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In an effort to support European Union Water Framework Directive goals, we have set up a national demonstrator project to identify the advantages and limitations of passive samplers for regulatory monitoring of polar contaminants in surface waters. Here we carried out successive 14 day-deployments of polar organic chemical integrative samplers (POCIS) for one year at three sites. In parallel, we used the passive sampler deployment/retrieval operations to collect spot water samples for comparative analysis. We observed that frequency of quantification was significantly higher in POCIS than spot samples for 29 contaminants, similar for 15, and lower for one, because POCIS lowered the limits of quantification for most contaminants (median value factor of 11). We built a database of sampling rates (Rs) according to quality indices to convert concentrations in POCIS to concentrations in water (23 contaminants with a high-quality median Rs value, 20 with an approximate Rs and two with no usable Rs). Several phenomena were observed over one-year monitoring period. For example, after a flood episode, dilution phenomenon in rivers is correctly observed by using POCIS sampling whereas significant concentration increased due to soil leaching is observed with both passive and spot sampling. Cases of episodic contamination that were missed by spot sampling were observed with POCIS as it was able to capture contamination of short duration but sufficient intensity. Contamination by pharmaceuticals was found to come from wastewater treatment plant discharges and showed relatively little variation over the course of the year in both POCIS and spot samples. POCIS enables more reliable annual monitoring of pesticide and pharmaceutical contamination than spot sampling. Furthermore, POCIS also improves the environmental quality standards based assessment of chemical status and on annual average concentrations compared to spot sampling. This study demonstrates the value and practicability of POCIS-based chemical monitoring for use in regulatory control networks.

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BACKGROUND: De Materia Medica written by Pedanios Dioscorides (1 century CE) has shaped European and Mediterranean herbal medicine to a large extent. Despite its fundamental importance for modern medico-botanical traditions the content of this work has never been systematically assessed. PURPOSE: We present a quantitative survey of the botanical drugs described in De Materia Medica (ex Matthioli, 1568) and identify overall therapeutic, diachronic and botanical patterns. The extracted data may serve as a baseline and help to better contextualize research on herbal drugs and phytotherapy. METHODS: Therapeutic uses of herbal drugs were extracted through line-by-line reading of a digitized version of the treatise. For each plant usage mentioned in the text we recorded (I) the chapter number, (II) the putative botanical identity, (III) the plant part, (IV) the symptoms or disease, (V) the mode of administration, (VI) our biomedical interpretation of the ancient ailment or disease description as well as (VII) the organ- and symptom-defined category under which the use was filed. SECTIONS: An introduction to Dioscorides' De Materia Medica and Matthioli's Renaissance commentary is followed by a description of the employed methodology. The results and discussion section introduces the generated database comprising 5314 unique therapeutic uses of 536 plant taxa and 924 herbal drugs. Separate subsections address salient patterns such as the frequent recommendation of Fabaceae seeds for dermatology, Apiaceae seeds as antidotes and Apiaceae exudates for neurology and psychosomatic disorders as well as the heavy reliance on subterranean parts as drugs. CONCLUSIONS: The therapeutic knowledge described in De Materia Medica (ex Matthioli, 1568) offers unique insights into classical Mediterranean epidemiology and herbal medicine. Drugs that lost importance over time as well as remedies used for diseases now controlled by preventive medicine and industrially produced drugs may be interesting starting points for research on herbal medicine and drug discovery. Apart from promoting future data mining, the study may also help to prove the tradition of use, which is required for the regulatory approval of certain herbal products.

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In the 26th year of life a young woman suffered a portal and mesenteric thrombosis followed by portal hypertension with splenomegaly, esophageal varices and pancytopenia. After splenorenal shunt surgery and splenectomy hematologic parameters resolved rapidly. Also, she was suffering of Proteus syndrome, which is an extremely rare and sporadic hamartomatous disorder characterized by a variety of cutaneous and subcutaneous tumors including vascular malformations, several types of nevi, partial gigantism of the hands and/or feet and cystic visceral affections. It has been demonstrated that concurrence of several prothrombotic risk factors occur relatively often in patients with portal vein thrombosis. An extensive investigation of thrombophilic factors revealed reproduced high anti-beta2-glycoprotein I antibody titers together with mildly increased homocysteine levels. Other coagulation parameters were normal or negative. The presence of myeloproliferative moglobinuria was ruled out. Together with the history of recurrent superficial thrombophlebitis and portal vein thrombosis in the absence of other underlying diseases allowed for diagnosis of primary antiphospholipid syndrome being aggravated by hyperhomocysteinemia and vascular malformations caused by Proteus syndrome. Because of combined risk factors for further thrombembolisms permanent oral anticoagulant therapy was initiated.

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Several unusual features were observed during routine histopathological confirmation of a clinical diagnosis of Alzheimer's disease (AD) in an 85-year-old, right-handed, married male. The patient presented with a 12-year history of slowly progressive cognitive impairment, which increased in severity just prior to death. Detailed postmortem examination of the frontal lobes revealed a significant number of neuritic plaques and neurofibrillary tangles. Multifocal spongiform encephalopathic changes, mononuclear perivascular infiltrates, subcortical demyelination and gliosis were also found. Of particular interest were well-defined neuronal and astrocytic intranuclear inclusion bodies (Cowdry type I and I), suggestive of viral disease. Electron microscopy, immunohistochemical and immunohistofluorescent studies confirmed a Herpes simplex type I encephalitis (HSV-I). These histological results and the clinical history of progression suggest that reactivation of a latent viral infection may have contributed to the rapid progression of dementia prior to death. The present analysis underscores the fact that multiple etiologic factors may act simultaneously to produce dementia. While one such process may be identified or diagnosed (in the present case AD), it is necessary to be open to the possibility that another mechanism may come into play during the time course of that illness. A differential diagnosis may be difficult when the symptoms of the two disease processes are very similar. Such may be the case if there is reactivation of a previously undiagnosed herpes virus infection. With the development of PCR and in situ hybridization diagnosis will be simplified and more definitive.

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The HT4-agonist Cisapride (CIS) and the peripheral D2-antagonist Domperidone (DOMP) have distinct prokinetic actions. We compared their clinical efficacy in 127 dyspeptic patients. Patients with upper abdominal complaints of > 1 month duration, who had a normal UGE were allocated to the REFLUX-group (RG), (predominance of heartburn, acid regurgitation or retrosternal pain) or if devoid of this specific symptomatology to the DYSPEPSIA-group (DG) In a double-blind randomised fashion and allocated to 10 mg CIS or 20 mg DOMP qid (RG) or tid (DG) for 1 month and followed-up for further 2 months. In RG (N = 43, p < 0.05) the response rates were clearly in favour of CIS, but not in DG (N = 84). In RG DOMP was more effective against nausea. The benefit of both therapies was largely maintained in the follow-up period. Cisapride and domperidone were effective in the treatment of dyspepsia. Cisapride was more effective than domperidone in the REFLUX-Group.

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A prospective trial involving 282 patients, beginning in December 1993, was undertaken to assess the correlation between our sonographic impression of prostatic malignancy and the histological findings of a random six quadrant biopsy in addition to histology of any sonographically evident focal peripheral zone (PZ) abnormality. The sonographic criteria used to suggest malignancy were: (i) presence of hypo-echoic PZ nodule; (ii) inhomogeneity of PZ; and (iii) loss of zonal architecture (ZA). The sonographic appearance was graded as either definitely benign, indeterminate, or definitely malignant. These impressions were then compared with the histology results. Eighty-two patients had histologically proven malignancy. Ultrasound showed the correct extent and site of malignancy in 42 patients. A further 26 patients had the extent of their malignancy either over- or under-estimated or had the malignancy placed in an incorrect site. Fourteen patients with histologically proven carcinoma had sonographically normal PZs. These findings highlight the shortcomings of ultrasound as a diagnostic tool in prostate cancer and show that six quadrant random biopsy of the prostate is far superior to unifocal biopsy of sonographically evident masses in the detection of prostate cancer.

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A 35 year old woman with right upper quadrant abdominal pain was found to have peliosis hepatis. This was attributed to oral contraceptive use and 6 month follow up after cessation of oral contraceptives showed these lesions to have reduced in extent.

PIP: Peliosis hepatis is an uncommon entity characterized by multiple oval and irregularly shaped blood-filled cystic cavities in the liver parenchyma. The spaces are lined by either hepatocytes or endothelial cells. They communicate with the sinusoids, many of which are dilated. The condition has been associated with cirrhosis, malignancy, infection with tuberculosis and HIV, and medication such as anabolic or androgenic steroids. The etiology is uncertain, but toxic injury to the sinusoidal wall is postulated. The condition may present with hepatomegaly, cirrhosis and portal hypertension, hepatic failure, or shock from hepatic or splenic rupture. The authors report the case of a patient who developed peliosis hepatis while taking oral contraceptives. Abdominal ultrasound performed upon the 35-year-old woman presenting with right upper quadrant abdominal pain identified multiple, well-circumscribed liver lesions of varying size and echogenicity. No blood flow was detected on color duplex ultrasound and the rest of the abdominal examination was normal. Her condition was attributed to oral contraceptive use. Such use was therefore discontinued, and 6 months later the lesions were found to have reduced in size. The patient's pain had reduced considerably and she was clinically well. Follow-up is mandatory in such cases following diagnosis and treatment.

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Several authors have reported regression of rectal polyps after administration of sulindac in patients with familial adenomatous polyposis (FAP) and subtotal colectomy. However, only a few reports have been published about the effect of sulindac in the intact colon of FAP-patients. 12 patients (FAP n = 10, Lynch-I-syndrome n = 1, juvenile polyposis n = 1/patient with intact colon n = 6, ileorectal anastomosis n = 4, right-sided hemicolectomy n = 2) have been treated with sulindac (3 x 100 mg/d orally) for 4 months. In all patients colonoscopy (if postcolectomy, rectoscopy) with videotape documentation was performed before and after sulindac therapy. Some polyps were excised for histology. In 11/12 patients a regression of the number and size of polyps occurred. In addition, in patients with intact colon no polyps were observed proximal to the sigmoid colon. In one patient sulindac had to be discontinued after 4 weeks' course because of abdominal pain. A control colonoscopy revealed only slight reduction in polyps. In 3/12 patients no polyps remained after sulindac. In a further 3/12 patients with initial tubulous adenomatous polyps, only microadenomas were observed after treatment. We therefore conclude that sulindac is effective in FAP-patients (and very probably in other hereditary polyposis syndromes) with intact colon as well as after (hemi-)colectomy in reducing the number and size of polyps. Long term studies are needed to clarify the optimal dosage, treatment time period, and long term potential for development of carcinoma under sulindac treatment.

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Campylobacter pylori (C.p.) infection is often found in patients with antral gastritis and peptic ulcer disease. Pathophysiological links are still unclear, and we therefore tested the hypothesis whether C.p. affects the gastrointestinal peptides and thus influences gastric acid secretion and protective factors. 94 patients were examined by upper GI endoscopy and blood analyzed for gastrin, somatostatin, pancreatic polypeptide and neurotensin. Biopsies of antral mucosa were investigated for C.p. in urease testing, culture and microscopy. C.p. was found in 42 patients (45%). In microscopy all of these patients had chronic gastritis (100%). A significant increase in gastrin uninfluenced by C.p. was found in patients with antral gastritis (normal: 6.4 +/- 0.7, [n = 27]; gastritis without C.p.: 18.4 +/- 5.9 [p less than 0.02], [n = 7]; gastritis with C.p.: 10.7 +/- 2.2, [n = 22]). Somatostatin, pancreatic polypeptide and neurotensin showed no difference.

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The case is reported of a 73-year-old man presenting with a history arthralgia, conjunctivitis, fever and typical lesions of acute febrile neutrophilic dermatosis (Sweet's syndrome). Due to massive leukocytosis, an unclassifiable myeloproliferative disorder was later diagnosed. The disease responded well to hydroxyurea but only partly to steroids. The case demonstrates the necessity of close hematologic follow-up in Sweet's syndrome, since some 10% of patients develop hematologic malignancies weeks or months later.

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