[Complications in the endoscopic polypectomy of colonic adenomas]

Endoscopic polypectomy is associated with a small but definite risk of bleeding and perforation. Patients with large adenomas are thus usually hospitalized for endoscopic resection. In order to evaluate whether these procedures can be performed in the setting of one day surgery, we retrospectively analyzed the complications and results of polypectomy done in the period from 1.1.1990 through 31.12.1994. Of 1399 colorectal adenomas respected in 680 patients, 385 (28%) were larger than 1 cm. Altogether we observed only 3 (0.2%) clinically significant complications: bleeding was seen in 2 patients, of whom only one required transfusion of one unit. One patient required surgery because of perforation after removal of a sessile cecal adenoma with uneventful outcome. These results show that endoscopic resection of colorectal adenomas is safe even if the polyps are large.

[Measuring amniochorionic membrane thickness with high frequency ultrasound]

The postpartal thickness of the amniochorionic membrane was measured by means of 20 MHz ultrasound after 28 inconspicuous deliveries in the course of a prospective study. The aim of our investigation was to determine the thickness of the amniochorionic membrane using high frequency ultrasound and to evaluate the results for a statistical correlation with fetal and maternal parameters. The data obtained were compared with histological sections for measurement accuracy using a linear regression analysis method. Membrane thickness of the total study group was 0.83 +/- 0.11 mm (0.72-1.08 mm). Based on a statistical comparison with the histological sections, the high frequency ultrasonographic examination was shown to be highly reliable with a correlation coefficient of r = 0.96 (p < 0.0001). Results obtained by ultrasonography were correlated with maternal (gestational age, patient age, parity) and neonatal (size and weight at birth, sex, placental weight, Apgar 1/5/10) parameters by means of linear regression analysis. There was a statistically significant correlation between parity and membrane thickness (r = 0.485, p < 0.05). There was also a correlation of Apgar scores at 5 minutes post partum (r = 0.485, p < 0.05). We were able to demonstrate that the measurement of membrane thickness by ultrasound is an objective and reliable method and may be a gain to prenatal diagnostics when used in vivo.

Determination of oenothein B as the active 5-alpha-reductase-inhibiting principle of the folk medicine Epilobium parviflorum

Several extracts from Epilobium parviflorum, a plant used in Central Europe for the treatment of prostate disorders, were evaluated in a biochemical assay with 5-alpha-reductase. The aqueous extract displaying inhibition of the enzyme was analyzed, the fraction responsible for this activity was purified, and the active compound identified as a macrocyclic tannin, oenothein B (1).

Measurement of amniochorionic membrane thickness using high-frequency ultrasound

Premature rupture of the membranes (PROM) accounts for approximately 30 per cent of all preterm deliveries. PROM is thought to be mainly due to a decrease in membrane integrity. The aim of our investigation was to determine, post-partum after 28 normal deliveries, the thickness of the amniochorionic membrane using a 20 MHz high-frequency ultrasound. The data obtained were compared with histological sections for measurement accuracy using a linear regression analysis method. The membrane thickness of the total study group was 0.83 +/- 0.11 mm (0.72-1.08 mm). Based on a statistical comparison with the histological sections, the high-frequency ultrasound examination was shown to be highly reliable, with a correlation coefficient of r = 0.96 (P < 0.0001). High-frequency ultrasonographic examinations of membrane thickness are an objective and reliable method and may be a gain to prenatal diagnostics once this method can be used in vivo.

No mutations within conserved domain I of the p53 gene in medullary thyroid cancer

Abnormal mobility shifts in single strand conformational polymorphism (SSCP)-analysis of exons 2 and 3 of the p53 gene in 2 out of 5 medullary thyroid cancers (MTC) prompted us to sequence the corresponding genomic region spanning codons 9-32. We found no mutations of the conserved domain I in the two MTCs that had previously shown mobility shifts, nor in a third MTC case indicating wild-type p53 (in this region). However, we detected a polymorphism consisting of a GC to CG transversion in intron 2 in two of the primary MTCs and one associated blood sample. In addition, we report on a deviation of the published sequence of intron 2 affecting positions 11817-8 and 11874, seen in 7/7 samples analyzed. Our findings corroborate the hypothesis, that MTC carcinogenesis does not require p53 mutations (Yana et al, Jpn J Cancer Res 1992).

Preschoolers of dysphoric mothers

Dysphoric mothers rated their preschool children as having more internalizing and externalizing behavior problems than children of nondysphoric mothers. Observers rated the dysphoric mothers as having more negative affect during play interactions, although their children's affect was not rated more negatively. The dysphoric mother-infant dyads were also rated as having a poorer quality interaction. These data suggest that mothers' chronic dysphoria (75% were chronically dysphoric) has a negative impact on the mothers' perceptions of their children as well as the mothers' and children's interaction behavior.

Efficient expression and secretion of Aspergillus niger RH5344 polygalacturonase in Saccharomyces cerevisiae

An Aspergillus niger endopolygalacturonase (EC 3.2.1.15) cDNA was expressed in the yeast Saccharomyces cerevisiae. Secretion of the protein into the growth medium was efficiently directed by the fungal leader sequence, and processing occurred at the same site as in Aspergillus. The expression level was significantly enhanced by using a "short" version of the yeast ADHI promoter. An additional increase in the yield of heterologous protein was due to a higher plasmid stability and a rise in plasmid copy number. This was achieved by deleting most of the bacterial sequences from the expression vector. The yeast-derived enzyme showed the same enzymatic and biochemical properties as the fungal polygalacturonase, such as substrate specificity, pH and temperature optima and pI value. The yeast-derived enzyme, however, showed a higher degree of glycosylation and exhibited a more pronounced temperature stability than the fungal enzyme.

[Initial results with laparoscopic fundoplication]

17 patients underwent laparoscopic Nissen fundoplication for gastroesophageal reflux disease not responding to medical treatment. Conversion to laparotomy was necessarily due to large paraesophageal hiatus hernia (3) or severe peri-esophagitis (1) in 4 patients. There was no perioperative morbidity or mortality. At 3 months all patients were symptom-free. Esophageal manometry revealed a rise in mean lower esophageal sphincter pressure from 4 mm Hg preoperatively to 11 mm Hg postoperatively, and lengthening of the high pressure zone from 2.3 to 3.3 cm. One patient needed reoperation one year after fundoplication due to wrap disruption with recurrent reflux disease. Laparoscopic fundoplication involves low perioperative morbidity and shortens the postoperative recovery time in selected patients.

The effects of hormone substitution in depot form on the uterus in a group of 50 perimenopausal women--a vaginosonographic study

The aim of our study was to examine the effects of hormone replacement on the size of the uterus and the development or increase of myomatas. Fifty perimenopausal women were included in the study (53.8 +/- 5.0 years). Patients received a substitution therapy composed of a combination of 4 mg estradiovalerate and 200 mg prasteronenantate (Gynodian Depot cartridges) given as a muscular injection in 6-10 week intervals (mean 7 weeks +/- 4 days). Prior to the onset of therapy with Gynodian and after a period of 12 months (+/- 13 days) vaginosonography was performed. Measurements taken were length, thickness, height of endometrium, size of ovaries and of myomas. Data obtained were correlated with baseline findings. Within 1 year, significant increases in uterus length from 73.4 mm to 88.2 mm, in uterus thickness from 33.9 mm to 43.5 mm and in endometrium height from 4.1 mm to 6.7 mm were observed (median values). There was an increase in both the number (from 2.2 to 3.5) and the size of the myomatas (29.4-35.0 mm diameter). A statistical analysis conducted by means of the Wilcoxon matched pairs signed-rank sum test showed P < 0.001. No significant change occurred in the size of the ovaries. Our study shows that hormone substitution may have an impact on uterus growth and that therefore vaginosonographical monitoring can be recommended.

[Neurotoxicity of aluminum. Study of a long-term exposed sample of workers of an aluminum powder industry]

Within the framework of a transverse study, the mental performance of a group of subjects exposed to aluminium over many years (n = 32; aluminium powder industry) was compared with that of a structurally similar control group (n = 30). Neuropsychological and electrophysiological tests revealed no signs of cognitive performance, despite aluminium burdening. Aluminium levels in plasma and urine were elevated.

[Age and sex specific differences in bone density of 4,000-year-old individuals. Bone density measurement of early Bronze Age femurs from excavations in Unterhautzenthal, Lower Austria]

Bone density measurements of 14 individuals (early Bronze Age, 2200-1600 BC), analyzed by dual-energy absorptiometry, showed a distinct difference between women and men. In men, there was a high bone density (+17.9%-0.290 g/cm2 difference). In females, a constant decrease in bone density was found after the age of 20-25 years (from 1.2 g/cm2 at 20 years to 0.8 g/cm2 at 40 years of age). With caution, the results are comparable with those of the present time.

[Neurological complications in infectious endocarditis]

Despite considerable progress in both diagnostic studies and therapeutic management serious complications of infectious endocarditis have become rather more common. Next to intracardiac complications arterial embolization to the central nervous system is the second most common life-threatening event, which might lead to infarction, hemorrhage, mycotic aneurysm and/or metastatic infection with a wide spectrum of neurological symptoms and an overall very poor prognosis. The most effective prevention of neurological complications is the early diagnosis of infectious endocarditis with isolation of the infecting agent and adequate antimicrobial chemotherapy in combination with well-timed cardiosurgical measures. Computed tomography and cerebral angiography is mandatory in any patient with neurological symptoms to check the need for a neurosurgical intervention as well as in patients assigned for anticoagulation for cardiac reasons.

Expression in Escherichia coli: production and purification of both subunits of the human general transcription factor TFIIE

Both subunits of the human class II transcription factor TFIIE (rTFIIE alpha and rTFIIE beta) have been overexpressed in Escherichia coli at 26 degrees C using a T7 RNA polymerase expression system and further purified to apparent homogeneity. As in this system rTFIIE alpha was poorly expressed and copurified with a truncated form, we expressed rTFIIE alpha as a fusion protein. These overexpressed subunits of TFIIE are similar to the endogenous subunits according to the following criteria: molecular weight, microsequencing, and transcription activity.

[Agraphia of Gerstmann syndrome--attempt at characterization]

A review is given of well documented cases of Gerstmann's syndrome covering one century from 1888 to 1991 complemented by two own observations, Convergencies as well as divergencies are pointed out. It is concluded, that although aphasia may be an accompanying condition, aphasic agraphia as described in linguistic terms is not a sufficient explanation of agraphia in Gerstmann's syndrome which implies spatial-graphic particularities like disturbances of symmetry, reduplications of strokes, defective line orientation, choice of a different letter type and occurrence of nonsense characters not contained in the alphabet. Literal paragraphs may appear as well, while semantic errors are virtually lacking. These features are known to occur in apractic or constructive agraphia whose localisation is usually in the left angular/subangular region coincident with a disconnection from homotopic right hemisphere areas by damage of commissural fibres. Lesions of these non-dominant areas may lead to spatial agraphia.

Oral hairy leukoplakia in a patient with ulcerative colitis

A 30-year-old man with ulcerative colitis developed oral hairy leukoplakia (OHL). Serological examination for human immunodeficiency virus (HIV)-1 and HIV-2 infection showed no abnormalities. Biopsy specimen of the lateral tongue showed ballooned prickle cells, and electron microscopy revealed herpes-type viruses. Immunologic investigation of the patient showed a marked decrease in T-helper cells as a result of immunosuppressive regimen. The present report appears to be the first well-documented case of OHL in an HIV-negative patient with ulcerative colitis. OHL may be a marker for severe immunosuppression but is not necessarily associated with HIV infection. Patients with iatrogenic immunosuppression should be monitored for OHL. Concerning the marked decrease in T-helper cells in this case, the presence of OHL may imply the examination of T-lymphocyte subsets in patients such as HIV-infected individuals or in organ transplant recipients.

[Lipofibroma of the median nerve. Clinical report of two cases]

The following article presents two new cases of a lipofibroma of the median nerve. This formation is a very rare benign tumor of peripheral nerve tissue. Up to now 30 cases have been reported in the literature and are reviewed in this article and are compared with the two cases reported. Besides the operative treatment, which made the neuropathological diagnosis possible, preoperative diagnosis has been extended by MNT-scans of the involved parts of the nerve. The noninfiltrating character of the tumor could be well recognized on these scans. The signal quality and the anatomical proximity to the median nerve made the diagnosis of a lipofibroma likely. By the postoperative histological reviews the diagnosis was confirmed in classic manner. The immunological marking of the S-100 protein showed a remarkable reduction of this protein in these peripheral nerve tumors. The two cases reported by us recapitulate the clinical history typically and describe symptoms and our treatment for the lipofibroma of the median nerve.

Treatment with propranolol of severe self-injurious behavior in a blind, deaf, retarded adolescent

Self-injurious behavior represents a significant barrier to behavioral interventions with retarded children. The etiology of this behavior is hypothesized as secondary to a state of overarousal. beta blockers are believed to be uniquely useful medications in having an effect on self-injurious behaviors through their ability to reduce arousal in the face of stimulation and demands. The case presented describes a multiply handicapped adolescent with severe self-injury who responded to 300 mg of propranolol with a gradual but steady reduction in self-injury over 12 months. Concurrent with this was the emergence of increased interactions and benefit from behavioral interventions.

Myocardial effects of experimental neoplastic disease

The purpose of this study was to determine the effects of the 7288ctc Morris hepatoma on heart size and performance. Hearts from tumor bearing and control animals were perfused in the working configuration one to three weeks post implantation. As tumor growth progressed there was an inverse linear relationship between tumor size and heart weight. When intrinsic heart work (defined as the product of the cardiac output and peak systolic pressure) was assessed in vitro over a range of physiologic preloads, significant differences were found between tumor-bearing and non-tumor-bearing animals. The hearts from the tumor-bearing animals (tumor weight 10-20 grams) developed only 76% of the heart work of control animals at maximal left atrial filling pressure (25 cm H2O). Hearts excised from rats with tumor masses from 30-65 grams developed 43% of the myocardial work as controls at the same (25 cm) preload. At the time of sacrifice resting blood pressures, blood glucose, insulin, and tumor necrosis factor (TNF) levels were similar in both groups. Blood from tumor bearing animals were negative for both aerobic and anaerobic bacteria. The data suggests that the decrements in cardiac size and performance are independent of several vectors known to influence heart size and performance and occur in the absence of detectable bacteremia.

"Depressed" mothers' perceptions of their preschool children's vulnerability

"Depressed" mothers who scored in the depression range on the Beck Depression Inventory when their infants were 3-months-old were asked to complete the Vulnerable Child Scale when their children were preschool age. Depressed versus non-depressed mothers rated their preschool children as being more vulnerable (as did an independent observer) as well as having more behavior problems. The vulnerability ratings were significantly related to infancy stage measures including the POMS (mothers' depressed mood), the infants' behavior ratings and heart rate range during interactions with a nondepressed stranger. These measures of the mothers' and infants' behavior tapped during early infancy may have contributed to the mothers having perceived their children as "vulnerable" during the preschool stage.

HIV and quality of life: a rehabilitation perspective

Access to families affected by HIV in their own home puts health visitors in a prime position to encourage health promotion strategies for people with HIV infection, and to recognise and make early referral for rehabilitation needs, writes Cherry Lang. Here she describes how physiotherapy and stress management techniques can help tackle symptoms of HIV infection.

1993 up & comers

The achievements of the healthcare industry in the 21st century will depend on the quality of its leadership. In recognition of the contributions of the new generation of healthcare executives, MODERN HEALTHCARE salutes its 1993 Up & Comers. They are a group of healthcare professionals, all 40 or younger, who have refused to be restricted by the ways of the past. Instead, they have contributed to efforts to improve the quality of medical care, expand access to the system and reconfigure the delivery system. The group, whose accomplishments are outlined in the following pages, were selected from a field of nearly 50 candidates nominated by MODERN HEALTHCARE's editorial staff and magazine readers.

Brain imaging techniques applied to chronically solvent-exposed workers: current results and clinical evaluation

The application of neuroimaging techniques such as cerebral blood flow (CBF), single photon emission tomography (SPECT), X-ray computed tomography (CAT), and magnetic resonance imaging (MRI) on solvent-exposed workers and patients with toxic encephalopathy results in different and somewhat inconclusive pictures. The aim of this paper is to therefore critically review the current knowledge on chronic neurotoxicity of solvent exposures with respect to neuroimaging technique. CAT measurements of 86 house or construction painters, 82 spray painters, and 81 nonpainters showed no abnormal diffuse brain atrophy due to chronic solvent exposure after controlling for confounding variables such as age, alcohol consumption, or former disease. Correlation analyses did not show any consistent, biologically plausible exposure-effect relationship. Neuropsychologic test results did not correlate significantly with CAT parameters, whereas a strong age dependency exists. It is concluded that long-term exposure to solvent concentrations not exceeding permissible occupational limit values does not cause increased brain atrophy.

Keratinocyte allografts accelerate healing of split-thickness donor sites: applications for improved treatment of burns

Grafting with split-thickness autograft skin remains the most effective method for treating burn wounds. When insufficient donor sites are present, decreasing the time required for healing of available donor sites permits more frequent reharvests to continue the grafting process. Cultured human keratinocytes speed wound healing by providing cover and by producing growth factors and extracellular matrix proteins. In this study we compare the rates of healing induced by allografts of cultured keratinocytes applied to split-thickness donor sites with healing by a standard treatment. Sheets of cultured human keratinocytes derived from neonatal foreskins are applied to a portion of a split-thickness donor site while the remainder is covered with a temporary skin substitute. The wound is inspected at 5, 7, 9, 11, 14, 17, 20, and 23 days. Biopsies are obtained at 7 days for light and electron microscopy. In 10 patients the average time to healing for sites covered with keratinocytes was 6.6 +/- 1.96 days compared with 12.6 +/- 4.32 days for control sites (p < 0.002). By day 7 most keratinocyte-covered sites showed reepithelization with the formation of a basement membrane and hemidesmosomes at the dermal-epidermal junction. Control areas were unhealed without epithelial coverage. The reepithelized donor sites from three patients treated with cultured keratinocytes were reharvested. In each case these grafts took, and they were equivalent to skin used from donor sites harvested for the first time. Keratinocyte allografts speed healing of split-thickness donor sites, thereby increasing the availability of autograft skin for burn wound coverage.

Different TBP-associated factors are required for mediating the stimulation of transcription in vitro by the acidic transactivator GAL-VP16 and the two nonacidic activation functions of the estrogen receptor

The estrogen receptor (ER) contains two nonacidic transcriptional activation functions, AF-1 and AF-2 (formerly TAF-1 and TAF-2). In this study we show that AF-1 and AF-2 are able to stimulate transcription in vitro in a HeLa cell system when fused to the DNA binding domain of the yeast activator GAL4. We also demonstrate that a factor(s) required for the function of the ER AFs is chromatographically separable from a factor(s) necessary for the activity of the acidic activation domain of VP16. Moreover, immunoprecipitation experiments using a monoclonal antibody directed against the TATA box binding protein (TBP) indicate, that these different factors are associated with TBP in distinct TFIID complexes.

[Recurrent selective bronchial intubation in laparoscopic cholecystectomy]

Selective endobronchial intubation occurred three times in a 38-year-old female patient undergoing laparoscopic cholecystectomy. She weighed 58 kg and was 165 cm tall. Anaesthesia was obtained with propofol, fentanyl and vecuronium. Endotracheal intubation was carried out with a Mallinckrodt tube, size 7.5. It was attached to the cheeks with the 22 cm marking at the teeth. The diagnosis of endobronchial intubation was made when he SpO2 fell abruptly to 79, 87 and 93% respectively. Simultaneously, the peak inspiratory pressure increased and PetCO2 decreased. The third time, both lung fields were auscultated; no breath sounds were found on the left side. The first two incidents were cured by exsufflating the artificial pneumoperitoneum. Pulling out the tube 4 cm definitely solved the problem. These endobronchial intubations were due to the tube being too close to the carina. During insufflation of the pneumoperitoneum, the carina is pushed upwards with the corresponding part of the mediastinum.

Influence of repetitive magnetic stimuli on verbal comprehension

The influence of repetitive magnetic transcranial stimulation over the temporo-parietal cortex on verbal comprehension was investigated in 44 healthy subjects. In right-handed subjects, trains of 50 Hz magnetic stimuli over the left hemisphere produced more errors than stimulation over the right hemisphere. The result is not very clearcut, however; thus the test cannot be used for diagnostic investigation of language dominance.

Antibacterial in vitro-activity of meropenem against 200 clinical isolates in comparison to 11 selected antibiotics

The antimicrobial activity of meropenem, a new parenteral carbapenem, was tested in vitro by an agar dilution method against 200 clinical isolates (gram-negative/positive aerobes and anaerobes). Meropenem was compared with imipenem, ceftazidime, cefotaxime, piperacillin, ciprofloxacin, gentamicin; and metronidazole, cefoxitin, chloramphenicol, clindamycin, vancomycin when appropriate. Meropenem and imipenem exhibited an extended spectrum of activity with low minimal inhibitory concentrations (MICs). Only one strain each of Enterococcus faecium and Pseudomonas (Xanthomonas) maltophilia were resistant. Of the carbapenems, imipenem was slightly more active against Enterococcus faecalis, Streptococcus agalactiae, and staphylococci, but meropenem was obviously more active against enterobacteriaceae and Clostridium perfringens. Both, meropenem and imipenem had similar activities towards Pseudomonas aeruginosa, Acinetobacter calcoaceticus, Streptococcus pyogenes and Bacteroides sp. All other antibiotics tested were less potent than the carbapenems with the exception of ciprofloxacin which generally exhibited similar antibacterial activities, except for anaerob microorganisms.

Neurotoxicity of solvent mixtures in spray painters. II. Neurologic, psychiatric, psychological, and neuroradiologic findings

A multidisciplinary cross-sectional study was performed to examine the chronic neurotoxicity of organic solvents. Participating in the study were 105 persons employed as spray painters and having long-term solvent exposure (10-44 years) and a control group consisting of 58 construction workers, electricians, and plumbers without occupational contact to solvents. Samples were matched for age, preexposure intelligence level, occupation, and socioeconomic status. After controlling for potentially non occupational confounding factors (neuropsychiatric diseases, metabolic disorders, high blood pressure, alcohol intake) 83 spray painters and 42 controls were entered finally into the study. The evaluation included work history, self-rating questionnaire, neurologic investigation, psychiatric analysis using the Present State Examination (PSE), psychological testing, and computerized axial tomography (CAT) of the brain. Physical and neurologic examinations demonstrated no case of overt disorders of the central or peripheral nervous system. An important result of the psychiatric analysis was that the syndromes "special features of depression" and "loss of interest and concentration" occurred significantly more frequently among spray painters than among controls. Further analyses demonstrated an association with chronic exposure over 30 years and repeated acute neurotoxic effects during solvent exposures. Neither psychological nor performance tests demonstrated any statistically significant differences in the performance sets after adjustment according to premorbid intelligence level; this finding supports the presumption of only a low grade of mental dysfunction. Correlation analyses indicated a relationship between subjective health complaints and long-term solvent exposure; however, the effect of age cannot be completely ruled out.(ABSTRACT TRUNCATED AT 250 WORDS)

[Psychometric speech studies in Alzheimer's dementia with the Aachen aphasia test]

Dementias of the Alzheimer type seem to be frequently accompanied by language disturbances. These may represent a feature which can be of help in distinguishing them from other types of dementias. We used the Aachen aphasia test in 32 patients suffering from Alzheimer dementia according to research criteria, and a mixed sample of 35 patients suffering from other dementias. From these 2 groups 2 subsamples of 21 patients each were gathered which were comparable with regard to age, disease onset, level of education, verbal intelligence and severity of senility. Nevertheless it was possible to distinguish the groups to a certain degree on grounds of psychometric language criteria alone. Alzheimer patients were more severely handicapped communicatively, less dysarthric, produced more automatisms and discretely more phonemic paraphasias with fluent speech which was sometimes paragrammatic. A relatively better level of repetition compared to the Token test and written language was fairly specific. A computer-assisted classification yielded language disturbances similar to Wernicke's aphasia more often than with non-Alzheimer dementias. We found no Alzheimer patients with a Broca's type of language disorder, while amnestic and global types were bound to the level of overall impairment to a certain degree. The significance of these results with regard to the use of psychometric language test in the dementias, particularly Alzheimer's dementia, and to differential diagnostic considerations are reviewed briefly.

[Fecal occult blood--does a hemoglobin-specific tests improve the diagnosis of relevant colonic neoplasms?]

The object of this study was to assess whether an immunological test specific for human hemoglobin improves the detection of bleeding from colorectal tumors as compared to a conventional guaiac test for occult fecal blood. We examined one stool sample from 134 patients prior to a complete colonoscopy by the Colo-Immun-Test (CI) as well as the Colo-Rectal-Test (CR). CI proved to have a higher sensitivity for occult bleeding from all colonic lesions, but this difference was not statistically significant. There was, however, no difference in the sensitivity of the two tests in detecting bleeding from relevant colonic neoplasms. In this study the immunological CI did not improve the detection of occult fecal blood loss due to adenomas and carcinomas of the colon in comparison with CR.

[Ocular manifestations in a patient with Cockayne syndrome and simultaneous reduced DNA repair]

A 14 year old white boy presented with the typical clinical findings of Cockayne syndrome. Photodermatosis was known since the third week of life. He had disproportionate short stature with a short trunk, long limbs and flexion contractures of the large joints. He also was cachectic and prematurely aged. He had a typical facies. The hearing was slightly impaired. The prominent ocular findings were corneal opacifications, salt and pepper like retinal pigment epithelial changes and optic atrophy. On fibroblast culture the DNA repair activity is usually normal in patients with Cockayne syndrome. The DNA repair activity in our patient however was markedly reduced to 25% of normal. On lymphocyte culture a significantly increased 4-nitroquinoline-1-oxide sensitivity (cytotoxicity and increased break-rate) was found. These findings indicate that the boy has a specific variant of Cockayne syndrome with simultaneously reduced DNA-repair activity.

[Encephalitis in Legionella bozemanii pneumonia]

A 44-year-old man, a known alcoholic and heavy smoker, was hospitalized with high fever and respiratory failure which a few hours later required intubation and artificial ventilation, although the chest x-ray had been unremarkable. Later serial chest x-ray films showed intrapulmonary infiltrations, while Legionella Bozemanii was demonstrated by direct immunofluorescence. Cranial computed tomography was unremarkable, despite the onset of tetraparesis and a severe midbrain syndrome. Cerebrospinal fluid contained merely mild lymphocytic pleocytosis. However, magnetic resonance imaging revealed symmetrical demyelinization foci in the brainstem as a sign of encephalitis. The neurological deficits regressed almost completely after several weeks of antibiotic treatment and rehabilitation measures over several months.

[Diagnostic differentiation of dementia diseases by modern imaging procedures]

We present a review on recent neuroimaging techniques, like x-ray computed tomography (XCT), magnetic resonance imaging (MRI), positron emission tomography (PET) and single photon emission tomography (SPECT) in dementia and related diseases. Significant new findings have been obtained using techniques reflecting proton density, regional brain perfusion and brain metabolism. In dementia of the Alzheimer type, for example, temporoparietal and sometimes also frontal reductions in cerebral blood flow and metabolism are characteristic. The infarctions found in multi-infarct dementia are especially well visualized on T2-weighted MRI images. Pick's disease is characterized by brain atrophy and decrease of radiotracer activity in the frontal lobes. In huntington's chorea the metabolic rate on PET scan in the area of the caudate nuclei may be reduced even before signs and symptoms become apparent. Furthermore, neuroimaging provides us with fairly typical finding in Creutzfeld-Jakob's disease, alcoholic dementia, Wilson's disease, hydrocephalus, Parkinson's disease, progressive supranuclear ophthalmoplegia, Fahr's disease, and the olivopontocerebellar ataxias. Neuroimaging techniques, however, have always to be interpreted in conjunction with clinical findings, thus disclosing their full range of information.

The leucine zipper domain of avian cMyc is required for transformation and autoregulation

Small deletions of 7 to 48 amino acids have been generated in the leucine zipper domain of the avian cMyc protein and the mutant cMyc proteins expressed using an avian retroviral vector. Retrovirally encoded cMyc protein transforms primary chick embryo fibroblasts and leads to abnormal regulation of the endogenous c-myc gene. Deletion of the most C-terminal leucine of the zipper motif confers a partial phenotype affecting some but not all parameters of transformation. Complete loss of transforming activity results from deletion of further leucine residues, including one which is not part of the heptad repeat. In cMyc transformed cells endogenous c-myc mRNA is expressed at a low level and is abnormally refractory to induction by serum stimulation. In contrast, a non-transforming cMyc protein which lacks the zipper does not affect normal c-myc expression. These results demonstrate that the leucine zipper domain of avian cMyc is required for both transformation and autoregulation, and suggests that essential leucine residues within the motif may be spaced differently from those in the zippers of Fos and Jun.

Neuropsychological findings in treated Wilson's disease

Seventeen patients, treated for Wilson's disease (WD), underwent a set of neuropsychological tests and were compared with a closely matched control group. There were clear differences between the groups (chi 2-test, p less than 0.0001). Wilson patients with only hepatic involvement, however, did not at all differ from their controls. Wilson patients with neuropsychiatric signs differed from controls on a reasoning test (p = 0.0016), and the entire WD group differed on a perceptual speed task (p = 0.0025). Compared to normal test values, however, the patients' group means were all within plus or minus one standard deviation from the normal mean. Special testing procedures and construction of the test battery excluded a factor of motor deficits as a major cause for the differences. The neuropsychological findings are viewed in relation to other findings in patients with motor disorders and predominantly subcortical lesion sites. Wilson's disease may be a dementing condition, but not when treated adequately.

Is Wilson's disease a dementing condition?

A case presentation in this journal by Rosselli, Lorenzana, Lasselli and Vergara (1981) has raised the issue of intellectual deterioration in Wilson's Disease. Relevant findings in the recent literature are discussed.