Induction of T helper cell type 1 response and elimination of HBeAg during treatment with IL-12 in a patient with therapy-refractory chronic hepatitis B

This study reports the increase of immunoregulatory T helper cell type 1 response and elimination of HBV-DNA during IL-12 therapy in a patient with chronic hepatitis B virus infection who had not responded to three previous interferon-alpha therapies and one treatment with Famciclovir over a period of 6 years. The patient received IL-12 at a dose of 0.5 microgram/kg bodyweight weekly. Peripheral blood mononuclear cells were isolated before and during IL-12 application and incubated for 7 days with specific type 1 (purified protein derivative) and type 2 (tetanus-toxoid) TH cell antigens as well as with a macrophage/monocyte activating antigen (Bacille Calmette-Guérin). In the supernatants cytokines were determined by a double-sandwich ELISA. After 8 weeks HBV-DNA became negative and HBeAg seroconversion to anti-HBeAg occurred. Immunologically the loss of viremia was accompanied by a strong increase of the purified protein derivative-induced production of the type 1 cytokine interferon-gamma (1219 pg/mL before, 13,138 pg/mL after IL-12 therapy). Furthermore, Bacille Calmette-Guérin-induced secretion of the macrophage/monocyte-associated cytokines IL-1, tumor necrosis factor-alpha and granulocyte-macrophage colony-stimulating factor was higher at the end of therapy. This case indicates that IL-12 enhances type 1 T helper cell activity which may be a predisposition for elimination of HBeAg and successful treatment of hepatitis B.     

Acute Isovolemic Anemia Does Not Impair Peripheral or Central Nerve Conduction

Background: Previous studies have found subtle slowing of responses in tests of addition and digit-symbol substitution during acute severe isovolemic anemia to a hemoglobin concentration of 5 g/dl in healthy unmedicated humans. In this study, the authors tested the hypothesis that such changes relate to the slowing of afferent neural traffic.

Methods: The median nerve was stimulated at the wrist in seven healthy unmedicated volunteers before and after induction of acute isovolemic anemia to a nadir hemoglobin concentration of 5.1 +/- 0.3 g/dl (mean +/- SD). Times for neural impulses to travel from the stimulus site to the brachial plexus, cervical spinal cord, and cerebral cortex were measured using somatosensory evoked potentials. Tests were repeated during acute anemia with the subject breathing oxygen. As a control for time and intrasubject variation, the testing was repeated on a separate day when anemia was not produced at times equivalent to those on the experimental day.

Results: Induced acute severe isovolemic anemia decreased nerve conduction latencies from the wrist to the contralateral cerebral cortex (i.e., to the N20 peak) by 2.3 +/- 1.6% compared with values at a mean hemoglobin concentration of 12.7 g/dl (P < 0.01). These decreased latencies were due solely to an increased peripheral conduction velocity, from the wrist to the brachial plexus (P < 0.05), and were not altered when subjects breathed oxygen (P > 0.05). Conduction velocity from the brachial plexus or cervical spinal cord to the cerebral cortex did not change with acute anemia (P > 0.05). Latencies did not differ on the control day among the times of testing (all P > 0.05), nor did they differ at baseline between the control and experimental days (all P > 0.05).     

New classification of recommendations for forensic assessment of patients with scoliosis

In 1977, for the first time, a recommendation for the expert evaluation of scoliosis-sufferers was given out. On the basis of this a new classification followed, which takes into consideration modern orthetics and new operative procedures. Unchanged are the classifications of incapacity to work with regard to decreasing lung capacity. The levels of vital capacity are still the main factor for determining lung capacity.     

Zur Frage der Konstanz und Abgrenzbarkeit myeloarchitektonischer Rindenfelder

Zusammenfassung An Hand von Faserpräparaten der hinteren Zentralwindung von 11 verschiedenen Hemisphären und des Schläfenlappenpols von 10 verschiedenen Hemisphären wurde zu zeigen versucht, daß die an den genannten Rindenstellen beschriebenen Felder konstant bei allen Individuen vorkommen und sich stets scharf abgrenzen lassen. Zur raschen Orientierung an der Hirnrinde sowie zur genauen Bestimmung des Sitzes von Herden erscheint die myeloarchitektonische Methode besonders geeignet.Mit 9 Textabbildungen.Herrn Prof. Kleist in Verehrung und Dankbarkeit zum 75. Geburtstag gewidmet.     

Irritation des Plexus lumbalis durch Aneurysma der Aorta abdominalis

Case report on a 67-year-old patient presenting sensory disturbances involving the segments L1--L3 and absence of the knee jerk in the left leg. At postmortem examination an arteriosclerotic aneurysm of the aorta abdominalis was found to be the cause for the lesion of the upper lumbar roots.     

Eine faktorielle Studie von 6 Interventionen zur Vermeidung von Übelkeit und Erbrechen nach Narkosen

BACKGROUND: Untreated, one third of patients who undergo surgery will have postoperative nausea and vomiting. Although many trials have been conducted, the relative benefits of prophylactic antiemetic interventions given alone or in combination remain unknown.METHODS: In a randomized, controlled trial of factorial design, 5,199 patients at high risk for postoperative nausea and vomiting were randomly assigned to 1 of 64 possible combinations of 6 prophylactic interventions: 1) 4 mg of ondansetron or no ondansetron; 2) 4 mg of dexamethasone or no dexamethasone; 3) 1.25 mg of droperidol or no droperidol; 4) propofol or a volatile anesthetic; 5) nitrogen or nitrous oxide; 6) remifentanil or fentanyl. The primary aim parameter was nausea and vomiting within 24 h after surgery, which was evaluated blindly.RESULTS: Ondansetron, dexamethasone, and droperidol each reduced the risk of postoperative nausea and vomiting by about 26%, propofol reduced the risk by 19%, and nitrogen by 12%. The risk reduction with both of these agents (i.e., total intravenous anesthesia) was thus similar to that observed with each of the antiemetics alone. All the interventions acted independently of each other and independently of the patients' baseline risk. Consequently, the relative risks associated with the combined interventions could be estimated by multiplying the relative risks associated with each intervention. However, absolute risk reduction was a critical function of patients' baseline risk.CONCLUSIONS: Because antiemetic interventions are similarly effective and act independently, the safest or least expensive should be used first. Prophylaxis is rarely warranted in low-risk patients, moderate-risk patients may benefit from a single intervention, and multiple interventions should be reserved for high-risk patients.     

Erfahrungen mit der Anwendung der Crutchfield-Klammer

Zusammenfassung Anwendungsweise und Anzeigestellung für den Gebrauch der Kopfklammer nach Crutchfield bei Halswirbelverletzungen werden an Hand von Beispielen beschrieben. Gegenüber dem Dauerzug mittels der Glissonschlinge hat die Crutchfield-Klammer den Vorteil einer weit besseren Verträglichkeit und Ruhigstellung, sowie Essenserleichterung. Ja nach der Höhe der vorliegenden Verletzung werden verschieden große Zuggewichte benötigt. Die Sicherung des erzielten Korrekturergebnisses erfolgt in der Regel durch nachfolgenden Schanzschen Watteverband, wobei ältere Personen zur späteren Wiederkehr der Wirbelverschiebung infolge schlechterer Regenerationsbedingungen neigen. Weitere Anwendungsbereiche der Crutchfield-Klammer sind zerstörende Prozesse im Bereiche der Halswirbelsäule, die eine Dauerzugbehandlung über Monate erfordern und schwere Skoliosen mit Lähmungserscheinungen zur Dauerzugsvorbereitung für die Laminektomie.Wegen der einfachen Technik der Anwendung und der Zuverlässigkeit ist die Crutchfield-Klammer der weit weniger leistungsfähigen Glissonschlingenextension vorzuziehen.Mit 16 Textabbildungen (32 Einzelbilder).