Prognostic value of SSEP in early aneurysm surgery after SAH in poor-grade patients

We evaluate the prognostic value of somatosensory evoked potentials (SSEP) in poor-grade patients after early surgery for aneurysmal subarachnoid hemorrhage compared to the Hunt and Hess (H&H) and WFNS scales. Ninety patients with angiographically proven aneurysms graded H&H IV or V were evaluated retrospectively. The aneurysms of 72 patients were clipped. In 53 out of 72 patients 147 SSEP examinations were recorded. The SSEP were classified according to the central conduction time (CCT) and the number of cortical potentials. Outcome was determined according to the Glasgow Outcome Scale. To evaluate the predictability of the SSEP to clinical grading scales receiver operating characteristic (ROC) analysis was done. The H&H scale did not demonstrate statistically significant predictability for poor-grade patients. The WFNS scale predicted the outcome for only one group (survival/death) (p = 0.035). Predictability of outcome by the SSEP was statistically confirmed. Normal CCT indicated a potential for a good recovery, but not consistently so. Bilaterally enhanced CCT was predictive of a poor outcome. Bilateral lack of cortical responses was always related to fatal outcome. ROC analysis confirmed that SSEP are superior to clinical grading scales in determining prognosis in poor-grade patients. In doubt, whether early aneurysm surgery or conservative treatment in a poor-grade patient should be done, SSEP will be helpful.     

Source activity in the human secondary somatosensory cortex depends on the size of corpus callosum

If corpus callosum (CC) mediates the activation of the secondary somatosensory area (SII) ipsilateral to the side of stimulation, then the peak latencies of the contra- and ipsilateral SII activity as well as the amplitude of the ipsilateral SII activity should correlate with the size of CC. Innocuous electrical stimuli of five different intensities were applied to the ventral surface of the right index finger in 15 right-handed men. EEG was recorded using 82 closely spaced electrodes. The size of CC and of seven callosal regions was measured from the mid-sagittal slice of a high-resolution anatomical MRI. The activation in the contralateral and ipsilateral SII was evaluated using spatio-temporal source analysis. At the strongest stimulus intensity, the size of the intermediate part of the callosal truncus correlated negatively with the interpeak latency of the sources in ipsi- and contralateral SII (r = -0.83, P < 0.01). Stepwise regression analysis showed that the large size of the intermediate truncus of CC was paralleled by a latency reduction of peak activity of the ipsilateral SII, whereas both contra- and ipsilateral peak latencies were positively correlated. The peak amplitude of the ipsilateral SII source correlated positively with the size of the intermediate truncus of CC, and with the peak amplitudes of sources in the primary somatosensory cortex (SI) and in the mesial frontal cortex. The results suggest that in right-handed neurologically normal men, the size of the intermediate callosal truncus contributes to the timing and amplitude of ipsilateral SII source activity.     

Centralizing surgery for gynecologic oncology--a strategy assuring better quality treatment?

OBJECTIVE: The objective of this study was to assess the association between the type of hospital and the previously reported shortcomings in surgical treatment for ovarian and endometrial carcinomas in Hesse, Germany. METHODS: The types of hospitals)primary, secondary, tertiary and central care referral or university clinic) at which patients with endometrial and ovarian cancer were treated were correlates with the following variables: patients' functional status, tumor stage (FIGO), the performance of lymphadenectomy and/or omentectomy, and the frequency of intraoperative and postoperative complications. Data came from the GQH project, which assessed all diagnostic, surgical, and postoperative gynecologic procedures undertaken in Hesse between 1997 and 2001. RESULTS: In 1119 cases of endometrial cancer significantly fewer (P < 0.001) lymphadenectomies were performed in primary care hospitals despite the fact that patients treated in primary care hospitals were younger and had a better functional status and lower tumor stage than patients treated in other types of hospitals. In ovarian cancer too, lymphadenectomy rates varied considerably with the type of hospital (P = 0.010) even when the analyses were restricted to patients whose functional status was good (ASA 相似文献   

Laboratory-based diagnosis of brucellosis--a review of the literature. Part I: Techniques for direct detection and identification of Brucella spp

Brucellosis is a world-wide re-emerging zoonosis and the most frequent laboratory-acquired bacterial infection, causing severe disease in humans with unspecific clinical signs affecting numerous organs. Contact with infected animals, ingestion of contaminated animal products and handling of Brucella isolates in laboratories are risk factors. Various other febrile illnesses, e.g. malaria, tuberculosis, typhoid fever and tularemia may present with the same symptoms. Therefore, clinical diagnosis is difficult to establish but effective therapy requires an early diagnosis. Vaccines for humans are still not commercially available. Blood culturing of Brucella is time-consuming and not reliable. Thus diagnosis is usually based on indirect serological tests, i.e. serum agglutination test, complement fixation or the Coombs test. However, these 'conventional' serological tests lack sensitivity and specificity. Hence, a combination of various tests is mandatory for a definite diagnosis. Enzyme-linked immunosorbent assays can be used for screening and confirmation of brucellosis in one step. Molecular techniques like the polymerase chain reaction and restriction fragment length polymorphism are needed to differentiate species and strains within the genus Brucella. This review will summarize advantages and disadvantages of the techniques used in clinical laboratories for direct detection and identification of Brucella spp.     

Aortic Homograft Endocarditis Caused by <Emphasis Type="Italic">Rhodotorula mucilaginosa</Emphasis>

Serious infections caused by Rhodotorula spp. are rare and usually occur in immunocompromised people, especially in patients with tumors and long-time use of indwelling central venous catheters. We report a case of Rhodotorula mucilaginosa homograft endocarditis in an otherwise healthy man, which was successfully treated by surgery in combination with amphotericin B and subsequently intraconazole. Received: September 9, 2002 · Revision accepted: November 9; 2002 H.F. Günthard (corresponding author)     

Tissue expression of copines and isolation of copines I and III from the cytosol of human neutrophils

Copines are a recently identified group of proteins characterized by two Ca(2+)-binding C2-domains at the N terminus and an A-domain at the C terminus. Although pEST sequences indicate the existence of at least seven copines in man, only copines I, III, and VI have been identified at protein level. Here, we describe the isolation of copines I and III in the cytosol of human neutrophils by use of Ca(2+)-induced hydrophobic chromatography. This is the first demonstration that copines are coexpressed in the same cell. We found that copine III exists in the cytosol of human neutrophils as a monomer with a blocked N terminus. Copines I and III undergo conformational changes upon Ca(2+) binding that lead to exposure of hydrophobic patches. Examination of RNA from 68 human tissues demonstrated that copines I-III are ubiquitously expressed whereas copines IV-VII each has a more restricted and individual expression profile. Expression of copines I-III was also demonstrated in neutrophil precursors from bone marrow. Copine I was uniformly expressed at all stages of neutrophil differentiation, whereas copine II and even more so, copine III were expressed in the more immature neutrophil precursors, which indicates an individual function of these copines.