[Chemoprevention of breast cancer: a literature review and report on the current status in Germany]

The prevention of breast cancer is increasingly of focus in health-politics policies and has gained a valid position in the area of medical intervention. Data from a current meta-analysis of all four randomised Tamoxifen prevention studies illustrate a reduction of 38 % (Odds ratio 0.62; 95 % CI 0.42-0.89) in the incidence of breast cancer. This observation lead to registration of this drug in the USA for the prevention of breast cancer in women with a calculated 5-year risk of > 1.66 %. In addition to Tamoxifen, further substances are currently being tested with the aim of improving the therapeutic index whilst reducing incidence and mortality rates. These are primarily substances which have proven efficacy in the treatment of breast cancer (other antioestrogens, aromatase inhibitors and GnRH-analogues) or those whose mechanism of action predict a preventative effect (retinoids, phytooestrogens, substitution preparations e. g. Tibolone). In Germany, chemoprevention is currently only to be recommended within study protocols, as to date no substance is approved in the indication 'prevention of breast cancer'. A essential contribution to the accrual of valid data is the conduct of breast cancer prevention trials. The participation of women with high risk of breast cancer in Germany is, in contrast to comparable international studies, problematic. Data on the current knowledge and attitude of the female population towards such trials (gathered via a questionnaire of the DACH in 7 000 women) show that only 19.5 % of the women questioned during a consultation with a gynaecologist were aware of the possibility of active chemoprevention. However, 55.3 % stated that they would be prepared to take such a substance, were chemoprevention possible. Studies for both pre- and post-menopausal women with increased risk of breast cancer are currently active in Germany (GISS and IBIS-II of the study group GABG - German Adjuvant Breast cancer Group). An intensive information campaign to raise public awareness of breast cancer risk amongst women and their physicians is planned in conjunction with the IBIS-II study (www.brustkrebsvorbeugen.de). Latest literature recommendations for prevention of breast cancer (Chlebowski et al.) have been assessed.

Invasive intrauterine treatment of pulmonary atresia/intact ventricular septum with heart failure

The mortality and morbidity of children with pulmonary atresia/intact ventricular septum (PA/IVS) are linked to the degree of right ventricular (RV) hypoplasia. Opening up the pulmonary valve (PV) in fetal life could result in improved growth of the RV making it amenable to biventricular repair postnatally. Successful valvulotomy of the PV was performed in a fetus with heart failure at 28 weeks. Following the procedure there was significant growth of the tricuspid valve and RV. The neonate was delivered at 38 weeks with a RV suitable for biventricular repair. In utero pulmonary valvulotomy is feasible and may change the natural history of the condition in affected fetuses with PA/IVS.

[Real time 3D sonography of the normal fetal heart--clinical evaluation]

AIM

Aim of the study was to determine the clinical feasibility of real time 3D ultrasound in the examination of the normal fetal heart compared to conventional 2D fetal echocardiography.

METHOD

Twenty fetuses with normal hearts at 20 to 38 weeks of gestation underwent real time 3D ultrasound. Examination data were stored on an external notebook. Later analysis and interpretation was done by a different sonographer using a special software.

RESULTS

In the assessment of the four chamber view and the out flow tracts real time 3D ultrasound was equivalent to conventional ultrasound. Advantages of realtime 3D ultrasound were the possibility of later time-independent off-line analysis and post-processing of volume data and generation of new views not available in 2D imaging. Disadvantages included low frame rate (16 frames/s), low lateral resolution and the lack of Doppler and colour information.

CONCLUSION

Simultaneous display of 3 different views of the fetal heart as well as the construction of spatial perspectives ("new views") provide additional useful information to conventional fetal echocardiography. Later off-line analysis of 3D volume data can be used for sequential analysis of the normal fetal heart with good diagnostic results. Currently it remains unclear whether this new method may provide additional important information in the assessment of fetal congenital heart defects.

Characterizing voltage-dependent Ca(2+) channels coupled to VIP release and NO synthesis in enteric synaptosomes

In enteric synaptosomes of the rat, the role of voltage-dependent Ca(2+) channels in K(+)-induced VIP release and nitric oxide (NO) synthesis was investigated. Basal VIP release was 39 +/- 4 pg/mg, and cofactor-substituted NO synthase activity was 7.0 +/- 0.8 fmol. mg(-1). min(-1). K(+) depolarization (65 mM) stimulated VIP release Ca(2+) dependently (basal, 100%; K(+), 172.2 +/- 16.2%; P < 0.05, n = 5). K(+)-stimulated VIP release was reduced by blockers of the P-type (omega-agatoxin-IVA, 3 x 10(-8) M) and N-type (omega-conotoxin-GVIA, 10(-6) M) Ca(2+) channels by ~50 and 25%, respectively, but not by blockers of the L-type (isradipine, 10(-8) M), Q-type (omega-conotoxin-MVIIC, 10(-6) M), or T-type (Ni(2+), 10(-6) M) Ca(2+) channels. In contrast, NO synthesis was suppressed by omega-agatoxin-IVA, omega-conotoxin-GVIA, and isradipine by ~79, 70, and 70%, respectively, whereas Ni(2+) and omega-conotoxin-MVIIC had no effect. These findings are suggestive of a coupling of depolarization-induced VIP release primarily to the P- and N-type Ca(2+) channels, whereas NO synthesis is presumably dependent on Ca(2+) influx not only via the P- and N- but also via the L-type Ca(2+) channel. In contrast, none of the Ca(2+) channel blockers affected VIP release evoked by exogenous NO, suggesting that NO induces VIP secretion by a different mechanism, presumably involving intracellular Ca(2+) stores.

Fifty years of prison suicide in Austria: does legislation have an impact?

The absolute and relative frequency of suicides in jails and prisons in Austria over the 50 years from 1947 to 1996 is described. Important legislational changes regarding the criminal justice system are discussed with regard to possible consequences for the incidence of prisoners' suicides. Within the five decades a significant increase in the absolute numbers of jail and prison suicides was evident in spite of the considerable decrease in the total inmate population. Therefore, the suicide rate of inmates of correctional facilities increased significantly. Possible reasons for this phenomenon are discussed in relation to changes of the criminal law.

Clinical validity of ICD-10 neurasthenia

BACKGROUND

Neurasthenia was defined over a century ago. In view of a questionable clinical validity, it was omitted from the 3rd edition of the American Psychiatric Association's DSM, while it remains as an own diagnostic category in the WHO's ICD-10. The purpose of this study was, therefore, to examine the clinical validity of ICD-10 neurasthenia in a consecutive sample of chronic pain patients.

PATIENTS AND METHODS

We included 193 patients (mean age 45.1, SD +/- 10.2, 63% females) in the study. Psychiatric diagnoses were established by the use of ICD-10 Diagnostic Criteria for Research. In addition, the Screening List for Somatization Symptoms was administered: self-rating of 53 medically unexplained somatic symptoms, and 11 additional screening questions concerning weakness after slight mental or physical exertion and disease conviction.

RESULTS

Thirty-three percent of the patients who fulfilled the criteria of ICD-10 neurasthenia also fulfilled the criteria of ICD-10 somatization disorder, 69% the criteria of ICD-10 undifferentiated somatoform disorder, 14% the criteria of ICD-10 hypochondriacal disorder, 66% the criteria of ICD-10 somatoform autonomic dysfunction, 85% the criteria of ICD-10 persistent somatoform pain disorder and 14% the criteria for sexual dysfunction not caused by organic disorder or disease. The symptom profile of ICD-10 neurasthenia was not clearly distinguishable from the symptom profiles of ICD-10 somatoform disorders and ICD-10 sexual dysfunction.

DISCUSSION

Due to this substantial diagnostic overlap, the clinical validity of ICD-10 neurasthenia remains questionable.

Memory deficits in patients with DSM-IV obsessive-compulsive disorder

Neuropsychological testing provides increasing evidence that certain memory deficits might play an essential role in the emergence of doubts and, as a result, in perpetuating checkers' rituals. Another account of doubting implicates meta-cognitive factors, such as confidence in memory. The present study examined mnestic functioning and self-perception of memory ability in a group of 27 nondepressed patients with obsessive-compulsive disorder (OCD) and 27 normal controls. All patients met DSM-IV and ICD-10 criteria for OCD, displayed prominent behavioral checking rituals and had to show a score on the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) of at least 16. Significant deficits in intermediate (Lern- und Gedächtnistest; LGT-3) and immediate (Corsi Block-Tapping Test) nonverbal memory were identified in the patients with OCD compared to normal controls. Contrary to predictions, OCD patients also showed a significant deficit in general memory and verbal memory (LGT-3). With respect to meta-cognition, OCD patients reported less confidence in their memories than controls. These findings suggest that obsessional doubt reflects a deficit in memory as well as a deficit in memory confidence. Depending on which dysfunction predominates, different therapeutic procedures seem to be required.

Alexithymia in DSM-IV Disorder: Comparative Evaluation of Somatoform Disorder, Panic Disorder, Obsessive-Compulsive Disorder, and Depression

The purpose of this study was a direct comparative evaluation of alexithymia in patients with somatoform disorder, panic disorder, obsessive-compulsive disorder, and depression, taking into account the multidimensionality of the alexithymia construct. The authors administered the Structured Clinical Interview for DSM-IV (SCID) and the Toronto Alexithymia Scale (TAS-20) to a sample of 234 subjects. Panic disorder, but no other diagnosis, was significantly related to lower TAS-20 total scores (P=0.000). Regarding TAS-20 subfactors, Factor 1 was significantly associated with somatoform disorder (P=0.006) and depression (P=0.002), Factor 2 was significantly associated with depression (P=0.025), and Factor 3 was significantly associated with obsessive-compulsive disorder (P=0.001), whereas panic disorder showed a significant negative correlation with Factor 3 (P=0.001). The relationships of the three subfactors with various DSM-IV diagnoses and sociodemographic variables emphasize the multidimensionality of alexithymia.

[Investigations on the usefulness of the dry chemistry blood anaylsis system SPOTCHEM SP-4410in laboratory diagnosis of cattle]

The usefulness of the dry-chemistry blood analyzer, SPOTCHEM SP-4410, for analysis of bovine blood chemistry was studied in a veterinary clinic. The control serum Precipath-U, Boehringer-Mannheim, was used to measure precision within each run and between days. The coefficients of variation (CV) ranged between 1.54% and 4.86%, with the exception of albumin and creatine phosphokinase showing a CV of 6.3% and 10.03% for between-day precision. For methodological comparison bovine serum samples were assayed with both the SPOTCHEM SP-4410 and the automated blood analyzer HITACHI 705, which served as a wet-chemistry reference system. The following analytes were measured: glucose, urea, creatinine, total protein, albumin, total bilirubin and the enzymes AST, CPK and gamma-GT. For hemoglobin, which was measured in heparinized whole blood, the CO oximeter 855, CIBA-CORNING, was used as a reference system. The comparative analysis showed very good correlation in eight of ten parameters and their correlation coefficients (r) ranged between 0.962 and 0.998. Only the correlation coefficients of the analysis of total bilirubin (r = 0.903) and albumin (r = 0.771) were less satisfactory. The recovery test was carried out with the two parameters glucose and blood urea. The recovery of glucose was 93.7% and of urea 98.8%. The SPOTCHEM SP-4410 is easy to use and proved to be reliable and accurate, and therefore it seems to be useful for analysis of bovine blood samples.

Paroxetine decreases platelet serotonin storage and platelet function in human beings

BACKGROUND

Serotonin is a platelet agonist and potent vasoconstrictor that has recently received attention concerning its potential role in acute coronary artery thrombosis. Selective serotonin-reuptake inhibitors, such as paroxetine, are widely used antidepressant agents. We sought to characterize the potential inhibitory effect of paroxetine on platelet function.

METHODS

Healthy male volunteers received 20 mg/d paroxetine for 2 weeks in a randomized, double-blind, placebo-controlled, two-way cross-over trial.

RESULTS

Paroxetine decreased intraplatelet serotonin concentrations by -83% (P < .01). This inhibited platelet plug formation as reflected by a 31% prolongation of closure time measured with the platelet function analyzer-100 (P < .05). Furthermore, paroxetine lowered expression of the platelet activation marker CD63 in response to two different concentrations of thrombin receptor-activating peptide (P < .01). Plasma concentrations of prothrombin fragment, von Willebrand factor antigen, and circulating P-selectin remained unchanged in either period, indicating that paroxetine does not increase activation of coagulation, endothelium, or platelets in vivo, underlining a favorable safety profile.

CONCLUSIONS

Paroxetine substantially decreases intraplatelet serotonin content and thereby reduces platelet plug formation under shear stress, and responsiveness to thrombin receptor activating peptide-induced platelet activation. Further studies will reveal whether these pharmacodynamic effects can be exploited for treatment of thrombotic artery disease.

[Assessment of custodial suicide risk--jail and prison suicides in Austria 1975-1996]

OBJECTIVE

Although incarceration is a high-risk situation for suicide all over the world, hardly any results have been published concerning the situation of custodial suicide in German-speaking countries.

METHODS

We investigated the case notes of all suicides occuring in Austrian prisons between 1975 and 1996 (n= 207). Beside an evaluation of gender and preferred methods of suicide the suicide risk of different circumstances of custody was studied. Suicide rates of distinguishable, important subgroups of prisoners were calculated using the official statistical data of the Ministry of Justice.

RESULTS

The suicide rate for people on remand and offenders classified as mentally ill was 231/100,000 vs. 191/100,000, that was about eight times higher than the suicide rate in Austria's general population. The suicide rate for sentenced offenders was 80/100,000, about three times as high as the suicide rate in Austria's general population (1980-1990: 26.4/100,000). The suicide risk increased with the length of the announced sentence.

CONCLUSIONS

The suicide rate in custody was highest for prisoners on remand and mentally ill offenders. Female offenders had a high suicide risk, too. The common assumption that the suicide risk in jails and prisons is highest shortly after admission should be confirmed based on better methodology or be reconsidered.

Screening for DSM-IV somatoform disorders in chronic pain patients

BACKGROUND

The Screening Instrument for Somatoform Symptoms (SOMS) has been developed for selecting subjects with various somatoform disorders. To date, this instrument has not been used for pain patients. The purpose of this study was, therefore, to apply the SOMS to chronic pain patients, and to compare different SOMS cutoff item scores with regard to their sensitivity, specificity and (positive and negative) predictive value for selecting subjects with DSM-IV somatoform disorders among pain patients.

METHODS

In a consecutive sample of 105 chronic pain outpatients, the SOMS was administered in addition to an operationalized psychiatric assessment according to DSM-IV.

RESULTS

Patients with a somatoform disorder reported significantly more SOMS symptoms than patients without somatoform disorders (p < 0.02). As shown, a cutoff score of >/=4 somatoform items appeared useful for determining a somatoform disorder. However, only a limited number of cases could be correctly classified by the SOMS (range 53-66%).

CONCLUSION

Therefore, the applicability of the SOMS as a screening instrument for somatoform disorders in chronic pain patients awaits further clarification.

Somatotopic organization of primary afferent perikarya of the guinea-pig extraocular muscles in the trigeminal ganglion: a post-mortem DiI-tracing study

Apart from the somatotopic organization of the trigeminal ganglion (TG) into the ophthalmic, maxillary and mandibular divisions along the mediolateral axis, there exist further somatotopic organizations within these three divisions. According to literature, the cell organization in the TG and the somatotopy in the brainstem develop together, formed by naturally occurring cell death in the TG. Thus, the somatotopy of the primary afferent trigeminal perikarya is of special interest. The aim of this study was to investigate the location of the primary afferent perikarya of the extraocular muscles (EOMs) in the TG of guinea-pig. The primary afferent perikarya were labeled by post-mortem application of the carbocyanine DiI on the oculomotor nerve branches near their entrance into the single EOMs. The DiI-positive perikarya were found musculo-somatically organized in the ipsilateral ophthalmic part of the TG at a wide range along the dorsoventral axis, expressing an overlap of the representation areas. The primary afferent perikarya of the superior rectus and the superior oblique muscles were mainly localized in the dorsal part of the ganglion while those of the inferior rectus and the inferior oblique muscle mainly in ventral part. The lateral and the medial rectus were predominantly represented in between. An organization along the mediolateral axis of the TG was not observed. Although guinea-pigs lack classical EOM proprioceptors, the somatotopic representation of the extraocular muscle primary afferent perikarya in the TG found in this study is in line with findings in species with well known encapsulated proprioceptors within the EOMs.

Naturalistic course of obsessive compulsive disorder and comorbid depression. Longitudinal results of a prospective follow-up study of 74 actively treated patients

Seventy-four patients who met DSM-III-R criteria for obsessive compulsive disorder (OCD) were studied in a prospective follow-up study in order to investigate course and prognosis of OCD with or without comorbid depressive symptomatology. Subjects were examined three times: at admission (baseline), 6 months later (follow-up 1) and 12 months after follow-up 1 (follow-up 2). At admission, 51 (72.9%) OCD patients were assessed as depressive by the Hamilton Depression Scale score. Between admission and follow-up 1, all patients received behavior therapy and a serotonin reuptake inhibitor, between follow-up 1 and follow-up 2 they received different kinds of treatment in order to maximize therapeutic effects. A 25% Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) score reduction from admission to follow-up 2 and in addition, a total Y-BOCS score of below 16 at follow-up 2 was defined as 'good prognosis course'. The results obtained showed that OCD patients who followed a good prognosis course, showed no significant depressive symptomatology at follow-up 2 (p = 0.001). These results imply that patients with a diagnosis of OCD may present depression at admission and/or follow-up 1; however, if OC symptomatology decreases longitudinally, depressive symptoms disappear too. We may assume that OCD is dominant over depression, and it seems that a comorbid depression does not have any major influence on the prognosis of OCD.

Observations on the number, distribution and morphological peculiarities of muscle spindles in the tensor tympani and stapedius muscle of man

Although the middle ear muscles have been described for the first time more than four hundred years ago their role in modulation and transmission of sound is not yet fully understood. Surprisingly very little is known about proprioceptors in these muscles, especially in man, although this seems to be the key to the understanding of their various functions. Therefore, the question for proprioceptive sensory organs in these muscles is still relevant. The tensor tympani and stapedius muscles of four women who had donated their bodies to our institute were taken. Complete serial sections of these muscles were made which were either impregnated with silver, stained with ferric oxide for acidic polysaccharides or incubated with antibodies against S-100 protein. Thereby four to eight (mean five) muscle spindles distributed along the whole muscle could be detected in the tensor tympani muscles. These spindles contain one to three intrafusal muscle fibres and their length ranges from 140 to 4270 microm (mean 1492.8 microm). Furthermore, in three stapedius muscles one to two (mean 1.7) muscle spindles were found. They were from 350 to 500 microm (mean 482 microm) long and contained only one intrafusal muscle fiber. Regarding the diameter of intrafusal muscle fibers in both, the tensor tympani as well as the stapedius muscle, no difference to extrafusal muscle fibers of these muscles could be detected. The structure of these spindles differs considerably from those found in skeletal muscles. The morphological findings presented strongly suggest that muscle spindles occur regularly in both middle ear muscles. The results presented herein are consistent with clinical findings obtained from electromyographic studies and may help to elucidate all functions the middle ear muscles might serve in man.

Clinical utility of DSM-IV pain disorder

The utility of DSM-IV criteria for pain disorder was investigated within a consecutive sample of 90 chronic pain patients aged between 18 and 65 years. In this sample, 65.6% (n = 59) fulfilled diagnostic criteria for DSM-IV pain disorder. Of the patients with DSM-IV pain disorder, 22% fulfilled additional criteria for depressive disorder, 6.8% for hypochondriasis, and 23.7% for any other DSM-IV diagnosis. Only 54.2% of the patients with DSM-IV pain disorder had no comorbid psychiatric disorder. When assessing somatoform symptoms without hierarchical guidelines, there is a great overlap between the symptomatology of pain disorder and other somatoform disorders. Of 59 patients with DSM-IV pain disorder, 93.2% also met criteria for DSM-IV undifferentiated somatoform disorder and 10.2% for DSM-IV somatization disorder. The mean number of somatoform symptoms was 17 in the total sample. Despite the presence or absence of a general medical condition, there was no significant difference between pain disorder associated with both psychological factors and a general medical condition (code 307.89) and pain disorder associated with psychological factors (code 307.80) with regard to the pain duration, intensity, and type and the level of disability and educational level. The formulation of a distinct psychiatric entity for pain conditions may improve the consideration of psychosocial factors in the pathogenesis and clinical cause of pain. However, with regard to our data, the distinctive validity of different subtypes of pain disorder as provided by DSM-IV awaits further clarification.

Discriminating among incarcerated sexual offenders by their perception of interpersonal problems and experience-related anxiety

Fifty-seven (57) incarcerated sex offenders were assessed for their capacity to perceive interpersonal difficulties and experience related anxiety. The findings suggest that the men who have sexually transgressed against minors view themselves as easily exploitable and nurturant, and those who have sexually aggressed against adult females demonstrated minimal regard for external negative views of them. These two groups did not differ significantly from each other along social avoidance and non assertiveness dimensions. Assertiveness was found to decrease as a consequence of multiple incarcerations in both groups. Furthermore, perception of interpersonal difficulties and experience related anxiety in our study correctly classified 72% of high and low violent sexual offenders.

The blood supply of the sternocleidomastoid muscle and its clinical implications

BACKGROUND

The knowledge of the exact anatomy of the sternocleidomastoid (SCM) muscle and its nerve and blood supply must be considered a basic prerequisite for its use as a pedicle muscle flap.

OBJECTIVE

To give an exact description of the courses and variability of all vessels supplying the SCM muscle.

DESIGN

Anatomic analysis of all arteries supplying the SCM muscle.

SETTING

The blood supply of the SCM muscle was studied by dissecting bilaterally the anterior regions of the neck of 31 perfusion-fixed human cadavers of both sexes aged 50 to 94 years (mean, 78 years).

RESULTS

The blood supply to the SCM muscle can be divided into 3 parts: upper, middle, and lower. The upper third of the SCM muscle was found to be constantly supplied by branches of the occipital artery. According to their courses, these branches are categorized into types 1, 2a, 2b, and 3. The middle third of the SCM muscle receives its blood supply from a branch of the superior thyroid artery (42%), the external carotid artery (23%), or branches of both (27%). In most cases, the lower third of the muscle was supplied by a branch arising from the suprascapular artery (>80%), which has not been described until now.

CONCLUSIONS

In contrast to available data, the arterial blood supply of the lower third of the SCM muscle is constantly provided by a branch of the suprascapular artery. Since the SCM muscle flap is used in reconstructive surgery of the neck, the exact knowledge of its blood supply may help to minimize the risk of flap necrosis after surgical procedures.

Fine structural analysis of extraocular muscle spindles of a two-year-old human infant

PURPOSE

To clarify whether structural peculiarities formerly described in extraocular muscle (EOM) spindles of aged persons are already present in EOM spindles of a 2-year-old infant.

METHODS

Distal halves of two EOMs obtained from a 2-year-old multiorgan donor were immersion-fixed and prepared for electron microscopy. The fine structure of 10 muscle spindles and of 1 "false spindle" was investigated.

RESULTS

Extraocular muscle spindles of an infant 2 years of age had 2- to 4-layered outer capsules, 376 microm (range, 217-606 microm) long and 97 microm (range, 55-140 microm) wide. In 10 EOM spindles, 4 to 16 intrafusal muscle fibers (mean, 7.9) were present. From a total of 79 intrafusal fibers, 43 (54%) were nuclear chain fibers, and 8 of the 43 exhibited posttraumatic degenerative changes. Thirty-six (46%) intrafusal fibers indistinguishable from extrafusal fibers were called anomalous fibers. No nuclear bag fibers were found. Each muscle spindle contained a variable number of chain fibers and at least one anomalous fiber. Sensory nerve terminals were restricted to the 35 normal chain fibers but were absent from damaged chain fibers and from anomalous fibers. One "false spindle" without a periaxial space was composed of three anomalous fibers and one chain fiber, all of them devoid of sensory terminals.

CONCLUSIONS

Most structural particularities of human EOM spindles described in aged persons are already found in the infant. They cannot be interpreted as age-related changes, but rather they represent specific features of human EOM spindles.

The relevance of self-concepts discriminating in long-term incarcerated sex offenders

Lack of self-esteem and assertiveness have been thought to play an important role in the etiology and maintenance of sex offending behavior and to be significantly related to the number of previous convictions or violence of the assault. We, therefore, analysed self-concepts of 53 long-term incarcerated sex offenders to research the correlation between concepts of self-esteem, assertiveness, feelings towards others and relationships and the degree of violence of the last offense and risk of reoffense. We also investigated the relationship of previous convictions and duration of incarceration with the offenders' self-concepts and the influence of psychotherapeutic intervention on the offenders' self-concepts.

Carbocyanine postmortem neuronal tracing. Influence of different parameters on tracing distance and combination with immunocytochemistry

Carbocyanines (DiI, DiA, DiO) are able to travel along membranes by diffusion and therefore have been used as postmortem neuronal tracers in aldehyde-fixed tissues. Surprisingly, detailed data on the influence of different parameters on tracing distances are still missing. This study was carried out to optimize tracing procedures and to reveal the validity of the combination of postmortem tracing with immunocytochemistry. Carbocyanine crystals were applied to the cervical spinal cord, sciatic nerves, and brachial plexuses of humans and guinea pigs. Incubation in the dark at 37C for 12-15 weeks proved optimal to achieve longest tracing distances (28.9 +/- 2.2 mm) in human and animal tissues. Longer incubation times and incubation temperatures higher than 37C did not result in longer tracing distances. No differences were evident between adult and newborn animals and between central and peripheral nervous system. The diffusion coefficient for DiI was calculated to be 2.5 x 10(-7) cm2 sec-1. After application of DiI to nerves of guinea pig extraocular muscles, DiI-positive afferent perikarya were observed in the anteromedial part of the trigeminal ganglion. These perikarya were identified by calcitonin gene-related peptide immunoreactivity (CGRP-IR). The percentage of CGRP-IR neurons after tracing was concordant with the percentage of CGRP-IR in trigeminal ganglia exclusively processed for CGRP-IR without previous postmortem tracing. These results demonstrate carbocyanines to be specific tracers for exact neuronal mapping studies. (J Histochem Cytochem 46:901-910, 1998)

[Fetal outcome in reduced flow in the ductus venosus during atrial contraction]

OBJECTIVE

To document the fetal outcome in cases with pathologic Doppler findings in the fetal ductus venosus.

METHODS

The outcome of 12 fetuses with reduced velocities in the ductus venosus during atrial contraction was analyzed retrospectively and compared with that of a group of 57 fetuses with normal flow velocities in the umbilical artery and in the fetal ductus venosus.

RESULTS

The perinatal mortality was higher in the group with pathologic Doppler findings. There was no significant difference of pH (7.20 vs. 7.24) and Apgar scores (7.57 vs. 8.36) of survivors between the two groups. All 12 fetuses showed increased retrograde velocities in the inferior vena cava. Seven fetuses showed umbilical vein pulsations.

CONCLUSIONS

The diagnosis of altered velocities in the ductus venosus may influence prenatal decisions. Therefore Doppler examinations of the fetal ductus venosus should be performed in high-risk pregnancies.