A left nonrecurrent inferior laryngeal nerve in a patient with right-sided aorta, truncus arteriosus communis, and an aberrant left innominate artery

The identification and prevention of injury to the inferior laryngeal nerve is one of the main issues in thyroid surgery. Sound knowledge of anatomic variants of the nerve is of major importance. In rare cases the nerve does not run the recurrent way and it is therefore difficult to identify the nerve. Abnormal developments of the aortic arch during embryogenesis include malformation of the great vessels and can be the reason for anatomic abnormalities. A cause for a nonrecurrent nerve on the right side is the so-called lusorian artery, a right retroesophageal subclavian artery. Left-sided nonrecurrent nerves are seldom if ever documented. Only two cases have been published so far of patients with situs inversus viscerum, where left nonrecurrent nerves were associated with inverse, left-sided lusorian arteries.     

Relationship of cerebrospinal fluid immune activation associated factors to HIV encephalitis.

OBJECTIVES AND DESIGN: Because macrophages are the predominant immune cell and the predominant infected cell in the brains of patients with HIV encephalitis, we studied macrophage and immune activation-associated factors in the cerebrospinal fluid (CSF) from 39 autopsied AIDS cases for whom complete neuropathologic evaluation of the brain was available. RESULTS: CSF HIV p24 antigen was present in less than one-third of cases (11 out of 39). Less than half of the autopsies with moderate to severe parenchymal infection by HIV had high levels of CSF p24, although all autopsies with elevated levels of HIV p24 had moderate to severe HIV encephalitis. Elevated levels of cytokines, beta 2-microglobulin, neopterin, and quinolinic acid were observed. CONCLUSIONS: Although many of the CSF findings showed a strong correlation with each other, none showed a strong correlation with the severity of HIV infection of the brain itself. The absence of a close association between CSF abnormalities and HIV encephalitis could reflect the abundance of complicating opportunistic infections in these terminally ill patients or the inadequacy of CSF as a marker of basal ganglia involvement in HIV encephalitis. These findings complicate interpretation of clinical studies of CSF in patients with AIDS where neuropathologic evaluation is unavailable.     

视网膜母细胞瘤色素上皮-脉络膜分期与视神经浸润的关系

为探讨视网膜母细胞瘤色素上皮-脉络膜分期与视神经浸润的关系，于光镜下观察297例原发视网膜母细胞瘤摘除眼球的组织病理切片中视网膜色素上皮、玻璃膜和脉络膜的变化及视神经浸润的情况。将视神经浸润分为视神经无浸润（NO），筛板前浸润（N1）,筛板浸润（N2），筛板后浸润(N3)4其.结果显示，NO占61.95%，N1占21.21％，N2占10.78％，N3占6.06％。在视神经浸润度为N0-N2时，色素上皮-脉络膜分期也处于1期和Ⅱ期，此时视神经和球壁的局部屏障尚未破坏，肿瘤细胞转移率仅为0.73％，而视神经浸润破坏筛板屏障时（N3），色素上皮-脉络膜分期也达到Ⅳ期，此时肿瘤细胞转移率高达11.76％。因此，随着视神经浸润度的加深，色素上皮-脉络膜分期的程度也加重，肿瘤细胞发生转移的可能性也增大。     

Computerized calculation scheme for bitoric eikonic intraocular lenses

Despite full correction of the corneal astigmatism with toric intraocular lenses, the retinal image is distorted and the lateral image-object magnification is different in different meridians. The purpose of this study is to describe an iteration strategy for tracing an axial pencil of rays through the 'optical system eye' containing astigmatic refractive surfaces with their axes at random to calculate a thick bitoric lens implant which eliminates image distortion. The capabilities of this computing scheme are demonstrated with two clinical examples. We present a mathematically straightforward computer-based strategy for the calculation of thick bitoric eikonic lens implants. The iteration algorithm is initialized with a spherical front and a toric back surface and stepwise decreases the image distortion by adding cylinder lenses to the front lens surface corrected by the toric lens back surface. Total magnification can be modulated by varying the front-to-back surface power of the thick lens.     

Gadolinium-enhanced T1-weighted versus T2-weighted imaging of scrotal disorders: Is there an indication for MR imaging?

To evaluate the use of gadopentetate dimeglumine in magnetic resonance (MR) imaging of scrotal disorders, the clinical, ultrasound, and MR imaging data of 29 patients (age range, 19–75 years) with various intra- and extratesticular disorders were retrospectively analyzed. T1- and T2-weighted spin-echo images (T1-T2 group) were compared with T1-weighted spin-echo images before and after intravenous administration of gadopentetate dimeglumine (T1-Gd group). A receiver operating characteristic (ROC) analysis of the findings was undertaken. Better contrast between tumor and parenchyma and a clearer demonstration of the tunica albuginea were noted in the T1-T2 group (although not of diagnostic relevance). ROC analysis revealed no differences between the two imaging groups in the diagnosis of tumor, trauma, hydrocele, or hemorrhage; however, epididymitis was diagnosed more easily with contrast enhancement (0.8834 vs 0.7759, P = .04) and the diagnosis of orchitis was expressed more strongly (0.8221 vs 0.7184, P = .17). Four of the five observers were more confident in making the diagnosis with contrast enhancement. With MR imaging, the diagnosis was correctly suggested in three patients in whom clinical and ultrasound data were inconclusive. Gadolinium-enhanced MR imaging gives additional information in scrotal disorders and facilitates diagnosis. It may be helpful when findings at physical examination and ultrasound differ and when plain T1- and T2-weighted images are equivocal.     

The educational concept “primary school in motion” and its influence on the constitutional development and other features

The intention of the educational concept “Bewegte Grundschule” (‘school in motion’) is not only to change school education in general but also, literally, to replace sitting by movement. Movement of the pupils during classes is used to support teaching. In addition, the program aims to mediate physical exercise as a fundamental part of healthy living and more specifically, to improve posture, coordination and physical control. During the period of 1996 - 2000 the program “Bewegte Grundschule” was installed and scientifically controlled in four primary schools in Saxony and in one school in Rhineland-Palatinate. In this work, anthropometrics values, strength and mobility (functional muscle tests by Janda, Kendall) as well as posture (video recording of standardised positions which allows the analysis of the sagittal spine relie\ were studied. 183 children at the five test schools and for comparison, 88 children at four control schools were included in the analysis. Measurements were taken at the beginning of the first year and at the respective ends of the first to fourth year. Data revealed that the children of the schools, which participated in the program, showed a better development with respect to coordination, muscle strength and posture during the first four years of primary school.     

Systemic liberation of interleukin-8 in the perioperative phase of liver transplantation

Serum levels of interleukin-8 (IL-8) were investigated in the perioperative phase of liver transplantation (LTx) in order to help determine whether this cytokine might serve as a parameter for preservation injury. In a study of 45 patients undergoing LTx, systemic IL-8 was estimated at the end of the anhepatic phase, at 30, 60, and 120 min after reperfusion of the graft, and 24 h and 7 days after LTx. A maximum mean concentration of 665 ± 135 pg/ml was seen 60 min after LTx. The minimum was found on the 1st postoperative day (POD 1): 328 ± 33 pg/ml. Significant changes were found between 60 min and PODs 1 and 7, as well as between 120 min and POD 1. Differences in cold ischemia time were not found to be significant. We conclude that monitoring of systemic IL-8 levels is not useful in the development of new liver preservation concepts. Received: 12 September 1996 Received after revision: 27 February 1997 Accepted: 3 March 1997     

Nitroketenaminale, 8. Mitt.: Synthese von 4-Aryl-2,6-diamino-3,4-dihydro-3,5-dinitropyridinen

Nitroketenaminals, VIII: Synthesis of 4-Aryl-2,6-diamino-3,4-dihydro-3,5-dinitropyridines The synthesis of the title compounds 5 resp. 7 from aldehydes 2 resp. 6a , b and primary/tertiary nitroketenaminals 1c,d,e is described. The reaction of 1b and 2 leads to a 1,4-dihydropyridine 5bA .     

18FDG PET and acetazolamide-enhanced99mTc-HMPAO SPET in systemic lupus erythematosus

In systemic lupus erythematosus (SLE), brain and kidney are the most frequently affected organs. Measurements of cerebral blood flow and metabolism by means of positron emission tomography (PET) and single-photon emission tomography (SPET) can contribute to the diagnostic assessment of the involvement of the central nervous system (CNS) in SLE. Functional imaging has been proven to be more sensitive than morphological imaging (magnetic resonance imaging and computed tomography). In this report, we present the case of a 70-year-old female patient, suffering from SLE without symptoms of CNS involvement. In addition to a SPET study using technetium-99m hexamethylpropylene amine oxime (^99mTc-HMPAO) and a PET scan with fluorine-18 deoxyglucose (¹⁸FDG), a SPET study after acetazolamide injection was performed in order to assess the cerebral perfusion reserve. While the PET scan showed no major abnormalities, and the baseline SPET study revealed only minor changes, the acetazolamide-enhanced SPET study revealed a marked reduction of the cortical perfusion reserve, particularly in both frontal lobes. It is concluded that preclinical CNS involvement, mainly caused by pathological mechanisms involving the cerebral blood vessels, can be considered to exist in this patient with SLE.