Einfluss der Vakzination von Sauen gegen Mycoplasma hyopneumoniae auf den Impfschutz der Ferkel

Gegenstand und Ziel: Untersuchung der Wirkung der Impfstoffe Stellamune® Mycoplasma (Two-Shot) und Stellamune ® One (One-Shot) (Fa. Pfizer) gegen Mycoplasma hyopneumoniae nach Vakzination von Sauen und/oder Ferkeln. Material und Methoden: 254 Muttersauen und 423 Ferkel wurden fünf Gruppen zugeteilt: Gruppe 1: Sauen vakziniert, Ferkel One-Shot; Gruppe 2: Sauen vakziniert, Ferkel Two-Shot; Gruppe 3: Sauen nicht vakziniert, Ferkel One-Shot; Gruppe 4: Sauen nicht vakziniert, Ferkel Two-Shot; Gruppe 5: Sauen vakziniert, Ferkel nicht vakziniert. Von den Sauen wurde drei Wochen a. p., am Tag der Geburt und drei Wochen p. p. und von den Ferkeln am 1., 21., 63. und 140. Lebenstag Blut entnommen und auf Antikörper gegen M. hyopneumoniae untersucht. Nach der Schlachtung erfolgte eine Lungenbeurteilung. Die täglichen Zunahmen bis zum 105. Lebenstag wurden ermittelt. Ergebnisse: Im Alter von 20 Wochen bestanden keine signifikanten Unterschiede in der humoralen Immunantwort bei den Tieren der Gruppen mit Impfung der Ferkel und die Tiere der nicht vakzinierten Gruppe zeigten signifikant niedrigere Antikörpertiter. Die Probanden aller Gruppen mit einer Saugferkelvakzination hatten signifikant bessere Lungenscores als die Tiere der Gruppe ohne Saugferkelimpfung. Ein signifikanter Unterschied bestand zwischen den Tieren der beiden Gruppen mit einmaliger Impfung der Ferkel, wobei die Tiere der Gruppe ohne Vakzination der Sauen signifikant bessere Lungenscores aufwiesen. Bis zum 105. Lebenstag differierten die täglichen Zunahmen der Tiere der einzelnen Gruppen nicht signifikant. Schlussfolgerungen: Die Antikörpertiter bei den Ferkeln geimpfter und nicht geimpfter Sauen eine Woche p. n. zeigten, dass die Impfung von Sauen geeignet ist, hohe Konzentrationen maternaler Antikörper im Ferkel zu induzieren. Allerdings konnte kein Effekt auf die Tageszunahmen oder den Lungenscore festgestellt werden. In allen Gruppen mit Impfung der Ferkel lag der Lungenscore niedriger als bei der Kontrollgruppe ohne Impfung. Die verschiedenen Impfschemata wirkten sich bis zur Vormast nicht auf das Gewicht der Tiere aus. Klinische Relevanz: In diesem Bestand ließ sich durch die Vakzination der Ferkel mit den eingesetzten Impfstoffen die Lungengesundheit verbessern. Eine alleinige Vakzination der Sauen führte in diesem Versuchsbetrieb zu keinem ausreichenden Schutz.

Intradural-Extramedullary Cavernous Hemangioma of the Left Motor Root C7 - Case Report and Update of the Literature

OBJECTIVE

Intradural-extramedullary cavernomas of the spine are rare lesions with only 21 published cases to date. Due to their rareness and special characteristics diagnosis often is difficult. We report on an additional case of an intradural-extramedullary cavernoma of the spine.

PATIENT

A 56-year-old male presented with left shoulder pain and acute onset of pain affecting the whole spinal column two weeks prior to admission. There were no motor deficits, but a hypesthesia corresponding to the right distal C8-dermatome. MRI revealed an intradural-extramedullary, expansive lesion at the level of C6 with a hyperintense appearance in both T (1)- and T (2)-weighted images. Neither a hemosiderin rim nor contrast enhancement was visible.

RESULTS

During surgery a hematoma and a reddish, berry-like tumor adherent to the left motor root C7 were removed. There were no new neurological deficits, and shoulder and back pain resolved within a few weeks after surgery. Histopathologically a cavernous hemangioma was diagnosed.

CONCLUSIONS

The patient's symptoms were caused both by direct nerve compression and by spinal hemorrhage, most likely spinal SAH. As there was no characteristic hemosiderin rim and due to the hyperintense appearance in T (1)- and T (2)-weighted MR scans, a radiological diagnosis of hemorrhage and classification of the lesion was difficult. Despite their rareness, in patients with signs of spontaneous, spinal SAH and/or nerve compression syndromes cavernous hemangiomas have to be considered as a potential cause.

[Long-term experiences in the therapy of esthesioneuroblastoma]

BACKGROUND

Esthesioneuroblastoma is a rare and clinically variable tumor of nasal sinus and skull base and challenging for modern multidisciplinary therapy. There are no generally known prognostic factors or generally accepted standard therapy regimens.

PATIENTS AND METHODS

Between 1975 and 2001 26 patients were treated after the diagnosis of esthesioneuroblastoma was established. The cases were evaluated retrospectively. According to the classification of Kadish 1 patient (4 %) had stage A, 16 patients (53 %) stage B and 11 cases (43 %) had stage C tumors. Hyams grading could be obtained in 22 cases (81 %). Tumors were in 12 patients (52 %) graded I or II and in 10 cases tumors had grade III or IV (48 %). Operative therapy was performed in 23 patients (88.5 %), being in 5 patients a single mode therapy. In 18 cases combined therapy was performed (surgery and radiotherapy or radiotherapy and chemotherapy).

RESULTS

Actuarial survival was 61.5 % (16/26). Disease specific 10- and 15-year-survival according to the estimation of Kaplan-Meier was 76.2 %. Patients with small tumors (Kadish A/B) had a 15-year-survival of 86.7 % compared to 63.6 % in cases with advanced tumors (Kadish C). In 7 cases (26.9 %) recurrences developed. Salvage therapy was performed in 5 cases (71.4 %) with a success rate and a 15-year survival each of 60 %.

CONCLUSIONS

Therapy of esthesioneuroblastoma is challenging because of rarity and biologic variability of the tumor and and because of lack of a standard therapy. An interdisciplinary multimodal therapeutic approach is necessary especially in case of advanced tumors with promising results. Histopathological grading according to Hyams and tumor stage are important factors for survival and prognosis. Although recurrence can occur with high frequency even after prolonged time interval, long time survival can be improved after aggressive salvage therapy. Therefore longterm follow up is mandatory.

[Renal angiomyolipoma complicated by extension to the renal vein and inferior vena cava]

Renal angiomyolipomas are renal hamartomas. They are usually found incidentally, presenting as well-defined echogenic masses on sonography and fat containing tumors on CT and MRI. We report a case of angiomyolipoma with sonographic and CT evidence of extension to the renal vein and inferior vena cava.

Uterine lipoma: MRI features with pathologic correlation

Fatty tumors of the uterus are rare. Most reported cases have been of the mixed type, consisting of smooth muscle and mature adipose tissue. We present the first case of a pure lipoma with pathologic correlation in which a preoperative diagnosis was made by magnetic resonance imaging.

Delayed Facial Nerve Paresis Following Acoustic Neuroma Resection and Postoperative Vasoactive Treatment

OBJECT

Delayed facial nerve paresis is a well known clinical phenomenon following acoustic neuroma surgery, typically occurring early during the postoperative course. The clinical course of the delayed facial nerve paresis and intraoperative electromyographic (EMG) signals were evaluated in a subgroup of patients who underwent vasoactive treatment for preservation of hearing and developed secondary deterioration after termination of treatment.

METHODS

Between 1990 and 2001 seven patients were identified who received vasoactive treatment for preservation of hearing and developed a delayed facial nerve paresis after termination of medication. Intraoperative facial nerve EMG activity was analyzed in six patients.

RESULTS

All patients developed a delayed facial nerve paresis between 2-5 days following termination of a 10 day treatment consisting of HES and nimodipine. Medication was re-initiated and the facial nerve paresis improved in all patients. In two patients intraoperative EMG signals revealed "A-trains" waveform patterns, which are highly suggestive for an immediate postoperative facial nerve paresis, whereas in four patients no pathognomonic EMG patterns could be recorded.

CONCLUSIONS

The delayed onset of a facial paresis following termination of vasoactive treatment points to a disturbed microcirculation of the nerve as the main pathophysiological feature. Two groups could be identified on the basis of intraoperative EMG activity. In one group with presence of "A-trains" medication apparently masked the onset of an immediate postoperative facial nerve deficit. Four patients without "A-trains" did not develop a typical delayed facial nerve paresis during vasoactive treatment, but thereafter. The time lag between termination of treatment and onset of a delayed palsy points to a protective effect due to improved microcirculation.

[Multidetector CT and MRI in pancreatic diseases]

Multidetector CT and MRI are the most efficient non invasive techniques in the assessment of pancreatic diseases. As with MRI, multidetector CT has now become an all in one examination using 2 D and 3 D multiplanar reformations with the ability to perform with high accuracy: a) vascular assessment using MIP reconstruction and b) biliary and pancreatic ducts assessment using minIP reconstruction. This review compares and illustrates the respective advantages of MRI and multidetector CT in the assessment of pancreatic diseases.

Localisation of the sensorimotor cortex during surgery for brain tumours: feasibility and waveform patterns of somatosensory evoked potentials

OBJECTIVE

Intraoperative localisation of the sensorimotor cortex using the phase reversal of somatosensory evoked potentials (SEPs) is an essential tool for surgery in and around the perirolandic gyri, but unsuccessful and perplexing results have been reported. This study examines the effect of tumour masses on the waveform characteristics and feasibility of SEP compared with functional neuronavigation and electrical motor cortex mapping.

METHODS

In 230 patients with tumours of the sensorimotor region the SEP phase reversal of N20-P20 was recorded from the exposed cortex using a subdural grid or strip electrode. In one subgroup of 80 patients functional neuronavigation was performed with motor and sensory magnetic source imaging and in one subgroup of 40 patients the motor cortex hand area was localised by electrical stimulation mapping.

RESULTS

The intraoperative SEP method was successful in 92% of all patients, it could be shown that the success rate rather depended on the location of the lesion than on preoperative neurological deficits. In 13% of the patients with postcentral tumours no N20-P20 phase reversal was recorded but characteristic polyphasic and high amplitude waves at 25 ms and later made the identification of the postcentral gyrus possible nevertheless. Electrical mapping of the motor cortex took up to 30 minutes until a clear result was obtained. It was successful in 37 patients, but failed in three patients with precentral and central lesions. Functional neuronavigation indicating the tumour margins and the motor and sensory evoked fields was possible in all patients.

CONCLUSION

The SEP phase reversal of N20-P20 is a simple and reliable technique, but the success rate is much lower in large central and postcentral tumours. With the use of polyphasic late waveforms the sensorimotor cortex may be localised. By contrast with motor electrical mapping it is less time consuming. Functional neuronavigation is a desirable tool for both preoperative surgical planning and intraoperative use during surgery on perirolandic tumours, but compensation for brain shift, accuracy, and cost effectiveness are still a matter for discussion.

[Imaging of the anterior abdominal wall: ultrasonography and CT features]

US and CT have both become major tools in imaging of the anterior abdominal wall. The goal of this pictorial review is to illustrate the respective roles of US and CT in the evaluation of normal and abnormal anterior abdominal wall.

Vasoactive treatment for hearing preservation in acoustic neuroma surgery

OBJECT

Delayed hearing loss following surgery for acoustic neuroma indicates anatomical and functional preservation of the cochlear nerve and implies that a pathophysiological mechanism is initiated during surgery and continues thereafter. Intraoperative brainstem auditory evoked potentials (BAEPs) typically demonstrate gradual reversible loss of components in these patients.

METHODS

Based on this BAEP pattern, a consecutive series of 41 patients with unilateral acoustic neuromas was recruited into a prospective randomized study to investigate hearing outcomes following the natural postoperative course and recuperation after vasoactive medication. Both groups were comparable in patient age, tumor size, and preoperative hearing level. Twenty patients did not receive postoperative medical treatment. In 70% of these patients anacusis was documented and in 30% hearing was preserved. Twenty-one patients were treated with hydroxyethyl starch and nimodipine for an average of 9 days. In 66.6% of these patients hearing was preserved and in 33.3% anacusis occurred.

CONCLUSIONS

These results are statistically significant (p < 0.05, chi2 = 5.51) and provide evidence that these surgically treated patients suffer from a disturbed microcirculation that causes delayed hearing loss following removal of acoustic neuromas.

Clinical and neurophysiological observations after superior petrosal vein obstruction during surgery of the cerebellopontine angle: case report

IMPORTANCE

Preservation of venous drainage during surgery of the cerebellopontine angle has received little attention.

CLINICAL PRESENTATION

We describe changes in brainstem auditory evoked potentials after temporary obstruction of the superior petrosal vein during surgical resection of a small meningioma at the petrous apex via a standard suboccipital-lateral approach. Temporary clipping of the petrosal vein resulted in deterioration of the brainstem auditory evoked potentials. The tumor was removed with preservation of the superior petrosal vein.

CONCLUSION

A transient postoperative cochlear nerve deficit emphasizes the importance of venous drainage and its preservation during surgery for small lesions of the cerebellopontine angle that do not distort normal anatomic structures.