Clinical features of the spinal form of multiple sclerosis

Out of a data pool of 1271 patients with Multiple Sclerosis (MS) a total of 109 cases are selected having a sole spinal symptomatology throughout the course of the disease. This group differs in three particular features from the non-spinal forms of MS: In this group there is a higher percentage of females, the age at onset of the disease is higher, and the course of the disease is more often chronic progressive from the beginning. After the mean duration of 11 years, the spinal and the non-spinal cases show the same grade of disability. The ability to work is slightly better for spinal cases; office workers are able to keep their jobs longer after the onset to the disease than patients with any other occupation. The spinal form of MS is discussed in respect to its relationship to the classical form of MS and as a differential diagnosis to other spinal processes.     

Behandlungsergebnisse bei Aplasien im Frontzahngebiet

Zusammenfassung Bei einer Patietenzahl von 3055 wurden in 133 Fällen, das sind 4,35%, Nichtalagen einer oder mehrerer Frontzähne festgestellt. Die verschiedenen Behandlungsmöglickeiten, die ausschließlich kieferorthopädische und die kieferorthopädisch-prothetische, fanden Berücksichtigung. Es zeigte sich, daß nicht tramer die rein kieferorthopädische Therapie zum besten Behandlungsergebnis geführt hat, sondern daß man der Stellung des Eckzahnes besondere Beachtung schenken muß. Die Frage der Ausgleichsextraktion muß ebenso sorgfiltig bei der Planung bedacht werden. Verzichter man auf diese, sollte eine Distalokklusion von 1 Pb angestrebt werden. Ziel einer jeden Behandlung sollte die geschlossene Zahnreihe, vergesellschaftet mit einem funtkionellen und ästischen Optimum, sein.

---

Summary Follwing a survey of 3.055 patients, 133 or 4,35% were found to have one or more front teeth missing. When comparing the different prosthetic and orthodontic methods used, it was found that orthodontic arethods by themselves do not always show the best results. The position of the canines is especially importaut as also is the question of balancing extractions when considering the functional and aesthetic reslts.

---

Résumé Parmi 3.0355 patients, on a décelé chez 133 d'entre eux (soit le 4,35 %) l'absence d'une ou plusieurs dents antérieures. On aussi envisagé les différentes possibilités de traitement, soit exclusivement orthopodique dento-fciale, soit mi-orthopédique. Ce n'est pas toujours la seule orthopédie dento-faciale qui a donné les meilleurs résultats d'une part, et il faut faire bien attention à la position de la canine d'autre part. La question d'une extraction compensatoire doit être bien étudiée dans le plan de traitement. Y renonce-t-on, qu'il devient avantageux de recourir à une distoclusion d'une largeur de prémolatre. Le but de traitement tend à supprimer toute solution de continuité au niveau de l'arcade dentaire et à obtenir le meilleur résultat fonctionnel et esthétique.

---

---

Mit 10 Abbildungen     

Differential alterations by chronic treatment with morphine of pro-opiomelanocortin mRNA levels in anterior as compared to intermediate pituitary lobes of rats

Chronic treatment of rats with morphine by implantation of pellets over a period of 10 days resulted in a differential alteration of pro-opiomelanocortin (POMC) mRNA levels in individual pituitary lobes: Hybridisation studies using a 32P-labelled mouse POMC cDNA fragment of 150 bases as a probe revealed that chronic morphine treatment causes about 50% enhancement of POMC mRNA levels in the anterior lobe and about 40% decrease in the intermediate lobe of the pituitary. Significant changes were observed 3 days following commencement of administration and persisted over the rest of the morphine treatment.     

The limbus spiralis and its relationship to the developing tectorial membrane in the cochlear duct of the guinea pig fetus

Summary The development of the interdental cells of the limbus spiralis and of the inner spiral sulcus cells as well as the formation of the mesenchymal teeth of Huschke are described during fetal life up to the day of birth in the guinea pig. Additionally, the changes of the developing tectorial membrane are studied. The ultrastructural observations allow the conclusion that during fetal development at least a considerable part of the material of the tectorial membrane is secreted by the interdental cells of the limbus spiralis.Supported by Deutsche Forschungsgemeinschaft     

Results and complications after ileal pouch anal anastomosis: a meta-analysis of 43 observational studies comprising 9,317 patients

OBJECTIVE: To analyze the literature of ileal pouch anal anastomosis (IPAA) regarding complications and functional outcome, to provide audit data for individual surgeons and units to assess their own performance against and also to serve as reference standard for the assessment of novel alternatives. BACKGROUND: IPAA is the standard restorative procedure for ulcerative colitis (UC) and familial adenomatous polyposis (FAP). This operation is, however, associated with distinct rates of failure, complications and fecal incontinence. METHODS: A meta-analysis on pooled incidences of complications of IPAA was conducted. Medline search and cross-reference search identified studies on IPAA (n > or = 50). Two authors independently performed the data extraction on study characteristics, diagnosis, type of operation, pouch-related complications, pouch failure and functional results. In case of disagreement consensus was reached by joint review of the study. Estimates of pouch-related complications, pouch failure and functional results are described as pooled percentages with 95% confidence interval. RESULTS: The initial search based on 1,206 abstracts yielded 43 studies eligible for further analysis. Indications for IPAA were UC in 87.5%, FAP in 8.9% and other diagnoses in 3.6%. The median follow-up was 36.7 months. Pouch failure was 6.8%, increasing to 8.5% in case of follow-up of more than 60 months. Pelvic sepsis occurred in 9.5%. Severe, mild and urge fecal incontinence were reported in 3.7, 17, and 7.3%, respectively. No effect of experience, duration of follow-up and type of surgical technique on the incidence of pouch failure and pelvic sepsis was demonstrable. CONCLUSIONS: Current techniques for restorative surgery after proctocolectomy are associated with non-negligible complication rates and leave room for improvement and continuation of development of alternative procedures.     

Postnatally acquired cytomegalovirus infection via breast milk: effects on hearing and development in preterm infants

BACKGROUND: In preterm infants there is a high risk of transmission of cytomegalovirus (CMV) via breast milk from seropositive mothers with reactivation of the virus during lactation. There is little information about the long term sequel of early postnatally acquired CMV infection in pre-term infants. This study aimed to investigate whether there was an increased frequency of impaired neurodevelopmental outcome and sensorineural hearing loss in preterm infants with postnatally acquired CMV infection through transmission by CMV-positive breast milk. METHODS: Twenty-two preterm infants [median birth weight, 1020 g (range, 600 to 1870 g); median gestational age, 27.6 weeks (range, 23.6 to 32 weeks] with early postnatally acquired CMV infection by breast-feeding (onset of viruria between Days 23 and 190 postnatally) were compared with 22 CMV-negative preterm infants individually matched for gestational age, birth weight, gender, intracranial hemorrhage and duration of ventilation. At 2 to 4.5 years of age, follow-up assessments were conducted consisting of neurologic examination, neurodevelopmental assessment and detailed audiologic tests. RESULTS: None of the children had sensorineural hearing loss. There was no difference between the groups with regard to neurologic, speech and language or motor development. CONCLUSION: The results of this study suggest that early postnatally acquired CMV infection via CMV-positive breast milk does not have a negative effect on neurodevelopment and hearing in this group of patients. Because we studied a small number of infants, further follow-up studies are warranted in preterm infants with early postnatally acquired CMV infection.     

Site-specific intracoronary delivery of octreotide in humans: a pharmacokinetic study to determine dose-efficacy in restenosis prevention

Somatostatin analogues have been shown to inhibit smooth muscle cell proliferation after local administration in vivo in animal models and in vitro using human coronary smooth muscle cell cultures. However, the optimal dosage for attaining effective site-specific administration remains undefined. This study was performed to determine the required theoretical dose of the somatostatin analogue, octreotide, to be delivered site specifically, for prevention of restenosis after coronary angioplasty in humans using a previously described methodology to determine regional pharmacokinetics of site-specific intracoronary administrated compounds. In 7 patients, 111In-octreotide, a gamma-labeled somatostatin analogue, was infused post angioplasty at the site of dilatation via a coil-balloon and quantified using a radio-isotopic technique. Efficiency of delivery ranged from 0.1% to 2.7% of the total infused dose of 0.18 microg, corresponding to a mean peak delivered amount of 1.8 +/- 1.9 ng. Total locally bioavailable 111In-octreotide reached 2.28 +/- 2.15 ng h. Based on current in vitro bioavailability and peak concentration data to inhibit proliferation and thymidine incorporation in human coronary smooth muscle cells, a 4000x higher averaged dose (approximately 700 microg) should be infused site specifically to obtain a biologic efficacy in 50% of the treated patients (ED50). Quantification of regional pharmacokinetics enables the determination of a theoretical site-specific dose for achieving appropriate bioavailability above the therapeutic threshold concentration for smooth muscle cell inhibition. This approach is proposed for the determination of the appropriate site-specific coronary infusion dose for the inhibition of restenosis after balloon angioplasty.