Schädelsonographisches Neugeborenenscreening: Eine retrospektive 10-Jahresstudie an 11 887 Neugeborenen

We retrospectively analyzed the results of a sonographic cranial screening study, performed between 1985 and 1994 to determine the incidence of intracranial hemorrhage and cerebral anomalies based on obstetrical risk factors. In the Department of Obstetrics and Gynecology of the University Giessen, Giessen, Germany, 94.6 % (n = 11,887) of all children born during the study period were included and underwent sonographic cranial screening within the first 10 days after birth. Cerebral abnormalities were found in 653 (= 5.5 %) cases, and peri-/intraventricular hemorrhages (PIVH, grade I-IV) in 303 cases. Periventricular leucomalacia, porencephaly, subarachnoidal hemorrhage and hydrocephaly were rare (< or = 0.2 %). The Apgar index proved to be a good prognostic factor, particularly at 1 and 5 minutes after birth (p < 0.0001). In contrast, correlation between PIVH and cardiotocography, arterial cord blood gases, and pH was poor. We did not observe a higher incidence of PIVH in newborns with growth retardation, preeclampsia and premature ruptures of membranes or prolonged labor. With decreasing gestational age, the frequency of PIVH increased progressively from 0.4 % at 39 weeks to 53.2 % at 27 weeks (p < 0.001). We also found a higher risk of intracranial hemorrhage in preterm newborns with amniotic infections (38.1 %, p < 0.001). In mature babies, we did not find a difference between the incidence of PIVH and delivery-modes; however, we noted a higher risk of PIVH Grade IV in preterm newborns with breech presentation for vaginal delivery versus caesarean section (38.5 % versus 7.4 %, p = 0.005). The incidence of PIVH over this 10 year time period did not increase despite an increasing number of preterm newborns over time. In conclusion, this study, which represents one of the largest patient cohorts studied for PIVH, indicates that neonatal sonographic cranial screening is an important tool to define quality control in obstetrics.

Combined action of the ACE D- and the G-protein beta3 T-allele in major depression: a possible link to cardiovascular disease?

Although it is well established that depression is a major risk factor for the development of coronary artery disease and that cerebrovascular disease can be a major contributing factor for the development of depression, the information about the interplay between the central nervous system and cardiovascular disease is still limited. We investigated the angiotensin I converting enzyme (ACE) ID and the G-protein beta3-subunit (Gbeta3) C825T polymorphism in 201 patients with unipolar major depression and 161 ethnically and age-matched controls. Both gene variants have earlier been associated with either cardiovascular disease or affective disorders, making them good candidates for a combined analysis. We found a significant increase in the Gbeta3 T allele (OR = 1.61, 95% CI 1.17-2.2, P = 0.0035) and a marginal altered genotype distribution of the ACE ID polymorphism with decrease in the II genotypes (chi(2) = 6.43, df=3, P = 0.04) in the patients' group. Analysing the data for both genes we found that the combined actions of ACE and Gbeta3 genotypes accumulate in carriers of the ACE D allele (ID and DD) and Gbeta3 TT homozygotes with ID/DD-TT carriers showing a more than five-fold increase in risk for major depression (crude OR = 5.83, 95% CI 1.99-17.08, P = 0.0002). As our study was carried out with depressive patients without serious cardiac impairment at the time of the investigation, we are presently unable to predict whether this combined action of the ACE ID/DD-Gbeta3 TT genotype is increasing the risk for both disorders. Nevertheless our study reports for the first time that the same allelic combination of two genes that have been shown to increase the risk for myocardial infarction (Naber et al, 2000) increase the vulnerability for depressive disorder.

Brain tissue oxygen guided treatment supplementing ICP/CPP therapy after traumatic brain injury

OBJECTIVE

To evaluate the effects of a brain tissue oxygen (P(ti)O(2)) guided treatment in patients with traumatic brain injury.

METHODS

P(ti)O(2) was monitored in 93 patients with severe traumatic brain injury. Forty patients admitted from 1993 to 1996 were treated with intracranial pressure/cerebral perfusion pressure (ICP/CPP) management alone (ICP < 20 mm Hg, CPP > 70 mm Hg). Fifty three patients admitted from 1997 to 2000 were treated using ICP/CPP management, but in this second group CPP was also increased as individually required to raise the P(ti)O(2) above 1.33 kPa (10 mm Hg) (P(ti)O(2) guided group).

RESULTS

Cerebral hypoxic phases with P(ti)O(2) values below 1.33 kPa occurred significantly less often in the P(ti)O(2) guided group. P(ti)O(2) values were higher over the whole monitoring period. No statistical differences could be observed in outcome at six months, despite a positive trend in the P(ti)O(2) guided group.

CONCLUSIONS

Cerebral hypoxic events can be reduced significantly by increasing cerebral perfusion pressure as required. To show a clear beneficial effect of P(ti)O(2) guided cerebral perfusion pressure management on outcome, a multicentre randomised trial needs to be undertaken.

Differences in hamstring muscle stretching of elite field hockey players and normal subjects

OBJECTIVES

To investigate differences in stretching behaviour of hamstring muscles in elite field hockey players and normal subjects.

METHODS

16 normal healthy subjects (group A) and 16 elite field hockey players (group B). Stretching of the hamstrings was performed with a knee extension device. Two successive single stretches (1 and 2) until the maximum stretch tolerance was achieved were applied to each subject twice. Simultaneously range of movement (ROM), passive resistance to stretch (PRS) at 36 degrees ROM, and electromyographic (EMG) activity of the biceps femoris and semitendinosus muscles were recorded.

RESULTS

ROM (p=0.02 for stretch 1; p=0.04 for stretch 2) and PRS (p=0.04 and p=0.03) were significantly higher in group B, as compared to group A. The EMG activity of the biceps femoris (p=0.02 for stretch 1; p=0.3 for stretch 2) and semitendinosus (p=0.03 and p=0.11) were significantly higher in group B only for stretch 1. From stretch 1 to 2, a significant increase in ROM was observed in both group A (p=0.002) and group B (p=0.0003), as well as a significant decrease of PRS (p=0.0002; p=0.002). EMG activity only showed a significant decrease in group B (biceps p=0.03;semitendinosus p=0.01), but not in group A (p=0.6; p=0.06). The EMG activity sets in when the subjects begin to perceptive pain in the stretched muscles.

CONCLUSIONS

Significant differences exist. in the stretching behaviour of elite field hockey players and non-athletes. ROM, PRS and EMG activity are higher in athletes. Implications for treatment should be considered, but recommendations cannot be made on the basis of this study yet.

Effects of decompressive craniectomy on brain tissue oxygen in patients with intracranial hypertension

This report examined the intraoperative course of partial pressure of brain tissue oxygen (P(ti)O(2)) and intracranial pressure (ICP) during surgical decompressive craniectomy for medically intractable intracranial hypertension due to diffuse brain swelling in three patients after severe subarachnoid haemorrhage and aneurysm coiling. The mean ICP decreased from 59 mm Hg to 10 mm Hg in a two step fashion, relating to bone flap removal and dural opening. Simultaneously, P(ti)O(2) increased rapidly from 0.8 kPa (6 mm Hg) to 3.07 kPa (23 mm Hg). P(ti)O(2) and ICP remained at non-critical ranges postoperatively. Despite these beneficial effects on ICP and P(ti)O(2), the patients' clinical status remained poor with two in a persistent vegetative state and one dead.

[SCIWORA-syndrome. Case report and review of the literature]

The SCIWORA-syndrome was firstly described by Pang and Wilberger in 1982 [11]. It is characterized by a neurological injury without radiological appearance. Since the standardized use of MRI in spinal cord diagnosis, the number of the "real" SCIWORA-syndromes decreases. By the case report of a 14 years old boy falling down from a wall of 2 meters height with a complete paraplegia from Th12 without radiographic abnormality (even in MRI) we will give a short review of the literature.

Lumbar ependymoma presenting with paraplegia following attempted spinal anaesthesia

Neurological deterioration from intraspinal haematoma following insertion of a spinal needle is extremely rare. We present the case of a 28-yr-old female, who presented with complete paraplegia following attempted spinal anaesthesia for delivery of her third child. Space-occupying iatrogenic spinal haemorrhage from a previously undiagnosed lumbar ependymoma was found to be the precipitating cause. Following laminotomy with blood clot and tumour removal her neurological function improved.

Sacral insufficiency fracture, an unsuspected cause of low-back pain in elderly women

Sacral insufficiency fractures (SIF) usually occur in elderly women and are secondary to various conditions, mainly postmenopausal or steroid-induced osteoporosis and radiation therapy. They are often overlooked or confused clinically and radiographically with metastatic disease. We report a case of a 72-year-old woman who presented to our department with severe low-back pain. She was thoroughly investigated for the cause of her back pain. Plain X-rays did not reveal any abnormality, but magnetic resonance (MR) scan revealed marked oedema within both sides of the sacrum, suggesting a neoplastic lesion. Bone scintigraphy did show a hyperfixation pattern forming an 'H' in the sacrum which is a characteristic sign of SIF. Computed tomography (CT) confirmed sclerotic changes interpreted as insufficiency fractures through both sacral alae. Increased awareness of these fractures may help to avoid unnecessary investigations and treatment. Bed rest and analgesia followed by rehabilitation provide good relief of symptoms.

(22)Ne(alpha,n)(25)Mg: the key neutron source in massive stars

The excitation function of the reaction (22)Ne(alpha,n)(25)Mg, the key neutron source in the astrophysical s process in massive stars, has been determined from threshold at E(alpha) = 570 up to 1450 keV with an experimental sensitivity of 10(-11) b. For all resonances in this energy range new resonance parameters have been measured. For a possible resonance at about 635 keV a new upper limit omega gamma < 60 neV for the strength was obtained. Based on the new data, improved reaction rates were calculated as a function of temperature. The new uncertainty limits are considerably smaller than in previous determinations, ruling out the large enhancement factors, up to 500, assumed in some stellar model calculations.

Dysphonia subsequent to severe traumatic brain injury: comparative perceptual, acoustic and electroglottographic analyses

We tested the applicability of the Goettinger Hoarseness Diagram (GHD) for quantitative evaluation of voice disorders after severe traumatic brain injury (TBI) and compared the obtained data with those from established voice analysis systems such as the Multi-Dimensional Voice Program (MDVP), electroglottography (EGG) and perceptual ratings using sustained vowel productions from 10 patients with TBI dysarthrophonia at late stages postinjury and of 10 healthy control speakers. Statistical analyses revealed significant intergroup differences with respect to various acoustic and perceptual measures, i.e., irregularity component, noise component, noise-to-harmonic ratio, shimmer, jitter, roughness, creakiness, strained-strangledness, hypernasality. By contrast, the considered EGG estimates, i.e., open quotient and speed quotient, did not allow for separation of patients and controls. In addition, the two GHD components exhibited close correlations to perceived roughness and creakiness, on the one hand, and breathiness and, to some degree, nasality, on the other, whereas the MDVP parameters failed to differentiate between these two perceptual modes of phonation.

Biomechanical analysis of Graf's dynamic spine stabilisation system ex vivo

The most frequent causes of chronic lumbar spine instability are of degenerative or traumatic origin. Numerous anterior and posterior stabilisation devices were developed for anatomical reconstruction of the spinal alignment and fusion of the spine to restore stability. Fusion of the spine results in increased load of adjacent segments with an increased risk of secondary degeneration which might result in instability or stenosis. To avoid the disadvantages of static devices, Graf developed a method of dynamic surgical treatment of spinal column instabilities, which is based on the principle of flexible stabilisation. This study is analysing the kinematics of discoligamentary intact motion segments compared with the experimentally destabilised human lumbar spine and the influence of Graf's stabilisation. According to our results, rotational instabilities cannot be satisfactorily stabilised by Graf's ligamentoplasty. With the present ex vivo study, it could be shown that it is possible to restore stability after discoligamentary lesion and after facetectomy using Graf's dynamic lordosis ligamentoplasty.

Morbidity profile of high-performance fencers

There are only very few data available about the morbidity of elite fencers athletes. The aim of this study was to elucidate the nature and history of the morbidity in high-performance fencers. The injury profile over 15 years of 93 fencers at a highly competitive level was analysed by clinical assessment and examination. We found a positive correlation between the injured upper extremity with the dominant fencing side while the lower extremity showed no side preference with regard to vulnerability. Achillodynia occurred more frequently at the contralateral side. The joint most affected was the knee. The dominating symptom was patellofemoral pain which occurred in 39.8 %.

Association between Epstein-Barr virus infection and late acute transplant rejection in long-term transplant patients

Recently we reported about a possible involvement of extrarenal systemic cytomegalovirus (CMV) infection in graft deteriorating immune processes. We now examined whether Epstein-Barr virus (EBV) may also be associated with late renal graft injury. We analyzed the expression of early antigen-, viral capsid antigen-, and a latency-associated EBV-RNA-transcript, which is not translated into protein in peripheral blood mononuclear cells of kidney transplant patients with histologically proven late acute rejection and no signs of CMV or any other infection (A), patients with stable graft function (B), and healthy probands (C). A total of 40% in group A vs. 5 and 0% in groups B and C, respectively, expressed early antigen-mRNA (P<0.05) suggesting an activation of lytic EBV infection. Response to steroid bolus therapy in group A was comparably poor with that observed in CMV-related graft injury. Our data suggest that extrarenal lytic EBV infection may also be involved in the pathogenesis of late graft injury. A controlled ganciclovir trial may prove the significance of our observation.

Is hyperhomocysteinemia due to the oxidative depletion of folate rather than to insufficient dietary intake?

Hyperhomocysteinemia is considered as a risk factor for cardiovascular diseases. Usually, an inverse relationship exists between homocysteine and folate levels, and supplementation with folate lowers homocysteine concentrations in patients. Therefore, hyperhomocysteinemia is mainly ascribed to the insufficient dietary intake of folate. Hyperhomocysteinemia has also been observed in infections and inflammatory diseases. Oxidative stress appears to be involved in the pathogenesis of these disorders, and associations have been found between homocysteine and e.g., neopterin concentration. Increased neopterin concentration indicates immune system activation and also allows an estimate of thus elicited oxidative stress. It may be relevant that the active cofactor, tetrahydrofolate, is very susceptible to oxidation. Immunologically induced oxidative stress could lead to folate depletion resulting in hyperhomocysteinemia. Thus, hyperhomocysteinemia in patients can be considered as an indirect consequence of hyperconsumption of antioxidant vitamins during prolonged states of immune activation.

Repositioning and flap placement in fingertip injuries

After finger amputations, replantation is often the best option of treatment. However, microvascular repair may not be feasible for more distal amputations. Reposition of the amputated segment associated with a local flap can provide length, sensation, and bulk. This is especially useful in distal-to-distal interphalangeal joint fingertip amputations. From 1994 to 1998, 30 reposition and flap procedures were performed by the authors. In 28 cases, the homodigital unipedicle island flap was used and in two cases the Tranquilli-Leali flap was used. Patients were observed for 24 months to evaluate joint mobility, nail aesthetics and function, as well as sensitivity. Mobility was considered satisfactory in all repositioned segments except two, in which a 20-deg extension deficit at the proximal interphalangeal joint was noticed. Digit length was approximately the same in relation to the opposite side, and the nail did not change markedly from case to case. Two-point discrimination ranged from 7 to 9 mm. Intolerance to cold was observed in 7 patients. Reposition associated with a local flap has been a good surgical alternative for more distal amputations because it preserves digit length and sensitive digital pinch.

trans-3,4-dihydroxy-anti-1,2-epoxy-1,2,3,4-tetrahydrodi- benz[a,j]acridine involvement in dibenz[a,j]acridine DNA adduct formation in mouse skin consistent with Ha-ras mutation patterns in tumors

Dibenz[a,j]acridine (DBA), is a N-heteropolycyclic aromatic environmental carcinogen found in complex combustion mixtures. The major route of DBA metabolic activation is reportedly through the trans-3,4-dihydroxy-3,4-dihydroDBA (DBA-3,4-DHD). The present studies were undertaken to determine the role of trans-3,4-dihydroxy-anti-1,2-epoxy-1,2,3,4-tetrahydroDBA (DBADE) in DBA activation pathway(s), the DNA bases involved in the binding of DBA to DNA, and whether the adducts produced are consistent with the mutation pattern in the Ha-ras gene. DBA (300 microg) or 50 microg synthesized (+/-)-DBADE was applied to the back of female Hsd:ICR(Br) mice. The mice were sacrificed 48 h later, and skin DNA was isolated, hydrolyzed, and analyzed with (32)P-postlabeling. Of the four adducts produced in vivo, adduct 1 was the major adduct for DBA (>50%) and adduct 2 was the major adduct for DBADE (89%). After the reaction of (+/-)-DBADE with purine nucleotides or calf thymus (CT) DNA in vitro, 100% of the DBADE-2'-dAMP adducts and 94% of DBADE-CT DNA adducts were chromatographically identical on TLC with adduct 2 and 86% of the DBADE-2'-dGMP adducts were chromatographically consistent with adduct 1 by (32)P-postlabeling. Papillomas were induced on the backs of mice by a single application of 0.2 micromol of DBA followed by twice-weekly application of 12-o-tetra-decanoylphorbol-13-acetate (TPA, 2 microg) for 24-26 weeks. Skin carcinomas were induced by twice weekly applications of DBA (0.1 micromol) on the backs of mice. A to T and G to T transversions were found in codons 12, 13, and 61 of the Ha-ras gene in the treated mouse skin carcinoma and papilloma DNA. The mutational spectra in the Ha-ras gene are consistent with the DNA binding of DBA to dG or dA in vivo. Thus, this research has indicated that DBADE plays an important role in DBA metabolic activation and DNA binding in mouse skin, and an alternative pathway through a bis-dihydrodiol-epoxide of DBA may also be involved.

Carpal bone maturation assessment by image analysis from computed tomography scans

Bone maturation is the only reliable indicator of growth and its radiologic assessment with or without automated systems is a qualitative method. Image processing allows the study of bone maturation with quantitative data. Carpal bone maturation was studied in 20 children (13 boys and 7 girls, ages ranging from 4 to 15 years) without any clinical evidence of endocrine disease by image analysis from computed tomography (CT) scans. Each wrist CT scan was processed in order to extract the carpal bones and to measure quantitative data regarding volume, axes of inertia and density for each bone. The volumes and the length of the inertia axes were significantly correlated with age. Whatever the age, there were strong correlations between the volume or the length of the main inertia axis of one carpal bone and that of all others. The decrease in the carpal bone volume measured from the processing procedure compared with the theoretical volume of bone defined from the length of the three inertia axes indicated a change in bone shape during growth. Although the mean density was constant, there was an increase in the standard deviation of density with age. Skeletal maturity assessment with image analysis from CT scans seems to be a good complementary investigation to determine bone age in children.

12C(alpha,gamma)16O: the key reaction in stellar nucleosynthesis

The angular distributions of gamma rays from the 12C(alpha,gamma)16O reaction have been measured at 20 energy points in the energy range E(cm) = 0.95 to 2.8 MeV. The sensitivity of the present experiment compared to previous direct investigations was raised by 1-2 orders of magnitude, by using an array of highly efficient ( 100%) Ge detectors shielded actively with BGOs, as well as high beam currents of up to 500 microA that were provided by the Stuttgart Dynamitron accelerator. The S(E1) and S(E2) factors deduced from the gamma angular distributions have been extrapolated to the range of helium burning temperatures applying the R-matrix method, which yielded S(300)(E1) = (76+/-20) keV b and S(300)(E2) = (85+/-30) keV b.

[Assessment of carpal bone maturation by imaging: an alternative to bone age determination or a complementary study?]

Radiographic evaluation of skeletal maturation with or without automated systems relies on the comparison between the radiographic appearance of portions of a child's skeleton and the standardized appearance in a comparable population of children. Assessment of skeletal maturation using image analysis of wrist computerized-assisted tomography is a quantitative method allowing for measurements of the volume of each carpal bone, the axis of inertia, and the mean bone density. Morphological modifications of carpal bones are characterized by quantitative data relating to the length of the axis of inertia and the volume. Imaging is a potentially useful method for carpal bone assessment during growth.

Speech disorders following severe traumatic brain injury: kinematic analysis of syllable repetitions using electromagnetic articulography

Using electromagnetic articulography, the lips, the tip of the tongue, and the tongue dorsum were tracked during repetitions of the syllables [pa], [ta] and [ka] in 10 speakers with dysarthria following severe traumatic brain injury and in 10 age-matched control subjects. When asked to produce the syllable trains as fast as possible, the patient group showed a rather homogeneous pattern of movement abnormalities including prolonged syllable durations and reduced peak velocity/amplitude ratios. Most presumably, limited speed generation gives rise to the impaired ability to increase speech rate. During the habitual speaking condition, reduced velocity/amplitude ratios were restricted to the tongue tip and tongue dorsum. Obviously, the tongue and the lips are differentially affected in dysarthria following severe traumatic brain injury.

A novel cell line that retains the morphological characteristics of the cells and matrix of odontogenic myxoma

Little is known about the histogenesis of the human odontogenic myxoma or the relation between tumour cells and the matrix. In order to attempt to remedy this situation, we established and investigated a cell line derived from a human odontogenic myxoma. To our knowledge this is the first cell line derived from this tumour. The cell line, named Mix 1, preserved features of the tumour cells. Mix 1 cells expressed vimentin, type I collagen, fibronectin, tenascin and hyaluronic acid. Ultrastructural analysis of cells of the tumour and cell line demonstrated similarities, both containing Golgi apparatus, rough endoplasmic reticulum and mitochondria indicative of secretory cells. Ultrastructural analysis showed the matrix to be represented by bundles of collagen fibrils in the tumour, and by irregular filaments in cultures more than 60 days old. The Mix 1 cell line promises to be an excellent model for investigating the biology of the odontogenic myxoma.

Barrier cream application reduces the formation of DNA adducts in lung tissue of mice dermally exposed to used gasoline engine oil

Epidemiological evidence suggests that auto mechanics are at higher risk for lung and urinary bladder cancer. Used gasoline engine oils (UGEO), a common exposure for many mechanics, are carcinogenic and increase carcinogen-DNA adduct levels in the skin and lungs of mice treated topically. The ability of a barrier cream to reduce dermal absorption of carcinogens in UGEO was evaluated. Groups of five animals were treated topically for 5 days with 25 microliters/day UGEO. A barrier cream was applied to two groups prior to exposure. Skin of both groups was washed with a commercial hand cleaner, the first group, one hour after UGEO application, the other, eight hours after application. Two other groups did not receive barrier creams before UGEO application, but were washed at one or eight hours after the oil was applied. Another group was treated with UGEO five times but was never washed; other groups consisted of barrier cream and commercial cleaner controls. Skins and lungs were harvested 24 hours after the final exposure and DNA isolated. Carcinogen-DNA adduct levels were determined by 32P-postlabelling followed by thin-layer chromatography to separate the adducts and scintillation counting to quantify the adduct level. Pre-application of barrier cream reduced markedly the carcinogen-DNA adduct levels in both skin and lung tissue of mice treated with UGEO and washed at eight hours. In the lung, this reduction was statistically significant. Adduct levels in both tissues were approximately the same in the groups washed at one hour, indicating that if the skin is washed promptly after exposure, barrier cream application is unnecessary. If, however, washing does not take place until several hours after exposure, the pre-application of barrier cream appears to significantly reduce the DNA adduct levels. These data are of practical importance to mechanics who may be working with oily parts for extended periods.

The osmotic migration of cells in a solute gradient

The effect of a nonuniform solute concentration on the osmotic transport of water through the boundaries of a simple model cell is investigated. A system of two ordinary differential equations is derived for the motion of a single cell in the limit of a fast solute diffusion, and an analytic solution is obtained for one special case. A two-dimensional finite element model has been developed to simulate the more general case (finite diffusion rates, solute gradient induced by a solidification front). It is shown that the cell moves to regions of lower solute concentration due to the uneven flux of water through the cell boundaries. This mechanism has apparently not been discussed previously. The magnitude of this effect is small for red blood cells, the case in which all of the relevant parameters are known. We show, however, that it increases with cell size and membrane permeability, so this effect could be important for larger cells. The finite element model presented should also have other applications in the study of the response of cells to an osmotic stress and for the interaction of cells and solidification fronts. Such investigations are of major relevance for the optimization of cryopreservation processes.