Rezeptive Felder und Neuroplastizität

In addition to the recently published series of papers concerning translational research and manual medicine this article also intends to correlate the results of basic pain research and clinical observations. The contents of this publication are also continuously compared and agreed in consensus between the participating basic research scientists and the clinical physicians. Neuroanatomy and neurophysiology of primary, secondary and tertiary receptive fields are explained. The mechanisms responsible for the different range and function of receptive fields, so-called neuroplasticity, are outlined in relation to clinical symptoms or syndromes. Hypotheses concerning segmental mechanisms on the synaptic level and the clinical consequences are described. Enlargement of nociceptive receptive fields can weaken the efficacy of inhibitory receptive fields and can even induce adverse effects of functional therapy based on intended activation of inhibitory receptive fields. Pseudoradicular pain, head zones and referred pain are clinical signs of enlarged secondary nociceptive receptive fields which have to be considered therapeutically with respect to the special aspect of central sensitization. By being aware of these interdependencies the suitable mechanism-oriented therapy can be specifically and effectively implemented.     

大花紫玉盘中新多氧取代环己烯类的结构鉴定

从番荔枝科紫玉盘属植物大花紫玉盘( Uvaria grandiflora Roxb.)根茎中分得4种新的多氧取代环己烯及已知化合物zeylenol,应用波谱分析、X-射线衍射、园二色谱和 Mosher 酯制备等手段确定了全部新化合物的结构及其绝对构型,分别命名为大花紫玉盘醇A(1),B(2),E(3)和F(4)。     

Plasmodium falciparum associated placental pathology: a light and electron microscopic and immunohistologic study

Pathological changes were studied by light and electron microscopy on term placentas collected in Malawi from 20 P. falciparum infected women (11 primiparas and 9 multiparas). One placenta from an uninfected term primipara and 4 from multiparas were studied as controls. Changes included the presence of parasitized erythrocytes and malarial pigment particles in the intervillous space, excessive syncytial knotting, chronic basal villitis, malarial pigment deposits in the trophoblasts, trophoblastic damage with focal necrosis, partial loss of microvilli, and thickening of the trophoblastic basement membrane. Infected erythrocytes were not seen in the fetal circulation. Severity appeared to correlate with the level of maternal and placental parasitemias, regardless of infant birth weight or placental weight. Differences in the severity of pathological changes between primiparas and multiparas could not be demonstrated. Immunohistochemistry revealed that 45% of the placentas stained strongly for IgG and 15% stained for C3 and for P. falciparum antigens in the trophoblastic cytoplasm and basement membrane.     

Endocrine tumors of the duodenum. A study of 55 cases relative to clinicopathological features and hormone content

BACKGROUND/AIMS: Study of prognosis of duodenal endocrine tumors. METHODOLOGY: Retrospective study concerned 55 duodenal endocrine tumors discovered in biopsy or surgical specimens. Follow-up records available for 49 patients indicated that inconspicuous associated clinical manifestations were often found subsequently. Seven patients were classified as Zollinger-Ellison syndrome and seven as multiple endocrine neoplasia (6 MEN I and 1 MEN II). RESULTS: Tumors were small (mean 1.28cm) and located preferentially in the first and second part of the duodenum. Fifty-four were well-differentiated and one poorly differentiated. Immunochemistry revealed 30 G-cell tumors (54.6%), 15 D-cell (27.3%), two plurihormonal (EC cell and G cell), and one GRH-cell, whereas seven could not be classified. Fifteen patients died (five in relation to their disease). Twenty-one had metastases (liver, nodes, lung), eight of whom are still alive. CONCLUSIONS: Eighty-eight percent of duodenal endocrine tumors were gastrinomas, small plurifocal tumors and somatostatinomas preferentially located in the ampullar region and diagnosed because of hematemesis or icterus. Size is an important prognostic factor in determining whether surgery is required. The prognosis is better for D- and G-cell tumors than pancreatic endocrine tumors. Duodenal endocrine tumors in multiple endocrine neoplasia have a good prognosis, but can be associated with pancreatic plurihormonal tumors and metastases.     

Preoperative evaluation of chronic alcoholics assessed for surgery of the upper digestive tract

BACKGROUND: Alcoholics are at risk of developing major complications in the postoperative period. Adequate prophylactic treatment, as well as preoperative abstinence, can significantly decrease the rate of complications. However, the preoperative diagnosis of alcoholism is difficult to establish. The purpose of this study was to assess whether three preoperative visits, an alcohol-related questionnaire (CAGE), and the laboratory markers carbohydrate-deficient transferrin (CDT) and gamma-glutamyltransferase (GGT) would increase the rate of detection of chronic alcoholics. METHODS: The study included the Departments of ENT, Facial and Maxillofacial Surgery, and General Surgery of a university hospital; 705 male patients were assessed for tumor surgery of the upper digestive tract and were allocated to 5 different groups. All patients were seen three times, and five different strategies were used to detect chronic alcoholics. The gold standard was the diagnosis of alcohol misuse made by an experienced (blinded) investigator according to the DSM-III-R. The main outcome measurements were the detection rates of the different test strategies. RESULTS: By clinical routine alone, only 16% were detected during the first visit and 34% after three visits. If the CAGE questionnaire was added, sensitivity increased to 64%. The further addition of GGT or CDT led to 80 and 85% detections, respectively. A combination of all tests had a sensitivity of 91%. CONCLUSIONS: To detect more alcoholic patients at risk for major complications, patients should be seen more often, and additional diagnostic tools such as the CAGE, CDT, and GGT should be used before surgery.