Seizures and non-ketotic hyperglycemia

In patients older than 50 years, a first seizure can reveal non-ketotic hyperglycemia, regardless of any previous history of diabetes mellitus. Partial motor seizures are observed in most cases, sometimes with epilepsia partialis continua. Plasma glucose levels are usually above 20 mmol/L, and serum osmolarity is normal or slightly elevated. The absence of ketoacidosis may promote the occurrence of seizures. EEG and neuroimaging between seizures are usually normal. Treatment involves correction of the hyperglycemia with insulin treatment and rehydration.     

Pumpless extracorporeal lung assist (pECLA) in patients with acute respiratory distress syndrome and severe brain injury

BACKGROUND: A retrospective analysis was performed to estimate the practicability of a pumpless extracorporeal lung assist system (pECLA) in trauma patients suffering from severe brain injury and the acute respiratory distress syndrome (ARDS). METHODS: Five patients with acute severe brain injury and ARDS, ventilated in a lung protective mode, were connected to pECLA to avoid the detrimental effects of hypercapnia on intracranial pressure (ICP) and cerebral outcome. With pECLA hypercapnia was eliminated in all patients while the minute volume of artificial ventilation could be reduced. Subsequently, ICP was reduced, systemic hemodynamics and cerebral perfusion pressure remained stable. One patient died due to multi-organ failure as a consequence of multi-trauma. The remaining patients survived showing a good neurologic function. CONCLUSIONS: pECLA is a promising alternative compared with conventional pump-driven systems for patients with ARDS and brain injury, since the pECLA system has minor restrictions, limitations and side effects.     

Integrated intensive treatment of tinnitus: method and initial results

In recent years, no major advances have been made in understanding the mechanisms underlying the development of tinnitus. Hence, the present therapeutic strategies aim at decoupling the subconscious from the perception of tinnitus. Mindful of the lessons drawn from existing tinnitus retraining and desensitisation therapies, a new integrated day hospital strategy of treatment lasting 7-14 days has been developed at the Charité Hospital and is presented in the present paper. The strategy for treating tinnitus in the proximity of patient domicile is designed for patients who feel disturbed in their world of perception and their efficiency due to tinnitus and give evidence of mental and physical strain. In view of the etiologically non-uniform and multiple events connected with tinnitus, consideration was also given to the fact that somatic and psychosocial factors are equally involved. Therefore, therapy should aim at diagnosing and therapeutically influencing those psychosocial factors that reduce the hearing impression to such an extent that the affected persons suffer from strain. The first results of therapy-dependent changes of 46 patients suffering from chronic tinnitus are presented. The data were evaluated before and after 7 days of treatment and 6 months after the end of treatment. Immediately after the treatment, the scores of both the tinnitus questionnaire (Goebel and Hiller) and the subscales improved significantly. These results were maintained during the 6-month post-treatment period and even improved.     

American Podiatric Medical Association Best Walking City Competition, 2004

In 2004, the American Podiatric Medical Association conducted its third annual "Best Walking City Competition." This study improved on the 2002 and 2003 studies by increasing the number of cities competing for the title of "Best Walking City" and by including a variety of new measures of walking activities to provide a more comprehensive and equitable basis for comparing cities. The top 20 best walking cities in 2004 were identified from among the 200 largest cities across the United States. Lists of top cities were also developed by city population size and geographic region and by three different types of walking activities prevalent in each city.