Continued progress in the legal aspects of integrating handicapped patients--recommendations of the Federal Council on Rehabilitation to SGB IX]

In January 1991, the Government coalition parties agreed that the existing rehabilitation and severely disabled persons legislation should be rearranged in a distinct manner and integrated in the German Social Code as Book IX--Integration of disabled persons. This forthcoming codification moreover is intended as an opportunity for introducing appropriate adjustments and amendments, as well as for considering the possibilities for limited material reform. The Federal Rehabilitation Council has submitted a number of proposals to the Federal government aimed at settling various intersectoral aspects of rehabilitation legislation in the forthcoming Book IX.     

Cytoskeletal modulation of the response to mechanical stimulation in human vascular endothelial cells

Possible interactions of cytoskeletal elements with mechanically induced membrane currents and Ca²⁺ signals were studied in human endothelial cells by using a combined patch-clamp and Fura II technique. For mechanical stimulation, cells were exposed to hypotonic solution (HTS). The concomitant cell swelling activates a Cl^– current, releases Ca²⁺ from intracellular stores and activates Ca²⁺ influx. To interfere with the cytoskeleton, cells were loaded either with the F-actin-stabilizing agent phalloidin (10 mol/l), or the F-actin-depolymerizing substance cytochalasin B (50 mol/l). These were administered either in the bath or the pipette solutions. The tubulin structure of the endothelial cells was modulated by taxol (50 mol/l), which supports polymerization of tubulin, or by the depolymerizing agent colcemid (10 mol/l) both applied to the bath. Immunofluorescence experiments show that under the chosen experimental conditions the cytoskeletal modifiers employed disintegrate the F-actin and microtubuli cytoskeleton. Neither of these cytoskeletal modifiers influenced the HTS-induced Cl^– current. Ca²⁺ release was not affected by cytochalasin B, taxol or colcemid, but was suppressed if the cells were loaded with phalloidin. Depletion of intracellular Ca²⁺ stores by thapsigargin renders the intracellular [Ca²⁺] sensitive to the extracellular [Ca²⁺], which is indicative of a Ca²⁺ entry pathway activated by store depletion. Neither cytochalasin B nor phalloidin affected this Ca²⁺ entry. We conclude that F-actin turnover or depolymerization is necessary for Ca²⁺ release by mechanical activation. The tubulin network is not involved. The Ca²⁺ release-activated Ca²⁺ entry is not modulated by the F-actin cytoskeleton.     

Estimation of patient age based on plain chest radiographs

Patient age is an essential part of a clinical history, but it is not always provided by referring physicians. We assessed the ability of four radiologists with different levels of expertise (first-year resident to professor emeritus) to predict patient age based on postero-anterior and lateral chest radiographs from 171 patients. All four were able to predict age with a mean error of less than 15 years, but there were statistically significant differences among them. Surprisingly, observer experience did not correlate with accuracy of patient age estimation. While many factors probably operate, the estimation of patient age relies heavily on "gestalt."     

Physicochemical Characterization of Protein-Free Low Density Lipoprotein Models and Influence of Drug Loading

Purpose. Drug free and drug loaded protein-free low density lipoprotein (LDL) models consisting mainly of phospholipids, cholesterol, cholesterol esters, and triglycerides in ratios found for physiological LDL have been prepared. Their physicochemical characteristics were compared with those of physiological LDL. Methods. Different characterization methods were used: photon correlation spectroscopy, transmission electron microscopy, X-ray solution scattering, and ¹H nuclear magnetic resonance spectroscopy (NMR). Results. Particle sizes are highly dependent on the preparation method and in particular on the homogenization conditions. Electron microscopy indicates that the size distributions of model systems are much broader than those of physiological LDL. The X-ray solution scattering patterns of the model systems display a temperature dependent maximum near 3.8 nm similar to that found in the patterns of physiological LDL. NMR indicates a comparable mobility of the lipid molecules in model particles and in physiological LDL. The influence of drug loading is similar to that found earlier for physiological LDL. In particular, the incorporation of the anti-cancer drug WB 4291 seems to have a fluidizing effect on the lipids in the core region of the particles. Conclusions. The preparation method of LDL model systems is of crucial importance as only the solvent evaporation method yielded systems in the size range of physiological LDL with acceptable high lipid concentrations. The fluidizing influence of temperature and drug incorporation (WB 4291) may be a disadvantage in drug targeting.     

Synkope bei einem jungen Mann türkischer Herkunft

Zusammenfassung Bei einem jungen Mann türkischer Herkunft trat nach Genuss von sog. "pontischem" Waldhonig eine Synkope auf. Neben einer Sinusbradykardie und Hypotonieneigung bestanden gastrointestinale Symptome. Als Ursache der Synkope ist eine Intoxikation mit Grayanotoxinen anzunehmen. Unter symptomatischen Maßnahmen bildeten sich die Beschwerden innerhalb weniger Stunden vollständig zurück. Intoxikationen mit Grayanotoxinen aus "pontischem" Honig sind in unseren Breiten selten, sollten aber bei unklaren Bradykardien v. a. bei Patienten mit entsprechender Reiseanamnese in Länder der Schwarzmeerküste differenzialdiagnostisch mit in Betracht gezogen werden.

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The need for caution with topical anesthesia during endoscopic procedures, as liberal use may result in methemoglobinemia

During upper gastrointestinal endoscopy, topical oropharyngeal anesthesia with lidocaine and/or benzocaine is used routinely by many endodscopists. Although such a practice is usually safe, there have been a number of reports of methemoglobinemia induced by topical anesthesia. Early treatment is extremely important as the development of methemoglobinemia is potentially fatal. Methemoglobinemia should be considered when oxygen desaturation occurs without another explanation. In this case series, we report 4 cases of methemoglobinemia that followed the liberal application of Cetacaine for ERCP. All patients recovered after appropriate treatment but these cases serve to highlight the potential problem, the importance of early recognition and treatment, and the most appropriate treatment options.     

Clinical value of 18F-FDG-PET/CT in suspected serious disease with special emphasis on occult cancer

Annals of Nuclear Medicine - Suspected serious disease (SSD) is a disease designation often given to patients with one or more non-specific symptoms of severe disease that could be due to cancer;...