A rare cause for knee pain: fracture of the femoral component after TKR. A case report

We report the rare case of sudden knee pain due to fracture of the total knee replacement nine years after implantation. Fracture occurred because of subsequent osteolysis due to polyethylene wear.

Konduktives Knochenersatzmaterial mit variabler Antibiotikaversetzung

BACKGROUND

A new bone substitute, consisting of hydroxylapatite and calcium sulphate, was prepared in two formulations and analysed for its mechanical strength and antibiotic elution.

MATERIAL AND METHODS

The bone substitute PerOssal has osteoconductive and degradable properties. The material has a built-in capillary structure, which results in an immediate fluid uptake. Antibiotics absorbed to the bone substitute resulted in a prolonged release rate. Mechanical strength was investigated by an unconfined compression test up to failure under both wet and dry conditions for both formulations of the bone substitute. Antibiotic release was analysed microbiologically for two antibiotics, vancomycin and gentamicin, over an elution period of 10 days using the agar diffusion method.

RESULTS

The drug release analysis resulted in a prolonged release rate of both antibiotics over 10 days. In vitro the amount of gentamicin and vancomycin eluted at day 10. From one pellet still exceeded the minimal inhibitory concentration of most aetiologically important pathogens. Formulation two of the present bone substitute is significantly harder in both wet and dry conditions when compared to formulation one. Both formulations lose strength in the wet condition relative to their performance in the dry condition. However, formulation two is as hard under wet conditions as formulation one is when dry.

CONCLUSION

PerOssal is a suitable new degradable osteoconductive bone substitute that can be loaded with antibiotic solutions, which are released in effective doses over 10 days. The mechanical strength of PerOssal is sufficient to support cancellous bone defects in non-weight-bearing areas or in combination with osteosynthesis.

Horizontal cell receptive fields are reduced in connexin57-deficient mice

Horizontal cells are coupled by gap junctions; the extensive coupling of the horizontal cells is reflected in their large receptive fields, which extend far beyond the dendritic arbor of the individual cell. In the mouse retina, horizontal cells express connexin57 (Cx57). Tracer coupling of horizontal cells is impaired in Cx57-deficient mice, which suggests that the receptive fields of Cx57-deficient horizontal cells might be similarly reduced. To test this hypothesis we measured the receptive fields of horizontal cells from wildtype and Cx57-deficient mice. First, we examined the synaptic connections between horizontal cells and photoreceptors: no major morphological alterations were found. Moreover, horizontal cell spacing and dendritic field size were unaffected by Cx57 deletion. We used intracellular recordings to characterize horizontal cell receptive fields. Length constants were computed for each cell using the cell's responses to concentric light spots of increasing diameter. The length constant was dependent on the intensity of the stimulus: increasing stimulus intensity reduced the length constant. Deletion of Cx57 significantly reduced horizontal cell receptive field size. Dark resting potentials were strongly depolarized and response amplitudes reduced in Cx57-deficient horizontal cells compared to the wildtype, suggesting an altered input resistance. This was confirmed by patch-clamp recordings from dissociated horizontal cells; mean input resistance of Cx57-deficient horizontal cells was 27% lower than that of wildtype cells. These data thus provide the first quantification of mouse horizontal cell receptive field size and confirm the unique role of Cx57 in horizontal cell coupling and physiology.

Protein kinase A-mediated phosphorylation of connexin36 in mouse retina results in decreased gap junctional communication between AII amacrine cells

Gap junctions in AII amacrine cells of mammalian retina participate in the coordination of the rod and cone signaling pathway involved in visual adaptation. Upon stimulation by light, released dopamine binds to D(1) receptors on AII amacrine cells leading to increased intracellular cAMP (cyclic adenosine monophosphate) levels. AII amacrine cells express the gap junctional protein connexin36 (Cx36). Phosphorylation of Cx36 has been hypothesized to regulate gap junctional activity of AII amacrine cells. However, until now in vivo phosphorylation of Cx36 has not been reported. Indeed, it had been concluded that Cx36 in bovine retina is not phosphorylated, but in vitro phosphorylation for Cx35, the bass ortholog of Cx36, had been shown. To clarify this experimental discrepancy, we examined protein kinase A (PKA)-induced phosphorylation of Cx36 in mouse retina as a possible mechanism to modulate the extent of gap junctional coupling. The cytoplasmic domains of Cx36 and the total Cx36 protein were phosphorylated in vitro by PKA. Mass spectroscopy revealed that all four possible PKA consensus motifs were phosphorylated; however, domains point mutated at the sites in question showed a prevalent usage of Ser-110 and Ser-293. Additionally, we demonstrated that Cx36 was phosphorylated in cultured mouse retina. Furthermore, activation of PKA increased the level of phosphorylation of Cx36. cAMP-stimulated, PKA-mediated phosphorylation of Cx36 protein was accompanied by a decrease of tracer coupling between AII amacrine cells. Our results link increased phosphorylation of Cx36 to down-regulation of permeability through gap junction channels mediating light adaptation in the retina.

Proposal for a histopathological consensus classification of the periprosthetic interface membrane

AIMS

The introduction of clearly defined histopathological criteria for a standardised evaluation of the periprosthetic membrane, which can appear in cases of total joint arthroplasty revision surgery.

METHODS

Based on histomorphological criteria, four types of periprosthetic membrane were defined: wear particle induced type (detection of foreign body particles; macrophages and multinucleated giant cells occupy at least 20% of the area; type I); infectious type (granulation tissue with neutrophilic granulocytes, plasma cells and few, if any, wear particles; type II); combined type (aspects of type I and type II occur simultaneously; type III); and indeterminate type (neither criteria for type I nor type II are fulfilled; type IV). The periprosthetic membranes of 370 patients (217 women, 153 men; mean age 67.6 years, mean period until revision surgery 7.4 years) were analysed according to the defined criteria.

RESULTS

Frequency of histopathological membrane types was: type I 54.3%, type II 19.7%, type III 5.4%, type IV 15.4%, and not assessable 5.1%. The mean period between primary arthroplasty and revision surgery was 10.1 years for type I, 3.2 years for type II, 4.5 years for type III and 5.4 years for type IV. The correlation between histopathological and microbiological diagnosis was high (89.7%), and the inter-observer reproducibility sufficient (85%).

CONCLUSION

The classification proposed enables standardised typing of periprosthetic membranes and may serve as a tool for further research on the pathogenesis of the loosening of total joint replacement. The study highlights the importance of non-infectious, non-particle induced loosening of prosthetic devices in orthopaedic surgery (membrane type IV), which was observed in 15.4% of patients.

Intracellular Calcium Is Regulated by Different Pathways in Horizontal Cells of the Mouse Retina

Horizontal cells modulate the output of the photoreceptor to bipolar cell synapse, thereby providing the first level of lateral information processing in the vertebrate retina. Because horizontal cells do not generate sodium-based action potentials, calcium is likely to play an important role for graded potential changes as well as for intracellular events involved in the modulatory role of horizontal cells within the retinal network. Therefore we wanted to determine how the activation of glutamate receptors, voltage-gated calcium channels, and release of calcium from internal stores shape the calcium signal in horizontal cells. All horizontal cells responded to depolarizing voltage steps with sustained inward currents, which activated at around –20 mV, reached a peak amplitude of –79.1 pA at 5 mV, and reversed sign at around 66 mV. The current was insensitive to tetrodotoxin, and it was partially blocked by the L-type channel antagonists verapamil and nifedipine. The N-type channel blocker ω-conotoxin GVIA induced an additional reduction of current amplitudes. Calcium influx through ionotropic glutamate receptors was mediated by both AMPA and kainate but not by N-methyl-d-aspartate receptors. Two agonists at group I metabotropic glutamate receptor, trans-1-amino-1,3-cyclopentanedicarboxylic acid and quisqualate, had no effect. However, intracellular calcium was increased by caffeine, indicating release of calcium from internal stores via ryanodine receptors. These data show that intracellular calcium in horizontal cells is regulated by voltage-dependent L- and N-type calcium channels, ionotropic AMPA and kainate receptors, and release of calcium from internal stores after activation of ryanodine receptors.

[Stability of pedicle screws in comparison to anterior vertebral body screws after kyphoplasty augmentation]

AIM

Aim of the study was to compare stability of pedicle screws and ventral implanted screws after insertion in soft or cured kyphoplasty cement.

METHODS

Pedicle screws were inserted in a total of 40 thoracolumbar vertebrae of 10 different formalin-fixed human specimens: each 10 pedicle screws were implanted in soft (group 1) and cured cement (group 2), each 10 ventral screws were placed in soft (group 3) and cured (group 4) cement. Pedicle screws were then evaluated for biomechanical axial pullout resistance.

RESULTS

Mean pull-out force was 452 N (range 60-1 125 N) in group 1, 367 N (range 112-840 N) in group 2, 364 N (range 65-875 N) in group 3 and 271 N (range 35-625 N) in group 4.

CONCLUSION

Implantation of pedicle screws and ventral implanted screws in soft and cured kyphoplasty cement is a sufficient method. We achieved more stability with pedicle screws compared with ventral implanted screws in soft and cured cement. No significant difference was seen.

The structure and composition of liposomes can affect skin regeneration, morphology and growth factor expression in acute wounds

Liposomal gene transfer is an effective therapeutic approach to improve dermal and epidermal regeneration. The purpose of the present study was to define whether the biological or chemical structure of a liposome influences cellular and biological regeneration in the skin, and to determine by which mechanisms possible changes occur. Rats were inflicted a full-excision acute wound and divided into three groups to receive weekly subcutaneous injections of DMRIE liposomes plus the Lac Z gene, or DOTAP/Chol liposomes plus the Lac Z gene, or saline. Planimetry, immunological assays, histological and immunohistochemical techniques were used to determine cellular responses after gene transfer, protein expression, dermal and epidermal regeneration. DOTAP/Chol increased IGF-I and KGF protein concentration and caused concomitant cellular responses, for example, by increasing IGFBP-3, P<0.05. DOTAP/Chol liposomes improved epidermal regeneration by exhibiting the most rapid area and linear wound re-epithelization compared to DMRIE or control, P<0.001. DOTAP/Chol and DMRIE exerted promitogenic and antiapoptotic effects on basal keratinocytes, P<0.05. Dermal regeneration was improved in DOTAP/Chol-treated animals by an increased collagen deposition and morphology, P<0.001. DOTAP/Chol liposomes increased vascular endothelial growth factor concentrations and thus neovascularization when compared with DMRIE and saline, P<0.001. In the present study, we showed that different liposomes have different effects on intracellular and biological responses based on its chemical and molecular structure. For gene transfer in acute wounds, the administration of DOTAP/Chol liposomes appears to be beneficial.

Connexin45 mediates gap junctional coupling of bistratified ganglion cells in the mouse retina

Direction selectivity, a key feature of visual perception, originates in the retina and is transmitted by bistratified ganglion cells that, in the rabbit retina, exhibit a particular coupling pattern. We intracellularly labeled ganglion cells in different transgenic mouse lines, allowing a morphological classification of bistratified ganglion cells, an analysis of their coupling pattern, and the molecular identification of the connexins responsible for the coupling. Based on dendritic characteristics including co-fasciculation with the dendrites of cholinergic starburst amacrine cells, we were able to distinguish three types of bistratified ganglion cells. Two of these co-fasciculate with starburst amacrine cells and exhibit a specific homologous coupling pattern. Connexin45 (Cx45) appears to be the major component of the gap junctional channels because tracer coupling is absent in Cx45-deficient animals whereas it persists in Cx36-deficient animals. It is speculated that the transjunctional voltage dependence of Cx45 channels could support the transmission of direction selectivity.

Connexin36 mediates gap junctional coupling of alpha-ganglion cells in mouse retina

Alpha-ganglion cells are present in all vertebrate retinae and are subdivided into ON and OFF types according to their level of dendritic ramification within the inner plexiform layer. They have large dendritic fields and usually a good responsiveness to moving stimuli. They were the first ganglion cells in which tracer coupling was observed, suggesting the presence of gap junctions composed of unknown connexins. Here we show that ON-alpha-ganglion cells in the mouse retina are coupled to amacrine cells, whereas OFF-alpha-ganglion cells are coupled to other OFF-alpha-ganglion cells and to amacrine cells. These tracer coupling patterns were completely absent in mice deficient in connexin36 (Cx36). The expression of Cx36 protein in alpha-ganglion cells but not in coupled amacrine cells was confirmed in mice in which the Cx36 coding DNA was replaced by the lacZ reporter gene. The dendritic localization and the distribution pattern of Cx36 patches, analyzed in mice in which the enhanced green fluorescent protein (EGFP) was linked to the C-terminal region of the Cx36 protein, revealed a rather small number of fluorescent plaques and different patterns for ON- and OFF-alpha-ganglion cells. Furthermore, tracer coupling between OFF-alpha-ganglion cells could be inhibited by quinine, a gap junctional blocker with a slight preference for gap junctions formed by Cx36. These data strongly suggest that Cx36 gap junction channels are functional not only in interneurons but also in output neurons of the retina and are responsible for distinct coupling patterns of ganglion cells.

[Unusual complication of silicon synovitis in the rheumatoid wrist]

Silicone synovitis is an important clinical entity recognized in rheumatoid patients after arthroplasties with silicone implants. It is a foreign body reaction to particulate material (silicone elastomer) characterized clinically by the re-occurrence of pain, stiffness and swelling at the site of arthroplasty after initial relief of symptoms. Whereas silicone synovitis is a rare complication in metacarpophalangeal implants, it is an important one in the wrist implant. Long-term follow-up studies have revealed that the rates of fracture and subsidence are high and that the implants deteriorate with time necessitating operative revisions in up to 50% of cases. Indications should therefore be restricted to a painful wrist in the elderly, very low demand patient with insufficient bone stock to permit total wrist arthroplasty with a metal-on-plastic design. Severe preoperative deformity and the need for use of ambulatory aids may further limit the indication. The unusual case of direct perforation of silicone particles from the wrist into the tendon sheath of the M. flexor pollicis longus inducing a tumor-like synovitis and a secondary carpal tunnel syndrome is presented. The importance of silicone synovitis and the indication at present for implantation of a silicone wrist spacer in the rheumatoid patient are discussed.

Closed head injury and perceptual processing in dual-task situations

Using a classical psychological refractory period (PRP) paradigm we investigated whether increased interference between dual-task input processes is one possible source of dual-task deficits in patients with closed-head injury (CHI). Patients and age-matched controls were asked to give speeded motor reactions to an auditory and a visual stimulus. The perceptual difficulty of the visual stimulus was manipulated by varying its intensity. The results of Experiment 1 showed that CHI patients suffer from increased interference between dual-task input processes, which is related to the salience of the visual stimulus. A second experiment indicated that this input interference may be specific to brain damage following CHI. It is not evident in other groups of neurological patients like Parkinson's disease patients. We conclude that the non-interfering processing of input stages in dual-tasks requires cognitive control. A decline in the control of input processes should be considered as one source of dual-task deficits in CHI patients.

Functional expression of connexin57 in horizontal cells of the mouse retina

Horizontal cells are interneurons of the vertebrate retina that exhibit strong electrical and tracer coupling but the identity of the channel-forming connexins has remained elusive. Here we show that horizontal cells of the mouse retina express connexin57 (Cx57). We have generated Cx57-deficient mice by replacing the Cx57 coding region with a lacZ reporter gene, expressed under control of the endogenous Cx57 promoter. These mice were fertile and showed no obvious anatomical or behavioural abnormalities. Cx57 mRNA was expressed in the retina of wild-type littermates but was absent from the retina of Cx57-deficient mice. Previously reported results that the Cx57 gene was very weakly expressed in several other mouse tissues turned out to be unspecific. Cx57 mRNA is abundantly expressed in the retina and weakly in the thymus of adult mice but absent in all other adult tissues tested, including brain. Furthermore, Cx57 is expressed in embryonic kidney at E16.5 to E18.5 days post-conception, as indicated by the pattern of lacZ expression. Within the retina, lacZ signals were assigned exclusively to horizontal cells based on co-localization with cell-type-specific marker proteins. Microinjection of Neurobiotin into horizontal cells of isolated retinae revealed less than 1% of tracer coupling in Cx57-deficient retinae compared with wild-type controls. Cx57 is the first connexin identified in mammalian horizontal cells and the first connexin whose expression is apparently restricted to only one type of neuron.

Actin filaments regulate voltage-gated ion channels in salamander retinal ganglion cells

The regulation of voltage-activated K(+), and Ca(2+) currents by actin filaments was studied in salamander retinal ganglion cells, using the whole-cell patch clamp technique and Ca(2+) imaging. Disruption of F-actin by cytochalasin B or latrunculin B resulted in a reduction of L-type Ca(2+) current by 55+/-4%, and a sustained outward K(+) current (I(k)) by 41+/-3%. The effect was diminished when the F-actin stabilizing agent phalloidin was present in the patch pipette. In a group of cells where I(K) exhibited a small degree of inactivation, the effect of F-actin disruption on current was dual; it increased it by 89+/-16%, at -10 mV, and reduced it by 37+/-5% at +50 mV voltage step from the same holding potential of -70 mV. This was accompanied by a shift in a voltage of half-maximal activation toward negative potentials by approximately 20 mV. In Ca(2+) imaging experiments, 30 min incubation of isolated neurons with latrunculin A reduced a depolarization-induced Ca(2+) accumulation by 45+/-5%. These results suggest a role for the actin cytoskeleton in regulating voltage-gated ion channels in retinal ganglion cells.

Prosthetic joint infections with osteomyelitis due toCandida albicans

We report the case of a 78-year-old woman who suffered from a severe soft tissue and bone infection of her left knee 3 years after a total knee-joint replacement without loosening of her endoprosthesis. Cultures from joint aspiration and tissue specimen identified Staphylococcus aureus and Candida albicans. Direct microscopic examination of vital spongy bone and fibrous tissue revealed microabscesses and seeds of yeasts inside the fatty marrow and interface. After removal of the prosthesis several soft tissue and bone specimens were taken during planned re-operations. The histological examination showed no morphological changing, no reduction or extinction of the yeast cells under fluconazole therapy with a dosage of 6 mg kg(-1) body weight (400 mg daily). Curing of the fungal infection with eradication of the yeasts in the bony specimens was achieved with higher doses of 12 mg kg(-1) body weight (800 mg day(-1)) over a 2 month regimen in combination with repeated surgical debridements.

Die nicht erkannte und unbehandelte Achillessehnenruptur

Although the clinical picture of an acute rupture of the Achilles tendon is clear, it remains unrecognized or falsely evaluated in up to 10% of all cases. Wrong management without surgical intervention or adequate immobilization frequently leads to unstable scar tissue, requiring completely different therapy and rehabilitation than in the case of an acute injury. Between 6/2000 and 3/2002 11 patients (average age 53 years, M:F=9:2) with a neglected rupture of the Achilles tendon undergoing reconstruction of unstable scar tissue were evaluated in a prospective study. The preoperative cardinal symptoms were loss of strength and stress pain. The length of the unstable scar tissue measured 3.5 cm on average (2.0-6.0 cm). After resection of the scar lesion, a broad central gastrocnemius aponeurotic flap was performed in nine cases,whereas two cases underwent a central tendon shift. As a result of the surgical tendon reconstruction,we noted a 40% mean increase of strength in the final examination. This improvement was associated with less pain and a comparable range of motion. Protracted wound secretion and superficial wound necrosis were recorded on one and two occasions, respectively. Ultrasound and X-ray as preoperative imaging diagnostic tools in addition to the clinical picture appear to be sufficient for proper indication and planning of surgical intervention. The broad central aponeurotic flap has proven to be the most successful method in our patients. In cases of a short distal end, the "grip-box plasty" with a central tendon shift is indicated. Even lesions up to 6 cm can thus be repaired with autologous tissue.

Postprandial triglycerides in response to high fat: role of dietary carbohydrate

BACKGROUND

The postprandial triglyceride response following a meal high in fat (HFM) has been related to atherogenesis and insulin resistance. We examined the influence of dietary carbohydrate and the accompanying insulin secretory response on the postprandial triglyceride response following a HFM. MATERIALS AND DESIGN: High-fat meals of equal fat content (fat 80 g) containing either 20 g (low) or 100 g (high) of carbohydrate (HFM-LC and HFM-HC, respectively), and therefore not isocaloric (4250 kJ of HFM-LC and 5450 kJ of HFM-HC), were consumed by seven (four male, three female) normolipidaemic subjects (aged 32.9 +/- 3.7 years, BMI 24.7 +/- 1.8 kg m-2). Blood and indirect calorimetry data were collected at 0-4 h.

RESULTS

HFM-HC produced a significant rise in plasma glucose (Delta0.54 +/- 0.23 mmol L-1, P = 0.05) at 2 h, while a HFM-LC elicited no mean change from baseline. Following a HFM-LC, the plasma insulin incremental area under the curve (AUC) was significantly lower (31.3 +/- 6.7 vs. 83.2 +/- 11.9 mU l-1 h-1, P < 0.0003) and the postprandial triglyceride response AUC was significantly greater (1.66 +/- 0.36 vs. 1.24 +/- 0.31 mmol L-1 h-1, P < 0.006) compared with a HFM-HC. Plasma free fatty acids were suppressed by 44% (P = 0.04) and 66% (P < 0.0001) at 1 h following HFM-LC and HFM-HC, respectively, compared with baseline. There were no significant differences between the meals in energy expenditure, substrate oxidation rates, or respiratory quotient responses.

CONCLUSIONS

By design, the HFMs were not isocaloric but the presence of carbohydrate in a HFM invoked an insulin response that significantly reduced the 4 h postprandial triglyceride response even in healthy, normolipidaemic subjects. This phenomenon may have clinical implications, particularly in relation to insulin sensitivity.

Effects of pallidal deep brain stimulation and levodopa treatment on reaction-time performance in Parkinson's disease

Basal ganglia-thalamocortical circuits play an important role in movement preparation and execution. Tracer, single-cell, and lesion studies in monkeys suggest the existence of topologically segregated motor and nonmotor basal ganglia cortical circuits. In this study we used deep brain stimulation (DBS) of the posteroventrolateral globus pallidus internus (GPi) in patients with Parkinson's disease to elucidate the function of the GPi in human sensorimotor behavior. This question was investigated by comparing the influence of DBS on patients' performance in various reaction-time tasks that differed with respect to cognitive but not motor requirements. As a main result, DBS improved performance on the different tasks independently of the complexity of the involved cognitive processing functions. Furthermore, the observed effects did not depend on the modality of the processed information. These results suggest that the functional state of the posteroventrolateral GPi selectively affects the motor stage in simple sensorimotor acts, because this stage was the only stage involved in all investigated tasks. In addition to DBS, we manipulated the levodopa medication state of the PD patients. In contrast to DBS, levodopa effects on reaction times were less consistent. Levodopa improved reaction times in choice reaction tasks significantly, while affecting reaction times in a simple reaction task to a lesser extent. Error analysis revealed that the medication-dependent reaction-time improvement in the choice reaction tasks was accompanied by an increase in errors, suggesting a shift of the speed-accuracy criteria of the patients. A similar pattern of results was not observed for the DBS effects. Taken together, our data are in agreement with recent findings in monkeys that indicate a topological organization of the GPi in which motor functions are localized in posterolateral regions apart from cognitive regions. Furthermore, our data show a way to uncover the subcortical-cortical circuitry serving human sensorimotor behavior.

Multiple bottlenecks in information processing? An electrophysiological examination

When two stimuli are to be processed in rapid succession, reaction time (RT) to the second stimulus is delayed. The slowing of RT has been attributed to a single processing bottleneck at response selection (RS) or to a central bottleneck following the initiation of the first response. The hypothesis of a response initiation bottleneck is mainly based on reports of underadditive interactions between stimulus onset asynchrony (SOA) and the number of stimulus-response alternatives (simple vs. two-choice response). The present study tested the hypothesis of a response initiation bottleneck by recording the lateralized readiness potential (LRP), a brain wave, emerging during or immediately following RS. The LRP findings were consistent with a central bottleneck but did not support the late bottleneck hypothesis. Instead, the LRP provided direct evidence that the underadditive interaction of number of alternatives and SOA is due to an increase of response anticipations in the simple response condition.

Differential demands on working memory for guiding a simple action sequence: evidence from closed-head-injured subjects

In the present study, a working memory paradigm was used to assess coordinative abilities required for the flexible control of a sequence of actions. Subjects had to maintain and recall a list of digits that functioned as an ensemble of activity cues used for guiding a sequence of forced-choice responses. In three task conditions, the demand on the selection of the activity cues was varied parametrically to manipulate the requirement of coordinating maintenance and processing operations of working memory for guiding the response sequences. A comparison between subjects suffering from severe closed head injury (CHI) and matched controls in a blocked presentation of task conditions revealed that patients, in contrast to controls, did not preplan the sequence by rearranging the ensemble of activity cues prior to execution of the action sequence. Patients' performance was more comparable to controls tested in a random presentation in which preplanning was not possible. Our results further suggest that patients are less efficient in selecting activity cues from working memory, especially in more demanding situations when activity cues have to be completely reordered for guiding a sequence of actions. These results point to an executive dysfunction in CHI subjects that may contribute to the deficits known as inflexible and rigid behavior.

Prefrontal cortex activation in task switching: an event-related fMRI study

When a switch between two tasks has to be carried out, performance is slower than in trials where the same task is performed repeatedly. This finding has been attributed to time-consuming control processes required for task switching. Previous results of other paradigms investigating cognitive control processes suggested that prefrontal cortex is involved in executive control. We used event-related fMRI to investigate prefrontal cortex involvement in task switching. Regions in the lateral prefrontal and premotor cortex bilaterally, the anterior insula bilaterally, the left intraparietal sulcus, the SMA/pre-SMA region and the cuneus/precuneus were activated by the task repetition condition and showed additional activation in the task switch condition. This confirmed the hypothesis that lateral prefrontal cortex is involved in task switching. However, the results also showed that this region is neither the only region involved in task switching nor a region specifically involved in task switching.