FC12-03 - DTI-based in vivo mapping of subregions within the human hypothalamus

Introduction

The hypothalamus is involved in many aspects of behavioral responses but parcellations of hypothalamic subnuclei have only been feasible in post-mortem brains. Thus it would be-from a clinical point of view-highly desirable if hypothalamic subnuclei could be delineated also noninvasively in living subjects. This study is a first step in this direction: We exploited the directionality information inherent in high-resolution DTI data to map subregions of the hypothalamus in healthy volunteers.

directionality information using DTI data to map subregions of the hypothalamus.

Methods

We scanned 10 subjects with a Siemens 3 T scanner, acquired DTI and T1 scans. We computed the similarity of fiber orientations between all voxels and subjects, and clustered the similarity matrix in 3 regions using a k-means algorithm.

Results

The diffusion images showed anisotropic tissue orientation within the hypothalamus which was consistent across subjects. The clustering in 3 regions resulted in an anatomically coherent arrangement of clusters across hemispheres and subjects. In each ROI, we found an anterior, a posteromedial, and a lateral subdivision with consistent microscopic tissue orientations across subjects.

Conclusion

This is to our best knowledge the first study that demonstrates the fine-grained microstructural organization within the human hypothalamus noninvasively in living subjects.

Aroma development in high pressure treated beef and chicken meat compared to raw and heat treated

Chicken breast and beef muscle were treated at 400 and 600 MPa for 15 min at 5 degrees C and compared to raw meat and a heated sample (100 degrees C for 15 min). Vacuum-packed beef meat with a smaller fraction of unsaturated fatty acids showed better oxidative stability during 14 days of cold storage, as shown by a low steady-state level of hydroperoxide values, than vacuum-packed chicken meat. Accordingly, the critical pressures of 400 MPa and 600 MPa for chicken breast and beef sirloin, respectively, were established. Volatiles released after opening of the meat bags or during storage of open meat bags, simulating consumer behaviour, were measured under conditions mimicking eating. Quantitative and olfactory analysis of pressurised meat gave a total of 46 flavour volatiles, mainly alcohols (11), aldehydes (15), and ketones (11), but all in low abundance after 14 days of storage. Overall, beef meat contained less volatiles and in lower abundance (factor of 5) compared to chicken meat. The most important odour active volatiles (GC-O) were well below the detection thresholds necessary to impart a perceivable off-flavour. Lipid oxidation was significantly accelerated during 24h of cold storage in both cooked chicken and beef when exposed to oxygen, while the pressurised and oxygen-exposed chicken and beef meat remained stable. Pressure treatment of beef and chicken did not induce severe changes of their raw aroma profiles.

Pyrogen testing of lipidic parenterals with a novel in vitro test--application of the IPT based on cryopreserved human whole blood

The European Pharmacopoeia has made the testing of small volume parenterals (< 15) obligatory since 2004. This concerns many formulations, e.g. vitamins, steroids and hormones, many of which are applied intramuscularly using a lipidic carrier. Lipopolysaccharides, the best established endotoxins from Gram-negative bacteria, bind strongly to lipophilic substances, which mask them in Limulus amebocyte lysate assays. End-product testing, therefore, can only be carried out in rabbit pyrogen tests. This will lead to a pronounced increase in animal experiments if no alternative procedures become available. We have described a novel in vitro pyrogen test (IPT) based on human whole blood, which has recently been validated in a collaborative study including the European Pharmacopoeia. Here, the utility of the IPT for lipophilic substances and lipid-containing end-products was assessed. For a variety of lipids commonly added to formulations of injectable endproducts, namely peanut oil, sesame oil, miglyol and paraffin, a protocol which allows interference-free testing was established applying the pharmacopoeial criterion of 50 to 200% retrieval of an LPS spike. Furthermore, end-product testing for three sample formulations was possible. In all, a method could be established which allows the determination of given or calculated ELC (endotoxin limit concentrations) according to Pharmacopoeia. It is concluded that monocytes do react to lipid-bound LPS, indicating that immune responses to contaminated endproducts must be anticipated, and that the IPT is suitable for endproduct control of these formulations.

PTH secretion in patients with chronic renal failure assessed by a modified CiCa clamp method: effects of 1-year calcitriol therapy

BACKGROUND

Secondary hyperparathyroidism (secondary HPT) in patients with chronic renal failure (CRF) is characterized by parathyroid gland hyperplasia and an intrinsic defect in the recognition of parathyroid hormone (PTH) secretion. Conflicting results have been reported regarding the set point for calcium-regulated PTH release and its modification by calcitriol therapy in hemodialysis patients. Additionally, the effect of calcitriol on the calcium/PTH relationship in predialysis CRF patients with early secondary HPT has not been investigated. Our objective in this controlled study was to investigate the calcium/PTH relationship and to determine the calcium set point in patients with early stages of CRF before and after a 1-year treatment with calcitriol and in normal volunteers.

METHODS

Nine patients with an early stage of CRF (GFR between 20 and 50 ml/min x 1.73 m2 b.s.) aged 35-77 years and 13 healthy volunteers (HV) aged 26-60, years were included in the study. All participants were investigated by sequential lowering and raising of serum calcium levels comprising the following phases: blood-ionized calcium (Ca2+) was lowered by about 0.2 mmol/l (3 steps), steady-state hypocalcemia of Ca2+ 0.2 mmol/l below the baseline (step 4), stop of the infusion for 5 minutes (step 5), Ca2+ was raised to about 0.2 mmol/l above baseline (steps 6 and 7), and a steady state hypercalcemia of Ca2+ 0.2 mmol/l above baseline (step 8). Ionized calcium and intact PTH (iPTH) were measured at 30 time points during 240 minutes. The calcium set point was determined using the classical 4-parameter model. The CiCa clamp test was performed before and after a 1-year treatment with 0.5 microg of calcitriol thrice weekly.

RESULTS

No differences in the set point were observed between HV and CRF patients with early secondary HPT. Four of 9 patients responded to calcitriol treatment with a decrease in basal serum iPTH levels ("responders"). There was no difference between renal function (GFR 18 +/- 6 vs. 17 +/- 8 ml/min x 1.73 m2 b.s.), set point (Ca2+ 1.07 +/- 0.13 vs. 1.07 +/- 0.06 mmol/l) and suppressibility of PTH secretion (PTHmin% 7.3 +/- 1.6 vs. 8.2 +/- 2.9) in responders vs non-responders, nor did these values change after treatment with calcitriol. PTHmin% decreased significantly in the whole group after treatment (10.4 +/- 8.5 vs. 7.8 +/- 2.4).

CONCLUSIONS

Although the calcium set point was not different in predialysis CRF patients with early secondary HPT compared to HV, calcitriol treatment improved the calcium-related suppression of PTH secretion (PTHmin%).

Nature and nurture in vitamin B12 deficiency

We report on a child in whom severe nutritional vitamin B12 deficiency was exacerbated by a genetic impairment of the folate cycle, causing reduced CSF concentrations of the methyl group donor 5-methyltetrahydrofolate. Some patients with vitamin B12 deficiency may benefit from high dose folic acid supplementation, even if plasma concentrations are high.

Tightening elongated ACL grafts by application of bipolar electromagnetic energy (ligament shrinkage)

In ACL transplants showing elongation with functional deficit but no interruption of structure (Marburg Arthroscopic Score type III) there is the possibility of reinsertion, augmentation, or revision ACL reconstruction to stabilize the joint. Bipolar electromagnetic energy can be used to induce the tightening of elongated ACL transplants. We examined 14 patients with a secondary instability after ACL transplantation (mean 23.6 months). During arthroscopy a type III transplant without signs of nonisometric position was found. The elongated transplants were treated by bipolar application probe. All knees where protected by an unlimited orthosis over a period of 12 weeks. Postoperative follow-up took 9.4 months. There was a significant improvement in subjective discomforts (35.9 to 88.5 points on the Lysholm score), and the Rollimeter test showed a reduction of the ventral tibial translation (13.1 to 2.6 mm). There was a correlation between the degree of chondral damage and a Lysholm score but not between subjective discomforts and the degree of instability. Our findings confirm that elongated ACL transplants can be tightened by applying bipolar electromagnetic energy during rearthroscopy, thus avoiding revision ACL reconstruction in some cases.

[Significance of minimal residual disease for the estimation of the prognosis and for therapeutic decisions in solid tumors]

The detection of disseminated tumor cells in bone marrow and blood is increasingly used for staging and therapeutic decisions in breast cancer and other solid tumors. Molecular biological methods improve the diagnostic accuracy. Limitations of the approach relate to the lack of disease-specific marker genes. The detection of tumor cells in the bone marrow after primary therapy is a negative prognostic parameter in many solid tumours. Axillary lymph node dissection and histopathology remain the standard staging procedure in breast cancer, but nodal negative patients exhibiting tumor cells in the bone marrow have an inferior outcome and may benefit from adjuvant therapy. The immunohistochemical and molecular detection of tumour cells in lymph nodes reduces the number of truly nodal-negative patients considerably. Tumour cells in bone marrow and blood may be used to directly monitor therapeutic responses.

Comparison and validation of novel pyrogen tests based on the human fever reaction

The absence of pyrogens (fever-inducing contamination) in injectable drugs is a crucial safety control because pyrogens can pose a life-threatening risk to the patient. The field of applications for pyrogen-testing is expanding and becoming more diverse due to innovative high-tech products such as medical devices, cellular therapies and species-specific agents (e.g. recombinant proteins). The overall aim of the consortium is to develop, evaluate and validate a method based on the human fever reaction to replace the rabbit pyrogen test and the Limulus assay. The network brings together the six most prominent test systems developed recently in Europe for trans-national comparison and subsequent validation of the most promising models. This pre-competitive development will initiate further applications and exploitations for new fields of pyrogen testing such as cellular therapies, medical devices and pyrogen pollution control in the work place. A method for introduction into the European Pharmacopoeia will be developed as a replacement for the rabbit pyrogen test for end-product control.

[Cocaine abuse in maintenance therapy with methadone in narcotic dependent patients]

INTRODUCTION

From a clinical point of view, additional consumption of cocaine by methadone maintained patients seems to have increased during the last few years. In order to verify this clinical impression, we carried out a retrospective analysis about cocaine abuse by opioid-dependent patients undergoing methadone maintenance therapy at the drug addiction clinic, Department of Psychiatry, University of Vienna.

METHODS

Supervised urinalysis was performed on a frequent basis in 160 patients during the investigational time frame of 1997 and 1999. Concomitant consumption of opioids, cocaine and benzodiazepines in urine toxicology results (n = 2242) was compared in a post hoc analysis.

RESULTS

In 1997, 45% of urine toxicology tests were positive for opioids, 14.1% for cocaine and 22.1% for benzodiazepines. In 1999, however, 33.1% urine toxicology tests showed positive results for opioids, 22.2% for cocaine and 24% for benzodiazepines. It could be shown that the number of cocaine positive toxicology results increased significantly (p < 0.05) over the course of two years, and that the number of opioid positive tests decreased significantly (p < 0.05), whereas benzodiazepine consumption did not change. Age, and the duration of opioid dependence showed a significant influence on cocaine positive urinalysis.

DISCUSSION

The significant increase of additional cocaine consumption in methadone maintained patients reflects the enhanced availability of the substance in Austria, as it has been shown in other European countries and the USA. In addition, evidence based treatment trials are needed to prove the efficacy of alternative opioid maintenance therapy and to evaluate whether cocaine consumption is less of a problem.

[Pregnancy and substance dependency]

Substance dependency in pregnancy leads to severe health risks for the expecting mother and for the foetus and the new-born. The problem of substance dependent pregnant women lies not only in the use of illegal substances but also to a high degree in the use of legal substances such as alcohol and nicotine. In contrast to most other substances of abuse, opioids do not show cytotoxic or teratogenic characteristics. The primary goal should be the stabilisation of the patient and a reduction of additional illicit consumption. The ideal goal of abstinence is difficult to reach and often puts the women under enhanced risks. Detoxification after week 32 should not be undertaken in order to avoid preterm delivery. It should be standardised that a multiprofessional and interdisciplinary therapeutical care leads to a stabilisation in opioid dependent pregnant addicts and therefore improves the outcome for neonates. Special awareness needs to be addressed towards the diversification of opioid maintenance therapy. Based on the positive results in opioid maintenance therapy in pregnant opioid dependent women, it will be required to establish standards. Furthermore there is a need to establish consistent guidelines for the treatment of the neonatal abstinence syndrome.

Cardiac troponins have no prognostic value for acute and chronic cardiac events in asymptomatic patients with end-stage renal failure

BACKGROUND

Cardiovascular diseases determine overall mortality in patients with end-stage renal failure. Therefore, testing for myocardial ischemia is important. Elevation of cardio-specific troponins have been frequently measured in patients with end-stage renal failure. Thus, we studied systematically whether patients on chronic intermittent hemodialysis without overt coronary heart disease have increased serum levels of cardiac troponin T and cardiac troponin I. After 2 years, the patients were screened again for cardiac events.

METHODS AND RESULTS

The patients had no history of angina during the previous 3 months or myocardial infarction (MI) within the previous 2 years. For analysis we used two cardio-specific assays for troponin T as well as for troponin I and compared the results with the CK-MB concentration. In a number of patients serum concentrations were elevated above the reference range as follows: troponin T rapid bedside assay: 41 of 100 patients, troponin I rapid bedside assay: 27 of 100 patients, quantitative measurement oftroponin T: 22 of 100 patients, quantitative measurement oftroponin I: 7 of 100 patients, CK-MB: 2 of 100 patients. The increased serum levels of cardiac troponins were neither the result of uremic perimyocarditis (pericardial effusion), changes in the hemodialysis regimen, pulmonary congestion nor were they consistent with the etiology of renal failure. None of the patients with an elevated troponin level in either of the test suffered from any acute cardiac event initially. Within 2 years 18 of 100 patients died, 13 out of them because of cardiac events. Fourteen patients had a myocardial infarction and 19 patients developed angina pectoris. Sensitivity and specificity (0.75 and 0.67) of troponin T rapid bedside assay for MACE (angina pectoris, MI, cardiac death) was lower compared to studies in patients with normal renal function. Correlation between troponin elevation and late outcome was low or absent.

CONCLUSION

Patients on chronic intermittent hemodialysis frequently present with elevated TnT and TnI levels which cannot be used as predictors of acute and chronic cardiac events. Rapid bedside assays have a lower specificity than quantitative assays.

Copper(I) complexes, copper(I)/O(2) reactivity, and copper(II) complex adducts, with a series of tetradentate tripyridylalkylamine tripodal ligands

Copper(I) and copper(II) complexes possessing a series of related ligands with pyridyl-containing donors have been investigated. The ligands are tris(2-pyridylmethyl)amine (tmpa), bis[(2-pyridyl)methyl]-2-(2-pyridyl)ethylamine (pmea), bis[2-(2-pyridyl)ethyl]-(2-pyridyl)methylamine (pmap), and tris[2-(2-pyridyl)ethyl]amine (tepa). The crystal structures of the protonated ligand H(tepa)ClO(4), the copper(I) complexes [Cu(pmea)]PF(6) (1b-PF(6)), [Cu(pmap)]PF(6) (1c-PF(6)), and copper(II) complexes [Cu(pmea)Cl]ClO(4).H(2)O (2b-ClO(4).H(2)O), [Cu(pmap)Cl]ClO(4).H(2)O (2c-ClO(4).H(2)O), [Cu(pmap)Cl]ClO(4) (2c-ClO(4)), and [Cu(pmea)F](2)(PF(6))(2) (3b-PF(6)) were determined. Crystal data: H(tepa)ClO(4), formula C(21)H(25)ClN(4)O(4), triclinic space group P1, Z = 2, a = 10.386(2) A, b = 10.723(2) A, c = 11.663(2) A, alpha = 108.77(3) degrees, beta = 113.81(3) degrees, gamma = 90.39(3) degrees; 1b-PF(6), formula C(19)H(20)CuF(6)N(4)P, orthorhombic space group Pbca, Z = 8, a = 14.413(3) A, b = 16.043(3) A, c = 18.288(4) A, alpha = beta = gamma = 90 degrees; (1c-PF(6)), formula C(20)H(22)CuF(6)N(4)P, orthorhombic space group Pbca, Z = 8, a = 13.306(3) A, b = 16.936(3) A, c = 19.163(4) A, alpha = beta = gamma = 90 degrees; 2b-ClO(4).H(2)O, formula C(19)H(22)Cl(2)CuN(4)O(5), triclinic space group P1, Z = 4, a = 11.967(2) A, b = 12.445(3) A, c = 15.668(3) A, alpha = 84.65(3) degrees, beta = 68.57(3) degrees, gamma = 87.33(3) degrees; 2c-ClO(4).H(2)O, formula C(20)H(24)Cl(2)CuN(4)O(5), monoclinic space group P2(1)/c, Z = 4, a = 11.2927(5) A, b = 13.2389(4) A, c = 15.0939(8) A, alpha = gamma = 90 degrees, beta = 97.397(2) degrees; 2c-ClO(4), formula C(20)H(22)Cl(2)CuN(4)O(4), monoclinic space group P2(1)/c, Z = 4, a = 8.7682(4) A, b = 18.4968(10) A, c = 13.2575(8) A, alpha = gamma = 90 degrees, beta = 94.219(4) degrees; 3b-PF(6), formula [C(19)H(20)CuF(7)N(4)P](2), monoclinic space group P2(1)/n, Z = 2, a = 11.620(5) A, b = 12.752(5) A, c = 15.424(6) A, alpha = gamma = 90 degrees, beta = 109.56(3) degrees. The oxidation of the copper(I) complexes with dioxygen was studied. [Cu(tmpa)(CH(3)CN)](+) (1a) reacts with dioxygen to form a dinuclear peroxo complex that is stable at low temperatures. In contrast, only a very labile peroxo complex was observed spectroscopically when 1b was reacted with dioxygen at low temperatures using stopped-flow kinetic techniques. No dioxygen adduct was detected spectroscopically during the oxidation of 1c, and 1d was found to be unreactive toward dioxygen. Reaction of dioxygen with 1a-PF(6), 1b-PF(6), and 1c-PF(6) at ambient temperatures leads to fluoride-bridged dinuclear copper(II) complexes as products. All copper(II) complexes were characterized by UV-vis, EPR, and electrochemical measurements. The results manifest the dramatic effects of ligand variations and particularly chelate ring size on structure and reactivity.

Diagnostic challenges in aspiration cytology of the salivary glands

The main goal of fine-needle aspiration (FNA) of salivary gland lesions is to assist the clinician in the management of patients who present with a mass lesion. Cytologic examination aims to determine, if a process is inflammatory and/or reactive, benign or malignant neoplasm and if possible renders a specific diagnosis. It has been argued that in the area of salivary gland tumors, surgical management relies less heavily on a specific preoperative diagnosis, because almost all neoplastic salivary gland lesions will undergo surgical excision. However, knowing beforehand if a lesion is malignant or benign, will aid in planning surgery and may prompt or postpone decisions for surgical intervention. The salivary glands are unique in their histologic complexity and morphological variability of tumors, which is reflected in the cytologic material. In addition to the overlapping morphologic patterns of salivary gland tumors, they also represent relatively rare lesions, thus making it more difficult to acquire diagnostic expertise in FNA. Other than approaching salivary gland tumors by a description of single entities in their benign and malignant categories, we favor a more practical approach to diagnosis based on the key morphologic features noted in FNAs. This article addresses differential diagnoses according to the predominant cytologic presentation with attention to the cell type and size, nature of the cytoplasm, and the smear background.

Syntheses and structural characterization of dinuclear and tetranuclear iron(III) complexes with dinucleating ligands and their reactions with hydrogen peroxide

The iron(III) complexes [Fe(2)(HPTB)(mu-OH)(NO(3))(2)](NO(3))(2).CH(3)OH.2H(2)O (1), [Fe(2)(HPTB)(mu-OCH(3))(NO(3))(2)](NO(3))(2).4.5CH(3)OH (2), [Fe(2)(HPTB)(mu-OH)(OBz)(2)](ClO(4))(2).4.5H(2)O (3), [Fe(2)(N-EtOH-HPTB)(mu-OH)(NO(3))(2)](ClO(4))(NO(3)).3CH(3)OH.1.5H(2)O (4), [Fe(2)(5,6-Me(2)-HPTB)(mu-OH)(NO(3))(2)](ClO(4))(NO(3)).3.5CH(3)OH.C(2)H(5)OC(2)H(5).0.5H(2)O (5), and [Fe(4)(HPTB)(2)(mu-F)(2)(OH)(4)](ClO(4))(4).CH(3)CN.C(2)H(5)OC(2)H(5).H(2)O (6) were synthesized (HPTB = N,N,N',N'-tetrakis(2-benzimidazolylmethyl)-2-hydroxo-1,3-diaminopropane, N-EtOH-HPTB = N,N,N',N'-tetrakis(N' '-(2-hydroxoethyl)-2-benzimidazolylmethyl)-2-hydroxo-1,3-diaminopropane, 5,6-Me(2)-HPTB = N,N,N',N'-tetrakis(5,6-dimethyl-2-benzimidazolylmethyl)-2-hydroxo-1,3-diaminopropane). The molecular structures of 2-6 were established by single-crystal X-ray crystallography. Iron(II) complexes with ligands similar to the dinucleating ligands described herein have been used previously as model compounds for the dioxygen uptake at the active sites of non-heme iron enzymes. The same metastable (mu-peroxo)diiron(III) adducts were observed during these studies. They can be prepared by adding hydrogen peroxide to the iron(III) compounds 1-6. Using stopped-flow techniques these reactions were kinetically investigated in different solvents and a mechanism was postulated.

Pharmacodynamics and pharmacokinetics of polyethylene glycol-hirudin in patients with chronic renal failure

BACKGROUND

Hirudin selectively inhibits thrombin without cofactors and is eliminated via the kidneys. Recombinant hirudin (r-hi) has a terminal elimination half-life (t1/2) of about 50 to 100 minutes. Coupling of polyethylene glycol (PEG) to r-hi, giving PEG-hirudin (PEG-Hi), prolongs its t1/2 while enhancing efficacy. We looked at the pharmacodynamic and pharmacokinetic behavior of PEG-Hi in patients with impaired renal function.

METHODS

Anticoagulant activity and the pharmacokinetic parameters of a single intravenous bolus injection of 0.05 mg/kg body weight PEG-Hi were studied in 38 subjects. They were assigned to five groups: group IA, creatinine clearance (CCr) >/= 80 mL/min, 8 healthy volunteers; group IB, CCr >/= 80 mL/min, 8 patients with normal renal function); group II, CCr 79 to 50 mL/min, 7 patients with mild chronic renal failure (CRF); group III, CCr 49 to 20 mL/min, 10 patients with moderate CRF; and group IV, CCr </= 19 mL/min, 5 patients with severe CRF. Plasma and urine samples were collected from patients for up to 120 hours after dosing and from healthy volunteers for up to 24 hours.

RESULTS

PEG-Hi was well tolerated in all groups. No serious adverse events were noted. Cmax values were similar in all groups; area under the curve (AUC) increased in patients from 2.9 +/- 1.0 microg. h/mL (IB) to 21.3 +/- 5.0 microg h/mL (IV). According to the severity of renal function, t1/2 was prolonged from 2 hours (IB) to 38.4 hours (IV), while total body clearance (CTB), renal clearance (CRenal), and recovery of PEG-Hi in the urine (FEo-t) decreased as follows: CTB from 23.3 +/- 6.6 (IB) to 2.9 +/- 0.6 mL/min (IV), CRenal from 7.8 +/- 5.0 (IB) to 0.8 +/- 0.5 mL/min (IV), and FEo-t from 40.2 +/- 18. 9% (IB) to 12.6 +/- 13.0% (IV). Total plasma clearance of PEG-Hi was well correlated with CCr. Anti-IIa activity of PEG-Hi showed a closer linear relationship to ecarin clotting time than to activated partial thromboplastin time.

CONCLUSION

Hence, PEG-Hi is considered safe in patients with CRF, but dosing and/or dose intervals should be adjusted according to the severity of renal impairment. Ecarin clotting time is well suited for safe and reliable monitoring of PEG-Hi.

Prevalence and distribution of hepatitis C subtypes in patients with opioid dependence

AIM AND SETTING: The drug addiction out-patient clinic at the University Hospital for Psychiatry in Vienna performed a study to identify the prevalence of hepatitis C virus (HCV) infections in a group of opiate-dependent patients, to detect the distribution of HCV subtypes and to calculate the comorbidity of human immunodeficiency virus (HIV) and hepatitis B virus (HBV).

DESIGN AND PARTICIPANTS

We consecutively investigated unselected patients (n = 173) during an observation period of 2 months with the diagnosis of opioid dependence (DSM-IV: 304.0) and polysubstance dependence (DSM-IV: 304.9).

MEASUREMENTS

Blood was investigated focusing on liver enzymes and on viral status including HIV, hepatitis B and hepatitis C, followed by subtyping of the virus.

FINDINGS

In 80.3% hepatitis C antibodies were found, 66.5% were HCV RNA (PCR) positive. 3a was the most frequent subtype (35.6%), followed by 1a (28.8%) and 1b (22.0%). Four patients had both subtypes 1a and 1b (6.8%), 3 were 2b positive (5.1%) and 1 patient had subtypes 2a/2c (1.7%). No significant difference in aspartate (AST) and alanine aminotransferases (ALT) concerning the different subtypes (AST: p = 0.290; ALT: p = 0.260) could be calculated; 11.6% showed co-infection with HIV, 2 patients had a chronic infection with hepatitis B.

CONCLUSIONS

The rate of HCV infection in substance-dependent patients at our drug addiction out-patient clinic is extremely high. The distribution of subtypes showed a relatively homogeneous distribution of the types 1a, 1b and 3a. The recommended therapy with alpha-interferon should be initiated in drug-dependent patients under considerations of an enrollment in oral maintenance with synthetic opioids.

Comparison of VIDAS with direct immunofluorescence for the detection of respiratory syncytial virus in clinical specimens

BACKGROUND

requirements for infection control measures and the decision for treatment with antiviral agents make the rapid detection of respiratory syncytial virus (RSV) essential for hospitalized, pediatric and immunocompromised patients. Immunofluorescence is considered to be the most rapid and sensitive method for direct detection of RSV in clinical specimens, but several enzyme-linked immunoassays have also been commercially available.

OBJECTIVES

to compare the performance of VIDAS RSV assay (Vitek ImmunoDiagnostic Assay System, BioMerieux Vitek), which is an automated enzyme-linked fluorescent immunoassay (ELFA) to direct immunofluorescence (DFA), in rapid detection of RSV in respiratory specimens.

STUDY DESIGN

respiratory specimens collected during the 'RSV season', between the months of November 1997 and February 1998, were tested by both methods. DFA was performed upon receipt of the sample and an aliquot of the original specimen was stored in -70 degrees C for batch testing with VIDAS.

RESULTS

from 238 samples that were tested, 231 could be evaluated by both methods. The two assays were in agreement for 213 specimens (92%), or 32 positive and 181 negative results. Eighteen discrepant results were generated; seven specimens were VIDAS-/DFA+ and 11 specimens were VIDAS+/DFA-. In addition, seven specimens had an inadequate number of cells for evaluation with DFA. One of these samples tested positive with VIDAS. VIDAS relative sensitivity and specificity were 82% and 94%, respectively, when compared to DFA.

CONCLUSIONS

VIDAS is simple to perform, does not require expertise in interpretation and appears to be an acceptable method for the rapid detection of RSV.

Outpatient opiate detoxification treatment with buprenorphine. Preliminary investigation

In an open study design, 50 opioid-dependent subjects (DSM-IV: 304. 0) were investigated in a gradual detoxification treatment with buprenorphine. The study was performed at the drug addiction outpatient clinic of the Department of General Psychiatry at the University of Vienna. Subjects had to contact the outpatient clinic on a daily basis and buprenorphine was administered according to their clinical status. Withdrawal symptoms were evaluated by applying the WANG scale. Urine samples were screened for drug toxicology to exclude additional consumption. In this investigation buprenorphine was applied sublingually in a free dosage scheme aimed at completing detoxification treatment within 10 days by reducing buprenorphine on a daily basis. A mean daily dosage of 2.3 mg buprenorphine was required by patients on day 1 of the treatment period. The highest mean daily buprenorphine dosage was given on day 2, followed by a daily reduction over the study period. The result of this open study design revealed that a gradual daily reduction of buprenorphine might be a successful alternative outpatient detoxification treatment in opioid-dependent subjects. Compliance was 70%, the reported and evaluated withdrawal symptoms during the study period were moderate.

Follow-up of atypical glandular cells in cervical-endocervical smears

Atypical glandular cells of undetermined significance (AGUS) is a diagnostic category of the Bethesda system encompassing glandular-type cells that show either endometrial or endocervical differentiation and display greater atypia than expected for a reactive process but do not meet the criteria for invasive adenocarcinoma. We investigated AGUS in a follow-up study of cervical-endocervical smears with either histology or repeat cytology follow-up. From the cytology files at Northwestern Memorial Hospital over a 4-year period, 136 cervical-endocervical smears were diagnosed with AGUS, which were further subdivided into atypical glandular cells, unqualified (AGC-U); atypical glandular cells, favor reactive (AGC-FR); or atypical glandular cells, favor neoplasia (AGC-FN). Of 96 cases with either histologic or cytologic (cervical-endocervical smear) follow-up, 39 cases of AGC-U had a variety of diagnoses on follow-up, with mostly benign entities in 72% and squamous intraepithelial lesions in 28%. Follow-up of the 36 cases of AGC-FR also demonstrated mostly benign entities (82%) and five cases of squamous intraepithelial lesions. The largest number of premalignant and malignant diagnoses (48%) was found during follow-up of patients with an initial diagnosis of AGC-FN, including the only two cases of adenocarcinoma in situ in our study. In conclusion, our study confirms that AGUS encompasses a wide spectrum of diagnoses, most of which prove to be benign. Subclassification of these cases into "favor reactive" and "favor neoplasia" was found to be helpful in predicting the follow-up status of these patients. However, the small but distinctive percentage of preneoplastic and neoplastic diagnoses seen on follow-up warrant further diagnostic procedures and/or close monitoring in patients with this diagnosis.

[Adenosarcoma and other uterine sarcomas]

Sarcomas are tumors of conjunctive origin, rarely relating to the gynaecological sphere; among these, the adenosarcoma only represent one particular aspect. From one clinical case and from literature, the authors attempt to sum up the situation on the different clinical, para-clinical and therapeutic aspects of those bad-know neoplasia.

Risk of suicide in depression and its implication for psychopharmacological treatment

Suicide is one of the leading causes of death among adults in the general population. There is a well-established relationship between suicide and mood disorders and it has been estimated that 50-80% of completed suicides are associated with mood disorders. About 15% of depressed patients commit suicide, with tablet poisoning (mostly antidepressants) often chosen as the suicide method. Naturally, this presents the doctor with a dilemma since certain antidepressants are suitable both for the treatment of depression and for a suicide attempt. Two questions seem to be of particular practical relevance in this respect, which will be reviewed and discussed in more detail in this paper: (1) can antidepressants induce a suicidal tendency? and (2) can the degree of toxicity of antidepressants be estimated in cases of overdosage? There is no evidence that newer antidepressants, like the selective serotonin reuptake inhibitors (SSRIs), induce a suicidal tendency as has been suggested by a spectacularly written case report. In fact, it seems likely that antidepressants with a predominantly serotonergic mechanism of action may be of particular benefit in patients with suicidal problems, which is in line with neurobiological theories about suicidal behaviour. This and the decreased toxicity of SSRIs makes them an attractive choice for treatment of depressed patients who are at risk for suicide.

[Therapy of post-stroke depression with fluoxetine. A pilot project]

Depression is a common but often unrecognized complication after cerebrovascular stroke. Tricyclic antidepressants (TCA) have been found to be effective in poststroke depression, but side effects such as orthostatic hypotension, arrhythmia limit their wider use. In this pilot study the effects of treatment with the specific serotonin reuptake inhibitor (SSRI) fluoxetine (20 mg) in 10 severely depressed patients (HAM-D score between 27 and 35) after cerebrovascular stroke were investigated. Four patients dropped out of the study prematurely because of worsening of their condition (n = 4) and one patient discontinued the study because of transfer to a nursing home. After 3 weeks of fluoxetine treatment there was a significant amelioration in all the measured scores (HAM-D, Beck, CGI and Barthel: P < 0.05). At the end of the study one patient with recurrent cerebrovascular lesions still had an HAM-D score of 25, but the other four patients had HAM-D scores between 6 and 11. The physical rehabilitation scores measured with the Barthel Index showed negative correlations with the HAM-D, Beck and CGI scores for most items; this has to be interpreted with caution considering the number of patients involved in this investigation. The authors suggest that future double blind trials are warranted to test the efficacy of fluoxetin therapy for poststroke depression. Methodological problems in connection with pharmacological trials in these severely ill patients are discussed.

[EEG changes in schizophrenic diseases--a critical review]

To identify specific changes in the electroencephalogram of schizophrenic patients has been an important target of clinical neurophysiology ever since the introduction of the EEG. Results of EEG-amplitude- and frequency-analysis in schizophrenics--although sometimes contradictory--are presented. Special emphasis is laid upon possible clinical applicabilities, for instance the prediction of the clinical course by means of neurophysiological changes after administration of a neuroleptic test dose. Finally, the usefulness of examining electrophysiological changes in such a heterogeneous group, as schizophrenics are, is discussed critically.

MTT-assay and neutral red release (NRR)-assay: relative role in the prediction of the irritancy potential of surfactants

A comparative study on the in vitro and in vivo irritancy of anionic, amphoteric and non-ionic surfactants was performed. In vitro ED50 values of the surfactants were determined by two cytotoxicity assays, the dimethylthiazoldiphenyltetrazoliumbromide (MTT) assay and the neutral red release (NRR) assay on serum-free cultured human foreskin keratinocytes. In vivo human irritancy data were obtained by a 24 hour occlusive patch test in volunteers and the irritant skin response quantified by visual scoring, evaporimetry and colorimetry. A close relationship between the evaluation methods of the patch test was observed (r = 0.92 to r = 0.96), confirming that the 'bioengineering' methods, such as evaporimetry and colorimetry are suitable for measuring skin irritation. For six surfactants evaluated we found a good correlation (r = 0.91) between the ED50 values of the MTT assay and the in vivo irritancy data. The NRR assay yielded less satisfactory correlation coefficients with regard to MTT assay (r = 0.42) and in vivo irritancy data (r = 0.46). This can be mainly attributed to a misinterpretation of the amphoteric and non-ionic surfactants by the NRR assay. While the NRR assay may better evaluate the anionic surfactants, the MTT assay seems to be more suitable when testing a broader range of chemically diverse surfactants. Limitations of cell culture systems are noted, although the potential usefulness of cultured human skin cells for skin irritancy testing has been clearly demonstrated.

[Differential diagnosis of transplant function disorders in therapy with monoclonal antibodies OKT3]

The use of OKT3 monoclonal antibodies has improved the immunosuppressive therapy. Due to the high efficiency of this treatment there is an increased risk of overimmunosuppression and occurrence of life-threatening viral infections. Therefore a cautious application of OKT3 is mandatory, a reliable differential diagnosis of the deteriorating graft function essential. In this study the high diagnostic value of urinary neopterin in the early and reliable diagnosis of CMV infection under OKT3 therapy in contrast to serum amyloid A as a marker of rejection could be shown. A differential therapy, supporting or reducing the immunosuppression, might be facilitated by daily monitoring of the neopterin and serum amyloid A.

Becker muscular dystrophy: carrier detection by real-time ultrasound

The applicability was tested of real-time ultrasound imaging to the high musculature for the carrier detection of Becker muscular dystrophy (BMD). A total of 17 obligate carriers were examined. Ultrasound images in 3 patients, aged between 46 and 59 years, showed moderate differences compared with the controls. In 3 other obligate carriers, aged between 46 and 71 years, only doubtfully abnormal findings could be made; ultrasound images showed no differences in 11 BMD carriers aged between 10 and 47 years. In women aged over 40 years, compared with adequate controls of the same body type, real-time ultrasound imaging may provide additional evidence and thus help in the detection of BMD carriers.