To What Extent Can We Trust Home Blood Pressure Measurement? A Randomized,Controlled Trial

Increasingly, patients measure and record their home blood pressure. However, the accuracy with which they report their readings to their physicians is largely unknown. The authors assessed the accuracy and quality of self-reported home blood pressure values in an ambulatory managed care population. Forty-eight hypertensive outpatients were randomly allocated to either receive information about the storage capabilities of a home blood pressure measuring device or not to receive such information. All patients were asked to record the measurement results in a logbook twice daily over a 7-day period. The main outcome measure was the difference in the number of fictional or manipulated reports per group and the difference in missing values. The combined parameter manipulated or fictional registrations occurred significantly less frequently in the informed group than in the noninformed group. (10/728 vs. 29/616; relative risk, 0.292; 95% confidence interval, 0.15-0.57; Pearson chi squared=13.15; p<0.0001). Informed patients had fewer missing registrations than the noninformed (13/728 vs. 41/616 measurements; relative risk, 0.27; 95% confidence interval, 0.15-0.47; Pearson chi squared =20.5; p<0.0001). The mean of the fictional data did not differ systematically from the mean of the correctly reported individual blood pressure values. There was no trend to over- or underestimate blood pressure values in the noninformed group. With this study design, it was possible to identify manipulation of home blood pressure values for the first time. Accuracy and interpretation of home blood pressure measurement may be increased by using devices with a memory function.     

Generation of an apoptotic intracellular peptide by gamma-secretase cleavage of Alzheimer's amyloid beta protein precursor

The amyloid beta protein precursor (AbetaPP) is sequentially processed by beta- and gamma-secretases to generate the Abeta peptide. The biochemical path leading to Abeta formation has been extensively studied since extracellular aggregates of amyloidogenic forms of Abeta peptide (Abeta42) are considered the culprit of Alzheimer's disease. Aside from its pathological relevance, the biological role of AbetaPP proteolysis is unknown. Although never previously described, cleavage of AbetaPP by gamma-secretase should release, together with Abeta, a COOH-terminal AbetaPP Intracellular Domain, herein termed AID. We have now identified AID-like peptides in brain tissue of normal control and patients with sporadic Alzheimer's disease and demonstrate that AID acts as a positive regulator of apoptosis. Thus, overproduction of AID may add to the toxic effect of Abeta42 aggregates and further accelerate neurodegeneration.     

A new nephelometric assay for beta-trace protein (prostaglandin D synthase) as an indicator of liquorrhoea

OBJECTIVES: To determine the sensitivity and specificity of a nephelometric beta-trace protein assay for the diagnosis of liquorrhoea. METHODS: One hundred and forty clinical samples with suspected liquorrhoea were analysed by a newly developed nephelometric assay. An established electroimmunoassay served as a reference method. The sensitivity and specificity of the beta-trace nephelometric assay were calculated by a 2x2 contingency table for 10 different versions of a dichotomised nephelometric variable. In 52 patients (79 samples), the nephelometric findings were validated by referring to the clinical diagnosis based on the course of the disease, imaging techniques, and surgical inspection. RESULTS: Given a specificity of 100%, a beta-trace protein concentration of 6 mg/l or higher in a sample indicated liquorrhoea with a sensitivity of 92% compared with the reference method and of 93% compared with the clinical evaluation. The relation between the electroimmunoassay and the nephelometric assay was highly significant (p<0.001). CONCLUSIONS: The nephelometric beta-trace protein assay is a simple and rapid method for the detection of liquorrhoea with high sensitivity and specificity and may facilitate the diagnosis of fistulas leaking CSF.     

Quantification of aortic valvular insufficiency by MRI

Flow-encoded MRI sequences nowadays allow a quantitative evaluation of blood flow in any slice position. For the first time there is the possibility of determining quantitatively the volumes of both left ventricular ejection and regurgitation over the aortic valve in a non-invasive ways, thus obtaining the regurgitation fraction as a reliable measure for the evaluation of aortic valvular insufficiencies. The quantitative assessment of aortic valvular insufficiencies was carried out by MRI and compared with the diagnosis by means of Doppler ultrasound and in some cases by cardiac catheter also. The new MRI method is characterized by a good correlation with the clinical grading of aortic valvular insufficiencies. It should be possible to develop a new non-invasive standard for quantifying aortic valvular insufficiencies. Correspondence to: G. Engels     

Accidental drowning with extreme hypothermia--rewarming with extracorporeal circulation

A 3 1/2 year old boy had fallen into a fishpond. After about one hour the boy was brought to our hospital. He was cyanotic and bloated, the rectal temperature was 18.4 degrees C. There was no heart beat, the pupils were wide without reaction to light. Via a sternotomy the heart lung machine was connected and core rewarming was achieved. After 7 days of artificial respiration the boy could be extubated, after 16 days the boy left our hospital without neurological consequences.     

Duodenal duplication. Case report and review of the literature

A case of duodenal duplication (cyst) in a 42-year-old male is reported. The late manifestation of this rare, little-known, but noteworthy congenital malformation was characterized by repeated attacks of acute pancreatitis and development of a high, duodenal obstruction. Radiographic examination and fiberoptic endoscopy was followed by exploratory laparotomy which demonstrated the accurate diagnosis. A review of the literature including 39 duodenal duplications in more than 300 duplications of the alimentary tract is presented.