Deep brain stimulation for Parkinson's disease dissociates mood and motor circuits: a functional MRI case study.

Behavioral disturbances have been reported with subthalamic (STN) deep brain stimulation (DBS) treatment in Parkinson's disease (PD). We report correlative functional imaging (fMRI) of mood and motor responses induced by successive right and left DBS. A 36-year-old woman with medically refractory PD and a history of clinically remitted depression underwent uncomplicated implantation of bilateral STN DBS. High-frequency stimulation of the left electrode improved motor symptoms. Unexpectedly, right DBS alone elicited several reproducible episodes of acute depressive dysphoria. Structural and functional magnetic resonance imaging (fMRI) imaging was carried out with sequential individual electrode stimulation. The electrode on the left was within the inferior STN, whereas the right electrode was marginally superior and lateral to the intended STN target within the Fields of Forel/zona incerta. fMRI image analysis (Analysis of Functional NeuroImages, AFNI) contrasting OFF versus ON stimulation identified significant lateralized blood oxygen level-dependent (BOLD) signal changes with DBS (P < 0.001). Left DBS primarily showed changes in motor regions: increases in premotor and motor cortex, ventrolateral thalamus, putamen, and cerebellum as well as decreases in sensorimotor/supplementary motor cortex. Right DBS showed similar but less extensive change in motor regions. More prominent were the unique increases in superior prefrontal cortex, anterior cingulate (Brodmann's area [BA] 24), anterior thalamus, caudate, and brainstem, and marked widespread decreases in medial prefrontal cortex (BA 9/10). The mood disturbance resolved spontaneously in 4 weeks despite identical stimulation parameters. Transient depressive mood induced by subcortical DBS stimulation was correlated with changes in mesolimbic cortical structures. This case provides new evidence supporting cortical segregation of motor and nonmotor cortico-basal ganglionic systems that may converge in close proximity at the level of the STN and the adjacent white matter tracts (Fields of Forel/zona incerta).     

The use of autogenous costal cartilage graft in septorhinoplasty

INTRODUCTION: Reconstructive septorhinoplasty in complex nasal deformities often requires harvesting a large amount of tissue for grafting. Autogenous septal cartilage has generally been considered the gold standard grafting material. The aim of this paper was to report our experience with the use of costal cartilage grafts in cases with significant structural deformities and insufficient septal cartilage. DESIGN: Retrospective chart review. PATIENTS: Between 1998 and 2006, 37 patients underwent septorhinoplasty using costal cartilage as the primary source for grafting. Twenty-two men and 14 women with a median age of 42 were enrolled in the study. Patient demographics, indications for surgery, and immediate and late complications were reviewed. The follow-up range was 3 to 72 months. CONCLUSIONS: Autogenous costal cartilage graft is a viable option in reconstructive septorhinoplasty. We advocate the use of this graft in septorhinoplasty cases requiring a large volume of tissue and insufficient septal cartilage.     

Antibodies in guinea-pigs immunized with kidney and lung basement membranes

The cross-reaction of antibodies to tubular basement membrane (TBM) with alveolar basement membrane (ABM) has been studied in guinea-pigs with tubulointerstitial (TI) nephritis. Forty-three of fifty-two Hartley guinea-pigs immunized with rabbit TBM in complete Freund's adjuvant developed TI nephritis. In addition to linear deposits of guinea-pig IgG and C3 in the TBM, thirty-two of the nephritic animals showed linear immune deposits in ABM; twelve of these animals had thickened alveolar septa and increased numbers of polymorphonuclear (PMN) leucocytes in lung tissue. Sera and eluates of kidney and lung from nephritic guinea-pigs reacted strongly with TBM and more weakly with ABM of normal animals. Absorption experiments suggested that antibodies to TBM and ABM were closely related or identical. Only a minority of guinea pigs immunized with TBM showed in vivo binding of IgG to glomerular basement membrane (GBM). Immunization of guinea-pigs with lung-homogenate-induced antibodies binding to TBM and ABM (in approximately 45% of animals) and to GBM (in approximately 30% of animals). Immunization with crude GBM-induced antibodies which reacted preferentially with TBM and ABM. In contrast, collagenase-treated GBM-induced antibodies preferentially reactive with GBM. TI nephritis was induced in both Strain 13 and Strain 2 guinea-pigs, but the nephropathy developed much faster in Strain 13 animals. Immunization with rabbit TBM-induced antibodies reactive with ABM in 25% of Strain 13 guinea-pigs and in 50% of Strain 2 guinea-pigs, respectively.     

COOP-WONCA charts: a suitable functional status screening instrument in acute low back pain?

BACKGROUND: Functional status is considered an important measure of health status in primary care. The COOP-WONCA charts, which comprise six single-item scales, have mainly been used to determine functional ability in chronically ill patients. AIM: A study was carried out to determine whether the charts are able to measure the degree of functional impairment associated with acute illness and the improvement in functional ability accompanying the process of recovery. METHOD: A total of 95 patients presenting with acute low back pain were recruited from 15 single-handed general practices in northern Germany. At presentation and at two-week follow up, these patients completed self-administered questionnaires which included the COOP-WONCA charts. The charts ask patients to use the timescale of the past two weeks when rating their condition. Baseline and follow-up measurements of the charts were compared and correlations of chart scores with patients' measurements of pain intensity on a visual analogue scale, general practitioners' ratings of impairment and patients' measurements of recovery were analysed. RESULTS: Only the chart measuring change in health revealed a deterioration in functional ability associated with the onset of pain and an improvement in functional status at follow up. Two of the other charts indicated a deterioration at follow up. Only the chart measuring change in health was correlated with ratings of pain and impairment at baseline. At follow up, strong correlations were found between general practitioners' assessments of impairment, patients' ratings of pain and patients' ratings of recovery for all scales except for those measuring social activities and daily activities. The patients interpreted the instructions for using the COOP-WONCA charts differently; some included the period of acute back pain while others did not. CONCLUSION: Of the six charts only the change in health chart proved to be a suitable scale for measuring short-term changes in functional ability among general practice patients with acute low back pain. This may partly be a result of patients misunderstanding the instructions. If the COOP-WONCA charts are used with acutely ill patients, the fixed two-weeks timescale is not appropriate. It is suggested that patients consider their present complaints when rating their condition.     

Die Serumlipoide unter besonderer Berücksichtigung des Plasmalogens

Zusammenfassung Unter Cortison kommt es bei Leberkranken zu einer Hyperplasmalogenämie, wie sie auch bei Gesunden unter gleichen Bedingungen beobachtet wird. Die Gesamtphosphatide schwanken wie die Cholesterinfraktionen und die Esterfettsäuren, ohne daß sich eine Gesetzmäßigkeit erkennen läßt.Die Ergebnisse wurden teilweise auf dem 3. Internationalen Kolloquium über die Biochemie der Lipoide, Brüssel 1956, mitgeteilt.     

Acute lung inflammation induced in the rabbit by local instillation of 1-0-octadecyl-2-acetyl-sn-glyceryl-3-phosphorylcholine or of native platelet-activating factor.

The intratracheal instillation into rabbits of 1-0-octadecyl-2-acetyl-sn-glyceryl-3-phosphorylcholine (AGEPC) or native platelet-activating factor (PAF) was shown to induce a dose-dependent acute pulmonary inflammation characterized by accumulation of macrophages in the alveolar space, degenerative and necrotic changes of alveolar epithelium, and accumulation of polymorphonuclear leukocytes (PMNs) and platelets in the alveolar capillary lumens with degenerative changes of endothelial cells. Infiltration of alveolar septa by inflammatory cells and, in a later stage, pulmonary fibrosis were also observed. Intrabronchial instillation of lysoglyceryl ether phosphorylcholine (lyso-GEPC) produced no inflammatory changes or only mild ones. In comparison with acute inflammation induced by intratracheal instillation of C5a des Arg, which is mainly characterized by the presence of neutrophils, red blood cells, and fibrin in the alveolar space, AGEPC and native PAF seem to induce a more severe accumulation of macrophages in the alveolar space and septa and of platelet and PMNs in the lumens of alveolar capillaries. These results are compatible with the concept that during inflammatory reaction an intraalveolar release of PAF contributes to the development of pulmonary injury.     

Circulating immune complexes and kidney lesions following 131I administration in mice with thyroglobulin antibodies

Immune complexes containing thyroglobulin have been described in kidneys of some patients with thyroid disease. We investigated the circulating immune complexes (with the Raji cell radioassay) and the kidney histopathology (by immunofluorescence and electron microscopy) in mice that received radioiodine to release thyroglobulin in the circulation, 2 or 4 weeks after immunization with mouse thyroglobulin in Freund's complete adjuvant. Circulating immune complexes and thyroglobulin, antibodies were found in all mice. Granular deposition of IgG, IgM, C3, and thyroglobulin, mainly in the mesangium but also in the capillary walls of the glomeruli, were observed in most of the mice. These experiments suggest that circulating immune complexes composed of thyroglobulin are responsible for the glomerular lesions. Hyperthyroid patients should be tested for thyroglobulin antibodies before treatment with radioiodine to avoid formation of thyroglobulin-containing circulating immune complexes.     

Sedation in palliative care - a critical analysis of 7 years experience

BACKGROUND: The administration of sedatives in terminally ill patients becomes an increasingly feasible medical option in end-of-life care. However, sedation for intractable distress has raised considerable medical and ethical concerns. In our study we provide a critical analysis of seven years experience with the application of sedation in the final phase of life in our palliative care unit. METHODS: Medical records of 548 patients, who died in the Palliative Care Unit of GK Havelhoehe between 1995-2002, were retrospectively analysed with regard to sedation in the last 48 hrs of life. The parameters of investigation included indication, choice and kind of sedation, prevalence of intolerable symptoms, patients' requests for sedation, state of consciousness and communication abilities during sedation. Critical evaluation included a comparison of the period between 1995-1999 and 2000-2002. RESULTS: 14.6% (n = 80) of the patients in palliative care had sedation given by the intravenous route in the last 48 hrs of their life according to internal guidelines. The annual frequency to apply sedation increased continuously from 7% in 1995 to 19% in 2002. Main indications shifted from refractory control of physical symptoms (dyspnoea, gastrointestinal, pain, bleeding and agitated delirium) to more psychological distress (panic-stricken fear, severe depression, refractory insomnia and other forms of affective decompensation). Patients' and relatives' requests for sedation in the final phase were significantly more frequent during the period 2000-2002. CONCLUSION: Sedation in the terminal or final phase of life plays an increasing role in the management of intractable physical and psychological distress. Ethical concerns are raised by patients' requests and needs on the one hand, and the physicians' self-understanding on the other hand. Hence, ethically acceptable criteria and guidelines for the decision making are needed with special regard to the nature of refractory and intolerable symptoms, patients' informed consent and personal needs, the goals and aims of medical sedation in end-of-life care.     

Release of O2- and LTC4 by murine eosinophils: role of intra- and extracellular calcium.

Using an experimental model of mouse peritoneal eosinophilia, we investigated the role of Ca2+ in the in vitro activation of these cells challenged with specific Mesocestoides corti antigen. We have detected LTC4, a metabolite derived from arachidonic acid by way of 5'lipo-oxygenase and superoxide anion from the oxidative burst, as inflammatory mediators produced by activated eosinophils. Preincubation with hyperimmune mice serum increases the amount of LTC4 and superoxide anion in response to the antigenic extract. Release of O2- is inhibited by Verapamil (a voltage-gated calcium channel) and Quin 2 (an intracellular trapped chelator of calcium). Also, LTC4 produced by preincubated eosinophils challenged with M. corti is dramatically inhibited by Quin 2. Our results suggest an intact mechanism for calcium control for the release of these inflammatory mediators by eosinophils, after specific antigenic stimulation.     

Titanium-porcelain system. Part III: effects of surface modification on bond strengths

During its development, titanium was found to be incompatible with conventional dental porcelains due to weak bond strength brought about by titanium's high yet oxidative nature. In spite of the development of new low-fusing porcelains designed for titanium application, previous studies have shown that sandblasting pre-treatment prior to porcelain application led to weakening of the metal-ceramic bonding. The aim of this study is to search for an effective alternative to sandblasting for the surface treatment of the titanium substrate in the titanium-porcelain system. The research evaluated the bond strength of 165 samples of titanium-porcelain systems divided into 11 groups. A three-point flexural bend test was conducted to measure the force required to fracture the porcelain on the titanium substrate. A correlation between the type of surface treatment and the bond strengths of each group was evaluated if it resulted to significant differences. The study found significantly differences in the energy-to-break of titanium-porcelain systems treated with hydrochloric acid and sandblasting compared with the control group. The bonds strength achieved by the titanium-porcelain system when treated with hydrochloric acid is comparable to that of conventional metal-ceramic alloy system. Hydrochloric acid treatment of the titanium substrate is a promising alternative to sandblasting for the surface treatment of the titanium substrate in the titanium-porcelain system.