Untersuchungen über das Tetanusgift

Ohne Zusammenfassung     

Generalized epileptic seizures as the presenting symptom of lacunar infarction in the brain

Summary Five elderly hypertensive patients presented with grand mal seizures and had computed tomographic (CT) findings consistent with lacunar infarction. Three of them had also a recent hemiparesis, contralateral to the side of the CT findings. Follow-up CT scans supported the diagnosis of lacunar infarction. Contrary to the accepted opinion, generalized epileptic seizures may be the presenting symptom of lacunar brain infarction.     

Evidence for an age cutoff greater than 365 days for neuroblastoma risk group stratification in the Children's Oncology Group.

PURPOSE: In the Children's Oncology Group, risk group assignment for neuroblastoma is critical for therapeutic decisions, and patients are stratified by International Neuroblastoma Staging System stage, MYCN status, ploidy, Shimada histopathology, and diagnosis age. Age less than 365 days has been associated with favorable outcome, but recent studies suggest that older age cutoff may improve prognostic precision. METHODS: To identify the optimal age cutoff, we retrospectively analyzed data from the Pediatric Oncology Group biology study 9047 and Children's Cancer Group studies 321p1-p4, 3881, 3891, and B973 on 3,666 patients (1986 to 2001) with documented ages and follow-up data. Twenty-seven separate analyses, one for each different age cutoff (adjusting for MYCN and stage), tested age influence on outcome. The cutoff that maximized outcome difference between younger and older patients was selected. RESULTS: Thirty-seven percent of patients were younger than 365 days, and 64% were > or = 365 days old (4-year event-free survival [EFS] rate +/- SE: 83% +/- 1% [n = 1,339] and 45% +/- 1% [n = 2,327], respectively; P < .0001). Graphical analyses revealed the continuous nature of the prognostic contribution of age to outcome. The optimal 460-day cutoff we selected maximized the outcome difference between younger and older patients. Forty-three percent were younger than 460 days, and 57% were > or = 460 days old (4-year EFS rate +/- SE: 82% +/- 1% [n = 1,589] and 42% +/- 1% [n = 2,077], respectively; P < .0001). Using a 460-day cutoff (assuming stage 4, MYCN-amplified patients remain high-risk), 5% of patients (365 to 460 days: 4-year EFS 92% +/- 3%; n = 135) fell into a lower risk group. CONCLUSION: The prognostic contribution of age to outcome is continuous in nature. Within clinically relevant risk stratification, statistical support exists for an age cutoff of 460 days.     

Mechanical model testing of rebreathing potential in infant bedding materials

Rebreathing of expired air may be a lethal hazard for prone sleeping infants. This paper describes a mechanical model to simulate infant breathing, and examines the effects of bedding on exhaled air retention. Under simulated rebreathing conditions, the model allows the monitoring of raised carbon dioxide (CO2) inside an artificial lung-trachea system. Resulting levels of CO2 (although probably exaggerated in the mechanical model compared with an infant, due to the model's fixed breathing rate and volume) suggest that common bedding materials vary widely in inherent rebreathing potential. In face down tests, maximum airway CO2 ranged from less than 5% on sheets and waterproof mattresses to over 25% on sheepskins, bean bag cushions, and some pillows and comforters. Concentrations of CO2 decreased with increasing head angle of the doll, away from the face down position. Recreations of 29 infant death scenes also showed large CO2 increases on some bedding materials, suggesting these infants could have died while rebreathing.     

The essential self: a commentary on Silverstein and Rose "On the mystique of the immunological self"

Historical precedent supports an argument that a variety of factors, including the physical and chemical nature of the antigen, dose, timing, mode of access to the immune system, etc., combine to make a self-nonself discrimination. This argument requires that specificity be ignored and the myriad of parameters that affect the class and magnitude of the response be dealt with — what might be called the immunogenicity-tolerogenicity discrimination. Just as there can be no immune response if there are no specific receptors available, so the presence of immune receptors does not guarantee that an immune response will occur, and factors that contribute to the regulation of the magnitude and class of the immune response cannot be used to determine if a receptor is anti-self or anti-nonself.     

Argon laser laparoscopy for treatment of pelvic endometriosis associated with infertility and pelvic pain

Argon laser laparoscopy was used for treatment of 46 patients with pelvic endometriosis. Infertility was the primary diagnosis in 31 patients, and pelvic pain was the primary diagnosis in 21 patients. A 600 mum laser fiber was used through the operative channel of the laparoscope, and the tip of the fiber was kept at a distance of 2-3 mm from the lesions. The power density used varied between 1604 and 1069 W/cm 2 at the tissue level. The pregnancy rate following treatment of the infertile group was 42%. Eighty-four percent of these pregnancies occurred within the first 8 months of treatment. In the group with pelvic pain, 8 patients experienced complete pain relief, and 13 patients experienced partial pain relief. Difficulties with the use of the fiber included breakage in 3 patients and melting of the fiber tip in 1 patient.