Campylobacter jejuni infection is one of the most widespread infectious diseases of the last century. The incidence and prevalence of campylobacteriosis have increased in both developed and developing countries over the last 10 years. The dramatic increase in North America, Europe, and Australia is alarming, and data from parts of Africa, Asia, and the Middle East indicate that campylobacteriosis is endemic in these areas, especially in children. In addition to C. jejuni, there is increasing recognition of the clinical importance of emerging Campylobacter species, including Campylobacter concisus and Campylobacter ureolyticus. Poultry is a major reservoir and source of transmission of campylobacteriosis to humans. Other risk factors include consumption of animal products and water, contact with animals, and international travel. Strategic implementation of multifaceted biocontrol measures to reduce the transmission of this group of pathogens is paramount for public health. Overall, campylobacteriosis is still one of the most important infectious diseases that is likely to challenge global health in the years to come. This review provides a comprehensive overview of the global epidemiology, transmission, and clinical relevance of Campylobacter infection.

Global Epidemiology of Campylobacter Infection

5-Aminolaevulinic acid (ALA)-induced prophyrin photosensitisation is an attractive option for photodynamic therapy (PDT) since skin photosensitivity is limited to 1-2 days. However, early clinical results on colon tumours using the maximum tolerated oral dose of 60 mg kg-1 showed only superficial necrosis, presumably owing to insufficient intratumoral porphyrin levels, although inadequate light dosimetry may also be a factor. We undertook experiments using ALA, 25-400 mg kg-1 intravenously, to establish the threshold doses required for a PDT effect. Laser light at 630 nm (100 mW, 10-200 J) was delivered to a single site in the colon of photosensitised normal Wistar rats at laparotomy. The animals were killed 3 days later and the area of PDT-induced necrosis measured. No lesion was seen with 25 mg kg-1. The lesion size increased with larger ALA doses and with the light dose but little benefit was seen from increasing the ALA dose above 200 mg kg-1 or the light dose above 100 J. Thus there is a fairly narrow window for optimum doses of drug and light. Further experiments showed that the PDT effect can be markedly enhanced by fractionating the light dose. A series of animals was sensitized with 200 mg kg-1 ALA and then treated with 25 J. With continuous irradiation, the lesion area was 13 mm2, but with a single interruption of 150 s the area rose to 94 mm2 with the same total energy. Results were basically similar for different intervals between fractions (10-900 s) and different numbers of fractions (2-25). This suggests that a single short interruption in the light irradiation may dramatically reduce the net light dose required to achieve extensive necrosis.

Enhancement of photodynamic therapy with 5-aminolaevulinic acid-induced porphyrin photosensitisation in normal rat colon by threshold and light fractionation studies.

The aim of this article was to review current evidence about cryotherapy in inflammatory rheumatic diseases (therapeutic and biological effects). For therapeutic effects, we performed a systematic review (PubMed, EMBASE, Cochrane Library, LILACS databases, unpublished data) and selected studies including non-operated and non-infected arthritic patients treated with local cryotherapy or whole-body cryotherapy. By pooling 6 studies including 257 rheumatoid arthritis (RA) patients, we showed a significant decrease in pain visual analogic scale (mm) and 28-joint disease activity score after chronic cryotherapy in RA patients. For molecular pathways, local cryotherapy induces an intrajoint temperature decrease, which might downregulate several mediators involved in joint inflammation and destruction (cytokines, cartilage-degrading enzymes, proangiogenic factors), but studies in RA are rare. Cryotherapy should be included in RA therapeutic strategies as an adjunct therapy, with potential corticosteroid and nonsteroidal anti-inflammatory drug dose-sparing effects. However, techniques and protocols should be more precisely defined in randomized controlled trials with stronger methodology.

Cryotherapy in inflammatory rheumatic diseases: a systematic review

Occurrence of fastidious Campylobacter spp. in fresh meat and poultry using an adapted cultural protocol.

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Topics In Photomedicine

BACKGROUND As yet, whole-body cryotherapy is especially used for the therapy of chronic inflammatory arthritis An analgetic effect has been described in several studies However, only few data exist concerning the long-term effects of this therapy PATIENTS AND METHODS A total of 60 patients with rheumatoid arthritis (n = 48), and ankylosing spondylitis (n = 12) was analyzed Patients underwent treatment with whole-body cryotherapy twice a day The average age was 557 +/- 1033 The study group consisted of 48 female and twelve male patients The average number of therapeutic treatments with cryotherapy was 158 +/- 837, the average follow-up 634 +/- 6348 days RESULTS 13 patients (217%) discontinued treatment because of adverse effects For patients with rheumatoid arthritis, DAS28 (Disease Activity Score) and VAS (visual analog scale) were determined A significant reduction of both parameters was found (DAS 39 +/- 122 vs 34 +/- 108; p < 001; VAS 514 +/- 1662 vs 379 +/- 1913; p < 001) BASDAI (Bath Ankylosing Spondylitis Disease Activity Index) was analyzed for patients with ankylosing spondylitis, and also showed a significant reduction (44 +/- 191 vs 31 +/- 134; p = 001) CONCLUSION Thus, whole-body cryotherapy is an effective option in the concept of treatment of inflammatory rheumatic diseases The relief of pain allows an intensification of physiotherapy A significant reduction of pain over a period of 2 months could be shown

[Whole-body cryotherapy in patients with inflammatory rheumatic disease. A prospective study].

Eine Infektion mit Campylobacter-jejuni kann zu verschiedenen extraintestinalen Manifestationen fuhren. Eine Myo-/Perikarditis und eine toxische Hepatitis sind in Einzelfallen beschrieben. Ein kombiniertes Auftreten dieser Komplikationen ist bisher nicht bekannt. Es wird uber eine 22-jahrige Patientin mit plotzlich aufgetretenen linksthorakalen Schmerzen berichtet. Bei einem Anstieg von Troponin T, Kreatinkinase und Myoglobin und sonst fehlendem Anhalt fur eine Ischamie musste von einer Myokarditis ausgegangen werden. Bei seit 5 Tagen bestehender Diarrho gelang der Nachweis von Campylobacter-jejuni. In der aufgrund eines Transaminasenanstiegs durchgefuhrten Leberbiopsie konnten durch den Erreger bedingte Veranderungen nachgewiesen werden. Bei steigender Haufigkeit der Infektionen mit Campylobacter-jejuni soll auf die extraintestinalen Komplikationen aufmerksam gemacht werden.

Campylobacter-jejuni-assoziierte Hepatitis und myokardiale Beteiligung

Leiomyosarcomas of the esophagus are rare tumors of mesenchymal origin. Apropos of a case we present clinicopathological features, diagnostic procedures and management of this seldom tumor of the esophagus. Primary gastrointestinal sarcomas cause less than 0.5% of all esophageal malign tumors, and present in ca. 5% as esophageal leiomyosarcomas. The most frequent incidence ranges between the fourth and fifth decade of life. The tumors originate from the muscular layers of the esophageal wall and are localized predominantly in the middle and distal third of the esophagus. Dysphagia is the most important and leading symptom although it presents late in the course of the illness. Endosonography is at the time the most accurate method to establish the tumor size. Differentiation between leiomyoma and leiomyosarcoma is only possible by histopathological examination and may be difficult in certain cases. Histopathological grading of the tumors as low- and high-grade sarcomas in dependence of the number of mitosis affects predominantly the prognosis of these patients. Differential diagnosis includes spindle cell carcinoma and carcinosarcoma of the esophagus. The most effective therapy consists in the complete operative removal of the tumor, in these cases five years survival rates of 30 to 40% are achieved, strongly influenced by tumor differentiation and size.

[Leiomyosarcoma of the esophagus. Clinical aspects, diagnosis and therapy based on an individual case].

Background: Photodynamic therapy (PDT) appears to be a promising method for the local treatment of malignant tumors. However, little data are available concerning the relationship between administered energy density and photosensitizer concentration with respect to the degree of tumor destruction. The present study was designed to evaluate this functional relationship in an in vivo tumor model with human gastrointestinal carcinomas. Methods: Sixteen different human gastrointestinal tumors (two esophageal, five gastric, five colonic and four rectal), heterotransplanted into nude mice (NMRI-nu/nu), were treated either with different energy densities between 25 and 300 J/cm 2 at a constant sensitizer dose of 9 mg/kg or, alternatively, treated with different sensitizer dosages of 1.5 to 9 mg/kg at a constant energy density of 150 J/cm 2

Dose-dependent destruction of human gastrointestinal neoplasms by photodynamic therapy: a quantitative pilot study in athymic nude mice

Das Leiomyosarkom des Osophagus ist ein, seltener Tumor mesenchymalen Ursprungs. Anhand eines Falles wird die klinische Symptomatik und das diagnostische Vorgehen dargestellt sowie auf Therapie und Pathohistologie eingegangen. Primare gastrointestinale Sarkome stellen weniger als 0,5% aller Osophagusmalignome dar, sie befallen die Speiserohre in etwa 5%. Die hochste Inzidenz liegt in der vierten und funften Lebensdekade. Die Tumoren sind submukos lokalisiert und betreffen die, muskularen Wandschichten uberwiegend im mittleren und distalen Anteil des Osophagus. Dysphagie als klinisches Leitsymptom tritt erst spat im Verlauf der Erkrankung auf. Die Endosonographie ist die derzeit genaueste diagnostische Methode zur Bestimmung der Tumorgrose. Eine Differenzierung zwischen benignem Leiomyom und malignem Leiomyosarkom ist nur histopathologisch moglich und kann in Einzelfallen schwierig sein. Von prognostischer Bedeutung ist die Differenzierung in „low-” und „high-grade” Sarkome aufgrund der Mitosenrate. Die Differentialdiagnose umfast das Spindelzellkarzinom und das Karzinosarkom der Speiserohre. Die operative Entfernung des Tumors stellt die Therapie der Wahl dar; die Funf-Jahres-Uberlebensrate liegt zwischen 30 und 40% und ist von der Tumordifferenzierung und der Tumorgrose abhangig.

Helmut Ernst

Papers

[Whole-body cryotherapy in patients with inflammatory rheumatic disease. A prospective study].

Campylobacter-jejuni-assoziierte Hepatitis und myokardiale Beteiligung

[Leiomyosarcoma of the esophagus. Clinical aspects, diagnosis and therapy based on an individual case].

Dose-dependent destruction of human gastrointestinal neoplasms by photodynamic therapy: a quantitative pilot study in athymic nude mice

Das Leiomyosarkom des Ösophagus