Histopathological validation of a three-dimensional magnetic resonance spectroscopy index as a predictor of tumor presence

OBJECT: Data obtained preoperatively from three-dimensional (3D)/proton magnetic resonance (MR) spectroscopy were compared with the results of histopathological assays of tissue biopsies obtained during surgery to verify the sensitivity and specificity of a choline-containing compound-N-acetylaspartate index (CNI) used to distinguish tumor from nontumorous tissue within T2-hyperintense and contrast-enhancing lesions of patients with untreated gliomas. The information gleaned from the biopsy correlation study was used to test the hypothesis that there is metabolically active tumor in nonenhancing regions of the T2-hyperintense lesion that can be detected using MR spectroscopy. METHODS: Patients suspected of harboring a glioma underwent 3D MR spectroscopy during their preoperative MR imaging examination. Surgical navigation techniques were used to record the location of tissue biopsies collected during open resection of the tumor. A receiver operating curve analysis of the CNI and histological characteristics of specimens at each biopsy location was performed to determine the optimal threshold of the CNI required to separate tumor from nontumorous tissue. Histograms of the CNIs within enhancing and nonenhancing regions of lesions appearing on MR images were generated to determine the spatial distribution of CNIs consistent with tumor. CONCLUSIONS: Biopsy samples containing tumor were distinguished from those containing a mixture of normal, edematous, gliotic, and necrotic tissue with 90% sensitivity and 86% specificity by using a CNI threshold of 2.5. The CNIs of nontumorous specimens were significantly different from those of biopsy specimens containing Grade II (p < 0.03), Grade III (p < 0.005), and Grade IV (p < 0.01) tumors. On average, one third to one half of the T2-hyperintense lesion outside the contrast-enhancing lesion contained CNI greater than 2.5.     

The opinion of general practitioners in East and west Germany on rehabilitation

GPs in the former German Democratic Republic (now called 'New Federal States') and in West-Germany (the 'Old Federal States') differ more than ten years after reunification in several respects. This survey shows that they have different attitudes to medical rehabilitation programmes as well. Written questionnaires were sent to all GPs in Hamburg and Schleswig-Holstein (representing the Old Federal States) and in Sachsen-Anhalt and Mecklenburg-Vorpommern (representing the New Federal States). GPs in the New Federal States value medical rehabilitation in general and single programmes more than those in the old ones. They see a higher number of patients who have a good benefit from rehabilitation and estimate the degree of overuse as smaller. They observe more often patients who do not take part in a rehabilitative programme because they are afraid of losing their job. The higher proportion of female GPs in the New Federal States does not explain these differences.     

Utilization of general (monitoring) practices based on environmental medicine problems

How often do general practitioners have to deal with environmental problems? To answer this question 23 GPs recorded all relevant consultations during one year in Hamburg. On an average, each of these GPs reported one contact once a month. The spectrum of both patient complaints and environmental sources was broad. The GP is less often convinced of a causal connection between both than the patient. In most cases a referral was not necessary. This study supports the assumption that the frequency of environmental problems in General Practice is--at least in the larger cities--lower than estimated from former studies and the self-image of general practice in Germany.     

Nitric oxide synthase-3 overexpression causes apoptosis and impairs neuronal mitochondrial function: relevance to Alzheimer's-type neurodegeneration

Dementia in Alzheimer's disease (AD) is correlated with cell loss that is mediated by apoptosis, mitochondrial (Mt) dysfunction, and possibly necrosis. Previous studies demonstrated increased expression of the nitric oxide synthase 3 (NOS3) gene in degenerating neurons of AD brains. For investigating the role of NOS3 overexpression as a mediator of neuronal loss, human PNET2 central nervous system-derived neuronal cells were infected with recombinant adenovirus vectors that expressed either human NOS3 or green fluorescent protein cDNA under the control of a CMV promoter. NOS3 overexpression resulted in apoptosis accompanied by increased levels of p53, p21/Waf1, Bax, and CD95. In addition, NOS3 overexpression impaired neuronal Mt function as demonstrated by the reduced levels of 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide and nicotinamide adenine dinucleotide (reduced form)-tetrazolium reductase activities and MitoTracker Red fluorescence. These adverse effects of NOS3 were associated with increased cellular levels of reactive oxygen species and impaired membrane integrity and were not produced in cells that were transfected with a cDNA encoding catalytically inactive NOS3. Importantly, modest elevations in NOS3 expression, achieved by infection with low multiplicities of adenovirus-NOS3 infection, did not cause apoptosis but rendered the cells more sensitive to oxidative injury by H(2)O(2) or diethyldithiocarbamate. In contrast, treatment with NO donors did not enhance neuronal sensitivity to oxidative injury. These results suggest that NOS3-induced neuronal death is mediated by Mt dysfunction, oxidative injury, and impaired membrane integrity, rather than by NO production, and that neuroprotection from these adverse effects of NOS3 may be achieved by modulating intracellular levels of oxidative stress.     

Clinical profile of astemizole. A survey of 50 double-blind trials

From clinical-pharmacologic and clinical data involving over 2,800 patients, astemizole appears to be a very effective and well-tolerated antihistamine. It is superior to placebo and commonly used antihistamines for the relief of rhinitis, particularly rhinorrhea and sneezing. It has a pronounced effect on ocular itching and lacrimation in conjunctivitis and on pruritus and wheals in urticaria. This superiority is due to a very specific, almost complete and sustained histamine H1-blockade. The clinical data confirm the experimental data in relation to its lack of sedative effects.     

CSF rhinorrhea: detection and localization using overpressure cisternography with Tc-99m-DTPA

We performed 32 overpressure radionuclide cisternography (ORNC) studies to examine 26 patients who were clinically suspected of having cerebrospinal fluid (CSF) fistula with rhinorrhea. Fifteen (47%) of these cisternography studies were positive, and the site of the leak was identified. No leak could be demonstrated in the other 17. Of 23 examinations performed in patients who had clinically documented CSF rhinorrhea, 15 (65%) were scintigraphically positive. The rapid cephalad transit of the radionuclide bolus allowed completion of the study within 30 to 45 minutes. Seven examinations were also performed with overpressure metrizamide CT cisternography (OMCTC), and five demonstrated concordant results with the radionuclide study. Patient discomfort and side effects were minimal. We conclude that radionuclide infusion cisternography is a safe, rapid, and accurate method of investigating a suspected or proven CSF rhinorrhea and that it is complementary to metrizamide cisternography.     

Medizin des Alterns und des alten Menschen Unterrichtskonzept im Querschnittsbereich Q7 der Approbationsordnung und erste Evaluierung durch Studierende

Inhalte der Altersmedizin wurden bislang im Medizinstudium in Deutschland nur vereinzelt und fakultativ an Universitäten und Medizinischen Hochschulen angeboten. Die reformierte Approbationsordnung enthält als einen neuen Querschnittsbereich die „Medizin des Alterns und des alten Menschen“ obligatorisch im klinischen Studienabschnitt. Verbindliche Lerninhalte liegen für diesen Querschnittsbereich jedoch nicht vor. Dieser Bericht beschreibt deshalb ein neu entwickeltes Curriculum mit seinem Schwerpunkt auf Seminaren in kleinen Gruppen, die ersten Erfahrungen sowie die Ergebnisse der Evaluation des Unterrichts durch Studierende an der Universität Hamburg. Die Ergebnisse belegen eine hohe Akzeptanz von Inhalt und Form des Unterrichts, der von den befragten Studierenden als interessant und lehrreich eingeschätzt wurde.