Orbicularis oculi-Reflexe und Summenpotentiale des Orbicularis oris bei idiopathischer Facialislähmung

In 84 patients with idiopathic, clinically complete Bell's palsy the electrically induced blink reflexes with their two components (OOR I and II) were electromyographically recorded on both sides using skin electrodes. In 67 of these patients the evoked responses of the orbicularis oris muscle were also studied. The latencies and amplitudes were measured and related to the clinical outcome of the facial paralysis. The patients were divided into two groups, one with good recovery of the palsy (46 patients), the other with significant residual paresis and/or strong associated movements of the facial musculature (38 patients). In the group with good recovery the following results were obtained: 1. the OOR I remained elicitable or reappeated during the first 12 days after the onset of palsy; 2. the OOR II began to rise during the first 10 days of palsy; 3. the amplitude of the orbicularis oris response did not decrease to below 10%. In the group with poor recovery: 1. both components of the OOR were absent or diminished to below 4% for more than 12 days after the onset of palsy; 2. the latency difference of the OOR I exceeded 8 msec; 3. the amplitude of the orbicularis oris responses decreased to below 10%. Using these criteria it appears to be possible in about 85% of patients to make a prognosis between the 3rd to 5th and the 10th to 12th day after the onset of Bell's palsy.     

The pathology of cerebral edema

In a review of the literature dealing with cerebral edema the author analyzes concepts, pathogenetic mechanisms, and the recent classification into vasogenic and cytotoxic forms. The relationship between systemic and cerebral edema is discussed, as well as the effects of hydrocephalus. Among the factors with a significant relationship to cerebral edema, particular reference is given to intracranial hypertension, the cerebrospinal fluid, the blood-brain barrier, and the extracellular space.The criteria used in demonstrating the existence of edema of the brain at the gross, light microscopic, and ultrastructural levels are discussed, as well as essential biochemical alterations. The relationship of spongy encephalopathies to cerebral edema is analyzed and the conclusion drawn that at least some do indeed represent special forms of edema.The author stresses that more work on the mechanisms of resolution of cerebral edema needs to be done and concludes by outlining potentially useful avenues of investigation.     

CD38 low IgG-secreting cells are precursors of various CD38 high-expressing plasma cell populations

Despite the important role immunoglobulin G (IgG)-secreting plasma cells play in memory immune responses, the differentiation and homeostasis of these cells are not completely understood. Here, we studied the differentiation of human IgG-secreting cells ex vivo and in vitro, identifying these cells by the cellular affinity matrix technology. Several subpopulations of IgG-secreting cells were identified among the cells isolated from tonsils and bone marrow, particularly differing in the expression levels of CD9, CD19, and CD38. CD38 low IgG-secreting cells were present exclusively in the tonsils. A major fraction of these cells appeared to be early plasma cell precursors, as upon activation of B cells in vitro, IgG secretion preceded up-regulation of CD38, and on tonsillar sections, IgG-containing, CD38 low cells with a plasmacytoid phenotype were found in follicles, where plasma cell differentiation starts. A unitary phenotype of migratory peripheral blood IgG-secreting cells suggests that all bone marrow plasma cell populations share a common precursor cell. These data are compatible with a multistep model for plasma cell differentiation and imply that a common CD38 low IgG-secreting precursor gives rise to a diverse plasma cell compartment.     

Home transfer of 2,3,7,8-tetrachlorodibenzo-p-dioxin and beta-hexachlorocyclohexane?

Persons living together with workers who have been exposed to dioxins, furans or hexachlorocyclohexane, accumulate increased concentrations of these molecules in the blood and in fatty tissue, in comparison with normal people. This result is based on an investigation of 14 workers and their female partners. The workers had been contaminated with high concentrations of 2,3,7,8-TCDD and moderate concentrations of beta-HCH, respectively, in contrast with their female partners who had never been exposed to these poisons. Nevertheless, the female partners accumulated a significant amount of these molecules, corresponding to 10% of the concentrations of their male partners. The origin of this correlation is still unknown. As a working hypothesis, we discuss the possibility of molecular transfer by clothing and underwear. The clinical consequences of these findings are still unclear. Further observations are needed.     

Obstetric and nonmalignant gynecologic bleeding: treatment with angiographic embolization

Eight patients (seven post partum, one post abortion) with massive pelvic hemorrhage related to pregnancy and one patient with uncontrollable bleeding following a cervical biopsy underwent angiography to facilitate the identification and treatment of bleeding sites. In all nine patients pelvic hemorrhage was successfully controlled with embolization under angiographic guidance. Angiographic embolization allowed preservation of the uterus in six patients referred prior to hysterectomy, and one patient subsequently became pregnant. When conservative measures and minor surgical repairs have failed, embolization should be the next step in the treatment of postpartum hemorrhage to avoid major surgery in an unstable patient and to maintain reproductive function.