Stadtkrankenhaus Schwabach

Zusammenfassung Wir berichten über den Fall einer 56-jährigen Patientin mit Morbus Basedow, ausgeprägter Hyperkalzämie und gesteigertem Knochenstoffwechsel. Die Patientin zeigte starken Gewichtsverlust, Müdigkeit, Übelkeit und erhöhte Leberwerte, was zunächst auf eine mögliche maligne oder paraneoplastische Erkrankung hindeutete. Laboruntersuchungen bestätigten eine ausgeprägte manifeste Hyperthyreose und positive TSH-Rezeptor (TRAK)-Antikörper. Kalzium war mit 3,08 mmol/l deutlich erhöht, während Parathormon mit 0,95 pmol/l erniedrigt war, wodurch ein primärer Hyperparathyreoidismus ausgeschlossen werden konnte. Da einzelne Tumormarker initial leicht erhöht waren und die Serumelektrophorese eine Hypergammaglobulinämie ergab, standen mehrere Ursachen für die Hyperkalzämie und den gesteigerten Knochenstoffwechsel im Raum. Die weiterführende Bildgebung und Durchuntersuchung ergab jedoch keine Hinweise auf eine maligne Ursache. Nach Beginn einer Therapie mit Thiamazol, β‑Blocker und Flüssigkeitssubstitution besserten sich die klinischen Beschwerden rasch und die Schilddrüsenwerte, Kalzium und die Knochenstoffwechselparameter Osteocalcin und β‑Crosslaps normalisierten sich. Die Hyperkalzämie wurde somit als Folge der gesteigerten Schilddrüsenfunktion und des dadurch erhöhten Knochenstoffwechsels interpretiert. Dieser Fall zeigt, dass eine Hyperkalzämie im Rahmen eines unbehandelten Morbus Basedow auftreten kann und bei der differenzialdiagnostischen Abklärung erhöhter Kalziumwerte berücksichtigt werden sollte.

Three new mitromorphid species, two of the genus Anarithma (Anarithma pseudoiozona sp. nov. and Anarithma tsuzukii sp. nov.) one of the genus Mitromorpha (Mitromorpha laboutei sp. nov.), are described from the Indo-Pacific. In absence of DNA sequences, differentiation with their closest congeners is based on their conchological characters only.

Key points Few issues generate more public concern in Canadian health care than long wait times for surgical procedures. Delays in care are associated with physical pain, psychological distress, long-term disability, or even death. Fortunately, wait times can be decreased substantially — up to 60

Abstract Background Aging has recently been associated with increased basal platelet activation and adenosine diphosphate (ADP) hyperreactivity on the one hand, but decreased platelet response to thrombin receptor stimulation on the other hand in individuals without antiplatelet therapy. In the current study, we investigated platelet response to agonist stimulation in elderly patients (70 years or older) on dual antiplatelet therapy with potent P2Y12 inhibitors. Methods Platelet aggregation in response to arachidonic acid (AA), ADP, collagen, the protease-activated receptor (PAR)-1 agonist SFLLRN and the PAR-4 agonist AYPGKF was assessed by multiple electrode aggregometry in 79 prasugrel- and 77 ticagrelor-treated patients 3 days after acute percutaneous coronary intervention. Results In the overall study population (n=156), patients aged ≥70 years (n=33) had lower platelet aggregation in response to AA, ADP and SFLLRN than younger patients (all p<0.05). In prasugrel-treated patients (n=79), those aged ≥70 years (n=13) showed significantly lower platelet aggregation in response to all agonists compared to younger patients (all p<0.05). In contrast, in ticagrelor-treated patients (n=77), those aged ≥70 years (n=20) only had significantly lower ADP-inducible platelet aggregation than younger patients (p=0.03), whereas platelet aggregation in response to AA, collagen, SFLLRN and AYPGKF was similar between elderly and younger patients on ticagrelor (all p>0.05). Among patients aged ≥70 years, prasugrel-treated patients showed significantly lower platelet aggregation in response to AA, collagen and AYPGKF than those receiving ticagrelor (all p<0.05). Conclusion Patients aged ≥70 years on potent P2Y12 inhibitors exhibit increased inhibition of ADP-inducible platelet aggregation. In addition, elderly patients on prasugrel show a significantly lower response to AA, collagen, SFLLRN and AYPGKF than younger patients.Platelet aggregation prasugrel patientsPlatelet aggregation ticagrelor patients

Multistable perception occurs in all sensory modalities, and there is ongoing theoretical debate about whether there are overarching mechanisms driving multistability across modalities. Here we study whether multistable percepts are coupled across vision and audition on a moment-by-moment basis. To assess perception simultaneously for both modalities without provoking a dual-task situation, we query auditory perception by direct report, while measuring visual perception indirectly via eye movements. A support-vector-machine (SVM)-based classifier allows us to decode visual perception from the eye-tracking data on a moment-by-moment basis. For each timepoint, we compare visual percept (SVM output) and auditory percept (report) and quantify the co-occurrence of integrated (one-object) or segregated (two-objects) interpretations in the two modalities. Our results show an above-chance coupling of auditory and visual perceptual interpretations. By titrating stimulus parameters toward an approximately symmetric distribution of integrated and segregated percepts for each modality and individual, we minimize the amount of coupling expected by chance. Because of the nature of our task, we can rule out that the coupling stems from postperceptual levels (i.e., decision or response interference). Our results thus indicate moment-by-moment perceptual coupling in the resolution of visual and auditory multistability, lending support to theories that postulate joint mechanisms for multistable perception across the senses.

In the published online article, the ESM files was not processed. The missed ESM has been processed in this article.