卡巴拉汀治疗路易体痴呆的疗效——一项随机双盲安慰剂对照的国际研究(译文)

1　前言路易体痴呆在过去 1 0年中已被认定是老年人痴呆的常见类型 ,占痴呆的 1 5 %～ 2 0 %。表现为波动性认知障碍和注意受损并常伴有反复的视幻觉及帕金森病表现。妄想、抑郁情绪、睡眠障碍、听幻觉是路易体痴呆的常见神经精神症状。对这一大组患者的治疗比较困难 ,因为在大     

Reproduzierbarkeit und Validität eines neuen automatisierten Verfahrens der spiegelmikroskopischen Hornhautendothelanalyse

Ziel dieser prospektiven Studie war die Prüfung der Reproduzierbarkeit eines automatisierten Verfahrens der Hornhautendothelanalyse und die Beurteilung seiner Validit?t im Vergleich zu einer Standardmethode. Personen und Methoden: Verwendet wurde ein Kontaktspiegelmikroskop mit integrierter Videokamera (Tomey EM-1000) und ein Computer (IBM kompatibler PC, 486DX33) mit zugeh?riger Software (Tomey EM-1100, Version 0.94). Grundprinzip des Verfahrens ist die direkte überführung eines Videoendothelbilds (Fl?che: 0,312 mm²) in ein digitalisiertes Computerbild und dessen automatisierte Prozessierung unter Umgehung einer Filmvorlage. Die Methode wurde bei 67 Probanden mit unauff?lliger Hornhaut (Alter: 30,9±8,6 Jahre) angewendet. Bei 42 Normalprobanden wurde die Zelldichte 3mal von demselben Untersucher (Retest-Stabilit?t), bei 25 Probanden je 1mal von 3 verschiedenen Untersuchern (Objektivit?t) bestimmt. Festgehalten wurden der nach Analyse des Rohbilds vom Rechner ermittelte Zelldichtewert sowie ein 2. Wert nach Korrektur des prozessierten Bilds durch den Untersucher. Zus?tzlich wurde die Endothelzelldichte anhand von Photographien (Spiegelmikroskop Bio Optics LSM 2000 A) in Fixed-frame-Technik durch manuelles Ausz?hlen ermittelt (Validit?t). Ergebnisse: Bezüglich der korrigierten Zelldichtewerte waren sowohl die Reteststabilit?t (Reliabilit?tskoeffizient r = 0,943) als auch die Objektivit?t (r = 0,904) hoch. Die Werte der automatisierten Methode (2415±214 Zellen/mm²) und nach manuellem Ausz?hlen (2431±228 Zellen/mm²) waren nicht signifikant verschieden (p = 0,898). Die mittlere Abweichung betrug 3,3±2,4%, wobei keine systematische Abweichung in eine Richtung vorlag. Die unkorrigierten Zelldichtewerte (2252±190 Zellen/mm²) lagen im Mittel um 7,2±2,6% unter den korrigierten. Bezüglich der unkorrigierten Werte waren die Reteststabilit?t (r = 0,856) und die Objektivit?t (r = 0,737) zufriedenstellend. Der unkorrigierte Wert war gegenüber dem durch manuelles Ausz?hlen ermittelten Wert signifikant erniedrigt (p<0,001). Schlu?folgerung: Das getestete Endothelanalyseverfahren liefert bei normaler Hornhaut schnell zuverl?ssige und reproduzierbare Ergebnisse, vorausgesetzt, da? vom Korrekturmodus der Software Gebrauch gemacht wird.      

Chlamydophila pneumoniae infection in adult asthmatics patients.

OBJECTIVES: This study has attempted to investigate the prevalence of Chlamydophila pneumoniae (CP) infection in patients with asthma. METHODS: A total of 84 patients with stable asthma (58 males + 26 females; mean age +/- SD; 37.3 +/- 11.0 years), 22 patients with asthma exacerbation (17 males + 5 females; mean age +/- SD; 33.2 +/- 9.1 years), and 34 healthy adults (18 males + 16 females; mean age +/- SD; 30.4 +/- 11.5 years) were included in the study. Serum and throat wash samples were obtained from all patients and healthy controls 2 times, 1 month apart. Micro Immuno Fluorescence method for detecting CP antibodies in serum, and polymerase chain reaction (PCR) method for detecting presence of CP infection in the throat wash samples were used. RESULTS: The frequency of PCR positivity for CP in throat wash samples was higher in the patients with stable asthma (28.6%) than in healthy control group (11.8%) (p < 0.01). However no significant difference was found between healthy control group and asthma exacerbated group (22.7%) (p > 0.05). In addition, seroprevalences of acute and chronic CP infections were not different between patient and control groups (p > 0.05). Serological acute infection for CP was not detected among patients with positive PCR results. In contrast, although not statistically significant, serologically chronic infection for CP was detected in 3 (60%) of 5 patients with asthma exacerbation, in 18 (75%) of 24 patients with stable asthma, and 2 (50%) of 4 with healthy controls (p > 0.05). CONCLUSION: CP infection detected by the PCR method was more prevalent among patients with stable asthma and chronic/persistent CP infection might have an important role in asthma pathogenesis.     

Cramp finding: can it be used as a new diagnostic and prognostic factor in lumbar disc surgery?

In this prospective study, the validity and the importance of a new finding (cramp finding) in the diagnosis and outcome after lumbar disc surgery were tested. The test is performed with the person in prone position. Against a forceful knee flexion, the examiner holds the leg with one hand and applies a force to overcome the knee flexion. The finding is positive if the examined person feels a disturbing cramp in the leg or thigh. The study was performed between October 1997 and December 1999. Besides the cramp finding, the classical disc herniation examination, including mechanical and neurological findings, magnetic resonance (MR) imaging tests, and laboratory findings were checked pre- and postoperatively. The positive cramp finding in the operated group was 72% (n=133) preoperatively and straight leg raising (SLR) test was positive in all of them. Cramp finding was positive in 70%, 52%, 34%, and 8% of patients postoperatively in the first, 3rd, 12th and 24th months, respectively. The presented finding appears to be as valuable as the SLR, and especially contralateral SLR, tests in lumbar disc surgery. Cramp finding is also important in outcome evaluation.     

Plasma D-lactate levels in diagnosis of appendicitis.

We investigated the possible use of D-lactate as a predictor in the diagnosis of appendicitis. C-reactive protein level (CRP) and leukocyte counts were also evaluated. Venous blood D-lactate, CRP, and leukocyte counts were measured preoperatively in 53 patients undergoing surgery for appendicitis, as well as in 20 healthy subjects. Levels of all three parameters in the surgical patients were significantly higher than in the control group (p <.05). Previous studies have shown that venous D-lactate is more specific to the intestine than CPR or leukocyte count. Based on our data, venous D-lactate, which had the lowest false-negative rate among these laboratory parameters, may be a useful diagnostic marker for appendicitis. None of these parameters were helpful in identifying the type of the appendicitis.     

Forced Eruption with Microscrew Anchorage for Preprosthetic Leveling of the Gingival Margin

Dental esthetics are often impaired by a disharmonious contour of the gingival margin in the anterior region. However, the soft tissue contour can be improved by orthodontic eruption of the relevant teeth prior to prosthodontic treatment. The successful use of an orthodontic microscrew implant as anchorage for the eruption appliance is demonstrated in a case report.     

Hydatid acute pancreatitis.

BACKGROUND/AIMS: Hydatid acute pancreatitis is a rare condition, mostly reported as case presentations. METHODS: A series of eight patients with hydatid acute pancreatitis, referred between January 1990 and January 2003, are reported. All patients presented acute pancreatitis confirmed with clinical presentation, radiologic examination and laboratory findings. All patients had elevated levels of blood amylase value (more than 500 U/L). Five patients (62%) had high bilirubin levels (2.1 to 3.4 mg/dl) during the initial hospitalization. Computed tomography findings revealed acute pancreatitis in four patients; two had associated pseudocyst formation. RESULTS: Endoscopic retrograde cholangiopancreatography was performed on all patients and revealed hydatid cystic material in the common bile duct secondary to cystobiliary rupture in all patients. All patients underwent endoscopic sphincterotomy that was performed after dilatation with extractor balloon, and hydatid material was removed in all. Six patients were operated on after the initial episode subsided. Drainage of the cyst, appropriate cavity management and T-tube drainage of the common bile duct was employed in all patients to control bile leakage after the operation. Scolices and hydatid membrane were detected during common bile duct exploration in all patients due to presentation of cystobiliary rupture. There was no mortality. Postoperative pulmonary infection and wound infection were encountered in one patient each. During two to 13 years' follow-up, one patient developed recurrent hydatid disease. Recurrent pancreatitis did not occur. CONCLUSIONS: Hydatid acute pancreatitis is a rare condition. However, it should be remembered in patients with abdominal pain, especially in endemic areas.