Stereotaktische Laserthermoablation bei mesialer Temporallappenepilepsie mit Hippocampussklerose rechts – Patientenentscheidung,Durchführung und Visualisierung von Gedächtnisfunktion

Clinical Epileptology - Wir berichten über einen 30-jährigen Patienten, der mit 21 Jahren an einer fokalen Epilepsie mit epigastrischen Auren und nicht bewusst erlebten...     

Response to: Human papillomavirus (HPV) vaccine safety concerning POTS,CRPS and related conditions

Clinical Autonomic Research -     

Emotional interference under low versus high executive control

Previous research has demonstrated that task‐irrelevant emotional distractors interfere with task performance especially under low phasic executive control (i.e., in nonconflict trials). In the present study, we measured medio‐frontal ERPs (N2 and correct‐related negativity, CRN) to elucidate which aspects of task performance are affected by emotional interference in a flanker task. To create emotional interference, negative and neutral pictures were presented during the flanker stimuli. N2 and CRN were reduced after negative pictures, indicating that conflict processing and performance monitoring are both affected by emotional interference. On the behavioral level, prolonged response times after negative pictures were observed under low phasic executive control (i.e., in compatible trials). Additionally, we explored whether emotional interference is modulated not only by phasic changes in executive control (i.e., conflict vs. nonconflict trials) but also by tonic changes in executive control (i.e., low vs. high overall conflict frequency). To this end, the flanker task consisted of two blocks with 25% versus 75% incompatible trials. Prolonged response times after negative pictures in compatible trials were observed only under low tonic executive control but not under high executive control.     

Die kondyläre Metastasierung

Background

Metastases in the mandibular condyle are rare. A survey of the literature showed that only 23 of 69 selected cases qualified under the criteria of Meyer and Shklar.

Report of a case

A 48-year-old white male suffering from a previously operated lung carcinoma was referred due to pain and discomfort in the left TMJ. A solitary condylar metastasis of the mandible was revealed. Because of diffuse tumorous infiltration into periarticular tissue, irradiation treatment was performed. During the long-term follow-up growth of additional skeletal metastases occurred.

Discussion

The course of condylar metastases in general is similar to other metastases involving the jaw. Breast cancer as the primary tumor is most frequent, followed by lung cancer. There are no specific clinical or radiological parameters leading to diagnosis. The clinician should take a potential metastasis into account when dealing with TMJ complaints, radiological oddities, and medical history of malignant tumors. For proper treatment planning, diagnosis should be based on histology. Since the diagnosis of metastasis is usually made at an advanced stage of disease, therapy will be mainly intended as palliative.     

Altered effective connectivity during working memory performance in schizophrenia: a study with fMRI and structural equation modeling

The present study aimed to explore altered effective connectivity in schizophrenic patients while performing a 2-back working memory task. Twelve right-handed, schizophrenic patients treated with typical or atypical antipsychotics and 6 healthy control subjects were studied with fMRI while performing a "2-back" working memory task. Effective connectivity within a cortical-subcortical-cerebellar network for mnemonic information processing was assessed and compared between both groups. The path model included cortico-cortical connections comprising the parietal association cortex, ventrolateral prefrontal cortex (VLPFC), and the dorsolateral prefrontal cortex (DLPFC) as well as a cortico-cerebellar feedback loop comprising prefrontal cortex, contralateral cerebellum, and thalamus. Group differences were analyzed with a stacked models approach. Relative to normal controls, both patient groups revealed a pattern of reduced connectivity within the prefrontal-cerebellar and the cerebellar-thalamic limbs but enhanced connectivity in the thalamo-cortical limb of the cortical-cerebellar circuit. Moreover, a direct comparison of both treatment groups revealed enhanced connectivity in the interhemispheric connections between the cortical association areas in patients treated with atypical antipsychotics. However, right prefrontal and left parieto-frontal path coefficients were lower in the patient group receiving atypical antispychotic drugs. The findings suggest that the relationship between pathology in cortical-subcortical cerebellar networks and associated functional connectivity is complex and may include aspects of increased and decreased levels of connectivity consistent with the notion of "cognitive dysmetria" in schizophrenia. The observed pronounced connectivity within thalamo-cortical projections could be attributed to a compensatory increase of thalamic input in the presence of disrupted effective connectivity within the preceding limb of the cortical-cerebellar circuitry. The study demonstrated the feasibility of structural equation modeling for the investigation of group and treatment-related differences in effective connectivity and provides a promising approach to further disentangle the relationship between altered functional capacity and associated fMRI signal changes.     

Are our expectations bigger than the results we achieve? A comparative study analysing potential advantages of ankle arthroplasty over arthrodesis

Purpose

Prior studies have reported improved gait performance and kinematics after total ankle arthroplasty (TAR) compared to ankle arthrodesis (AAD). Given these findings, AAD has been primarily considered as a salvage procedure that may lead to adjacent joint degeneration.

Methods

A total of 101 TAR and 40 screw arthrodeses were enrolled in a retrospective study with a prospectively designed follow-up examination that included gait analysis and outcome assessment with the AOFAS hindfoot score and FAOS questionnaire.

Results

Significant asymmetry in gait and reduced range of motion compared to normal remained after both procedures. Subjective outcome improved after both procedures, and pain was significantly better after TAR. Limited functional gains after TAR and joint degeneration to the same degree after both procedures was seen in the mid-term. Hindfoot fusion seemed to have a greater impact on postoperative function than ankle arthrodesis.

Conclusion

Considering only minor functional gains of TAR compared to AAD the implantation of current TAR designs in large patient series may be questioned.     

Stress doses of hydrocortisone in septic shock: beneficial effects on opsonization-dependent neutrophil functions

Objective To assess the effects of stress doses of hydrocortisone (HC) on clinical parameters and neutrophil functions in patients with septic shock. Design Prospective, double-blind, randomized, placebo-controlled study. Setting Intensive care units of a university hospital. Patients and participants 30 adult patients with septic shock. Interventions Patients were allocated to receive either HC (intravenous bolus of 100 mg preceding a continuous infusion 10 mg/h, n = 15) or placebo (n = 15), respectively. The effects of HC were assessed at baseline and after 24 h. Measurements and results As compared with placebo-treated patients, administration of HC significantly decreased norepinephrine requirements (from 1.5 to 0.8 mg/h; p < 0.001), interleukin-6 serum concentrations (from 388.8 to 88.8 pg/ml; p < 0.02), and the spontaneous release of hydrogen peroxide (H₂O₂) by neutrophils (−33.0%; p < 0.05). Additionally, HC treatment preserved the autologous plasma-induced amplification of phagocytosis of zymosan particles [factor of opsonin-induced amplification of phagocytosis of unopsonized particles: 1.80 for placebo vs. 1.75 for HC at baseline (not significant between groups) and 0.50 for placebo vs. 1.75 for HC after 24 h of treatment (p < 0.05)]. These effects were paralleled by respective changes in the phagocytosis-associated H₂O₂ production. Conclusions In patients with septic shock stress doses of HC exert beneficial effects in terms of improvements in hemodynamics, decrease in pro-inflammatory mediators, and oxidative stress without the compromise of opsonization-dependent phagocytic neutrophil functions; thus, HC treatment does not aggravate non-specific immunosuppression but instead improves innate immunity in the early stage of septic shock.