Nachbewegungen beim Menschen

Zusammenfassung Während die Argumente für einen peripheren Ursprung der Nachbewegung (Nb.) der Kritik nicht standhalten, läßt sich die Erscheinung auf das Überdauern einer zentralen (subkortikalen) Erregung, die von der längeren Willküranstrengung herstammt, zurückführen. Die Nb. bietet weitgehende Ähnlichkeit mit der auf einem Bestehen unterschwelliger Dauererregungen beruhenden Zunahme der Reflextätigkeit des Froschrückenmarkes nach funktioneller Beanspruchung. Der rhythmische Verlauf der Nb., ihr Umschlag in ein Schwererwerden der angestrengten Extremität, sowie eine Reihe von Summationserscheinungen und die willkürliche Hemmbarkeit, endlich die Tatsache der Beeinflussung entsprechender nicht angespannter Muskeln der andern Körperhälfte stützen den Beweis. Die subjektive Seite der Nb. ist, wie der Novocainversuch zeigt, im wesentlichen peripher bedingt zu denken.     

Postappendectomy fluid collections in children: incidence, nature, and evolution evaluated using US

At the authors' medical center, most patients with postappendectomy fluid collections are treated conservatively. Thirty-two (15%) of 216 children underwent postoperative sonography following appendectomies. In ten patients (31%), a total of 16 fluid collections were found on the initial postoperative sonogram. In the seven patients (70%) whose fluid collections were confined to the pelvis, the condition was treated conservatively and it resolved in 2-9 weeks. In three patients, fluid collections required surgical drainage and proved to be abscesses. In two of the three patients, abscesses were multiple and widely distributed in the abdomen, and the patients were clinically ill. The authors conclude that clinically symptomatic fluid collections develop postoperatively in approximately 5% of children who have undergone appendectomy for acute appendicitis and that the size and course of the fluid collection can be objectively monitored using sonography. Such fluid collections confined to the pelvis ultimately resolve with conservative, nonoperative therapy, although resolution may take up to 2 months.     

Cellulitis due to Escherichia coli in three immunocompromised subjects

A case of severe photosensitivity in a girl with the Smith–Lemli–Opitz syndrome is reported. Children with this recessively inherited metabolic disorder of cholesterol metabolism present with a variety of congenital abnormalities of the nervous system and internal organs in association with varying degrees of mental retardation. Photosensitivity is a feature which has previously only briefly been mentioned in the literature in association with this syndrome. However, more recently, it has become apparent that photosensitivity is not uncommon among children with the Smith–Lemli–Opitz syndrome, although the nature of the photosensitivity in these patients has remained undefined. Our patient has suffered from sunlight intolerance since early infancy, with redness and pruritus of sun-exposed skin developing within minutes of sun exposure. Monochromator ultraviolet (UV) radiation and visible light testing revealed an immediate and persistent reaction to low-dose UVA at 350 nm, and an abnormal erythemal response to visible light at 400 nm.     

Gzα deficient mice: enzyme levels in the autonomic nervous system, neuronal survival and effect of genetic background

Our laboratory has generated a genetically mutant mouse in which the alpha subunit of the heterotrimeric GTP binding protein, G(z) has been made dysfunctional by homologous recombination to determine its in vivo function. These animals show a characteristic failure to thrive phenotype. G(z alpha) is expressed in a variety of nervous system tissues as well as in the adrenal medulla. We therefore examined the autonomic nervous system of the G(z alpha) deficient mouse by measuring the activity of tyrosine hydroxylase and choline acetyltransferase in the superior cervical ganglia, submaxillary gland and the adrenal medulla. Preliminary results using animals of mixed BALB/c and C57BL/6 strains gave inconsistent results. Further experiments demonstrated differences in the activity of tyrosine hydroxylase and choline acetyltransferase between BALB/c and C57BL/6 mouse strains. The analysis of the pure strains showed a reduction in the size and enzyme levels of the adrenal gland and submaxillary glands of the G(z alpha) deficient mouse suggesting a role for adrenal insufficiency and/or nutritional disorders for the failure to thrive phenotype. The survival of sympathetic and sensory neurons was also examined in the G(z alpha) deficient mouse and in the presence of pertussis toxin, sympathetic but not sensory neuronal survival in G(z alpha) deficient mice was significantly attenuated. This suggests that in vivo other pertussis toxin sensitive G proteins may be recruited to compensate for the loss of G(z alpha).     

Comparison in the Same Patient of Aberrant Conduction and Bundle Branch Reentry After Dofetilide, a New Selective Class III Antiarrhythmic Agent

Dofetilide may induce aberrant intraventricular conduction due to its Class III effect. This report describes an atrial fibrillation patient in whom intraventricular conduction was studied before and after dofetilide using multiple endocardial recordings. Dofetilide provoked aberrant conduction during atrial fibrillation, and aberrancy could be mimicked with programmed atrial stimulation after restoration of sinus rhythm. However, during right ventricular slimulation, isolated bundle branch reentrant beats were recorded after induction of critical retrograde conduction delays. This occurred in the setting of relatively large differences in refractoriness between the right bundle branch and the right ventricular myocardium. This favored distal retrograde bundle branch block during ventricular extrastimulation, in turn enhancing bundle branch reentry. This potendal proarrhythmic mechanism deserves close attention in the further deveiopmeni of dofetilide and also of other new "pure" Class III agents.     

Low-dose cyclosporin A induces relapsing remitting experimental allergic encephalomyelitis in the Lewis rat

Experimental allergic encephalomyelitis (EAE) in Lewis rats is an acute monophasic autoimmune disease. It can be treated prophylactically and therapeutically with high doses of cyclosporin A (CsA). Here we demonstrate that low-dose CsA does not prevent a first attack of EAE, but, on the contrary, induces a chronic relapsing form of the disease in 100% of Lewis rats examined. Possible explanations for the high relapse rate after low-dose CsA treatment are discussed. Further studies will be needed to evaluate the immunological mechanisms responsible for these results.     

Blood levels of branched-chain α-keto acids in uremia: Therapeutic implications

Summary Serum levels of branched-chain keto acids (BCKA's), i.e., -keto-isocaproic acid (KICA), -keto-isovaleric acid (KIVA) and -keto--methyl-n-valeric acid (KMVA) as well as their corresponding amino acids were determined in uremic patients with compensated chronic renal failure, patients on hemodialysis, and in subjects without renal insufficiency.Uremic patients had significantly lower BCKA levels than controls without renal insufficiency. There was a negative correlation between serum BCKA's and the levels of blood urea and creatinine. BCKA's were detectable in the hemofiltrate. The concentrations of KICA and KMVA were significantly higher, that of KIVA identical compared to the respective concentrations in the hemofiltrate. This suggests a different protein binding of BCKA's. Oral administration of 5 g Ca-KICA to a healthy subject resulted in a transient increase in serum KICA and leucine. The maximum increase in KICA preceded the leucine peak.Serum BCKA levels did not change significantly in patients with compensated renal failure, who were — for 28 days each — first on an unrestricted diet plus supplementation, then solely on an unrestricted diet, followed by a protein-restricted diet (0.5 g/kg/day) plus supplementation and finally on a protein-restricted diet alone. Supplementation was with 5 essential amino acids, 4 keto acids and 1 hydroxyacid (6–9 g/day).The determination of BCKA's in serum offers a promising investigatory tool to study nitrogen metabolism in healthy and uremic subjects and might help to further evaluate the role of keto acids in the treatment of chronic renal failure.