Early diagnosis of spinal metastases by CT and MR studies

Fifteen patients with known metastatic or high-risk primary cancer, normal neurologic examinations, and new abnormalities on 99mTc bone scan were evaluated with spinal CT and magnetic resonance (MR) imaging. Four patients underwent CT metrizamide myelography. Spinal CT and MR agreed in 14 of 15 patients demonstrating spinal metastases in 12 patients and benign disease in two. In one patient spinal CT was normal, but MR showed altered marrow signal consistent with metastatic disease. Epidural tumor was demonstrated by CT metrizamide myelography in four cases, all correctly identified by MR. Further evaluation of spinal MR in this setting is warranted.     

Body fat assessment in women. Special considerations.

Methods of in vivo body fat estimation are based on simple assumptions about body composition which work reasonably well for men, while estimations in women have been largely extrapolated from the male studies so that women are treated as men with just more of the same fat. Compared to men, fat regulation in women is considerably more elaborate, with more and different sites for storage and a larger proportion of fat distributed to the extremities and in subcutaneous locations. Thus, a ratio of waist-to-hips girth which reflects increasing fatness in men only specifies 2 different extremes of a broader spectrum of possibilities for fat distribution in women. This complicates anthropometric prediction of total fatness and clearly limits the generalisability of any female equations. Anthropometric methods are further confounded by difficulties in the criterion methods against which they are developed. For example, the validity of assumptions about the fractional contributions of bone mineral and body water to fat-free mass and density may not hold through the reproductive cycles. Women athletes involved in weight-bearing or strength training may increase bone mineral content above average values but if they become amenorrhoeic, bone mineral density may fall significantly below average values. Fit premenopausal women distribute fat differently and have a higher bone mineral content than unfit postmenopausal women. Genetic factors which also affect criterion method assumptions in men are superimposed on these additional complications in women. Body fat in female athletes extends across almost the entire range of female fatness, with some of the lowest measurements in distance runners and body builders which fall into the normal male range, but also with some relatively high values in swimmers and strength athletes, which would classify these women as obese by male standards. Thus, total body fat reflects a more complex regulation and has a different meaning to health and performance in women than it does for men. Predictive equations for women athletes should be developed with a view to the specific group and ultimate purpose to which they will be applied.     

Bee-venom allergy in children: Long-term predictive value of standardized challenge tests

Venom immunotherapy (VIT) is able to protect insect venom-allergic patients against life-threatening sting reactions. Standardized sting challenges can be used as a diagnostic tool to check whether VIT is required. No data are available on the long-term predictive value of sting challenge tests. The purpose of this study was to investigate the long-term predictive value of sequential bee-sting challenges with respect to the ability to predict future sting reactions in bee-venom (BV) allergic children. Between 1988 and 1992, 92 BV-allergic children had been challenged with sequential bee stings at intervals of 2–6 weeks to determine the necessity of VIT. In 1996, all 92 families were followed-up using standardized telephone interviews. Until the follow-up, 61 children (66.3%) had experienced at least one natural bee sting. Based on the results of the initial challenge tests, 13 of the 61 patients had been started on VIT. Two of these 13 (15.4%) developed systemic reactions 1 year after VIT of 5 years, of which one was mild and one was severe. Among the 48 re-stung patients who were not treated with VIT, three children (6.3%) experienced mild systemic reactions, whereas 45 children reported no more than a local reaction. The long-term predictive value of sequential bee-sting challenge tests for systemic reactions in children not treated with VIT remained at a level of 93.8% (95% confidence interval: 82.8–98.7%) even over a period of more than 6 years. Based on this data, we conclude that sequential bee-sting challenges are a powerful tool to determine the necessity for VIT in BV-allergic children.     

Platelet monoamine oxidase activity in first-degree relatives of schizophrenic patients

Platelet monoamine oxidase (MAO) is under genetic control. A lower MAO activity in chronic schizophrenia has repeatedly been reported, and it has been suggested that reduced activity of this enzyme reflects an increased vulnerability to schizophrenia. To test this hypothesis platelet MAO was determined in 65 first-degree relatives of 22 schizophrenic index patients and in matched healthy controls. No difference in mean activity between the two samples could be detected, suggesting that reduced MAO activity in schizophrenia is more likely to be a phenomenon secondary to the disease. A significant parent-offspring correlation of MAO activities was obtained.This investigation was supported by the Deutsche Forschungsgemeinschaft     

Auswirkungen der funktionellen Störungen des Zungen-Wangenantagonismus

Ohne ZusammenfassungMit 12 Abbildungen     

Die aussagekraft von klinik,labor und kreislauf beim stumpfen bauchtrauma

In einem Siebenjahreszeitraum wurden 506 Patienten mit stumpfem Bauchtrauma in eine prospektive Untersuchung einbezogen. Ziel der Studie war, die Aussagekraft klinischer Untersuchungsparameter, routinemäsBig erhobener Laborparameter sowie der initialen Kreislaufsituation hinsichtlich einer abdominellen Organverletzung zu validisieren. Aus dem Gesamtkrankengut wurden drei Gruppen gebildet: Keine abdominelle Verletzung hatten 274 Patienten (Gruppe 1). 232 hatten gesicherte Organverletzungen (Operation, CT, Sono). 182 hiervon waren für die oben genannte Fragestellung auswertbar (Gruppe 2). Als Untergruppe 3 wurden die Patienten mit Milzruptur erfasBt und analysiert (N = 107). Unter den klinischen Hinweiszeichen: Spontanschmerz, Prellmarke, Abwehrspannung, Schulterschmerz, Druckschmerz kommt letzterem mit 92 % Häufigkeit in der Gruppe der Organverletzten eine hohe Aussagekraft zu. Relativierend musB jedoch berücksichtigt werden, dasB in Gruppe 1 in über der Hälfte der Fälle ebenfalls ein Druckschmerz registriert wurde. Von den Laborwerten: Hb, Hkt, Leukozyten kann lediglich den Leukozyten eine gewisse Bedeutung beigemessen werden. 83% der Gruppe 2 hatten Werte über 10 000. Die Kreislaufparameter: Blutdruck. Puls sind als Momentaufnahme wenig aussagekräftig. Ihre Bedeutung liegt eher in der kontinuierlichen Verlaufsregistrierung, womit sich Trends zur Verschlechterung oder Stabilisierung des Zustandes aufzeigen lassen.     

Similar muscles contribute to horizontal and vertical acceleration of center of mass in forward and backward walking: implications for neural control

Leg kinematics during backward walking (BW) are very similar to the time-reversed kinematics during forward walking (FW). This suggests that the underlying muscle activation pattern could originate from a simple time reversal, as well. Experimental electromyography studies have confirmed that this is the case for some muscles. Furthermore, it has been hypothesized that muscles showing a time reversal should also exhibit a reversal in function [from accelerating the body center of mass (COM) to decelerating]. However, this has not yet been verified in simulation studies. In the present study, forward simulations were used to study the effects of muscles on the acceleration of COM in FW and BW. We found that a reversal in function was indeed present in the muscle control of the horizontal movement of COM (e.g., tibialis anterior and gastrocnemius). In contrast, muscles' antigravity contributions maintained their function for both directions of movement. An important outcome of the present study is therefore that similar muscles can be used to achieve opposite functional demands at the level of control of the COM when walking direction is reversed. However, some muscles showed direction-specific contributions (i.e., dorsiflexors). We concluded that the changes in muscle contributions imply that a simple time reversal would be insufficient to produce BW from FW. We therefore propose that BW utilizes extra elements, presumably supraspinal, in addition to a common spinal drive. These additions are needed for propulsion and require a partial reconfiguration of lower level common networks.     

AKAP13, CACNA1, GRIK4 and GRIA1 genetic variations may be associated with haloperidol efficacy during acute treatment

We previously investigated a sample of psychotic patients acutely ill and acutely treated with haloperidol in the search for genetic predictors of response at PANSS scores during the first month of treatment. In the present work we extend the analysis to a wider panel of genetic variations including SNPs harbored by genes whose products are involved in molecular pathways consistent with the latest results of genome-wide association studies (GWAS) of antipsychotic efficacy. 96 Patients were investigated. The results were replicated in an independent sample of bipolar manic patients treated with antipsychotics (n tot=470, the sample was retrieved from the STEP-BD). Outcomes were the PANSS variation through time in the first sample, and changes of mania symptomatology at any two consecutive observations in the public available STEP-BD replication sample. A list of variations harbored by AKAP13, CACNA1, GRIK4 and GRIA1 were found to be significantly associated with outcome in both samples (different set of variations for each sample). Results did not survived multiple testing in the original sample but were replicated in both samples. This finding stresses the relevance of the glutamatergic system and regulatory molecular cascades in antipsychotic response. Nonetheless, the level of significance and the indirect and incomplete replication mandate cautiousness and further replication.