Einfluss der Vakzination von Sauen gegen Mycoplasma hyopneumoniae auf den Impfschutz der Ferkel

Gegenstand und Ziel: Untersuchung der Wirkung der Impfstoffe Stellamune® Mycoplasma (Two-Shot) und Stellamune ® One (One-Shot) (Fa. Pfizer) gegen Mycoplasma hyopneumoniae nach Vakzination von Sauen und/oder Ferkeln. Material und Methoden: 254 Muttersauen und 423 Ferkel wurden fünf Gruppen zugeteilt: Gruppe 1: Sauen vakziniert, Ferkel One-Shot; Gruppe 2: Sauen vakziniert, Ferkel Two-Shot; Gruppe 3: Sauen nicht vakziniert, Ferkel One-Shot; Gruppe 4: Sauen nicht vakziniert, Ferkel Two-Shot; Gruppe 5: Sauen vakziniert, Ferkel nicht vakziniert. Von den Sauen wurde drei Wochen a. p., am Tag der Geburt und drei Wochen p. p. und von den Ferkeln am 1., 21., 63. und 140. Lebenstag Blut entnommen und auf Antikörper gegen M. hyopneumoniae untersucht. Nach der Schlachtung erfolgte eine Lungenbeurteilung. Die täglichen Zunahmen bis zum 105. Lebenstag wurden ermittelt. Ergebnisse: Im Alter von 20 Wochen bestanden keine signifikanten Unterschiede in der humoralen Immunantwort bei den Tieren der Gruppen mit Impfung der Ferkel und die Tiere der nicht vakzinierten Gruppe zeigten signifikant niedrigere Antikörpertiter. Die Probanden aller Gruppen mit einer Saugferkelvakzination hatten signifikant bessere Lungenscores als die Tiere der Gruppe ohne Saugferkelimpfung. Ein signifikanter Unterschied bestand zwischen den Tieren der beiden Gruppen mit einmaliger Impfung der Ferkel, wobei die Tiere der Gruppe ohne Vakzination der Sauen signifikant bessere Lungenscores aufwiesen. Bis zum 105. Lebenstag differierten die täglichen Zunahmen der Tiere der einzelnen Gruppen nicht signifikant. Schlussfolgerungen: Die Antikörpertiter bei den Ferkeln geimpfter und nicht geimpfter Sauen eine Woche p. n. zeigten, dass die Impfung von Sauen geeignet ist, hohe Konzentrationen maternaler Antikörper im Ferkel zu induzieren. Allerdings konnte kein Effekt auf die Tageszunahmen oder den Lungenscore festgestellt werden. In allen Gruppen mit Impfung der Ferkel lag der Lungenscore niedriger als bei der Kontrollgruppe ohne Impfung. Die verschiedenen Impfschemata wirkten sich bis zur Vormast nicht auf das Gewicht der Tiere aus. Klinische Relevanz: In diesem Bestand ließ sich durch die Vakzination der Ferkel mit den eingesetzten Impfstoffen die Lungengesundheit verbessern. Eine alleinige Vakzination der Sauen führte in diesem Versuchsbetrieb zu keinem ausreichenden Schutz.

Split facial nerve course in vestibular schwannomas

Object

The facial nerve in vestibular schwannomas (VSs) is located on the ventral tumor surface in more than 90% of cases; other courses are rare. A split facial nerve course with two distinct bundles has thus far been described exclusively for medial extrameatal tumors.

Methods

Between 1996 and 2005, 16 consecutive cases of 241 surgically treated VSs were observed to have distinct splitting of the facial nerve. The mean tumor size measured 27 mm. In one third of the cases, intrameatal tumor extension with obliteration of the fundus was documented. All patients underwent extensive intraoperative neurophysiological monitoring using multichannel electromyography recordings. Patients were reevaluated 12 months after surgery.

In all 16 patients, distinct splitting of the facial nerve was demonstrated. The major portion of the facial nerve followed a typical course on the ventral tumor surface. The smaller nerve portion in all cases ran parallel to the brainstem up to the level of the trigeminal root exit zone and crossed on the cranial tumor pole to the internal auditory canal. The two nerve portions rejoined at the level of the porus acusticus. The smaller portion carried fibers exclusively to the orbicularis oris muscle, whereas the major portion supplied all three branches of the facial nerve.

Conclusions

In VSs, an aberrant course with distinct splitting of the facial nerve adds considerably to the surgical challenge. Long-term facial nerve results are excellent with extensive neurophysiological monitoring, which allows the differentiation and identification of aberrant facial nerve fibers and avoids additional risks to facial nerve preservation.

Intradural-Extramedullary Cavernous Hemangioma of the Left Motor Root C7 - Case Report and Update of the Literature

OBJECTIVE

Intradural-extramedullary cavernomas of the spine are rare lesions with only 21 published cases to date. Due to their rareness and special characteristics diagnosis often is difficult. We report on an additional case of an intradural-extramedullary cavernoma of the spine.

PATIENT

A 56-year-old male presented with left shoulder pain and acute onset of pain affecting the whole spinal column two weeks prior to admission. There were no motor deficits, but a hypesthesia corresponding to the right distal C8-dermatome. MRI revealed an intradural-extramedullary, expansive lesion at the level of C6 with a hyperintense appearance in both T (1)- and T (2)-weighted images. Neither a hemosiderin rim nor contrast enhancement was visible.

RESULTS

During surgery a hematoma and a reddish, berry-like tumor adherent to the left motor root C7 were removed. There were no new neurological deficits, and shoulder and back pain resolved within a few weeks after surgery. Histopathologically a cavernous hemangioma was diagnosed.

CONCLUSIONS

The patient's symptoms were caused both by direct nerve compression and by spinal hemorrhage, most likely spinal SAH. As there was no characteristic hemosiderin rim and due to the hyperintense appearance in T (1)- and T (2)-weighted MR scans, a radiological diagnosis of hemorrhage and classification of the lesion was difficult. Despite their rareness, in patients with signs of spontaneous, spinal SAH and/or nerve compression syndromes cavernous hemangiomas have to be considered as a potential cause.

Preservation of Facial Nerve Function after Postoperative Vasoactive Treatment in Vestibular Schwannoma Surgery

OBJECTIVE:

Facial nerve paresis and hearing loss are common complications after vestibular schwannoma surgery. Experimental and clinical studies point to a beneficial effect of nimodipine and hydroxyethyl starch for preservation of cochlear nerve function. A retrospective analysis was undertaken to evaluate the effect of vasoactive treatment on facial nerve outcome.

PATIENTS AND METHODS:

Forty-five patients with vestibular schwannoma removal, intraoperative electromyographic monitoring, and postoperative deterioration of facial nerve function were evaluated. Twenty-five patients underwent vasoactive treatment consisting of nimodipine and hydroxyethyl starch for improvement of hearing outcome. Twenty patients did not receive such treatment. Facial nerve function was evaluated before and after surgery, as well as 1 year after the surgical procedure. Patients were comparable regarding age, tumor size, and preoperative facial nerve function.

RESULTS:

Long-term results of facial nerve function were significantly improved in those patients who experienced severe postoperative deterioration of facial nerve function and received vasoactive treatment as compared with patients who did not receive nimodipine and hydroxyethyl starch after surgery. Treated patients showed a significantly higher rate of complete recovery compared with patients without treatment.

CONCLUSION:

The study points to a potential effect of vasoactive treatment for facial nerve function after vestibular schwannoma surgery. In particular, patients with postoperative disfiguring facial nerve palsy clearly benefit from intravenous hydroxyethyl starch and nimodipine with respect to a long-term socially acceptable facial nerve function.

[Long-term experiences in the therapy of esthesioneuroblastoma]

BACKGROUND

Esthesioneuroblastoma is a rare and clinically variable tumor of nasal sinus and skull base and challenging for modern multidisciplinary therapy. There are no generally known prognostic factors or generally accepted standard therapy regimens.

PATIENTS AND METHODS

Between 1975 and 2001 26 patients were treated after the diagnosis of esthesioneuroblastoma was established. The cases were evaluated retrospectively. According to the classification of Kadish 1 patient (4 %) had stage A, 16 patients (53 %) stage B and 11 cases (43 %) had stage C tumors. Hyams grading could be obtained in 22 cases (81 %). Tumors were in 12 patients (52 %) graded I or II and in 10 cases tumors had grade III or IV (48 %). Operative therapy was performed in 23 patients (88.5 %), being in 5 patients a single mode therapy. In 18 cases combined therapy was performed (surgery and radiotherapy or radiotherapy and chemotherapy).

RESULTS

Actuarial survival was 61.5 % (16/26). Disease specific 10- and 15-year-survival according to the estimation of Kaplan-Meier was 76.2 %. Patients with small tumors (Kadish A/B) had a 15-year-survival of 86.7 % compared to 63.6 % in cases with advanced tumors (Kadish C). In 7 cases (26.9 %) recurrences developed. Salvage therapy was performed in 5 cases (71.4 %) with a success rate and a 15-year survival each of 60 %.

CONCLUSIONS

Therapy of esthesioneuroblastoma is challenging because of rarity and biologic variability of the tumor and and because of lack of a standard therapy. An interdisciplinary multimodal therapeutic approach is necessary especially in case of advanced tumors with promising results. Histopathological grading according to Hyams and tumor stage are important factors for survival and prognosis. Although recurrence can occur with high frequency even after prolonged time interval, long time survival can be improved after aggressive salvage therapy. Therefore longterm follow up is mandatory.

[Renal angiomyolipoma complicated by extension to the renal vein and inferior vena cava]

Renal angiomyolipomas are renal hamartomas. They are usually found incidentally, presenting as well-defined echogenic masses on sonography and fat containing tumors on CT and MRI. We report a case of angiomyolipoma with sonographic and CT evidence of extension to the renal vein and inferior vena cava.

Uterine lipoma: MRI features with pathologic correlation

Fatty tumors of the uterus are rare. Most reported cases have been of the mixed type, consisting of smooth muscle and mature adipose tissue. We present the first case of a pure lipoma with pathologic correlation in which a preoperative diagnosis was made by magnetic resonance imaging.

Delayed Facial Nerve Paresis Following Acoustic Neuroma Resection and Postoperative Vasoactive Treatment

OBJECT

Delayed facial nerve paresis is a well known clinical phenomenon following acoustic neuroma surgery, typically occurring early during the postoperative course. The clinical course of the delayed facial nerve paresis and intraoperative electromyographic (EMG) signals were evaluated in a subgroup of patients who underwent vasoactive treatment for preservation of hearing and developed secondary deterioration after termination of treatment.

METHODS

Between 1990 and 2001 seven patients were identified who received vasoactive treatment for preservation of hearing and developed a delayed facial nerve paresis after termination of medication. Intraoperative facial nerve EMG activity was analyzed in six patients.

RESULTS

All patients developed a delayed facial nerve paresis between 2-5 days following termination of a 10 day treatment consisting of HES and nimodipine. Medication was re-initiated and the facial nerve paresis improved in all patients. In two patients intraoperative EMG signals revealed "A-trains" waveform patterns, which are highly suggestive for an immediate postoperative facial nerve paresis, whereas in four patients no pathognomonic EMG patterns could be recorded.

CONCLUSIONS

The delayed onset of a facial paresis following termination of vasoactive treatment points to a disturbed microcirculation of the nerve as the main pathophysiological feature. Two groups could be identified on the basis of intraoperative EMG activity. In one group with presence of "A-trains" medication apparently masked the onset of an immediate postoperative facial nerve deficit. Four patients without "A-trains" did not develop a typical delayed facial nerve paresis during vasoactive treatment, but thereafter. The time lag between termination of treatment and onset of a delayed palsy points to a protective effect due to improved microcirculation.

CT Angiography of Intracranial Aneurysms: A Focus on Postprocessing

Computed tomographic (CT) angiography is a well-known tool for detection of intracranial aneurysms and the planning of therapeutic intervention. Despite a wealth of existing studies and an increase in image quality due to use of multisection CT and increasingly sophisticated postprocessing tools such as direct volume rendering, CT angiography has still not replaced digital subtraction angiography as the standard of reference for detection of intracranial aneurysms. One reason may be that CT angiography is still not a uniformly standardized method, particularly with regard to image postprocessing. Several methods for two- and three-dimensional visualization can be used: multiplanar reformation, maximum intensity projection, shaded surface display, and direct volume rendering. Pitfalls of CT angiography include lack of visibility of small arteries, difficulty differentiating the infundibular dilatation at the origin of an artery from an aneurysm, the kissing vessel artifact, demonstration of venous structures that can simulate aneurysms, inability to identify thrombosis and calcification on three-dimensional images, and beam hardening artifacts produced by aneurysm clips. Finally, an algorithm for the safe and useful application of CT angiography in patients with subarachnoid hemorrhage has been developed, which takes into account the varying quality of equipment and software at different imaging centers.

[Multidetector CT and MRI in pancreatic diseases]

Multidetector CT and MRI are the most efficient non invasive techniques in the assessment of pancreatic diseases. As with MRI, multidetector CT has now become an all in one examination using 2 D and 3 D multiplanar reformations with the ability to perform with high accuracy: a) vascular assessment using MIP reconstruction and b) biliary and pancreatic ducts assessment using minIP reconstruction. This review compares and illustrates the respective advantages of MRI and multidetector CT in the assessment of pancreatic diseases.

Standardized evaluation of CT angiography with remote generation of 3D video sequences for the detection of intracranial aneurysms

Computed tomography (CT) angiography is a well-known imaging technique commonly applied to both the detection and therapy planning of intracranial aneurysms. For this purpose, current studies predominantly focus on three-dimensional (3D) representations of CT angiographic volumes obtained with varying visualization approaches on different computers. Interactive manipulation performed by users individually is an important prerequisite for data analysis. However, this leads to inconsistent and barely reproducible 3D visualization results. Furthermore, the quality of any 3D representation depends on the applied visualization strategy (eg, maximum-intensity projection, shaded-surface display, direct volume rendering). To overcome these limitations, the authors present a novel method for standardized visualization of CT angiographic volumes, consisting of three steps: (a) transfer of the image data to a remote high-end graphics workstation, (b) automatic 3D visualization with high-resolution direct volume rendering, and (c) consecutive video generation performed according to a standardized protocol. The recorded video sequences are transferred for evaluation to a local desktop computer. In the experimental setup, high-quality videos based on 3D visualizations were produced in less than 60 minutes per patient. Although aneurysms above the skull base are usually visualized with excellent quality, the analysis of aneurysms at the skull base is still difficult.

The facial nerve in medial acoustic neuromas

OBJECT

Functional results after surgery for acoustic neuromas that have little or no growth within the internal auditory canal are controversial, because these medial tumors can grow to a considerable size within the cerebellopontine angle (CPA) before symptoms occur.

METHODS

A prospective study was designed to evaluate the surgical implications of the course of the facial nerve within the CPA on medial acoustic neuromas. This study included a consecutive series of 22 patients with medial acoustic neuromas (mean size 32 mm, range 17-52 mm) who underwent surgery via a suboccipitolateral approach between 1997 and 2001. All patients underwent pre- and postoperative magnetic resonance imaging and preoperative electromyography (EMG). Evaluation was based on continuous intraoperative EMG monitoring and video recordings of the procedure. All patients were reevaluated at a mean of 19 months (6-50 months) postsurgery. Preoperative evaluation of facial nerve function revealed House-Brackmann Grade I in six, Grade II in 14, and Grade III in two patients. During surgery a distinct splitting of the nerve at the root exit zone through its intracisternal course was seen in eight patients and documented by selective electrical stimulation. The facial nerve was separated into a smaller portion that ran cranially and parallel to the trigeminal nerve, and a larger portion on the anterior tumor surface. Both components joined anterior to the porus without major spreading of the nerve bundle. In two cases the nerve was found on the posterior surface of the cranial tumor. In one case the facial nerve entered the porus of the canal at its lower part, obtaining the expected anatomical position proximally within the middle portion of the canal. An anterior cranial, middle (five cases each), or caudal course (two cases) was seen in the remaining patients. After surgery, facial nerve function deteriorated in most cases; on follow-up evaluation House-Brackmann Grade I was found in 11, Grades II and III in 10, and Grade V in one patient.

CONCLUSIONS

The facial nerve requires special attention in surgery for medial acoustic neuromas, because an atypical course of the nerve can be expected in the majority of cases. A split course of the nerve was found in 36% of the cases presented. Meticulous use of intraoperative facial nerve stimulation and continuous monitoring ensures facial nerve integrity and offers good functional results in patients with medial acoustic neuromas.

Localisation of the sensorimotor cortex during surgery for brain tumours: feasibility and waveform patterns of somatosensory evoked potentials

OBJECTIVE

Intraoperative localisation of the sensorimotor cortex using the phase reversal of somatosensory evoked potentials (SEPs) is an essential tool for surgery in and around the perirolandic gyri, but unsuccessful and perplexing results have been reported. This study examines the effect of tumour masses on the waveform characteristics and feasibility of SEP compared with functional neuronavigation and electrical motor cortex mapping.

METHODS

In 230 patients with tumours of the sensorimotor region the SEP phase reversal of N20-P20 was recorded from the exposed cortex using a subdural grid or strip electrode. In one subgroup of 80 patients functional neuronavigation was performed with motor and sensory magnetic source imaging and in one subgroup of 40 patients the motor cortex hand area was localised by electrical stimulation mapping.

RESULTS

The intraoperative SEP method was successful in 92% of all patients, it could be shown that the success rate rather depended on the location of the lesion than on preoperative neurological deficits. In 13% of the patients with postcentral tumours no N20-P20 phase reversal was recorded but characteristic polyphasic and high amplitude waves at 25 ms and later made the identification of the postcentral gyrus possible nevertheless. Electrical mapping of the motor cortex took up to 30 minutes until a clear result was obtained. It was successful in 37 patients, but failed in three patients with precentral and central lesions. Functional neuronavigation indicating the tumour margins and the motor and sensory evoked fields was possible in all patients.

CONCLUSION

The SEP phase reversal of N20-P20 is a simple and reliable technique, but the success rate is much lower in large central and postcentral tumours. With the use of polyphasic late waveforms the sensorimotor cortex may be localised. By contrast with motor electrical mapping it is less time consuming. Functional neuronavigation is a desirable tool for both preoperative surgical planning and intraoperative use during surgery on perirolandic tumours, but compensation for brain shift, accuracy, and cost effectiveness are still a matter for discussion.