Funktion des N. facialis nach operativer Therapie des Akustikusneurinoms

The aim of this study was to evaluate the influence of intraoperative monitoring on the function of the facial nerve after surgical treatment of acoustic neurinomas, classified according to the grading system of Stennert. One hundred thirty patients were divided into two groups. The first group underwent surgery without intraoperative facial monitoring; the second group included intraoperative facial monitoring. Concerning degree of paresis, preoperatively there was no statistically significant difference between the two groups (group 1: 0.77+/-1.5; group 2: 0.4+/-1.2). Despite structural preservation of the facial nerve, postoperative deterioration of its function was observed which consecutively improved postoperatively. Postoperatively, the mean degree of paresis increased to 4.4+/-3.0 in group 1 and 2.4+/-2.3 in group 2. For better understanding of the role of intraoperative monitoring, we investigated the outcome of patients with acoustic neurinomas who underwent surgery over the following 6 months postoperatively. At that time, function improved by 4.1+/-3.2 (group 1) and 2.0+/-2.3 (group 2). We could show that intraoperative monitoring of the facial nerve was a significant factor for better postoperative function in patients undergoing microsurgical excision of neurinomas (P=0.001) .     

Moderne Bildgebung der Nasennebenhöhlen

Depending on the problems, CT or MRI should be used in the differential diagnosis of conditions affecting the nasal sinuses. In particular, when chronic sinusitis is present, computed tomography should be performed before surgery to ascertain the condition of the bones. In most cases spiral CT with a decidedly lowered tube voltage and power (MAS product) is now used for this purpose. This means that the patient is exposed to about 70% less radiation than in other CT investigations. To avoid artefacts attributable to dental fillings, whenever possible the spiral should be tilted in such a way that the dental artefacts are not within the mass imaged. When an isotropic voxel is selected secondary reformatting is possible with no loss of quality. Diagnostic MRI should include both T1- and T2-weighted sequences before and after the administration of contrast agent. For the differential diagnosis of a space-occupying tumour coronal cuts about 2 mm apart are advised, whether the spiral or the conventional technique is used. A T2-weighted and fat-suppressed sequence or a STIR (short tau inversion recovery) sequence can also be helpful in the recognition and visualization of lymph nodes. If orbital involvement seems possible it is advisable to use a T1-weighted and fat-suppressed sequence in the coronal plane in addition to check this.     

Intraarterielle Lyse der A. cerebri media: ein Überblick

Zusammenfassung Bis 1996 bedeutete Schlaganfalltherapie die Verhinderung weitere ischämischer Insulte. Durch die Entwicklung der intravenösen und intraarteriellen Lysetherapie mit rt-PA wurde erstmals eine kausale Therapie möglich. In diesem Beitrag soll der Stand der intravenösen Lysetherapie kurz dargestellt werden, um dann den Stellenwert der lokalen intraarteriellen Lysetherapie zu bewerten.     

Die Entwicklung der Neuroradiologie

Zusammenfassung Seit der Entdeckung der Röntgenstrahlen gab und gibt es rasante und wichtige Entwicklungen in der Bildgebung, v. a. in der Neuroradiologie. Meilensteine waren der Einsatz von Kontrastmitteln, die digitale Subtraktionsangiographie, die Computer- und Magnetresonanztomographie. Letzte Errungenschaften sind die Darstellung von Hirnaktivierung sowie der Fasersysteme im Hirnparenchym. Mit neuen Kontrastmittel scheint es auch möglich zu sein, Bildgebung auf molekularer Ebene durchzuführen.     

Synaptic uptake and beyond: the sodium- and chloride-dependent neurotransmitter transporter family SLC6

The SLC6 family is a diverse set of transporters that mediate solute translocation across cell plasma membranes by coupling solute transport to the cotransport of sodium and chloride down their electrochemical gradients. These transporters probably have 12 transmembrane domains, with cytoplasmic N- and C-terminal tails, and at least some may function as homo-oligomers. Family members include the transporters for the inhibitory neurotransmitters GABA and glycine, the aminergic transmitters norepinephrine, serotonin, and dopamine, the osmolytes betaine and taurine, the amino acid proline, and the metabolic compound creatine. In addition, this family includes a system B(0+) cationic and neutral amino acid transporter, and two transporters for which the solutes are unknown. In general, SLC6 transporters act to regulate the level of extracellular solute concentrations. In the central and the peripheral nervous system, these transporters can regulate signaling among neurons, are the sites of action of various drugs of abuse, and naturally occurring mutations in several of these proteins are associated with a variety of neurological disorders. For example, transgenic animals lacking specific aminergic transporters show profoundly disturbed behavioral phenotypes and probably represent excellent systems for investigating psychiatric disease. SLC6 transporters are also found in many non-neural tissues, including kidney, intestine, and testis, consistent with their diverse physiological roles. Transporters in this family represent attractive therapeutic targets because they are subject to multiple forms of regulation by many different signaling cascades, and because a number of pharmacological agents have been identified that act specifically on these proteins.     

Focal astrocyte loss is followed by microvascular damage, with subsequent repair of the blood-brain barrier in the apparent absence of direct astrocytic contact

Blood-brain barrier (BBB) breakdown is a feature of cerebral ischaemia, multiple sclerosis, and other neurodegenerative diseases, yet the relationship between astrocytes and the BBB integrity remains unclear. We present a simple in vivo model in which primary astrocyte loss is followed by microvascular damage, using the metabolic toxin 3-chloropropanediol (S-alpha-chlorohydrin). This model is uncomplicated by trauma, ischaemia, or primary immune involvement, permitting the study of the role of astrocytes in vascular endothelium integrity, maintenance of the BBB, and neuronal function. Male Fisher F344 rats given 3-chloropropanediol show astrocytic damage and death at 4-24 h in symmetrical brainstem and midbrain nuclear lesions, while neurons show morphological changes at 24-48 h. Fluorescent 10 kDa dextran tracers show the BBB leaking from 24 h, progressing to petechial haemorrhage after 48-72 h, with apparent repair after 6 days. BBB breakdown, but not the earlier astrocytic death, is accompanied by a delayed increase in blood flow in the inferior colliculus. An ED1 inflammatory response develops well after astrocyte loss, suggesting that inflammation may not be a factor in starting BBB breakdown. This model demonstrates that the BBB can self-repair despite the apparent absence of direct astrocytic-endothelial contact. The temporal separation of pathological events allows pharmacological intervention, and the mild reversible ataxia permits long-term survival studies of repair mechanisms.     

Risk factors for suicide and other deaths following hospital treated self-poisoning in Australia

OBJECTIVE: To analyze the risk factors for suicide, premature death and all-cause death in a representative population of hospital-treated deliberate self-poisoning patients. METHOD: A prospective cohort study using data-linkage between the Hunter Area Toxicology Service Database and the National Death Index of the Australian Institute of Health and Welfare, from January 1991 to December 2000. RESULTS: There were 4105 subjects, of whom 228 (5.6%) died, 122 (2.9%) by premature death and 58 (1.4%) by suicide. The probability of suicide after 10 years follow-up was 2%. The adjusted hazard ratios (95% CI) for suicide were: 'disorders usually diagnosed in infancy, childhood and adolescence', 5.28 (95% CI = 2.04-13.65): male gender, 4.25 (95% CI = 2.21-8.14); discharge to involuntary psychiatric hospital admission, 3.20 (95% CI = 1.78-5.76); and increasing age, 1.02 (95% CI = 1.01-1.04). Men and women showed different patterns of multivariate risks, although increased risk with increasing age and discharge to an involuntary psychiatric admission was true for both. The standardized all-cause mortality ratio (95% CI) was: for men, 6.42 (95% CI = 5.44-7.57), and for women 4.39 (95% CI = 3.56-5.41). The standardized suicide mortality ratio (95% CI) was: for men, 20.55 (95% CI = 15.24-27.73), and for women 22.95 (95% CI = 13.82-38.11). CONCLUSIONS: Men and women have different risk factors for subsequent suicide after self-poisoning. Hospital-treated self-poisoning patients have increased risk of subsequent suicide, premature and all-cause death. Psychiatric assessment, leading to discharge decisions, is worthwhile in identifying patients at long-term risk of suicide, premature and all-cause death.