Role of DAT‐SPECT in the diagnostic work up of Parkinsonism

The diagnosis of idiopathic Parkinson's disease (PD) can be achieved with high degrees of accuracy in cases with full expression of classical clinical features. However, diagnostic uncertainty remains in early disease with subtle or ambiguous signs. Functional imaging has been suggested to increase the diagnostic yield in parkinsonian syndromes with uncertain clinical classification. Loss of striatal dopamine nerve terminal function, a hallmark of neurodegenerative Parkinsonism, is strongly related to decreases of dopamine transporter (DAT) density, which can be measured by single photon emission computed tomography (SPECT). The use of DAT‐SPECT facilitates the differential diagnosis in patients with isolated tremor symptoms not fulfilling PD or essential tremor criteria, drug‐induced, psychogenic and vascular Parkinsonism as well as dementia when associated with Parkinsonism. This review addresses the value of DAT‐SPECT in early differential diagnosis, and its potential as a screening tool for subjects at risk of developing PD as well as issues around the assessment of disease progression. © 2007 Movement Disorder Society     

Food service in Austrian hospitals: results of a survey]

130 medical and 130 administrative heads were asked to fill in a structured questionnaire to obtain an assessment of meals provided in Austrian hospitals. 62 questionnaires in each group were returned fully completed. Meals: ?S 46,--are available per patient and day; whereby the costs of special diets are ?S 11,--higher on average per day. Diets on offer: 96.8% of the questioned hospitals offered a diabetes diet; 95.2% a weight-reducing diet, 93.5% a light balanced diet and diet for patients with hyperlipidaemia and 90.3% a reduced salt diet (the worst accepted by the patients). 90.3% of these hospitals would consider dietary recommendations as a preventive measure. In fact, preventive dietary measure are implemented in 75.5% of the hospitals questioned. It was apparent that the staff in charge are aware of the influence of correct-nutrition in hospitals. It is recommended that nutritional advice should be offered more often in all wards (this is at present available in only 8.0% of the hospitals). It should be mentioned that financial resources concerning hospital meals should be increased for the more widespread establishment of "healthy food", too.     

Endosonography (ES) in the diagnosis of recurrent cancer of the rectum.

The ability of endosonography (ES) to detect local recurrence after "curative" surgery for rectal cancer was investigated in 65 patients. Fifteen patients developed local recurrence. All of these 15 patients had ES evidence of recurrence; in four cases recurrence was detected by ES alone. Ten of the 15 patients with local failure underwent reoperation. Four patients were candidates for reoperation for cure. Three patients with radical reoperation belonged to the group in which recurrence was detected by ES alone. ES is able to detect small tumors before there is evidence of recurrence in other available forms of examination.     

Functional analysis of the cag pathogenicity island in Helicobacter pylori isolates from patients with gastritis, peptic ulcer, and gastric cancer

Helicobacter pylori is the causative agent of a variety of gastric diseases, but the clinical relevance of bacterial virulence factors is still controversial. Virulent strains carrying the cag pathogenicity island (cagPAI) are thought to be key players in disease development. Here, we have compared cagPAI-dependent in vitro responses in H. pylori isolates obtained from 75 patients with gastritis, peptic ulcer, and gastric cancer (n = 25 in each group). AGS gastric epithelial cells were infected with each strain and assayed for (i) CagA expression, (ii) translocation and tyrosine phosphorylation of CagA, (iii) c-Src inactivation, (iv) cortactin dephosphorylation, (v) induction of actin cytoskeletal rearrangements associated with cell elongation, (vi) induction of cellular motility, and (vii) secretion of interleukin-8. Interestingly, we found high but similar prevalences of all of these cagPAI-dependent host cell responses (ranging from 56 to 80%) among the various groups of patients. This study revealed CagA proteins with unique features, CagA subspecies of various sizes, and new functional properties for the phenotypic outcomes. We further showed that induction of AGS cell motility and elongation are two independent processes. Our data corroborate epidemiological studies, which indicate a significant association of cagPAI presence and functionality with histopathological findings in gastritis, peptic ulcer, and gastric cancer patients, thus emphasizing the importance of the cagPAI for the pathogenicity of H. pylori. Nevertheless, we found no significant association of the specific H. pylori-induced responses with any particular patient group. This may indicate that the determination of disease development is highly complex and involves multiple bacterial and/or host factors.     

Über die sogenannten Myxome des Herzens

Zusammenfassung Die 15jährige Patientin litt wiederholt an Angina, die wohl über einer latenten Sepsis zu einer Endokardveränderung führte. Diese bedingte einen Thrombus des linken Vorhofes in der Gegend der Fossa ovalis. Aus der Zeit rühren embolische Narben der Milz und der linken Niere her. Unter eintretender Organisation des Thrombus wurde er durch den Blutstrom zu einem polypenförmigen Gebilde abgeglättet und ausgezogen. Er reichte nun durch das Ostium venosum sin. hindurch in die linke Herzkammer hinein und täuschte klinisch eine Insuffizienz der Klappe mit Stenose des Ostiums vor. Der organisierte Thrombus entartete in seinem größten Teile schleimig, während der neu angebildete Teil an der Basis auch jetzt noch wie ein typischer organisierter Thrombus aussah. Mikroskopisch konnte ich alle Bestandteile nachweisen, die die Autoren in den Myxomen beschrieben. Auch fand ich entzündliche Elemente, ebenso hyalines Fibrin, besonders in dem jüngeren, basalen Teile des Gebildes. Aus alledem komme ich zur Diagnose Thrombus myxomatodes und meine, daß auch alle die bisher beschriebenen primären Tumoren des endokards, außer den bösartigen Gewächsen, organisierte Thromben darstellen.Mit 5 Textabbildungen.