[Cerebral gliomas: imaging diagnosis and follow-up]

The management of gliomas evolves towards more aggressive strategies with a combination of surgery, radiotherapy and chemotherapy. Follow-up imaging based on morphological MRI, with simple and reproducible protocols, may be associated with functional MRI and spectroscopy. Baseline postsurgical MRI must be performed within the first three days. Follow-up examinations should be done 2 months after radiotherapy and during chemotherapy, usually after each cycle of two or three treatments. Continued follow-up after therapy is recommended to assess response and detect recurrences or therapeutic complications.

Heat shock proteins: endogenous modulators of apoptotic cell death

The highly conserved heat shock proteins (Hsps) accumulate in cells exposed to heat and a variety of other stressful stimuli. Hsps, that function mainly as molecular chaperones, allow cells to adapt to gradual changes in their environment and to survive in otherwise lethal conditions. The events of cell stress and cell death are linked and Hsps induced in response to stress appear to function at key regulatory points in the control of apoptosis. Hsps include anti-apoptotic and pro-apoptotic proteins that interact with a variety of cellular proteins involved in apoptosis. Their expression level can determine the fate of the cell in response to a death stimulus, and apoptosis-inhibitory Hsps, in particular Hsp27 and Hsp70, may participate in carcinogenesis. This review summarizes the apoptosis-regulatory function of Hsps.

Suivi iconographique d’un état de mal épileptique prolongé

We report the MR imaging findings in a 20 year old woman with status epilepticus of more than 3 months duration following an episode of lymphocytic meningitis. Repeated MR examinations showed progressive symmetrical cortical lesions, followed by subcortical and basal ganglia lesions which evolved to cortical laminar necrosis and hemorrhagic necrosis with eventual subcortical cerebral atrophy. This case has similarities with animal status epilepticus models. Biological investigations were all negative. This suggests that the brain lesions may be related to the prolonged status epilepticus.

Ist in der heutigen Gesellschaft eine Diskriminierung des Alters erkennbar?

It is the starting-point of this contribution that--on the precondition that requirements for development and usage of older people's potentials for creativity are adequately met--population ageing does not necessarily imply a loss in society's capability for innovation. Following a brief sketch of central perspectives in public discourse on demographic change cognitive representations of ageing are described as an important factor in the realisation of potentials in old age. This realisation might not only threatened by an exaggeration of negative aspects of ageing but also by an exaggeration of positive aspects. By contrast, only a society which takes note of the magnitude of different abilities, needs, and lifestyles in older people is able to meet the challenges of demographic change and to increase productivity in old age. Results from an empirical study suggest that cognitive representations of ageing are less salient, more differentiated and more optimistic than might be expected from the popular notion of ageist western societies. Similarly, policy makers show an increasing consciousness for the potentials of old age. The latter point is illustrated by the leading perspectives of the German government's fifth report on old age and older people.

[Risks and responsibilities in diagnostic and interventional radiology. Ethical and medicolegal considerations]

Medical risk management has one main purpose: to ensure the safety of care. The law of March 2002 has generated a true cultural revolution. The radiologist is involved with new and difficult areas of medical liability due to technical advances, the increasing number of imaging techniques, the increasing complexity of imaging techniques, their efficiency and the need for multidisciplinary approach. Imaging recommendations requiring increasing levels of technical and clinical skills. The radiologist is liable with regards to the indications of imaging studies, and also with regards to informed consent. The prevention of medicolegal problems is achieved by competency, which must be combined to good liability insurance and ongoing vigilance supported by appropriate continuous medical education.

Genotoxicity of phytoestrogens

Plant extracts containing phytohormones are very popular as 'alternative' medicine for many kinds of diseases. They are especially favored by women who enter menopause and are concerned about the side effects of hormone replacement therapy. However, adverse health effects of phytoestrogens have often been ignored. This review examines the literature on genotoxicity and apoptotic effects of phytohormones. Genistein, coumestrol, quercetin, zearalenone, and resveratrol exerted genotoxic effects in in vitro test systems. Other phytoestrogens such as lignans, the isoflavones daidzein and glycetein, anthocyanidins, and the flavonol fisetin exhibited only weak or no effects in vitro. However, some metabolites of daidzein showed a genotoxic activity in vitro. Practically all of the phytoestrogens exhibit pro-apoptotic effects in some cell systems. Further investigations regarding dose-response-relationships and other aspects relevant for extrapolation to human exposure seem necessary. Until then, care may be advised in taking concentrated phytohormones. Nevertheless, the intake of substantial amounts of plant-food in a normal diet constitutes an important, individual contribution to cancer prevention.

Neuroradiologie de la maladie de rendu osler

Hereditary Hemorrhagic telangiectasia is an autosomal dominant vascular disorder with high penetrance and variable expressivity. Most cases are caused by mutations in the endoglin gene on chromosome 9 (HHT type 1) or the activin receptor-like kinase 1 gene on chromosome 12 (HHT type 2). HHT is characterized by mucocutaneous telangiectases and visceral arteriovenous malformations (AVMs). Neurological complications occur in 8 to 10% of the patients. Brain ischemia or abscess are often associated with pulmonary arteriovenous fistula. Cerebral or spinal arteriovenous malformations are frequent but have a lower risk of haemorrhage than sporadic AVMs and routine screening should not be practiced in adult patients. Routine screening should be discussed for children with a familial history of cerebral haemorrhage and/or HHT type 1.

Adjuvant treatment with interleukin-2- and interferon-alpha2a-based chemoimmunotherapy in renal cell carcinoma post tumour nephrectomy: results of a prospectively randomised trial of the German Cooperative Renal Carcinoma Chemoimmunotherapy Group (DGCIN)

We conducted a prospectively randomised clinical trial to investigate the role of adjuvant outpatient immunochemotherapy administered postoperatively in high-risk patients with renal cell carcinoma. In total, 203 renal carcinoma patients' status post radical tumour nephrectomy were stratified into three risk groups: patients with tumour extending into renal vein/vena cava or invading beyond Gerota's fascia (pT3b/c pN0 or pT4pN0), patients with locoregional lymph node infiltration (pN+), and patients after complete resection of tumour relapse or solitary metastasis (R0). Patients were randomised to undergo either (A) 8 weeks of outpatient subcutaneous interleukin-2 (sc-rIL-2), subcutaneous interferon-alpha2a (sc-rIFN-α2a), and intravenous 5-fluorouracil (iv-5-FU) according to the standard Atzpodien regimen (Atzpodien et al, 2004) or (B) observation. Two-, 5-, and 8-year survival rates were 81, 58, and 58% in the treatment arm, and 91, 76, and 66% in the observation arm (log rank P=0.0278), with a median follow-up of 4.3 years. Two, 5-, and 8-year relapse-free survival rates were calculated at 54, 42, and 39% in the treatment arm, and at 62, 49, and 49% in the observation arm (log rank P=0.2398). Stage-adapted subanalyses revealed no survival advantages of treatment over observation, as well. Our results established that there was no relapse-free survival benefit and the overall survival was inferior with an adjuvant 8-week-outpatient sc-rIL-2/sc-rIFN-α2a/iv-5-FU-based immunochemotherapy compared to observation in high-risk renal cell carcinoma patients following radical tumour nephrectomy.

Gender-Specific Differences in School Sports Injuries

OBJECTIVE

About 5 % of the pupils suffer from an injury in school sports every year. In addition to the kind of injury, the localization and the type of sport, the corresponding reasons for the injuries should be investigated to provide insights for physical education.

METHODS

In a prospective study 213 accident cases with 234 injuries during physical education classes were examined. At primary presentation in our clinic, an empirical questionnaire was used to document the grade of class, the exact time point of the injury, the question of guilt, out-of-school sports activity as well as the mechanisms of injuries and the type of sport. Clinicians who worked in our out-patient clinic completed the questionnaire after physical examination documenting diagnosis, therapy and the duration of restriction of sports practice. All patients were followed until returning to physical education at school. The data were statistically analyzed using the chi (2)-test to examine gender-specific differences.

RESULTS

Gender-specific differences were seen in the type (p = 0.018) and mechanisms (p = 0.028) of injuries. The most common injuries were sprains (female pupils 36.8 % male pupils 24.5 %], contusions (female pupils 27.4 % male pupils 27.9 %) and fractures (female pupils 14.7 % male pupils 18.6 %). Frequent mechanisms of injuries were errors in basic motion training like running, jumping and catching (female pupils 35.8 % male pupils 28.8 %). No gender-specific differences could be shown for the localization of injuries or for the type of sport. The upper extremity with 55 % was more frequently involved than the lower extremity with 37 %. Playing soccer (21.2 %) and basketball (19.8 %) were the most frequent reasons for sports injuries. The highest prevalence of school sports injuries occurred at the onset of and during puberty.

CONCLUSION

For the girls it is necessary to improve the basic motor skills, while the boys need to learn considerate behavior and how to read the game. Basic skill levels in ball games must be improved before practice in competition form is initiated.

Mélanome primitif intrarachidien

Intra spinal primary melanoma is a rare entity. We report a new case, atypical in relation to its primary radicular location, and to its early metastatic intradural and extra-medullary location, six months later. MRI is the more valuable examination, showing a spontaneously hyper-intense lesion on T1-weighted MR images, intense enhancement after gadolinium administration, and decreased signal on T2-weighted MR images, thus suggesting a diagnosis of melanocytic or hemorrhagic lesion. Signal abnormalities are not specific and definitive diagnosis is established after histological analysis.

Activation of multidomain and BH3-only pro-apoptotic Bcl-2 family members in p53-defective cells

In the p53-deficient human B lymphoma Namalwa cell line that quickly undergoes apoptosis after DNA topoisomerase I inhibitor (camptothecin, CPT) treatment, we observed rapid and slight induction of the pro-apoptotic BH3-only Bik, Bim-EL, Bim-L and Bim-S proteins. In contrast, the expression levels of Bad and multidomain Bax-alpha and Bak remained mostly unchanged after CPT treatment. However, multiple pro-apoptotic proteins, including Bax-alpha, Bak, Bik, Bim-EL and Bim-L, translocated rapidly to the mitochondria after CPT treatment. Gel filtration chromatography experiments demonstrated that somes of the pro-apoptotic proteins assemble themselves into high molecular weight protein complexes. The protein composition of these oligomers was further analyzed by co-immunoprecipitation experiments performed on highly purified mitochondrial fractions, which revealed the formation of Bax/Bak, Bax/VDAC1, Bak/VDAC1, Bim/VDAC1 and Bim/Bcl-2 complexes after DNA damage induction. Thus, it appeared that induction, mitochondrial translocation and assembly in multimeric protein complexes of several pro-apoptotic members of the Bcl-2 family correlated with the rapid activation of apoptosis in a p53-independent pathway after CPT-mediated DNA strand breaks.

Contrast-enhanced transcranial Doppler sonography in the follow-up of intracranial aneurysms after endovascular treatment

Two pilot studies on a small number of patients demonstrated the feasibility of transcranial Doppler ultrasound evaluation in the follow-up of intracranial aneurysms treated with detachable coils. This prospective study aimed to assess the sensitivity of contrast-enhanced transcranial echo-Doppler in detecting partial aneurysmal occlusion following endovascular treatment. Transcranial Doppler sonography (TCD) with contrast administration and magnetic resonance angiography (MRA) or angiography were carried out after endovascular treatment in 92 patients for 98 aneurysms of the anterior circulation. In 18% of cases, the quality of ultrasound exploration was deemed unsatisfactory for evaluation of the aneurysmal site. Results were concordant in 63% of patients (49/78). When occlusion appeared satisfactory at angiography or MRA, the result was concordant with TCD in 68% of cases (44/77). When a residual aneurysm was detected, TCD sensitivity was 38% (8/18). An analysis of subgroups failed to disclose anatomic or morphological aneurysm features in which transcranial echo-Doppler is sufficiently sensitive and specific to detect possible residual aneurysm or recanalisation. In our experience, even after contrast administration TCD is not sufficiently sensitive or specific in the detection of residual aneurysm to replace angiography or MRA.

MRSA-Infektionen des Bewegungsapparats

INTRODUCTION

We present gentamicin-vancomycin-impregnated beads that can be produced intraoperatively in moulds and demonstrated their successful use in ten cases of problematic Methicillin-resistant Staphylococcus aureus (MRSA) infection.

METHODS

To produce the antibiotically loaded PMMA beads, a two-part mould of polyoxymethylene was used. The mixture of PMMA and antibiotic is poured into the mould halves, and during polymerisation the halves bond together. The in vivo antibiotic concentrations of wound secretion from the redon drainage were measured by fluorescence-polarisation immunoassay, and a concentration/time function was determined. The PMMA beads (2 g of vancomycin plus 0.5 g of gentamicin plus 40 g of PMMA) were implanted in ten patients aged 41-76 years.

RESULTS

In all ten patients, the infection was cured (follow-up 15 months).

CONCLUSION

The combination of gentamicin and vancomycin in the PMMA of standardised beads represents a good alternative in the treatment of MRSA infections. Understanding of the mechanism of antibiotic release from PMMA allows differentiated dosing during systemic application.

[Closed subfascial v.a.C.-therapy in periprosthetic hip infections]

Infections after hip arthroplasty can lead to protracted and complicated treatments. A great problem is thereby the persistant secretion after surgical revision. 8 patients (3 x after acetabulum cup replacement, 2 x after Girdlestone hip, 2 x after spacer implantation and one case of rearthroplasty) have been treated with a V.A.C.-therapy after bacterial infection and persistant wound secretion. In all cases a pathogen organism could be identified during the frustrated attempts of sanitation. After meticulous debridement and jet lavage in each case, 1-3 polyvinyl sponges have been placed either periprosthetic or in the resection cavity with a transcutan tube outgoing. The wounds have been closed in layers. Initially a pressure of 200 mm Hg via V.A.C. has been attached. After 48-72 h an alteration from haemorrhagic to serous secret could be observed and afterwards the pressure has been reduced to 150 mm Hg. After a mean period of 11 days (8-13) the infection parameters have been retrogressive, the wound secretion was obviously reduced and the sponges were removed. During the remaining hospitalization of each patient no complications occured. In the mean follow-up of 21 months (2-46) no reinfections have been observed. Although the V.A.C.-therapy does not count to the primary therapy concepts of periprosthetic hip infections, it stands for an effective therapy option in exclusive cases.

Ruptur der Sehne des Musculus tibialis anterior bei einem Seniorenfechter der Weltklasse

The rupture of the tendon of the M. tibialis ant. is a rare sport injury and has not been yet described in fencing. The lunge, the most common offensive movement in fencing, displays a high stress on the spanned tendons and ligaments over the ankle joint and led to the rupture of the pre-damaged tendon of our patient. Pain over the inner side of the foot should be assessed as knells of this tendon injury. The exact patient's history and the precise clinical investigation are adequate for diagnosing the rupture. Hereby, an absence of the tendon shape over the ankle joint and a distinct active deficit of the extension are presented in comparison to the other side where a gap in the tendon course is palpable. An x-ray is obligate, a sonography and a MRI are helpful for the operative planning. The surgical treatment is necessary for athletes. If possible, a primary tendon suture should be aimed, in case of a distal torn an osseous reinsertion should occur. An early functional, postoperative treatment with an orthesis should be rather preferred for athletes than an immobilization.

Anti-fetal immune response mechanisms may be involved in the pathogenesis of placental abruption

Placental abruption is an unpredictable severe complication in pregnancy. In order to investigate the possibility that the activation of the fetal nonadaptive immune system may be involved in the pathogenesis of this disease, IL-6 release from cord blood monocytes was examined by intracellular cytokine staining and flow cytometric analysis. Our results demonstrate that preterm placental abruption (n = 15) in contrast to uncontrollable preterm labor (n = 33) is associated with significantly (P < 0.001) increased release of IL-6 from the fetal monocytes. The same holds true for rhesus disease (n = 9, P < 0.001) that is characterized by a maternal production of antibodies against the rhesus-D antigen expressed by the fetal erythrocytes. This suggests that during rhesus disease, IL-6 release of monocytes is induced by antibody-mediated cross-linking of these cells to the erythrocytes in the fetal circulation. Hence, this assumption favors the idea that also in case of placental abruption, an increased maternal antibody production against paternal antigens leads to an elevated IL-6 release by the fetal monocytes. To elucidate this potential mechanism, the presence of anti-HLA-antibodies was assessed in the maternal circulation of patients with placental abruption (n = 17) and patients with uncontrollable preterm labor (n = 29). The percentage of women producing anti-paternal HLA-antibodies was significantly (P < 0.01) increased in the group of women with preterm placental abruption (47%) in comparison to women with uncontrollable preterm labor (14%). Therefore, our results suggest that an increased humoral immune response of the mother against the fetus may be decisively involved in the pathogenesis of placental abruption.

[Cellular and molecular purification processes based on the use of magnetic micro-and nanobeads]

Magnetic separation is a recent technology using magnetism properties. This technology is aimed to purify cells, cell organelles and biologically active compounds such as nucleic acids and proteins. Many magnetic separation procedures have been developed to isolate cells and molecules. The purpose of this review is to give an other view of various methods and strategies which can be employed for selection of targets cells and molecules. We describe techniques used to positive and negative cells selections, we show that magnetic selection is also aimed to perform multiparameter selection or functional selection. Then, we underline emerging technology used to select transfected cells and macromolecules such as proteins, DNA and RNA.