Mechanismen der Schmerzentstehung

The interaction between neurons, tissue cells and inflammatory cells is of major importance for the development of pain in the periphery. In this interaction a variety of inhibitory and activating circuits has been identified in recent years. In addition to the receptors for classical inflammatory mediators on the sensory terminals like bradykinin, axonal ion channels have been identified as major modulators of pain and sensitization apart from their traditional role in conduction of action potentials. Sensitization of spinal nociceptive processing is crucial for the expansion of pain beyond the initially injured site and contributes to chronic pain. Learning processes and extinction of aversive memory are of major importance for the development, but also the therapy of chronic pain states.     

Kranielle Bildgebung und Serologie bei Pupillotonie nicht hilfreich

BACKGROUND: Tonic pupil (TP) is a common disorder of parasympathetic innervation. In contrast to textbook recommendations, cranial imaging is still being performed in most of the patients with TP. The intention of the present study is to show that cranial imaging is of no benefit. PATIENTS AND METHODS: The medical records of 33 patients with TP were analyzed retrospectively. All patients had undergone a complete ophthalmological, orthoptic, and neurological investigation. Cranial imaging was performed by computed tomography or magnetic resonance imaging. Serology tests were carried out in some of the patients. RESULTS: Diagnostic imaging provided no additional data revealing the underlying cause of TP. CONCLUSIONS: Cranial imaging in isolated tonic pupil is not helpful. Because of therapeutic implications, diagnostic evaluation can be recommended only in patients older than 50 years to exclude giant cell arteritis and syphilis.     

Sp?tabendlicher Sport, Schlaf, Schlafhygiene und psychisches Wohlbefinden bei adoleszenten Fu?ballern

Objectives

Recent studies have demonstrated different effects of physical activity on sleep and the results ranged from positive over negative effects to no influence at all. The aim of this pilot study was to assess the sleep behavior of adolescent footballers, sleep hygiene and other psychological parameters compared to a less sportive control group. According to the literature it was to be expected that late night football would be negatively associated with sleep behavior.

Method

A total of 11 adolescents took part in this study, the 6 footballers and 5 controls kept a sleep diary and answered further questionnaires about anxiety, depressiveness and sleep hygiene.

Results

Analysis of the sleep diaries showed no differences between the groups although the footballers were physically active more often and later in the evening. Furthermore, the results of the subjective perception of normal routine performance and anxiety were equal for both groups. However, a tendency to better sleep hygiene and less depressiveness was found in the sport group.

Conclusions

The results of this pilot study showed no negative effects of late night football on sleep in adolescents; however, it has to be taken into account that not only different mediator variables might control the effect of physical activity on sport, e.g. time, intensity, duration and regularity but also aspects of the mental well-being and should be considered in future experiments.     

Pr?valenz der Rhizarthrose

Background

Using x-rays, the age and gender-related prevalence of arthrosis of the trapeziometacarpal joint was determined.

Methods

The radiographs of 235 patients who had presented with an isolated fracture of the distal part of the radius over a 4-year period were evaluated for evidence of trapeziometacarpal arthrosis; 9 patients had bilateral fractures. Trapeziometacarpal arthrosis was determined on radiographic views by 3 physicians. We used a three-grade rating system suitable for standard wrist radiographs. The number of patients with each grade of arthrosis was analyzed according to age and gender.

Results

The radiographic prevalence of trapeziometacarpal arthrosis in our patients (mean age 56 years) was 29%. Signs for arthrosis were first observed in 44-year-old patients and reached a prevalence of 60% in the group older than 70 years. There was a significantly higher prevalence in women (42%) than in men. Higher grades of osteoarthritis were found in women and in older patients. This rating system was demonstrated to have adequate interobserver reliability (??=0.66).

Conclusion

The radiographic prevalence of trapeziometacarpal arthrosis in patients presenting for treatment of a distal radial fracture is age-related. In women and in older patients, trapeziometacarpal arthrosis is more likely to appear and to show a higher grade of joint destruction.     

Behandlung angeborener komplexer Dysgnathien

Severe genetically determined malformations of the mid-facial bones, such as those which occur in craniofacial malformations, lead to a variety of functional limitations. These mostly include skeletal-linked occlusion disorders and malformation of the jaws. The treatment of dysgnathia represents a great challenge for the physician and for the patient. The complexity of the disease necessitates an interdisciplinary team and should ideally be carried out in a specialized centre. Only in this way can the various aspects of the disease and the wishes of the patient be sufficiently accommodated. The aims of the treatment include not only functional improvement but also harmonization of the facial profile. The present article deals with the orthopedic aspects of the jaws, the indications and risks of oral and maxillofacial and neurosurgical measures and the necessary supportive therapy. Options for correction of the mid-facial bones and malformation of the jaws will also be presented using case examples.     

Tryptophan catabolism is associated with acute GVHD after human allogeneic stem cell transplantation and indicates activation of indoleamine 2,3-dioxygenase

Induction of indoleamine 2,3-dioxygenase (IDO), the rate-limiting enzyme in tryptophan degradation along the kynurenine pathway, acts as a potent immunoregulatory loop. To address its role in human allogeneic stem cell transplantation, we measured major tryptophan metabolites, such as quinolinic acid and kynurenine, in serial urine specimens from 51 patients by liquid chromatography-tandem mass spectrometry. Samples were collected between admission and day 90 after transplantation, and metabolite levels were correlated with early clinical events and outcome. In selected patients, IDO gene expression was assessed by quantitative RT-PCR in intestinal biopsies. Surviving patients had significantly lower metabolite levels on days 28, 42, and 90, respectively, compared with patients dying of GVHD and associated complications (n = 10). Kynurenine levels were directly correlated with severity and clinical course of GVHD: Mean urinary quinolinic acid levels were 4.5 ± 0.3 μmol/mmol creatinine in the absence of acute GVHD, 8.0 ± 1.1 μmol/mmol creatinine for GVHD grade 1 or 2, and 13.5 ± 2.7 μmol/mmol creatinine for GVHD grade 3 or 4 (P < .001), respectively. GVHD-dependent induction of IDO was further suggested by increased expression of IDO mRNA in intestinal biopsies from patients with severe GVHD. Our data indicate reactive release of kynurenines in GVHD-associated inflammation.     

Mobile biometrische Ganganalyse

Parkinson's disease (PD) is characterized by progressive motor and non-motor symptoms, leading to distinct diagnostic and therapeutic challenges in all stages of the disease. This study investigated a mobile biosensor-based gait analysis system for patients in early and intermediate stages of PD compared to controls. Subjects wearing a motion sensor-equipped shoe performed a standardized gait exercise. Accelerometer- and gyroscope-based signals were analysed using a complex set of pattern recognition algorithms. The analysis was able (1) to distinguish between PD patients and controls, (2) to identify patients at an early stage of the disease and (3) to distinguish between early and intermediate stage patients. Thus, using this mobile biosensor-based analysis system we were able to obtain objective classifications of gait characteristics in PD. Future studies will show that mobile biosensor-based movement detection technology will support identification of early PD stages and allow objective characterization of motor fluctuations in advanced stages of the disease. This will provide an important and supportive tool for patients, caregivers and therapists.