Isolation of expressed sequence tags of skeletal muscle of neonatal healthy and splay leg piglets and mapping by somatic cell hybrid analysis

We have isolated 14 differentially displayed and 10 further expressed sequence tags (ESTs) from Musculus biceps femoris of newborn healthy and splay leg piglets. By comparison with EMBL/GenBank data we could identify nine porcine homologues to human genes (TATA box binding protein associated factor B TAF1B; B-cell CLL/lymphoma 7B BCL7B; pyruvate dehydrogenase kinase, isoenzyme 4 PDK4; ribosomal protein S10 RPS10; SPARC-like 1 SPARCL1; epithelial protein lost in neoplasm beta EPLIN; N-myc downstream-regulated gene 2 NDRG2; pleiomorphic adenoma gene like 2 PLAGL and, BCL-2 associated transcription factor short form BTFS). Eight fragments correspond to uncharacterized ESTs and 7 ESTs had no significant match with database sequences. These data provide the first expression profiles in skeletal muscle of neonatal piglets and are a basis for candidate gene investigations for congenital splay leg in piglets. Eleven ESTs were physically mapped to porcine chromosomes 1, 3, 4, 5, 7, 8, 9 and 10 and contribute to the comparative map of humans and pigs.

Depersonalization, self-esteem and body image in male-to-female transsexuals compared to male and female controls

Whether postoperative male-to-female transsexuals differ in regard to measures of self- and body image from a nontranssexual control group was investigated. A group of 30 postoperative male-to-female transsexuals and control groups of 30 males and 30 females completed self-report measures (depersonalization, self-esteem, gender identity traits, body image). Results showed that transsexuals and males scored higher on self-esteem and dynamic body image than the females did. No differences between the groups were found in terms of depersonalization and satisfaction. Transsexuals and females described themselves as more feminine than males. Regarding sex-role orientation, more androgynous subjects were found among transsexuals than in the control groups. General satisfaction is associated with feminine and masculine traits in transsexuals. Results are discussed in context of the function of these personality features for the identity development of male-to-female transsexuals.

Results of a double-blind, randomized study to evaluate the efficacy and safety of Antibiophilus in patients with radiation-induced diarrhoea

BACKGROUND AND AIMS

Gastrointestinal toxicity is frequently observed during radiotherapy for malignancies in the abdomen and pelvis. This study was performed to determine the efficacy and tolerability of Lactobacillus rhamnosus (Antibiophilus) in comparison to placebo in a double-blind trial design. Its aim was to determine any clinically relevant difference between Antibiophilus and placebo in terms of efficacy in patients suffering from mild to moderate diarrhoea induced by radiation therapy.

METHODS

The study was performed in two radiotherapy units in Hungary; the results are based on the data for 206 recruited patients.

RESULTS

Based on statistical analysis, Antibiophilus patients showed superiority with respect to the number of bowel movements (P < 0.10) and faeces consistency ratings by the investigators (P < 0.05) at the study end. Statistical analysis of the patients' self-ratings with regard to diarrhoea grade and faeces consistency showed a statistically highly significant treatment-by-time interaction (P < 0.001) which was supported by the evidence of tendencies or P values below the nominal 5% level in the second half of this study.

CONCLUSIONS

Overall, there was a highly favourable benefit/risk ratio in favour of Antibiophilus.

Low microsatellite variation in laboratory gerbrils

The Mongolian gerbil has become a model organism of increasing importance for the understanding of aging, epilepsy, the process of domestication or sociobiological questions. We report the development and characterization of the first nine polymorphic dinucleotide repeat loci in this species. Average observed heterozygosity and allele number of laboratory animals measured 0.136 (SE = +/-0.065) and 1.78 (SE = +/-0.278) compared to 0.761 (SE = +/-0.025) and 9.2 (SE = +/-0.57) found for a reference group of wild gerbils. The extreme low genetic variation observed in laboratory animals is caused by several severe population size bottlenecks due to the initial founder event and the later establishment of subpopulations. Reduced levels of allelic polymorphism in experimental animals hamper genetic mapping or parental studies. Therefore experiments relying on kinship analyses have to be carried out on wild animals. Estimates of genetic identity and parental exclusion were calculated as Pid = 2.8 x 10(-12) and Pex > 0.999 in wild gerbils. Laboratory gerbil strains show the expected high degree of genetic similarity. However, significant allele frequency differences (P < .001) between American and European gerbils at some microsatellite loci may still allow discrimination between breeding lines.

Value of spiral CT in patients with cricothyroid approximation

Cricothyroid approximation raises the vocal pitch by simulating contraction of the cricothyroid muscle with sutures. The aim of this study was to determine the role of spiral CT in patients scheduled for cricothyroid approximation. 29 transsexual patients were examined with spiral CT prior to and after laryngoplastic surgery. CT findings were correlated with phonographic findings in all patients. The average reduction of the cricothyroid distance was 6 mm (range 2-10 mm). Vocal pitch elevation was greatest in patients with the largest reduction of the cricothyroid distance. CT accurately determines the cricothyroid distance prior to and after surgery and is an ideal method for follow-up, especially in post-operative reversion towards a lower pitch. In addition, CT provides important data in determining the most appropriate extent and site of intracordal intervention to achieve a desired pitch elevation.

Spiral computed tomography before and after cricothyroid approximation

Cricothyroid approximation raises the vocal pitch by simulating the contraction of the cricothyroid muscle with sutures. The aim of this study was to determine the role of spiral computed tomography (CT) in patients scheduled for cricothyroid approximation. Twenty-nine transsexual patients were examined with spiral CT before and after laryngoplastic surgery. Computed tomography findings were correlated with phoniatric findings in all patients. The average reduction of the cricothyroid distance was 6 mm (range 2-10 mm). The vocal pitch elevation was more remarkable in the patient group with greater reduction of the cricothyroid distance. Computed tomography accurately determines the cricothyroid distance before and after surgery and is an ideal method for follow-up purposes, especially when there is a postoperative reversion towards a lower pitch. In addition, CT provides important data as to the most appropriate extent and site of intracordal intervention to be done for a desired pitch elevation.

Myelodysplastic syndrome at a large tertiary care community hospital: analysis according to the international prognostic scoring system

The outcome of patients diagnosed myelodysplastic syndromes (MDS) between 1990 and 1997 from William Beaumont Hospital (WBH) was analyzed according to the International Prognostic Scoring System (IPSS) risk categorization. A retrospective study of 195 MDS patients wa s performed. Seventy-nine patients with MDS, in whom a karyotype was obtained and with an adequate follow-up were included in the final analysis. Cases of proliferative CMML (WBC > 12x10(9)/l) were excluded from the study. The overall median survival was 3.1 years, and median survival stratified by IPSS was 3.4, 4.1 and 0.5 years for the INT-1, INT-2 and high risk group and not yet reached for the low risk group. The overall survival by IPSS subcategorization were 6.88, 5.29, 5.30 and 2.12 years for the low, INT-1, INT-2, and high risk groups respectively. Cytogenetics were significant in predicting the overall survival. The IPSS score stratified patients into risk categories for development of AML. The risk of development into AML was 8, 8, 33 and 54% for the low, INT-1, INT-2 and high risk groups, respectively. We conclude that IPSS score can be useful in predicting survival and AML evolution in some MDS patients.

[Stability of therapeutic outcome after child- and adolescent psychoanalytical therapy--a five-year catamnesis]

In the Heidelberg study about psychoanalytic therapy with children and adolescents 133 cases have been studied in a naturalistic design. Up to now results were published on the basis of assessments of experts only. This follow-up study has investigated the stability of therapy outcomes from the perspectives of different raters. For that outcome has been rated five years after the end of treatment by experts, parents and children themselves. Good outcomes have been stabile and have shown even after five years. Single variables showed further improvement in the time of follow-up, for example the social communicative impairment with parents. Thus the high rate of successful longterm psychoanalytic therapies with children and adolescents could be confirmed from different rater perspectives.

[How reproducible is blood pressure measurement? Intra- and interindividual blood pressure variability in routine practice]

Considering the reproducibility of blood pressure readings the epidemiologist and the physician in his clinical work take two different points of view. Studying drug effects the epidemiologist is interested in significant differences of blood pressures in a study population. The physician however, who estimates the effect of his prescription given to an individual patient has to compare single blood pressure readings in single individuals. In a pharmacological study we accept without any doubt the need of certain numbers of investigations to define a difference of 10 mm Hg as significant. In clinical routine however we behave quite differently and judge single readings intuitively as equal or different, independent of any statistical considerations. Not only the doctor but also the scientific societies with the highest reputation share the same point of view. In their recommendations they accept an arithmetic mean of two blood pressure readings as sufficient to judge blood pressures in individuals. In order to discuss this topic primarily from the doctors point, we analysed repeated blood pressure readings of 21 volunteers who tested 20 different blood pressure devices. We conclude, that the ongoing practice of judging the blood pressures of the patients meets only the needs of the epidemiologist. Reproducibility of single readings or mean values of two readings however are insufficient to draw satisfactory conclusions from the distributions of blood pressure in single individuals. Due to the short and long term blood pressure variability increasing the numbers of readings within a single day does not improve reproducibility sufficiently. It seems that the amount of blood pressure readings which are necessary to improve reproducibility of "the patients blood pressures" should be increased and taken over several days. If this is true, daily self-recordings should be the most promising approach.

Real-time interactive virtual endoscopy of the tracheo-bronchial system: influence of CT imaging protocols and observer ability

OBJECTIVE

To evaluate the influence of different spiral CT examination protocols suitable for clinical use on image quality and to assess the observer dependence in interactive real-time virtual bronchoscopy.

METHODS AND PATIENTS

Real-time perspective volume rendering of the airways in twenty normal patients based on four different spiral CT examination protocols was evaluated by four observers in regard to the order of depictable bronchi.

RESULTS

Best results were obtained using an examination protocol with a small beam collimation and a maximum pitch. Depending on the observer's ability to control the fly path and the orientation of the bronchi with respect to the slice plane up to sixth order bronchi could be depicted. Inter-observer variability was up to two branching orders.

CONCLUSION

The performance of virtual bronchoscopy strongly depends on the applied CT examination protocol and the observers experience with perspective volume rendering. Both of which have to be taken into account when virtual bronchoscopy is compared with fiberoptic bronchoscopy.

Studies toward the biomimetic synthesis of tropolone natural products via a hetero Diels-Alder reaction

Analogues of the tropolone natural products pycnidione and epolone B were synthesized via a hetero Diels-Alder reaction of benzotropolone 10 with humulene. The quinone methide benzotropolone 13 was generated in situ by thermalisation of benzotropolone 10. Benzotropolone 10 was derived from phthalic acid via carbonyl ylide 8a followed by an intramolecular 1,3-dipolar cycloaddition and subsequent acid-catalyzed ring opening.

Pelvic imaging with a selenium-based detector (Thoravision). Comparison with screen-film radiography in 75 patients

OBJECTIVE

To evaluate whether the selenium detector (Thoravision) provides sufficient diagnostic confidence in digital pelvic imaging compared with a conventional screen-film combination.

METHODS

In 75 patients, pelvic imaging with conventional screen-film and isodose selenium radiography using a dedicated postprocessing mode was compared independently by three radiologists. The depiction of cortical and cancellous bone was evaluated in the iliac wings, sacral and pubic bones, acetabulum, femoral head, and trochanter. Demarcation of soft tissue was assessed in the iliac and trochanteric region.

RESULTS

Visualization of cortical bone and soft tissue in the iliac area as well as soft tissue and cortical and cancellous bone in the trochanteric region was significantly superior with the selenium detector. However, conventional imaging was better in the trabecular bone of the sacral region, where results with the selenium system were particularly poor.

CONCLUSIONS

The selenium detector (Thoravision) is advantageous in imaging soft tissue adjacent to the iliac wings and the trochanter, but results for the cancellous sacral bone are poor. Further modifications of postprocessing modes may lead to improved depiction of this critical pelvic area.

[100 years of the Otto Körner ENT Clinic, Rostock. The merits of Christian Lemcke and Otto Körner in the development of ENT specialty]

BACKGROUND

The first special ENT hospital in Germany and northern Europe, the Department of Otorhinolaryngology, Head- and Neck-Surgery "Otto Körner" in Rostock is celebrating its 100th anniversary on October 25, 1999.

METHODS

There is a presentation on the efforts in the ENT-specialty from the beginning considering the special situation at the university of Rostock.

RESULTS

The efforts of Christian Lemcke (1850-1894), who associated the three sections Otology, Laryngology and Rhinology are appreciated, Otto Körner (1859-1935) continued this development. He achieved the building of a special ENT-hospital by his excellent knowledge and surgical skills. The opening date was October 25, 1899, Körner became the first full professor in Otology and Laryngology in Germany in 1901. His "Textbook Of Otology And It's Bordering Specialties" was published in 1906. As one of the first, he supported the independence of ENT-medicine as a separate field in the course of medicine.

CONCLUSION

Today, Otto Körner's claims are more relevant than ever before, because the today's students in their practical course of medicine and even young doctors at the hospitals obviously show a lack of knowledge in the ENT-field. The current "multiple choice" type of examinations could be one of the main reasons.

SPIO-MR imaging versus double-phase spiral CT in detecting malignant lesions of the liver

PURPOSE

To assess the diagnostic performance of superparamagnetic iron oxide MR (SPIO-MR) imaging compared with double-phase spiral CT in detecting liver metastases and hepatocellular carcinoma.

MATERIAL AND METHODS

Thirty-eight patients with a total of 144 malignant lesions of the liver were examined by CT and SPIO-MR. After definition of a gold standard by a panel of experts, the patient images were randomized and presented to a blinded jury of 5 independent observers whose task was to identify as many lesions as possible. The results were tested for statistical significance using multifactorial analysis of variance (alpha=5%).

RESULTS

SPIO-MR produced the highest detection rate and was significantly superior (p<0.05) to unenhanced MR imaging and double spiral-phase contrast-enhanced CT (DPS-CECT). Maximum performance in DPS-CECT was obtained during the portal venous contrast phase but was significantly inferior to SPIO-MR imaging. The scores for unenhanced CT and unenhanced MR were significantly lower than for the corresponding enhanced procedures. SPIO-MR imaging produced a higher incidence of false-positive findings (n=39).

CONCLUSION

SPIO-MR produced a significantly better detection rate for malignant focal liver lesions compared with double-phase spiral DPS-CECT but was associated with a higher rate of false-positive findings.

Prospective randomized study for an injection protocol for intravenous contrast media in abdominal and pelvic helical CT

OBJECTIVE

To develop an injection protocol for intravenous administration of contrast media in abdominal and pelvic helical CT which provides optimal contrast enhancement of arterial and venous vessels.

MATERIAL AND METHODS

For the study on a Somatom Plus 4 unit, a standard helical CT examination procedure of abdomen and pelvis consisted firstly of a native helical examination of the liver, a second one of the liver after intravenous injection of 120 ml nonionic contrast medium with a constant start delay of 50 s, and subsequently a third helical CT of the lower abdomen and pelvis. 125 patients were randomized for examination under different protocols, varying the injection flow from 2.0-4.0 ml/s and the time delay between the second and the third helical examinations from an additional 20-40 s. The efficacy of the contrast injection was checked by region of interest (ROI) measurements of HUs in aorta, inferior vena cava, and in femoral arteries and veins. The results were compared by t-test statistics.

RESULTS

A slow flow rate of 2.0 ml/s led to a higher contrast enhancement in the aorta than a flow rate of 3.0 and 4.0 ml/s. The difference between 2.0 ml/s and 4.0 ml/s was statistically significant. In the inferior vena cava, a flow of 3.0 ml/s caused a better contrast than a flow of 2.0 ml/s or 4.0 ml/s, but the measurements did not reach statistical significance. The measurements in the femoral arteries and veins did not show any significant differences. Maximal enhancement in the pelvic vessels was achieved when the third helical examination was started immediately after the second one had ended. Adding any delay (20 s, 40 s) led to a reduced contrast in the pelvic vessels, with a significant reduction in aorta and femoral arteries.

CONCLUSION

For routine abdominal and pelvic helical CT, we recommend an injection of 120 ml contrast medium with a flow rate of 3.0 ml/s. Contrast-enhanced examination of the liver should be started after 50 s, and examination of the lower abdomen and pelvis region should be performed without any further delay. This gives an appropriate contrast in the major vessels.

MRI of heart morphology. Comparison of nongradient echo sequences with single- and multislice acquisition

RATIONALE AND OBJECTIVES

A large variety of cardiac MRI sequences have been introduced for heart morphology evaluation. The aim of this study was to establish a practicable and robust examination protocol for standard high-field systems applying nongradient echo sequences with single- and multi-slice acquisition.

METHODS

Fifty-one patients received electrocardiogramgated MRI of the heart with "black-blood" preparation, comparing three single-slice and three multislice sequences with a T1-weighted turbo spin echo reference sequence. Demarcation of the left ventricular myocardium and cavity and the extent of flow and motion artifacts were assessed.

RESULTS

The myocardium and left ventricular cavity were depicted best with the single-slice T1- and T2-weighted turbo spin echo sequence. The nonbreath-hold multislice sequences produced marked artifacts and therefore were of poor diagnostic value. The TIRM haste sequence was best suited for fat suppression. The T2-weighted breath-hold single-shot sequence with half-Fourier imaging proved to be most appropriate for multislice imaging.

CONCLUSIONS

Sufficient depiction of heart morphology with comprehensive evaluation of signal changes can be achieved using nongradient spin echo and turbo spin echo sequences with breath-holding. For rational imaging of myocardial and heart chamber morphology, multislice and single-slice sequences should be combined.

Contrast-enhanced subtraction MR angiography in occlusive disease of the pelvic and lower limb arteries: results of a prospective intraindividual comparative study with digital subtraction angiography in 76 patients

PURPOSE

The purpose of this work was to evaluate the feasibility and clinical use of MR angiography (MRA) for examining the pelvic and lower limb arteries in patients with arterial occlusive disease.

METHOD

Seventy-six patients with clinical signs of peripheral arterial occlusive disease were included in the study. MRA was performed using a fast contrast-enhanced high-resolution 3D technique that covered the area from the distal abdominal aorta to the distal lower limbs in two examination steps.

RESULTS

In all patients, diagnostic images comparable with those of conventional intraarterial digital subtraction angiography (DSA) could be obtained. No false-negative findings were seen in the iliac, femoral, or popliteal arteries. Ten to 16% of the mild stenoses and 6-14% of the severe stenoses, mainly in the crural vessels, were overgraded compared with intraarterial DSA. Particularly in patients with proximal severe obstructions or occlusions, the crural segments could be depicted more clearly due to decreased arterial runoff in conventional angiography.

CONCLUSION

The consistency of the excellent depiction of the vascular territories of the distal aorta and the pelvic and lower limb arteries in a standardized setting suggests great potential for the use of MRA in the primary diagnosis of peripheral arterial occlusive disease.

[3D-computed tomography for spatial arrangement of the cranial bones of the human fetus]

Aim of the study was to assess the value of in vitro three-dimensional computed tomography (3D-CT) as a new method for the depiction of the fetal skull. 3D-CT images of a fetal head of 24 weeks gestational age were generated with the implemented software on the basis of contiguous CT slices of 1 mm thickness. 3D-CT gave real three-dimensional information about morphology and spatial arrangement of the cranial bones. Using cutting and rotating procedures fast evaluation of all imaged ossified structures in arbitrary views without disturbing superpositions was possible, thus allowing easy identification and accurate description of the cranial bones and making isolated examinations of particular macroscopic sections of the specimens unnecessary. Advantages of 3D-CT over other evaluation techniques for the fetal cranium and its limitations are discussed. In conclusion, 3D-CT promises to be an effective tool for the investigation of fetal cranial development.

[Risks of upper eyelid gold implantation in peripheral facial paralysis]

Peripheral facial paresis is often accompanied by incomplete closure of the eyelids and may lead to varying degrees of keratopathy. Conservative therapeutic measures are often not sufficient. To achieve better lid closure tarsorraphy has been the primary method of treatment but has certain functional and cosmetic drawbacks for the patient. Alternatively gold weight implants have been used to close the upper lid by the force of gravity and if needed can be combined with further reconstructive facial surgery. From May 1994 to January 1997 29 patients with peripheral facial paralysis were treated with gold weight upper lid implants. Postoperative closure of the lids was sufficient in all cases, and there was a statistically significant decrease in lagophthalmos and improvement in keratopathy. Complications observed included ptosis (n = 5), cosmetically unacceptable bulging of the gold implant (n = 5), extrusion of the implant (n = 1) and the development of a low-grade corneal astigmatism (n = 7). In all cases of astigmatism correction was achieved by the fitting of cylinder glasses. In all, functional results achieved showed that the gold implant was superior to the cosmetically bothersome tarsorraphy.

[Glomus tumor of the nose]

Between May 1995 and March 1996 we were able to diagnose and remove glomus tumors of the left nasal cavity from three female patients. Ages of the patients were 9, 36 and 74 years. All patients suffered from a frequent epistaxis and all were extremely sensitive to the slightest nasal touch. One patient reported breathing difficulties due to nasal congestion. Examination revealed a tumor that filled the entire nasal cavity. The method of choice in treatment of these tumors is surgical removal. Hemangiopericytoma, non-chromaffin paraganglioma, hidradenoma, cavernous hemangioma and nevus cell nevi have to be excluded by histology and immunohistochemical techniques. From a clinical perspective the bleeding septal polyp (granuloma telangiectaticum sive pyogenicum sive pediculatum) has to be considered because it often comes from Kieselbachi's plexus, has a mushroom-like appearance and bleeds slightly.

Lamotrigine in the prophylactic treatment of migraine aura--a pilot study

The aim of this study was to evaluate the efficacy of lamotrigine, a glutamate antagonist blocking voltage-sensitive sodium channels, in the prophylaxis of migraine aura symptoms. Glutamate is one of the main neurotransmitters involved in the development of cortical spreading depression. The study was conducted as an open longitudinal trial over 7 months, with a treatment phase of 4 months and a post-treatment period of 3 months. Thirteen patients suffering from migraine with aura and 2 patients with aura but without migraine were enrolled and treated with lamotrigine. The dose was gradually increased in steps of 25 mg up to 100 mg per day, depending on the patient's aura symptoms. Aura symptoms were reduced from baseline (an average of 1.3 aura episodes per month) to month 4 (0.1, p < 0.001). High statistical significance was also observed with regard to aura duration (23 min at baseline vs 4 min at 4 months, p < 0.001). In all 15 cases, increases in aura frequency (on average sevenfold, p < 0.001) and aura duration (minutes; on average more than threefold, p < 0.001) were evident following cessation of treatment. A number of mild to moderate adverse events without any medical consequences occurred. The study outcome suggests that lamotrigine is effective in preventing migraine aura symptoms and in influencing migraine headache frequency.

[Kinematic versus static MRI study of the cervical spine in patients with rheumatoid arthritis]

PURPOSE

The objective of this study was to compare the diagnostic value of cinematic magnetic resonance imaging with static MRI examinations in patients with rheumatoid arthritis and concomitant attack of the cervical spine.

METHODS

Dynamic functional MRI examinations of the cervical spine were performed one five subjects without complaints and 20 patients with rheumatoid arthritis. For the functional studies, a positioning frame was used that allowed infinitely variable forward and backward inclinations of the head.

RESULTS

Functional magnetic resonance imaging made possible a sufficiently good differentiation of the extension of pannus tissue cranial, ventral, and dorsal of the dens with possible displacing and impinging effects on the spinal cord during flexing and stretching movements. In addition, it is suitable for demonstration of the degree of instability in the atlanto-occipital and atlanto-axial planes. In contrast to conventional X-rays, CT, and static MRI, basilary impression as well as compressions and angulations of the cervical bone marrow are better visualized by cinematic magnetic resonance tomography.

CONCLUSIONS

Functional magnetic resonance tomography is an important diagnostic method for the induction of the cervical spine in patients with rheumatoid arthritis. In particular, fusion and instabilities as well as compressions of the bone marrow often can only be detected with the help of functional MRI.

[Unusual intra-extracranial extension of meningioma of the lateral skull base]

Extracranial meningiomas are rare tumors of the lateral skull base. A 37-year-old woman presented with tinnitus und progressive hearing loss of her right ear. A painful mass lesion was also palpable in her mandibular angle. CT and MRI scans revealed an intracranial mass with extension to the lateral skull base. These findings suggested the occurrence of a paraganglioma or meningioma. In a two-stage surgical procedure tumor was extirpated without functional impairment to the patient. Histology of the excised lesion demonstrated an endotheliomatous meningioma. Since an extracranial meningioma can present as a mass lesion of the lateral skull base, CT and MRI scans are essential in preoperative surgical planning.

Functional MR imaging of the cervical spine in patients with rheumatoid arthritis

PURPOSE

To evaluate functional MR imaging in patients with rheumatoid arthritis (RA) involving the cervical spine.

MATERIAL AND METHODS

We used a device that allows MR examination to be made of the cervical spine in infinitely variable degrees of flexion and extension. Dynamic functional MR imaging was performed on 25 patients with RA.

RESULTS

Functional MR imaging was able to show the degree of vertebral instability of the occipito-atlantal or atlanto-axial level as well as the subaxial level. By performing functional MR imaging, we were able to demonstrate the extent of synovial tissue around the dens, and the impingement and displacement of the spinal cord during flexion and extension. The basilar impression, the cord impingement into the foramen magnum, the cord compression, the slipping of vertebrae, and the angulation of the cord were all much more evident in functional than in static MR imaging.

CONCLUSION

Functional MR imaging provided additional information in patients with RA, and is valuable in patients who have a normal MR study in the neutral position and yet have signs of a neurological deficit. Functional MR imaging is important in the planning of stabilizing operations of the cervical spine.

Chlororganic pesticides and polychlorinated biphenyls in breast tissue of women with benign and malignant breast disease

Persistent chlorinated hydrocarbons assimilated through the diet may, as a result of their carcinogenic, immunotoxic, and, at least in regard to certain of these substances, estrogenic properties, play a role in the etiology of human breast cancer. As a consequence, increased concentrations of these ubiquitous environmental contaminants may be found in breast tissue of women suffering from malignant breast disease. To examine this possibility, surgically removed breast tissue samples from 65 women in Hesse, Germany were examined by capillary gas chromatography for p, p'-dichloro(diphenyl)trichloroethane (p,p'-DDT), p, p'-dichloro(diphenyl)-dichloroethane (p,p'-DDD), p, p'-dichloro(diphenyl)dichloroethene (p,p'-DDE), hexachlorobenzine (HCB), alpha-, beta-, and gamma-hexachlorocyclohexane (HCH) as well as the polychlorinated biphenyls (PCB) no. 28, 31, 49, 52, 101, 105, 118, 138, 153, 156, 170, and 180. Of the 65 patients, 45 were diagnosed with breast cancer. The control group of 20 women suffered from benign breast disease such as mastopathy. After statistical adjustment for age differences, higher concentrations of p,p'-DDT, p, p'-DDE, HCB as well as PCB-congeners no. 118, 138, 153, and 180 were detected in tissue from women with breast cancer than in tissue from control persons. These differences were weakly significant for p, p'-DDE (p = 0.017), for PCB 118 (p = 0.042) and for PCB no. 153 barely not significant (p = 0.083). On an average, a 62% higher concentration of p,p'-DDE was found in cancer tissue (cancer patients: 805 microg/kg fat; controls: 496 microg/kg fat) and 25% higher concentration of PCB no. 118 (81 microg/kg fat; 65 microg/kg fat). The concentrations of beta-HCH, PCB no. 156 and 170 were lower (not significant) in cancer tissue than in tissue from women with benign disease. PCB-congeners no. 105 and 149 as well as gamma-HCH could only be detected in individual tissue samples; congeners no. 28, 31, 49, 52, and 101 as well as alpha-HCH and p,p'-DDD were not detected in any of the samples. To rule out the possibility that the concentrations of chlorinated hydrocarbons measured were influenced by the surgical procedure, 20 samples of tissue that were at a distance (minimum 1 cm and maximum 3 cm) from the tumor, tissue that was in direct proximity to the tumor (no more than 5 mm from the tumor), and tumor tissue itself (center of tumor) were separately prepared and analyzed. The average concentrations of chlorinated hydrocarbons varied to differing degrees and only minimally in tumor and surrounding breast tissue, indicating that the surgical procedure did not influence the results.

[CT angiography of the pulmonary artery in patients with bronchial carcinoma]

The aim of the study was to evaluate 3D computed tomography (3D-CT) for the visualization of tumor extent with respect to the infiltration of the pulmonary arteries in patients with locally advanced small and nonsmall-cell lung cancer. A total 61 examinations in 40 patients with bronchial carcinoma were performed with contrast-enhanced (150 ml injected with 4 ml/s after bolus tracking) 2 mm spiral CT (pitch 1.5, increment 1 mm) (Somatom Plus4, Siemens AG, Germany). Using the implemented software cine mode, surface shaded display (SSD), and maximum intensity projection (MIP), reconstructions of the pulmonary arteries and the tumors were generated. In comparison to conventional spiral thoracic CT, the optimized cross-sectional images of the mediastium represented a benefit with the technique described, and this can help to diagnose vessel infiltration and may therefore be of value for pre- and post-therapeutic staging in modern stage-adapted multimodality treatment programs.

[MRI with supermagnetic iron particles versus double-spiral CT in identification of malignant liver lesions]

PURPOSE

The purpose of this study was to evaluate the efficacy of MRI with superparamagnetic iron oxide (SPIO) and double-spiral CT in the detection of liver metastases and hepatocellular carcinoma.

METHODS

38 patients with a total of 144 malignant hepatic lesions underwent CT and MRI. A panel of experts defined the gold standard. Five experienced judges performed independently blinded evaluation of the number of detectable lesions. Multifactorial variance analysis was used to determine the statistical significance.

RESULTS

SPIO-MRI shows the highest rate of detection and is significantly superior to native MRI and native CT. The highest rate of detection by CT is shown in the portal-venous phase of contrast; nevertheless, the rate is significantly inferior to SPIO-MRI. In general, the native phases of CT and MRI are significantly inferior to the contrast phases of both. SPIO-MRI shows a higher rate of false positive findings.

CONCLUSION

The time-consuming and cost-intensive SPIO-MRI significantly increases the rate of detectability for malignant liver lesions compared with double-spiral CT but it also increases the rate of false positive findings.

Paclitaxel in combination with weekly 24-hour infusional 5-fluorouracil plus leucovorin in the second-line treatment of metastatic breast cancer: results of a phase II study

PURPOSE

To evaluate the antitumor activity in terms of response rate (RR), time to progression (TTP) and survival of paclitaxel in combination with weekly 24-hour infusional 5-fluorouracil (5-FU)/leucovorin in pretreated metastatic breast cancer (MBC).

PATIENTS AND METHODS

Fifty-four patients with bidimensionally measureable disease were included during phase II. Thirty-two had anthracycline resistant disease. Treatment consisted of 5-FU (24-hour i.v. infusion) 2.0 g/m2, leucovorin (two-hour i.v. infusion prior to 5-FU) 500 mg/m2, weekly for six weeks (day 1, 8, 15, 22, 29, 36) and paclitaxel (three-hour i.v. infusion) 175 mg/m2 was administered additionally on days 1 and 22, q 50 days.

RESULTS

We observed complete remissions in 4% of patients (2 of 54), partial remissions in 55% (30 of 54), stable disease in 37% (20 of 54) and progressive disease in 4% (2 of 54). The overall RR was 59% (95% CI 48%-72%). The RR in 32 patients with anthracycline resistant disease was 59% (19 of 32). The median duration of response was 12 months (3-22), median TTP eight months (2-22) and median survival time 15 months (2-28). Neutropenia was common, but of CTC grade 2 or 3 in most patients. Nonhematologic toxicities mostly consisted of CTC grade 1 and 2 myalgia, diarrhea, mucositis, nausea and vomiting.

CONCLUSIONS

Paclitaxel combined with weekly 24-hour infusional 5-FU/leucovorin is well tolerated in the second line treatment of MBC. High efficacy was documented even in the treatment of anthracycline resistant disease, which warrants further evaluations.

[Possibilities and limits of automatic detection of pathologic intracranial pressure waves with FFT]

Owing to the existence of "reserve spaces" varying individually in extent and expressed by the term compliance, space-consumption intracranial processes do not raise the intracranial pressure (ICP) primarily. Only when this compliance has been exhausted may ICP rise dramatically and may rapidly reach dangerously high levels. It has been shown in the past that "anticipatory" initiation of ICP-reducing measures--i.e. very early in the development of increasing mean ICP--may greatly benefit patient outcome. To recognize an imminent ICP crisis, the available compliance needs to be known. The classical method for determining this latter is the bolus test, which, however, has the disadvantage of being discontinuous and associated with the risk of infection. Another, less invasive and continuous, option is the recognition of pathological intracranial pressure waves. However, recognition of such patterns requires specialized knowledge, that is not widely available. Since, however, knowledge of the compliance is of general importance for intensive care, the idea of developing a PC-based automated system for the identification of pathological waves was followed up. During the course of our basic research effort, we investigated the suitability of the fast Fourier transformation (FFT) algorithm for this purpose. We were able to show that while the FFT is theoretically useful for the detection of pathological intracranial waves, its shortcomings in terms of its sensitivity to extraneous signals (noise) (of considerable importance for biological data handling) and errors in correctly estimating the amplitudes of pathological waves (of great importance for clinical evaluation) make FFT appear less than optimally suitable for this purpose.

[Carcinoid syndrome. Recurrent upper abdominal pain, diarrhea and flush in a 15-year-old girl]

BACKGROUND

A carcinoid syndrome is typically diagnosed in elderly patients, median age at diagnosis was 60 years in two large series. We describe a patient with the carcinoid syndrome at the young age of 15 years.

CASE REPORT

The 15-year-old patient's history and findings on physical examination, clinical chemistry, abdominal ultrasound and liver biopsy were typical for a carcinoid with hepatic metastases. The patient's age, however, was very unusual. Because of her youth, we discussed a potentially curative treatment with resection of the primary tumor in the upper jejunum followed by liver transplantation at a second operation. This concept had to be abandoned, when the first operation revealed a tumor in the mesenterium, close to the primary, 5 cm in diameter and around the superior mesenteric artery. This tumor could not be resected. Liver transplantation therefore did not offer this young patient a chance for cure.

Heat treatment results in a loss of transgene-encoded activities in several tobacco lines

Heat treatment (37 degrees C) of transgenic tobacco (Nicotiana tabacum) plants led to a reversible reduction or complete loss of transgene-encoded activities in about 40% of 10 independent transformants carrying the luciferase-coding region fused to the 355 cauliflower mosaic virus or the soybean small subunit promoter and the nopaline synthase promoter driving the neomycin phosphotransferase gene, whereas the other lines had temperature-tolerant activities. Temperature sensitivity or tolerance of transgene-encoded activities was heritable. In some of the lines, temperature sensitivity of the transgene-encoded activities depended on the stage of development, occurring in either seedlings (40% luciferase and 50% neomycin phosphotransferase) or adult plants (both 40%). The phenomenon did not correlate with copy numbers or the homo- or hemizygous state of the transgenes. In lines harboring a temperature-sensitive luciferase activity, reduction of bioluminescence was observed after 2 to 3 h at 37 degrees C. Activity was regained after 2 h of subsequent cultivation at 25 degrees C. Irrespective of the reaction to the heat treatment, the level of luciferase RNA was slightly increased at 37 degrees C. Only in lines showing temperature sensitivity of transgene-encoded activities was the amount of luciferase and neomycin phosphotransferase strongly reduced. In sterile culture, heat treatment for 15 d did not cause visible damage or changes in plant morphology. In all plants tested a slight induction of the heat-shock response was observed at 37 degrees C.

Smoking and in vitro fertilization: a meta-analysis

PURPOSE

Including our own data and seven relevant publications from the literature, this meta-analysis aimed to establish the influence of the status of female smokers on the clinical pregnancy rate after the first attempt at in vitro fertilization-embryo transfer (IVF-ET).

METHODS

We started to collect information about our own patient's smoking habits in January 1996 to evaluate prospectively the influence on IVF success. Information regarding 799 patients (607 nonsmokers and 192 smokers) was obtained. Additionally we retrieved seven relevant publications from the unabridged MEDLINE 1982-1996. They were recalculated to first cycles, because from a biometrical point of view, only the results of the first IVF cycle are really well comparable, as the number of necessary IVF cycles always correlates with the number of pregnancies. These data were compared in the nonparametric sign test according to Dixon-Mood and calculated as relative success ratios, defined as the quotient of the probability of IVF-ET success of nonsmokers divided by that of smokers for each publication.

RESULTS

This meta-analysis, based on a total of 2314 first IVF-ET treatments, showed that almost twice as many IVF-ET cycles were needed for smokers as for nonsmokers to become pregnant. For the success quotient, we obtained a ratio of 1.79, with an associated 95% confidence interval of from 1.24 to 2.59. The total analysis shows, with a P value of less than 0.01, significantly higher pregnancy rates (21%) in nonsmokers compared to smokers (14%).

CONCLUSIONS

Based on the analyzed data there exists--from a statistical point of view--a significant negative effect on the chances of success for smokers to become pregnant compared to nonsmokers.

[Imaging methods in diagnosis of pheochromocytoma]

In the radiological evaluation of adrenal masses today computed tomography (CT) has the highest sensitivity of all imaging modalities for tumor detection. In addition, CT is able to assess potential concomitant processes in the surrounding tissues. Magnetic resonance imaging (MRI) is the method of choice, when adrenal masses cannot be differentiated by CT. When chemical-shift imaging, fat-suppression, and dynamic contrast-enhanced sequences are used for tissue characterization, pheochromocytomas can be distinguished from adenomas. Due to the multiplanar imaging ability MRI is optimal for the preoperative work-up of the anatomical situation in patients with adrenal masses. Extraadrenal paragangliomas can be assessed with MRI, too. Ultrasound is of minor relevance in the assessment of pheochromocytomas and other adrenal masses, as is angiography, which is only carried out in special cases to evaluate the vascular supply.

On the power of confession evidence: an experimental test of the fundamental difference hypothesis

In Arizona v. Fulminante (1991), a U.S. Supreme Court majority stated that confessions are similar to, not fundamentally different from, other types of evidence. To evaluate this claim, three mock juror studies compared the impact of confessions to other common forms of evidence. In Experiment 1, participants read summaries of four criminal trials (murder, rape, assault, theft), each of which contained a confession, an eyewitness identification, character testimony, or none of the above. Significantly, the confessions produced the highest conviction rates. In Experiments 2 and 3, participants read a murder or assault trial containing all three types of evidence and made a series of midtrial judgments. Results indicated that the confession was seen as the most incriminating, followed by the eyewitness and character testimony. Although the comparisons we made are limited in certain respects, our findings suggest that confessions are uniquely potent.

Computed tomographic study of bone availability for facial prosthesis-bearing endosteal implants

In a computed tomographic study, 56 patients with facial defects were examined to assess the availability of bone for extraoral Brånemark implants (3 or 4 mm long, 3.75 mm diameter) to bear facial prostheses. Bone depths were determined in the auriculotemporal (2-8 mm), infraorbital (0-10 mm), lateroorbital (8-14 mm), supraorbital (1-14 mm) and medioorbital (1-6 mm) areas as well as at the base of the nasal skeleton (1-5 mm). The low values for the supraorbital and infraorbital areas were determined at the points closest to the frontal- and maxillary sinuses, respectively. Implantation in these areas would be permissible only under certain conditions. The very thin osseous structures of the nasal region also present problems for implants. In the auriculotemporal region, the bone width is always sufficient, but at the orbital margin it can vary from 3 to 8 mm. The three-year success rates for implant survival were found to be 100% and 85.8% respectively for auricular and orbital defects. No serious skin complications were seen. Six patients (10.7%) required secondary corrective surgery in a total of 13 implant areas.

The McRoberts' maneuver for the alleviation of shoulder dystocia: how successful is it?

OBJECTIVE

Our purpose was to determine the rate of success of the McRoberts' maneuver as the initial treatment for shoulder dystocia and to compare the rate of maternal and neonatal morbidity with those cases of shoulder dystocia requiring additional obstetric maneuvers. A secondary goal was to assess those factors associated with successful McRoberts' maneuvers.

STUDY DESIGN

A retrospective review of shoulder dystocia cases occurring between 1991 and 1994 was performed. The identified cases were divided into two groups on the basis of the maneuvers used to relieve the shoulder dystocia. The first group comprised cases in which the McRoberts' maneuver was used as the sole treatment and the second group consisted of cases in which additional maneuvers were subsequently used. Exclusion criteria included lack of documentation concerning the maneuvers used or cases in which the McRoberts' maneuver was not the initial technique used. The two groups were compared with respect to various antepartum, intrapartum, and neonatal characteristics.

RESULTS

During the study period we identified 250 cases of shoulder dystocia among 44,072 vaginal deliveries, for an incidence of 0.57%. Of these, 236 cases (94%) fulfilled entry criteria. The McRoberts' position alone successfully alleviated the shoulder dystocia in 98 cases (42%). In the group of cases where the McRoberts' maneuver was the sole maneuver used, there were significantly lower mean birth weights (p = 0.008), shorter durations of the active phase of labor (p = 0.009), and shorter second stages (p < 0.0001). In the group of cases that required additional maneuvers to relieve the shoulder dystocia, there was a trend toward an increased incidence of postpartum hemorrhage and brachial plexus injury (p = 0.07).

CONCLUSIONS

These data suggest that the McRoberts' maneuver is associated with a significant degree of success in relieving shoulder dystocia and may be associated with decreased morbidity compared with other maneuvers. On the basis of these findings, we recommend the McRoberts' maneuver as the initial technique for disimpaction of the anterior shoulder.

3D-computed tomography: a new method for the evaluation of fetal cranial morphology

This study is the first presentation of three-dimensional computed tomography (3D-CT) for the in vitro evaluation of the prenatal human cranium. The study was based on CT examinations from 26 aborted normal fetuses between 10 and 25 weeks gestational age. Incremental coronal and transverse CT slices of 1 mm thickness and a threshold segmentation algorithm were used to generate 3D-CT reconstructions (surface-shaded display, SSD) of the cranial bones similar to their anatomical appearance. The threshold of the segmentation algorithm was selected after comparison of the 3D-CT images generated with varying thresholds and graphically reconstructed histological serial sections of particular sutures in five specimens. The variation of the segmentation threshold resulted in alterations of the bone sizes and suture widths. However, 3D-CT images allowed sensitive identification of the cranial ossification centers and accurate evaluation of the bone topography. Cutting and rotating procedures made it possible to evaluate all imaged bones in arbitrary views without disturbing superpositions, thus making isolated examinations of particular macroscopic sections of the specimens unnecessary. In conclusion, 3D-CT of the fetal cranium promises to be of considerable help in the evaluation of prenatal cranial development.

[CT volumetry of the liver before transplantation]

PURPOSE

Purpose of the study was to assess the predictive accuracy of preoperative CT volumetry for water displacement volume after liver transplantation.

METHODS

In a retrospective study the liver volume of 52 patients who underwent an orthotopic liver transplantation, was calculated preoperatively based on incremental and spiral computed tomography (CT). The calculated values were compared with the liver volume measured by water displacement and weight of the extirpated liver.

RESULTS

Marked differences of 19-21.5% were seen between calculated CT volume and water displacement volume for the entire group, and of 12.4-16.9% for livers with a plausible physical liver density (0.9 and 1.1 g/cm3). In this group, 68-86% of the livers were in the acceptable tolerance range for a predictive accuracy (+10% to -20%). Other error sources, such as the breathing shift of the abdominal organs and interobserver variability (1.5-2.7%), were of minor importance for volume calculation.

CONCLUSION

In conclusion, both incremental CT and spiral CT are reliable methods for the preoperative estimation of the liver volume, whereas best accordance with the corrected water displacement volume was obtained using the individual segmentation thresholds.