Is there neuroprotection in Parkinson syndrome?

Journal of Neurology - Parkinson's disease (PD) is a neurodegenerative disorder of the aging population with unknown etiopathogenesis. It is assumed that the underlying pathobiochemical...     

Discontinuous Monitoring of Propofol Concentrations in Expired Alveolar Gas and in Arterial and Venous Plasma during Artificial Ventilation

Background: Analyzing propofol concentration in expired alveolar gas (cPA) may be considered as a convenient, noninvasive method to follow the propofol concentration in plasma (cPPL). In the current study, the authors established procedures to measure cPA and cPPL for the assessment of their relation in two animal models during anesthesia.

Methods: Expired alveolar gas and mixed venous and arterial blood were simultaneously sampled during continuous application of propofol for general anesthesia to three goats and three pigs. Propofol infusion rates were varied to modify plasma concentrations. cPA, sampled cumulatively over several respiratory cycles, was quantified by thermal desorption gas chromatography-mass spectrometry. cPPL was determined using reversed phase high-performance liquid chromatography with fluorescence detection.

Results: cPA ranged from 0 to 1.4 and from 0 to 22 parts per billion in goats and pigs, respectively, at cPPL of 0-8 [mu]g/ml. The relation between cPA and cPPL was linear; however, the slopes of the regression lines varied between animals.     

Demonstration of HPV 24 in long-standing Heck's disease with malignant transformation.

We report on the rare case of a 64-year-old European woman with a viral acanthoma of the oral mucosa of the clinical Heck type with unprecedented molecular-biological proof of HPV 24 DNA and so far undescribed malignant transformation with a long existence of the vegetation. After surgical therapy a circumscribed relapse of viral acanthoma developed, which responded favourably to a combined antiviral and antiproliferative therapy with acitretin perorally and interferon, first subcutaneously, later intralesionally for 3 months.     

„Es gibt nichts Gutes—außer, man tut es!“

Ohne Zusammenfassung     

Computer aided time-lapse video analysis of hepatocyte morphology during adhesion to cellulose membranes

An investigation was performed to demonstrate that time-lapse cinematography and computer aided video analysis of cell morphology is suitable to study and compare the characteristics of hepatocytes during the adhesion process to membranes. We chose to compare ordinary cellulose Cuprophan membranes and membranes coated with collagen or fibronectin. Striking differences between uncoated cellulose and fibronectin or collagen coating were seen in the cell count per square millimeter and adhesion behaviour. On the investigated uncoated Cuprophan the hepatocytes were found to attach but not to spread whilst on collagen coated Cuprophan most of the cells spread spherically, and on fibronectin coated membranes most of the cells flattened spherically or polygonally. Time-lapse video microscopy seems to be a valuable technique for assessing the morphologic behaviour of cells in a detailed and quantitative manner in order to improve the hepatocyte culture technique in bioreactors for hybrid systems.     

Prognostic validation of a 17-segment score derived from a 20-segment score for myocardial perfusion spect interpretation

BACKGROUND: Recently, a 17-segment model of the left ventricle has been recommended as an optimally weighted approach for interpreting myocardial perfusion single photon emission computed tomography (SPECT). Methods to convert databases from previous 20- to new 17-segment data and criteria for abnormality for the 17-segment scores are needed. METHODS AND RESULTS: Initially, for derivation of the conversion algorithm, 65 patients were studied (algorithm population) (pilot group, n = 28; validation group, n = 37). Three conversion algorithms were derived: algorithm 1, which used mid, distal, and apical scores; algorithm 2, which used distal and apical scores alone; and algorithm 3, which used maximal scores of the distal septal, lateral, and apical segments in the 20-segment model for 3 corresponding segments of the 17-segment model. The prognosis population comprised 16,020 consecutive patients (mean age, 65 +/- 12 years; 41% women) who had exercise or vasodilator stress technetium 99m sestamibi myocardial perfusion SPECT and were followed up for 2.1 +/- 0.8 years. In this population, 17-segment scores were derived from 20-segment scores by use of algorithm 2, which demonstrated the best agreement with expert 17-segment reading in the algorithm population. The prognostic value of the 20- and 17-segment scores was compared by converting the respective summed scores into percent myocardium abnormal. Conversion algorithm 2 was found to be highly concordant with expert visual analysis by the 17-segment model (r = 0.982; kappa = 0.866) in the algorithm population. In the prognosis population, 456 cardiac deaths occurred during follow-up. When the conversion algorithm was applied, extent and severity of perfusion defects were nearly identical by 20- and derived 17-segment scores. The receiver operating characteristic curve areas by 20- and 17-segment perfusion scores were identical for predicting cardiac death (both 0.77 +/- 0.02, P = not significant). The optimal prognostic cutoff value for either 20- or derived 17-segment models was confirmed to be 5% myocardium abnormal, corresponding to a summed stress score greater than 3. Of note, the 17-segment model demonstrated a trend toward fewer mildly abnormal scans and more normal and severely abnormal scans. CONCLUSION: An algorithm for conversion of 20-segment perfusion scores to 17-segment scores has been developed that is highly concordant with expert visual analysis by the 17-segment model and provides nearly identical prognostic information. This conversion model may provide a mechanism for comparison of studies analyzed by the 17-segment system with previous studies analyzed by the 20-segment approach.     

Integration of automatically measured transient ischemic dilation ratio into interpretation of adenosine stress myocardial perfusion SPECT for detection of severe and extensive CAD.

The aim of our study was to derive and to validate the normal threshold for an automatically measured left ventricular transient ischemic dilation (TID) ratio in patients referred for adenosine stress myocardial perfusion SPECT (MPS) and to assess the value of integrating TID in detecting severe and extensive coronary artery disease (CAD). METHODS: Normal limits for the TID ratio were derived using dual-isotope MPS data from 38 patients with a low (<5%) likelihood of CAD. Criteria for abnormality were calculated on the basis of data from 179 consecutive patients who had undergone coronary angiography less than 3 mo after index adenosine MPS: 41 patients (23%) had severe and extensive CAD (> or =90% stenosis) in the proximal left anterior descending artery or in 2 or more coronary arteries, 64 (36%) had no significant CAD (<70% stenosis), and 74 (41%) had mild or moderate CAD. The criteria were then prospectively validated in a cohort of 177 patients, of whom 41 patients (23%) had severe and extensive CAD, 55 (31%) had no significant CAD, and 81 (46%) had mild or moderate CAD. RESULTS: By analysis of receiver-operating-characteristic curves, the best threshold for adenosine TID ratio abnormality was the mean adenosine TID ratio in the low-CAD-likelihood patients + 2 SDs (TID ratio > 1.36). Abnormal TID ratio using this threshold demonstrated high sensitivity and specificity for severe and extensive CAD (71% and 86%, respectively), and similar sensitivity and specificity were observed in the prospective validation group (73% and 88%, respectively). In the combined pilot and validation groups, the absence of both abnormal TID ratio and abnormal perfusion was highly specific for the absence of severe and extensive CAD; only one (1.3%) of 79 patients with severe and extensive CAD had neither of these abnormal findings on adenosine MPS. In patients with both abnormal TID ratio and abnormal perfusion, 55 of 84 (65%) had severe and extensive CAD. When patients had one but not both of these findings, 26 of 193 (13%) had severe and extensive CAD. CONCLUSION: The automatically measured TID ratio is a useful clinical marker that is sensitive and highly specific for identification of severe and extensive CAD in patients undergoing adenosine MPS. Integration of abnormal TID ratio into the dual-isotope MPS image interpretation algorithm improves the identification of severe and extensive CAD in adenosine MPS.     

Guidelines for Sclerotherapy of Varicose Veins (ICD 10: I83.0, I83.1, I83.2, and I83.9)

BACKGROUND: Sclerotherapy is the targeted elimination of intracutaneous, subcutaneous, and/or transfascial varicose veins (perforating veins) as well as the sclerosation of subfascial varicose vessels in the case of venous malformation by the injection of a sclerosant. With duplex-guide sclerotherapy and foam sclerotherapy, modified methods came into use. OBJECTIVE: The objective was to create a guideline, based on the available publications and on the European Consensus Document on foam sclerotherapy from April 2003. METHODS: This guideline was drafted on behalf of the German Society of Phlebology (Deutsche Gesellschaft für Phlebologie) and adopted by the committee and scientific advisory board of the Deutsche Gesellschaft für Phlebologie on June 15, 2001, and amended on December 5, 2003. The guideline considers the present state of knowledge as reflected in the literature. CONCLUSIONS: This guideline represents the recent state of the art of sclerotherapy of varicose veins in Germany including foam sclerotherapy.     

Simplified normal limits and automated quantitative assessment for attenuation-corrected myocardial perfusion SPECT.

BACKGROUND: We aimed to compare normal limits and the detection of coronary artery disease (CAD) with attenuation-corrected (AC) and non-attenuation-corrected (NC) myocardial perfusion single photon emission computed tomography (MPS) by use of a recently improved automated quantification technique. METHODS AND RESULTS: We acquired 415 rest/stress technetium 99m MPS studies on a Vertex dual-detector camera with a gadolinium 153 line source (Vantage Pro). Gender-specific NC, AC, and gender-combined AC normal limits were created from rest/stress images of 50 women and 50 men with a low likelihood of CAD (< 5%) and a median body mass index (BMI) of 30 kg/m2 in each gender group. BMI-specific normal limits (< 30 kg/m2 and > or = 30 kg/m2) were also compared. Total perfusion deficit and 17-segment summed scores in 174 patients were compared with angiography, and normalcy rates were established from 141 studies of low-likelihood patients. There were no differences between low-BMI and high-BMI normal limits for AC or NC studies. Male and female normal limits differed in 12 of 17 segments for NC stress studies and in 3 of 17 segments for AC stress studies (P < .01). The sensitivity, specificity, and normalcy rates for stenoses with 70% narrowing or greater were 89%, 73%, and 91%, respectively, for NC studies and 87%, 80%, and 95%, respectively, for AC studies (P = not significant). CONCLUSION: Automated detection of CAD by AC and NC MPS demonstrated similar sensitivity, specificity, and normalcy rates. Some gender differences were noted for AC normal limits.