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Objectives Objective and subjective evaluation of botulinum neurotoxin A (BoNTA) treatment for adductor type spasmodic dysphonia is presented. Therefore, a combinatorial approach based on patients’ and speech experts’ assessment of voice impairment, as well as on the acoustic analysis of spoken standardized text was performed. Study design Prospective clinical study. Materials and methods For 17 patients, the voice quality prior to and 4–8 weeks after BoNTA injection (9 transoral, 8 transcutaneous) was investigated. Voice Handicap Index-12 (VHI-12) questionnaires as well as ratings of the GRB (grade, roughness, breathiness) scale were analyzed. Moreover, objective parameters such as pure speech duration, local jitter, local shimmer and voice breaks were evaluated. Results The pre-post analysis of all patients revealed a significant reduction of the VHI-12 score, the jitter values and the number of voice breaks. Changes in speech duration and breathiness differed significantly for transoral vs. transcutaneous BoNTA injection. Conclusions We were able to correlate the questionnaire-based self-assessment with external evaluation of the speech roughness and with acoustic signal analysis parameters, in particular for the jitter. Our data indicated beneficial effects for transoral BoNTA application.

Im vorliegenden Fallbericht wird von einem 24-jahrigen deutschen Soldaten berichtet, der in der Silvesternacht 2009/2010 im Kosovo-Auslandseinsatz durch ein vom Himmel gefallenes Vollmantelgeschos in Folge von Freudenschussen, sog. „happy shooting“, im Bereich der rechten Schulter verletzt worden ist.

Immunosuppressive treatment increases the risk of infection and malignancy in organ transplant recipients. We report on a 42-year-old male renal transplant recipient who lost his first graft after reduction of immunosuppressive treatment due to Kaposi sarcoma and who successfully underwent a second renal transplant 10 years later. The patient’s current treatment consists of low-dose prednisone, and the two antiproliferative immunosuppressants mycophenolate mofetil and rapamycin. 4.5 years after his second transplant, the serum creatinine is 1 mg/dl and the patient has no signs of recurrent disease.

Seit 1992 wird die Bundeswehr zu friedenserhaltenden und -sichernden Masnahmen auserhalb der Bundesrepublik Deutschland eingesetzt. Bei Auslandseinsatzen kamen bisher 83 Soldaten ums Leben, insgesamt 129 wurden durch Fremdeinwirkung verwundet (Stand 07.12.2009). Zur sanitatsdienstlichen Versorgung der Soldaten in Nordafghanistan betreibt die Bundeswehr in Mazar-i-Scharif ein Einsatzlazarett mit multidisziplinarem Leistungsspektrum, auserdem 2 Rettungszentren in Kunduz und Faizabad zur notfallchirurgischen Erstversorgung. In den Rettungszentren werden lebensrettende und stabilisierende Operationen durchgefuhrt, um die schnelle Evakuierung in eine Sanitatseinrichtung der nachsthoheren Versorgungsebene und schlieslich die Ruckfuhrung in das Heimatland zu ermoglichen. Dabei sieht sich der Militarchirurg mit vielfaltigen sowohl medizinischen als auch logistischen Herausforderungen konfrontiert. Eine Besonderheit ist das weltweit einsetzbare Marineeinsatzrettungszentrum (MERZ) zur sanitatsdienstlichen Versorgung maritimer Einsatzverbande, das containergestutzt an Bord eines Einsatzgruppenversorgers (EGV) betrieben wird. Die „schwimmenden Lazarette“ stellen im Rahmen der medizinischen (Notfall-)Versorgung bei der Planung und Durchfuhrung von Einsatzen in Seegebieten mit schwierigen Raum- und Zeitfaktoren ein unverzichtbares Element dar. Durch den besonderen Wirkverbund zwischen EGV und MERZ sind zudem Spezialoperationen, Evakuierungen und humanitare Einsatze bei kustennahen Naturkatastrophen moglich.

An 18-year-old patient from Afghanistan, living in Germany for 3 years without interruption, was referred to our clinic with dyspnoea on exertion and palpitation due to new-onset atrial fibrillation with heart rate of 160–180 per minute. On further interrogation, weight loss, fever and sweating at night for about 3 months were reported. Echocardiography revealed tumor masses of the lateral wall in both atria. MRT of the thorax and the heart demonstrated extensive lymphomas of the mediastinum as well as tumor masses within both atria. The patient was admitted to our hospital under the suspicion of thoracic lymphoma. Because of short periods of nonsustained ventricular tachycardia he was transferred on an emergency basis to the intermediate care unit. On admission the patient was in a debilitated state. Physical examination revealed a blood pressure of 110/60 mmHg and a regular pulse rate of 88 bpm. Cardiac and pulmonary auscultation were normal. The lymph glands at the left side of the neck were enlarged (4 9 2 cm) and matted. ECG revealed negative T-waves in II, III, aVF and V3–V4. The chest X-ray was normal. The transthoracic echocardiography approved extensive tumor masses in both atria without pericardial effusion. Diameters, left and right ventricular function were within normal limits. Transesophageal echocardiography showed the largest tumor in the right atrium at the entrance of vena cava superior sized about 3.8 9 2.5 cm. Even though a biopsy of the neck lymphoma showed granulomas without caseation, tuberculosis was favored as differential diagnosis due to the patient’s Asian origin. To enable a histological diagnosis transvenous myocardial biopsy of the right atrial tumor, guided by transesophageal echocardiography, was performed (Fig. 1). It revealed caseating granulomata; no acid-fast bacilli were found. Quadruple therapy with rifampicin, isozid, myambutol and pyracinamid was initiated immediately. Some weeks later the cultural results of bronchial lavage revealed Mycobacterium tuberculosis. Follow-up after 3 and 6 months showed continuous regression of the tuberculomas (Fig. 2). The condition of the patient is excellent, he gained 10 kg of bodyweight. J. Licht C. Diefenbach (&) J. Bolte Department of Cardiology and Pneumology, Asklepios Clinic Hamburg-Altona, 22763 Hamburg, Germany e-mail: c.diefenbach@asklepios.com; c.diefenbach@t-online.de

Diffuse pulmonary fibroleiomyomas were detected by open-lung biopsy in a 33-year-old male patient. Lung function studies revealed severe airflow obstruction, hyperinflation, grossly impaired single-breath-diffusing capacity and a decrease in PaO2 during exercise, i.e. data which are compatible with pulmonary emphysema. However, static lung compliance was within normal limits excluding the existence of pure emphysema. Additional special lung function tests confirmed the assumption that in diffuse fibroleiomyomas of the lung, functional patterns characteristic of obstructive and restrictive lung disease are present that are in agreement with the histological features of this disease.

Measurement of DCO is known to be dependent upon functional inhomogeneities. Because different types of inhomogeneities are operative in patients with bronchial asthma and patients with emp

The oscillatory resistance to respiration (Ros) was measured in 218 children and 260 adults using the Siregnost FD5 (Siemens, Erlangen), and compared with whole body plethysmography (Raw) and with spirometry. There was a markedly better correlation between Ros and Raw (r=0.82;n=88) in children than in adults (r=0.53;n=260). Whereas additional recording of the phase angle in children does not yield any substantial additional information, it is of diagnostic importance in adults. Comparison of Ros with the spirometric values yielded the following sequence of decreasing correlation coefficients (linear regression): FEV1.0, PEF, V 75, MMEF, V 50, V 25, whereas in adults these relationships cannot be described by means of a linear correlation. The results enable us to conclude that in paediatric pneumology an alternative use of whole-body plethysmography and of oscillatory method appears justified.

Two methods for measuring respiratory mechanics by forced oscillations were compared, one using a frequency spectrum of 2–32 Hz produced by a pseudorandom noise generator (PRN), the other (Siregnost FD 5) a constant frequency of 10 Hz. In normals and patients with various lung diseases real part of impedance, Re, and phase angle, ψ, determined at 10 Hz with the two devices correlated well; however, Re measured by Siregnost FD 5 was always higher when compared to PRN. In patients with airway obstruction frequency dependence of resistance and reactance could be shown to be related to the severity of the disease. This important information cannot be obtained by Siregnost FD 5. As Siregnost FD 5 is a simple and reliable method, it is a valuable completion of standard lung function methods. However, for detailed analysis the respiratory system should be investigated at a variety of frequencies.

Although histamine plays an important role in the pathophysiology of asthma through stimulation of H1 receptors, H1 antagonists are of only limited use in this disease when given orally. In order to investigate the pharmacological response to a specific H1 antagonist administered by different routes, we measured the effect of inhaled clemastine on airway responsiveness to histamine aerosol and compared the results with those after oral and intravenous administration in normal and asthmatic subjects. Inhalation of 0.6 mg clemastine provided significant protection without side effects and was comparable to intravenous administration of 1.0 mg in both groups. In normal subjects 2.0 mg clemastine orally was significantly less effective than the two other routes of administration whereas in asthmatics an enhanced reaction to histamine was observed.

We investigated the modification of histamine-induced bronchoconstriction by the H2-antagonist cimetidine in conscious sheep. One hundred breaths of 5% histamine aerosol increased mean (SD) pulmonary resistance (RL) by 5.6 (1.4) cmH2O/l/sec. This increase in RL was completely blocked by intravenous clemastine (0.5 mg), a specific H1-antagonist, indicating that the histamine-induced bronchoconstriction was mediated by H1-receptors. Intravenous cimetidine caused a dose-dependent enhancement of the histamine response between 1 and 1000 mg with a mean peak delta RL of 15.3 (5) cmH2O/l/sec (p less than 0.05) at the 1000 mg dose, while it blocked the histamine response at a dose of 2400 mg [delta RL = 1.9 (2) cmH2O/l/sec, p = NS]. This paradoxic effect was not related to an anticholinergic mechanism as intravenous cimetidine (2400 mg) failed to block carbachol-induced (25 breaths of 1% solution) bronchoconstriction. We conclude that in the ovine airway, cimetidine is a selective H2-histamine receptor blocker at lower tissue concentrations, and a combined H2- and H1-histamine receptor blocker at high tissue concentrations.

The evaluation of a new high-performance liquid chromatographic method is described. It permits the separation and determination of the four components of dihydroergotoxine (dihydroergocristine, dihydroergocornine, dihydro-alpha-ergocryptine, and dihydro-beta-ergocryptine) in a single step. On reversed-phase microparticles, complete baseline separation is possible with different mobile phases containing about 10(-2) M base. The analysis of dihydroergotoxine mesylate drug substance or its dosage forms can be carried out in about 15 min. No reference substance is required for the determination of the proportions of the components. This method is simple and exhibits high accuracy, reproducibility, and selectivity. It permits the analytical control of dosage forms containing dihydroergotoxine mesylate to ensure that they comply with the specifications for the drug substance used in clinical and pharmacological studies.

Since the calcium antagonists nifedipine and verapamil have been shown to diminish exercise induced asthma, the effect of oral diltiazem, a calcium channel blocker not previously investigated in this context, was studied. Ten patients with bronchial asthma were given 60 mg diltiazem or placebo four hours before the challenge in a double blind, randomised, crossover fashion. Exercise was performed on a cycle ergometer while the subjects were breathing cold air, resulting in a respiratory heat exchange which was similar at the two study sessions. FEV1 and specific conductance (sGaw) were recorded before and three, 10, 15, and 30 minutes after the challenge. No significant differences were found between placebo and diltiazem days in the fall of FEV1 or sGaw after exercise. Thus unlike other calcium antagonists diltiazem, in a dose of 60 mg given orally four hours before exercise, failed to protect against exercise induced asthma.