during a free interval to prevent a recurrence.     

Priapism. Etiology, diagnosis and treatment

Priapism is a condition of prolonged penile erection which often causes pain and is unrelated to sexual desire. There is a high risk of impotence despite immediate intervention. The incidence has doubled since the introduction of intracorporeal injection therapy for impotence. Two subtypes of priapism have been described, depending on the underlying cause. The more common type, termed low flow, is characterised by inadequate venous outflow, leading to a hypoxic painful prolonged erection. The etiology is either idiopathic or related to intracorporeal injection therapy. Treatment consists of aspiration and instillation of a diluted alpha-adrenergic agent, or surgery, depending on the degree of hypoxia. The less common subtype, high flow, is arteriogenic, and causes less pain and no ischemia. Injury to a cavernous artery leads to a fistula between the artery and the corpora cavernosa. Treatment is either conservative with immediate ice pack and compression, or delayed selective embolization of the fistula.     

Chronic non-allergic rhinitis. Etiology, diagnosis and treatment

Chronic rhinitis can be defined as an inflammation of the nasal mucosa lasting for more than three months. The condition may be due to allergy or infection, or to a number of non-allergic and non-infectious causes, such as trauma, hormonal imbalance, toxic influence or locally applied drugs. The etiology, diagnostic procedures and treatment of non-allergic chronic rhinitis are discussed.     

Hyperthyroidism. Etiology, physiopathology, diagnosis, evolution, treatment]

Serum amyloid A (SAA) is an acute-phase reactant whose level in the blood is elevated to 1000-fold as part of the body's responses to various injuries, including trauma, infection, inflammation, and neoplasia. As an acute-phase reactant, the liver has been considered to be the primary site of expression. However, limited extrahepatic SAA expression was described in mouse tissues and in cells of human atherosclerotic lesions. Here we describe nonradioactive in situ hybridization experiments revealing that the SAA mRNA is widely expressed in many histologically normal human tissues. Expression was localized predominantly to the epithelial components of a variety of tissues, including breast, stomach, small and large intestine, prostate, lung, pancreas, kidney, tonsil, thyroid, pituitary, placenta, skin epidermis, and brain neurons. Expression was also observed in lymphocytes, plasma cells, and endothelial cells. RT-PCR analysis of selected tissues revealed expression of the SAA1, SAA2, and SAA4 genes but not of SAA3, consistent with expression of these genes in the liver. Immunohistochemical staining revealed SAA protein expression that co-localized with SAA mRNA expression. These data indicate local production of the SAA proteins in histologically normal human extrahepatic tissues.     

Arrhythmogenic right ventricular cardiomyopathy. Etiology, diagnosis and therapy

In the fungus Neurospora crassa, the chol-1 mutation blocks the synthesis of the lipid phosphatidylcholine and also lengthens the period of the circadian rhythm of conidiation under conditions of choline depletion. The frq mutations, which have no known metabolic defect, affect both the period of the rhythm and temperature compensation. In this article, the chol-1 mutant strain has been further characterized with respect to its temperature compensation and its interactions with frq. Choline depletion of chol-1 abolishes good temperature compensation: Low temperatures lengthen the period under choline-depleted conditions, and low choline lengthens the period at any one temperature. Double-mutant strains carrying both chol-1 and one of a series of frq alleles demonstrate interactions between chol-1 and frq: On high choline, the periods of the double mutants are identical to the corresponding chol+ strains, whereas on low choline all double mutants display very long periods (greater than 50 h). Short-period frq mutations shorten the long period on low choline, whereas long-period frq mutations frq mutations have no effect. A null frq mutation in the chol-1 background is arrhythmic on high choline but is robustly rhythmic on low choline and has no effect on the long period. The interactions between frq and chol-1 are similar to the interactions between frq and cel, another lipid-deficient mutant. These results provide support for the hypothesis that membrane lipids may be involved in temperature compensation of the circadian rhythm. The possibility is discussed that the frq gene may not be required for circadian rhythmicity under some conditions and therefore may not be a central component of the circadian oscillator but rather a component of an input pathway.     

Acute pancreatitis: diagnosis and therapy in general practice]

Acute pancreatitis is a frequently serious abdominal condition. The cause remains unknown. Biliary tract diseases as well as alcohol are the most important etiological factors. Diagnostic measures, of help in the emergency situation, differential diagnosis and therapeutic procedures, which can be initiated in general practice, are discussed.