Reduced number of functional glutamatergic synapses in hippocampal neurons overexpressing full-length TrkB receptors

Brain-derived neurotrophic factor (BDNF) acutely modulates the efficacy of central glutamatergic synapses via activation of the receptor tyrosine kinase TrkB. On a longer time scale, recent evidence suggests an additional role of TrkB signaling in the formation of excitatory synaptic connections. Here, we have overexpressed full-length TrkB receptors (fl-TrkB) in hippocampal neurons, to investigate the contribution of BDNF signaling to the maturation of glutamatergic synapses. Using patch clamp recordings, we show a three-fold reduction in glutamatergic excitatory autaptic and synaptic current amplitudes in neurons overexpressing fl-TrkB, and application of saturating concentrations of BDNF and NT-4/5 completely reverses this effect. Compatible with these overexpression data, in untransfected neurons, scavenging of endogenous BDNF and NT-4/5 by TrkB-IgGs reduces excitatory autaptic current (EAC) amplitudes. By overexpression of truncated TrkB receptors (TrkB.T1, TrkB.T2) and a chimeric receptor containing only the intracellular domain of fl-TrkB, we show that intra- and extracellular domains of fl-TrkB are necessary to observe the EAC reduction. Labeling of presynaptic terminals with FM 4-64 revealed, that the reduced EAC amplitudes in fl-TrkB overexpressing neurons are accompanied by a two-fold reduction in synapse number. These results suggest, that ligand-independent signaling through fl-TrkB receptors can decrease glutamatergic synaptic strength, if sufficient amounts of BDNF or NT-4/5 are not available.

Adsorption and separation of amino acids from aqueous solutions on zeolites

The adsorption of various amino acids on zeolites with different structures was studied with regard to dependence of the pH value of the solution and the aluminum content of the zeolite in order to design tailor-made adsorbents for amino acid separations.

Determination of 17alpha-hydroxypregnenolone in human plasma by routine isotope dilution mass spectrometry using benchtop gas chromatography-mass selective detection

A first assay based on stable isotope dilution/gas chromatography-mass spectrometry has been developed for plasma 17alpha-hydroxypregnenolone, the leading marker of 3beta-hydroxysteroid dehydrogenase deficiency. Equilibration of plasma with internal standard was followed by solid phase extraction. After clean up using Sephadex LH-20 mini columns, heptafluorobutyrates were prepared as derivatives. Quantification was achieved by selected ion monitoring of m/z 467.0 (analyte) and m/z 471.0 (internal standard). 0.030 pmol of 17alpha-hydroxypregnenolone gave a signal to noise ratio of 3.7. Calibration plot was linear. Spiking experiments showed good accuracy with relative errors < 3.7%. Intraassay precision CV was 8.3% and interassay precision CV was 5.6%. Requiring small amounts of plasma, the rapid, convenient work up and the application of bench top GC/MS instrumentation proved our method suitable for routine clinical use in adults and children.

Restricted diffusion within ring enhancement is not pathognomonic for brain abscess

BACKGROUND AND PURPOSE

Recent experience suggests that diffusion-weighted MR imaging may be decisive in the differential diagnosis of ring-enhancing cerebral lesions. Whether restricted diffusion within a ring-enhancing cerebral mass lesion is pathognomonic for abscess was studied.

METHODS

Seventeen patients with ring-enhancing cerebral lesions (three abscesses, six glioblastomas, eight metastases) on conventional contrast-enhanced T1-weighted images were examined with echo-planar diffusion-weighted MR imaging. Apparent diffusion coefficient (ADC) maps and the ADCs were calculated for all lesions. Lesions with signs of intralesional hemorrhage on unenhanced T1-weighted images were excluded.

RESULTS

The central portion of all six glioblastomas and seven of eight metastases showed unrestricted diffusion, whereas two of three abscesses showed restricted diffusion (low ADC values) in their cavity. However, restricted diffusion also was found in one metastasis, and one abscess within a postoperative cavity showed unrestricted diffusion within a larger nondependent portion.

CONCLUSION

In patients with ring-enhancing cerebral mass lesions, restricted diffusion might be characteristic but is not pathognomonic for abscess, as low ADC values also may be found in brain metastases.

Metachronous contralateral germ cell tumor 7 years after management of testicular intraepithelial neoplasia by chemotherapy and multiple control biopsies

We report about a metachronous germ cell tumor 7 years after chemotherapy of advanced testicular cancer and contralateral testicular intraepithelial neoplasia (TIN). Chemotherapy can not safely eradicate TIN. The safest treatment for TIN remains low dose radiation.

Persistent hypoglossal artery: MRI, MRA and digital subtraction angiography

We present the MRI, MRA and digital subtraction angiography (DSA) findings in a persistent hypoglossal artery found incidentally in a patient with cutaneous and intracranial haemangiomata.

Evaluation of an efavirenz-containing regimen: an open-label, multicenter study

PURPOSE

Efavirenz (EFV) has been shown to be a highly effective HIV therapy in antiretroviral-naïve patients when used with nucleoside reverse transcriptase inhibitors.

METHOD

The study participants were 314 patients, 45 of whom had not been previously treated with any antiretroviral medication. The other patients were heavily pretreated for about 3 years (1,047 days); 34 with two nucleoside reverse transcriptase inhibitors, 147 with triple therapy, and 88 with a quadruple regimen.

RESULTS

Suppression of plasma HIV-1 RNA to <50 copies/mL and <500 copies/mL was achieved in 56% and 72% of the pretreated patients and in 82% and 91% of the naïve patients, respectively, at week 80 (intention-to-treat analysis: noncompleters = failure: 10% and 15% and 20% and 22%, respectively). The viral load reduction at week 80 was 0.7 log(10) for the pretreated patients and 2.6 log(10) for the naïve patients. CD4 cell counts increased from 386 to 474 cells/microL at week 80 in the pretreated group and from 264 to 431 in the naïve patients. 118 patients discontinued the treatment due to adverse events (37 patients due to nervous system symptoms and 15 patients because of exanthema). There were no AIDS-defining events in the group of antiretroviral-treated patients.

CONCLUSION

EFV in combination with nucleoside reverse transcriptase inhibitors as antiretroviral therapy was potent and effective in reducing viral load, mainly in treating therapy-naïve patients and in preventing AIDS-defining events.

[The family emotional involvement and criticism scale]

The construct of expressed emotion is regarded as one of the most important predictors of the course of schizophrenia and has also proven to be a predictor of the course of depressive disorders, psychosomatic disorders and physical illness. Despite its clinical significance, the utility of the EE-construct has been limited since measurement by interview is time-consuming, and to date only applicable to psychotic illness. Questionnaires as a practicable alternative to the structured interview are also mostly applicable solely to psychotic disorders. One exception is the Family Emotional Involvement and Criticism Scale (FEICS, Shields et al.). This questionnaire allows a general assessment of EE and thus a practical application of EE to the general area of family research. In a sample of n = 202 patients, the German version of this instrument proved to be reliable in our research. The two-factor structure of the original American version was replicated. We found good correlation between the measured factors, and clinical and other diagnostic markers particular to family pathology. This questionnaire is therefore a brief, reliable and valid instrument for measuring EE in many disorders.

Evaluation of subcutaneous tissue gases and pH during induction of acidosis and alkalosis. An experimental study in pigs

Peripheral tissue oxygen utilization was studied during hypoxic-induced acidosis and sodium bicarbonate-induced alkalosis in 8 domestic pigs by measurements of subcutaneous oxygen tension (PscO2), carbon dioxide tension (PscCO2) and pH (pH(sc)) in relation to central hemodynamic parameters and oxygenation. Hypoxic-induced acidosis resulted in a decrease in P(sc)O(2) [corrected] and arterial oxygen tension (P(a)O(2)) to one third of baseline values (p < 0.05), an increase in PscCO2 and arterial carbon dioxide tension (PaCO2) from 41 to 55 and 34 to 39 mm Hg, respectively (p < 0.05), and a decrease in pH(sc) from 7.47 to 7.30 (p < 0.05). PscO2 and PaO2 increased during reversal of hypoxia and infusion of bicarbonate (p < 0.05), without reaching baseline values. In parallel PscCO2 decreased and pH(sc) increased but changes lagged behind changes in blood gases. Alkalosis established by further infusion of bicarbonate resulted in a decrease in PaO2 to 62 mm Hg whereas PscO2 remained below baseline values (p < 0.05). Correction of oxygen utilization in the subcutaneous tissue as measured by the markers PscCO2 and pH(sc) is slower than indicated by changes in tissue oxygen tension, blood gases and pH. Overcompensation of acidosis with bicarbonate resulting in alkalosis impairs oxygenation.

The catalytic activities of the bifunctional Azotobacter vinelandii mannuronan C-5-epimerase and alginate lyase AlgE7 probably originate from the same active site in the enzyme

The Azotobacter vinelandii genome encodes a family of seven secreted Ca(2+)-dependent epimerases (AlgE1--7) catalyzing the polymer level epimerization of beta-D-mannuronic acid (M) to alpha-L-guluronic acid (G) in the commercially important polysaccharide alginate. AlgE1--7 are composed of two types of protein modules, A and R, and the A-modules have previously been found to be sufficient for epimerization. AlgE7 is both an epimerase and an alginase, and here we show that the lyase activity is Ca(2+)-dependent and also responds similarly to the epimerases in the presence of other divalent cations. The AlgE7 lyase degraded M-rich alginates and a relatively G-rich alginate from the brown algae Macrocystis pyrifera most effectively, producing oligomers of 4 (mannuronan) to 7 units. The sequences cleaved were mainly G/MM and/or G/GM. Since G-moieties dominated at the reducing ends even when mannuronan was used as substrate, the AlgE7 epimerase probably stimulates the lyase pathway, indicating a complex interplay between the two activities. A truncated form of AlgE1 (AlgE1-1) was converted to a combined epimerase and lyase by replacing the 5'-798 base pairs in the algE1-1 gene with the corresponding A-module-encoding DNA sequence from algE7. Furthermore, substitution of an aspartic acid residue at position 152 with glycine in AlgE7A eliminated almost all of both the lyase and epimerase activities. Epimerization and lyase activity are believed to be mechanistically related, and the results reported here strongly support this hypothesis by suggesting that the same enzymatic site can catalyze both reactions.

[MR angiography: technical principles and uses in the diagnosis of neurological diseases]

During the last decade, magnetic resonance angiography (MRA) has been incorporated into the routine evaluation of patients with suspected cerebrovascular disease. Although digital subtraction angiography (DSA) is still the gold standard in diagnostics of intracranial vascular disease, it has been replaced by MRA in numerous clinical applications. In this paper we first provide a review of the various MRA techniques. In the second part, the diagnostic value as well as advantages and disadvantages of the different techniques are assessed for various cerebrovascular diseases, such as vessel occlusion, stenosis, dissection, cerebral aneurysms, and spinal and cerebral arteriovenous malformations.

Comparison of CT with diffusion-weighted MRI in patients with hyperacute stroke

Tissue changes in ischaemic stroke are detectable by diffusion-weighted MRI (DWI) within minutes of the onset of symptoms. However, in daily routine CT is still the preferred imaging modality for patients with acute stroke. Our purpose of this study was to determine how early and reliably ischaemic brain infarcts can be identified by CT and DWI. Three neuroradiologists, blinded to clinical signs but aware that they were dealing with stroke, analysed the CT and DWI of 31 patients with an acute ischaemic stroke. We calculated kappa-values to analyse inter-rater variability. The ratings were compared with follow-up studies showing the extent of the infarct. The combined assessment of all observers gave positive findings in 77.4% of all CT examinations, with kappa = 0.58. Areas of high signal were seen on all DWI studies by all observers (kappa = 1). Estimation of the extent of the infarct based on DWI yeilded kappa = 0.70 and that based on CT kappa = 0.39. DWI was much more reliable than CT in the detection of early ischaemic lesions and we believe that it should be used in acute ischaemic stroke before aggressive therapeutic intervention.

Pi-donation and stabilizing effects of pnicogens in carbenium and silicenium ions: a theoretical study of [C(XH2)3]+ and [Si(XH2)3]+ (X = N, P, As, Sb, Bi)

Quantum chemical calculations at the MP2 and CCSD(T) levels of theory are reported for cations of the general type [A(XH2)3]+ with A = C, Si and X = N, P, As, Sb, Bi. Population analysis, methyl stabilization energies (MSEs), and structural criteria were used to predict the p(pi)-donor ability of and the pi-stabilization energy exerted by this series of pnicogens. All of the substituents XH2 considered in these studies invariably stabilize the triply substituted carbenium as well as the silicenium ions. The calculated data show that the intrinsic p(pi)-donation of the group 15 atoms follows the order N < P < As < Sb < Bi. However, the trend of the stabilization energies is fully reversed. The intrinsic stabilization energies of the planar carbenium ions decrease monotonically from 161.2 kcal mol(-1) for X = NH2 to 98.0 kcal mol(-1) for X = BiH2. The effective stabilization of the pnicogens in the equilibrium structures, which also includes the energy-demanding pyramidalization of the XH2 substituents, follows the same trend, although the absolute numbers are reduced to 145.6 kcalmol(-1) for X = NH2 and 53.2 kcalmol(-1) for X = BiH2. This seemingly contrasting behavior of increasing p(pi) charge donation and decreasing stabilization has already been found for other substituents. Previous studies have shown that carbenium ions substituted by chalcogens up to the fourth row also stabilize C+ less effectively with respect to heavier substituents. Of the ions investigated in this study, only the silicenium ions that are stabilized by pnicogens from the third to the sixth row of the periodic system yield increased stabilizing energies that follow the corresponding intrinsic p(pi)-donor abilities of the respective substituent.

Intrathecal antibody production against Chlamydia pneumoniae in multiple sclerosis is part of a polyspecific immune response

Chronic intrathecal immunoglobulin (Ig) production is a hallmark of multiple sclerosis characterized by the presence of oligoclonal IgGs and, in addition, polyspecific recognition of different pathogens such as measles, rubella and herpes zoster virus. While the antigen specificity of the oligoclonal IgGs in multiple sclerosis is largely unknown, the oligoclonal IgGs arising during CNS infectious diseases are reactive against the specific pathogen. Recently, a link between Chlamydia pneumoniae and multiple sclerosis has been claimed. To test the possible role of C. pneumoniae in multiple sclerosis, we analysed (i) whether there is intrathecal IgG production against C. pneumoniae in multiple sclerosis and (ii) if the oligoclonal IgGs in the CSF of multiple sclerosis patients recognize C. pneumoniae. By studying paired serum-CSF samples from 120 subjects (definite multiple sclerosis, 46; probable multiple sclerosis, 12; other inflammatory neurological diseases, 35; other neurological diseases, 27) by enzyme-linked immunosorbent assay, we found that 24% of all patients with definite multiple sclerosis, but only 5% of patients with other inflammatory or non-inflammatory diseases, produced IgGs specific for C. pneumoniae intrathecally (definite multiple sclerosis versus other inflammatory neurological diseases: P = 0.027). The presence of intrathecal IgGs to C. pneumoniae was independent of the duration of disease and relatively stable over time. The major CSF oligoclonal IgG bands from multiple sclerosis patients with an intrathecal Ig production to C. pneumoniae did not react towards purified elementary bodies and reticulate bodies of C. pneumoniae on affinity-mediated immunoblot following isoelectric focusing (IEF-western blots). In contrast, the IgGs in the CSF of control patients with neuroborreliosis strongly reacted with their specific pathogen, Borrelia burgdorferi, by IEF-western blot analysis. Concomitant analysis of the CSF of 23 patients with a nested polymerase chain reaction for C. pneumoniae was negative in all cases. Together, our findings strongly suggest that the immune response to C. pneumoniae is part of a polyspecific intrathecal Ig production, as is commonly observed with other pathogens. This argues against a specific role for C. pneumoniae in multiple sclerosis.

[Urapidil for treatment of postanesthetic shivering following general anesthesia. A placebo controlled pilot study]

OBJECTIVE

Postanaesthetic shivering is common during recovery from general anaesthesia. Therefore we studied whether urapidil suppresses postanaesthetic shivering.

METHODS

With written informed consent and approval of the local ethics committee, patients (ASA I-II) recovering from general anaesthesia were monitored for 1 h. Patients with continuous shivering for a period of 5 min were randomly treated either with 5 ml placebo (isotonic saline) or 25 mg urapidil in a double-blind trial. This treatment procedure was repeated if shivering did not stop. A complete suppression of shivering was appraised as a sufficient treatment.

RESULTS

Shivering occurred in 20 of the patients studied and urapidil stopped shivering in 7 out of the 10 treated patients, whereas the placebo stopped shivering in only 2 out of 10 patients (P < 0.05).

CONCLUSION

In a placebo controlled trial, it was demonstrated that postanaesthetic shivering can be successfully treated by urapidil in 70% of the patients.

Hydrophobic forms of morphine-6-glucosides

NMR spectroscopy of 6-acetylmorphine (6-AM), a chloroform-soluble model compound for the hydrophilic, highly potent analgesic drug morphine-6-glucoronide (M6G), in a hydrophobic solvent indicates one hydrogen bonded water molecule per molecule of 6-AM. By analysis of nuclear Overhauser enhancements (NOEs) we find a 6-AM dimer in which the monomers are linked by two water molecules. Molecular modeling studies underscore the stability of such dimeric structures involving water molecules for 6-AM and point out their more lipophilic character allowing penetration of the blood-brain barrier.

Successful treatment of aids related PML with HAART and cidofovir

Progressive multifocal leukoencephalopathy (PML) is a progressive demyelinating infection of the central nervous system caused by the JC virus (JCV) in an advanced state of the acquired immunodeficiency syndrome (AIDS). Currently there are still no drugs with proven clinical efficacy against JCV, though highly active antiretroviral therapy (HAART) and the associated partial immune reconstitution have a beneficial effect on the survival time of AIDS-related PML. Various case reports have described an acceptable response under treatment with cidofovir which may be of particular benefit if HAART does not result in sufficient immune reconstitution. We report a patient with AIDS-related PML who improved under combined therapy with HAART and cidofovir. This suggests that the immediate combination of both drugs further improves the outcome of AIDS-related PML.

Up-regulation of cyclin-dependent kinase 4/cyclin D2 expression but down-regulation of cyclin-dependent kinase 2/cyclin E in testicular germ cell tumors

Testicular germ cell tumors (GCT) characteristically display two chromosome 12 abnormalities: the isochromosome i(12p) and concomitant deletions of the long arm. Some genes important in the control of the G(1)-S cell cycle checkpoint G(1)-S, i.e., cyclin-dependent kinases 2 and 4, cyclin D2 are located on this chromosomal region. Therefore, testicular GCTs were analyzed as to the expression of CDK2, CDK4, CDK6, and the expression of their catalytic partners cyclins D1, D2 and E by semiquantitative reverse transcription-PCR. Cyclin D2, located on 12p, was overexpressed in 69% (31 of 45) of the tumors by a mean factor of 8, including all histological subtypes. In addition, the cyclin D2 partner CDK4 was increased in 41% (21 of 51) of all tumors by a factor of 6, most strongly in embryonal carcinomas. Sixty-four percent of the seminomas and 23% of the non-seminomas had decreased expression of CDK6 by a mean factor of 5 (P = 0.009). Statistical analysis using configural frequency analysis and regression analysis revealed that cyclin D2 and CDK4 expression were strongly correlated (r(2) = 0.682; P = 0.000052), whereas expression of CDK6 did not correlate with either of them (r(2) = 0.382; P = 0.00085). CDK2 and its catalytic partner cyclin E were down-regulated in 40% (19 of 47) and 42% (19 of 45) of the tumors, respectively, by a factor of 7 each. Western blots and immunohistochemical experiments confirmed cyclin D2 and CDK4 overrepresentation and reduced expression of cyclin E and CDK2 tumors in the few tumors under protein study. Despite its localization on 12q13, a hot spot for loss of heterozygosity in testicular GCTs (>40%), Southern blotting revealed no gross DNA alteration of the CDK2 gene. Because up-regulation of the cyclin D2/CDK4 complex and down-regulation of cyclin E/CDK2 complex were found in seminomas as well as in non-seminomas and in all tumor stages, these findings seem to be early events during tumorigenesis of testicular GCTS: Together with previous findings that retinoblastoma mRNA and protein expression is strongly decreased in these tumors, these data suggest an unusual deregulated G(1)-S checkpoint as a decisive event for germ cell tumors.

The quest for beryllium peroxides

There is no experimental proof documented in the literature for the existence of any beryllium peroxide compound. All recent pertinent preparative attempts described in this work, using a range of beryllium salts with various peroxides as reagents under mild conditions, were equally unsuccessful. (1)H and (9)Be NMR investigations of aqueous solutions containing beryllium salts and hydrogen peroxide in a broad pH range also gave no definite evidence for the presence of peroxoberyllates as components of the manifold equilibria in such solutions. Quantum chemical calculations have therefore been carried out to delineate the energetics and structures of various beryllium peroxide model compounds. Standard Hartree-Fock and density functional methods were employed at various levels of sophistication. The series of prototypes considered consists of [BeOH](+), Be(OH)(2), Be(OH)(OOH), Be(OOH)(2), [Be(O(2))(2)](2-), [BeO(2)(OH(2))(2)], and [Be(2)(O(2))(2)(OH(2))(4)] (all in the gas phase). Surprisingly, the triatomic cation [BeOH](+) has been found to have a linear structure. All the Be-O(peroxide) bonds are found to be rather long, suggesting weaker bonding compared to the Be-O bonds in aquo, hydroxo, or oxo complexes. Hydrogen peroxide or anions derived therefrom are therefore not able to compete successfully with water (hydroxide anions) in aqueous solution. In the mononuclear beryllium peroxide molecules, the peroxide groups form chelating units at tetrahedrally 4-coordinate metal atoms. The binuclear compound [Be(2)(O(2))(2)(OH(2))(4)] has a puckered six-membered-ring structure, close to the standard chair conformation. A significant lengthening of the O-O bonds upon coordination to the Be(2+) centers has been calculated, but it is unlikely that the polarization of the peroxide group by the high positive charge density at Be(2+) is significant to cause an intrinsic instability of beryllium peroxides. All structures represent distinct local minima on the potential energy surface and are predicted to be (meta)stable species in nonaqueous media. The field of aluminum peroxides is a similar gray area on the map of metal and metalloid peroxides and is reminiscent of the well-established "diagonal-relation" of Be and Al in the periodic table of the elements.

Ist die Ischiadicusvarikosis eine Variante der Parvavarikosis?

Die Kniekehle und die Variationen der Parvavarikosis stellen in der Diagnostik des Krampfaderleidens häufig ein größeres Problem dar. So ist allein die reine V.s.p.-Mündung in Bezug auf die Mündungshöhe in die Vena poplitea bzw. in die distale Vena femoralis superficialis äußerst variantenreich. Daneben gilt es, eine Kniekehlenperforansvene von insuffizienten Gastrocnemiusvenen bzw. anderen Perforansvenen zu unterscheiden. Als eine weitere Variante zieht die so genannte Ischiadicusvarize subfaszial, längs durch das Gebiet der Kniekehle. Die Diagnose einer wahrscheinlich von der Vena glutaea inferior ausgehenden Varikosis der Vena ischiadica ist nur zulässig, wenn vorher atypische Mündungsareale am distalen und proximalen Oberschenkel zur Vena femoralis superficialis, zur Vena femoralis profunda oder zu Ästen der Vena saphena magna ausgeschlossen wurden. Unsere Untersuchungen zeigen, dass die als Ischiadicusvarize bezeichnete Vene topographisch nicht unbedingt direkt mit dem N. ischiadicus zusammenhängen muss.

Evaluation of splanchnic perfusion and oxygenation during positive end-expiratory pressure ventilation in relation to subcutaneous tissue gases and pH. An experimental study in pigs with oleic acid-induced lung injury

Evaluation of splanchnic perfusion and oxygenation was performed by measurements of serosal tissue oxygen tension (PserO2) and intramucosal pH (pHi) in relation to subcutaneous oxygen tension (PscO2), subcutaneous carbon dioxide tension (PscCO2) and subcutaneous pH (pHsc) in pigs subjected to oleic acid-induced lung injury during ventilation with increasing levels of positive end-expiratory pressure (PEEP). Lung injury resulted in a general hypoxia and redistribution of perfusion away from the subcutaneous and splanchnic tissues, illustrated by a decrease in PaO2 from 93 to 37 mm Hg (p < 0.01), PscO2 from 45 to 17 mm Hg (p < 0.01), PserO2 from 80 to 30 mm Hg (p < 0.01) and pHi from 6.84 to 6.74 (p < 0.05) and a decrease of porta flow from 0.77 to 0.57 l/min. Application of PEEP up to 10-15 cm H2O resulted in an increase of portal vein oxygen tension (PportaO2) from 21 to 34 mm Hg (p < 0.01), PscO2 from 17 to 26 mm Hg (p < 0.05) and PserO2 from 30 to 55 mm Hg (p < 0.05). At PEEP 20 cm H2O PserO2 decreased to 47 mm Hg (p < 0.05). Porta flow decreased continuously with increasing levels of PEEP. PserO2 correlated with PportaO2 (r = 0.7, p < 0.001). pHi correlated poorly with PportaO2 (r = 0.2) and porta flow (r = 0.4). PscO2 and PserO2 correlated well (r = 0.8, p < 0.001). In summary, splanchnic perfusion and oxygenation was better reflected by serosal oxygen tension than pHi in the colon. Changes in serosal oxygenation of the colon paralleled changes in subcutaneous tissue oxygenation.

Klinisch stumme Hirnembolien nach zerebraler Katheterangiographie

PURPOSE

To assess for the incidence of clinically silent cerebral lesions after cerebral catheter angiography.

METHODS

MRI including PD-, T2-, and diffusion-weighted images was performed shortly before and after 27 cerebral catheter angiographies.

RESULTS

After 5/27 angiographies (18.5%) we found 6 new, presumably embolic cerebral lesions with a typical diameter of 2-3 mm on diffusion-weighted images. No correlation was found between the occurrence of these lesions and a preexisting arteriosclerotic cerebrovascular disease, fluoroscopy time, or number of angiographic series.

CONCLUSION

Cerebral angiography appears to be associated with a relatively high risk (about 20%) of clinically silent cerebral embolism. This risk is higher than has been estimated based on the incidence of neurological deficits (0.1-0.3%) after cerebral angiography. The safety of cerebral angiography needs to be improved. Diffusion-weighted MR imaging is suitable to monitor the safety of angiographic procedures and material.

The psychosocial outcome of adolescent-onset schizophrenia: a 12-year followup

This study examines the educational/occupational outcome and social situation of patients treated for schizophrenia in adolescence (age at admission 11.5-17.9 years; mean 16.0 years). Out of 96 consecutively admitted patients between 1976 and 1987, 85 (89%) could be traced and 65 (68%) were reassessed more than 10 years after the first episode. At followup, 54 of the 65 (83%) had had at least one further inpatient-treated episode and 48 (74%) were receiving psychiatric treatment. Thirty-seven (57%) of the subjects were at least moderately impaired with respect to vocational functions (i.e., did not achieve their premorbid educational/occupational goals). Serious social disability was found in 42 (66%) of the 64 subjects for whom social disability data were available. Regarding means of maintenance, 49 (75%) were financially dependent, supported by parents or public assistance. Impairments were comparable for males and females. History of treatment (longer duration of inpatient stay; more than two inpatient episodes) was found to be predictive of lower vocational functioning at followup. Severity of positive symptoms and more than two inpatient episodes in the early course of illness predicted social disabilities in young adulthood. Findings support the view that, because of early onset, the long-term perspective for many adolescent-onset schizophrenia patients is that of poor social adjustment, severe functional impairment, and high socioeconomic dependence and suggest that consequences are more severe than in adult-onset schizophrenia.