The effect of anti-epileptic drugs on visual perception in patients with epilepsy

We investigated the influence of the antiepileptic drugs carbamazepine (CBZ), phenytoin (PHT) and valproic acid (VPA) on different aspects of visual perception in patients with epilepsy by three different methods. (i) The colour arrangement test Farnsworth Munsell D100. (ii) A monitor system generating 24 different Gaussian dots and 24 different vertical sinusoidal gratings. Luminance increments and decrements for achromatic discrimination and four different colours for chromatic discrimination were investigated with four different sizes each adding up to 24 stimuli. (iii) A Maxwellian view system providing a foveal blue test light either superimposed on a yellow adaptation field (increment threshold) or after switching off this field (postadaptation threshold). Five different adaptation levels were investigated. Patients on PHT offered the most abnormalities, particularly in the D100 and in all Gaussian dots recordings. The individual differences between increment and postadaptation threshold (transient tritanopia effect) were significantly elevated at the four higher adaptation levels, whereas no change was found in the increment thresholds and only for the highest luminance level in the postadaptation thresholds. With VPA, chromatic and achromatic increment discrimination was impaired particularly for larger Gaussian stimuli on the monitor system. Valproic acid also induced a consistent increment threshold increase on the Maxwellian view system, an increase of the postadaptation threshold at the highest luminance level and, like PHT, an increase of the threshold differences at level 3 and 4, but not at the highest background level 5. Patients on CBZ provided normal results in all investigations, with the exception of a slight but significant increase in the D100 error score. Sinusoidal gratings turned out to be much less sensitive than Gaussian dots since they remained unchanged in patients on all three drug groups.

[Neurophysiologic signal recording. New technical and general practice aspects of EEG recording electrodes]

The problem of electrode selection for neurophysiological monitoring, whether for routine clinical applications or special scientific research, still remains to be resolved. In addition to the classical types of electrode-cup (silver/silver chloride or gold) or needle electrodes, new self adhesive electrodes (e.g. zipprep electrodes) for rapid application and reliable recording have recently come onto the market. However, this electrode type can lead to superficial lesions of the skin or inflammatory infiltration, which so far have not been investigated. New developments in the field of cortex electrodes and so-called active electrodes are additionally discussed.

Brainstem auditory evoked potentials in respiratory insufficiency following encephalitis

Brainstem auditory evoked potentials (BAEPs) were recorded in 14 artificially ventilated patients (12 males, 2 females; mean age 33.3 +/- 16.3 years, range 18-67) with respiratory insufficiency resulting from severe inflammatory encephalopathies. The results were compared with those of 17 healthy volunteers (13 males, 4 females; mean age 27.4 +/- 5.3 years, range 21-45). BAEPs in the study patients showed prolonged interpeak latencies (I-III, I-V, III-V, IV-V) and delayed absolute latencies of waves I, II, III, and V at least on one side. Because the auditory pathways are in the near vicinity of the respiratory control centers in the brainstem, the electrophysiologic abnormalities of wave III and the IV/V complex may be a reflection of the disturbed central control of ventilation.

Electrical interactions of membrane active peptides at lipid/water interfaces

Vital functions of biological membranes are frequently controlled by amphipathic peptides that are associated with the lipid bilayer. The extent of association is largely determined by influences encountered at the interface between the aqueous and lipid moieties, especially involving electrostatic interactions. A basic thermodynamic analysis is presented in terms of a partitioning equilibrium where the membrane is treated as a non-ideal solution of peptide molecules in a two-dimensional lipid solvent. This may then be employed to interpret experimental association isotherms (i.e. the ratio of associated peptide per lipid plotted versus the free aqueous peptide concentration) in the light of a molecular mechanism. Special emphasis is directed towards the evaluation of original titration data under most general circumstances when the association can be monitored using a suitable linear signal (preferentially an optical one). The experimental approaches as well as the merits regarding possible information about the underlying structural and functional features are discussed with pertinent practical examples.

Pore kinetics reflected in the dequenching of a lipid vesicle entrapped fluorescent dye

Pore formation in lipid vesicle membranes can be monitored by the fluorescence signal F(t) arising from the induced release of a self-quenching dye in the course of the elapsed efflux time t. We present a basic theoretical analysis of pertinent experimental data allowing the quantitative evaluation of information on the pore kinetics and mechanism. This implies an investigation of the 'dynamic' quenching factor Qt exhibited by that fraction of dye which is still being retained inside the liposomes at t. It is shown how Qt depends on the mode of release which could be 'all-or-none' or more gradual as expressed by a parameter rho < or = 1 (related to the pore lifetime), i.e., the average dye retention factor in a vesicle after a single pore opening. A fit to measured values of Qt at a sufficient extent of efflux may be applied in order to determine rho. Then the pore formation rate per liposome, va(t), can be derived from the registered F(t). We give a practical demonstration of the procedures with carboxyfluorescein-loaded phosphatidylcholine liposomes of two different sizes to which the wasp venom peptide mastoparan X had been added.

[Cerebral monitoring in anesthesia and intensive care]

To ensure efficient computer-based cerebral monitoring in the ICU and during anaesthesia, sophisticated and sometimes expensive equipment is needed. It is thus all the more important that the clinician should have a good understanding and knowledge of the various methods involved, the origins of the different signals and their relationships, and of the possibilities of artefacts occurring, if the information that this equipment is capable of providing is to be fully and properly utilized. The present paper describes a number of new techniques of cerebral monitoring, and their successful application in the intensive care unit and the operating theatre.

Brain-stem auditory evoked potential monitoring. Variations of stimulus artifact in brain death

Brain-stem auditory evoked potentials (BAEPs) were recorded in 20 subjects with brain death (mean age, 33.2 +/- 15.1 years) and 20 healthy volunteers (mean age, 29.8 +/- 6.8 years). Brain death was due to head injury (n = 14), encephalitis (n = 3), brain-stem hemorrhage (n = 1), cerebellar hemorrhage (n = 1) or cerebral infarction (n = 1). The presence, latency and amplitude of the individual BAEP components and variations of the stimulus artifact were evaluated. The mean (+/- S.D.) amplitude of the stimulus artifact was 0.26 +/- 0.12 microV in the brain-dead subjects and 0.09 +/- 0.05 microV in the control group (P < 0.001, t test). The causes of the phenomenon of increasing stimulus artifacts in the evolution of brain death remain unclear.

[Osteochondromatosis in shoulder joint arthrosis--a case report]

We report on a 59 year old patient with repetitive shoulder trauma due to numerous grand mal convulsions and consequent severe osteoarthritis of the shoulder joint with formation of multiple loose bodies. We discuss the aetiology of the loose bodies as being different to those found in synovial chondromatosis, as well as the radiological, histological, clinical and therapeutical features of this entity.

Laser Doppler flowmetry--peripheral microcirculation during cessation of cerebral and cardiocirculatory function

Laser Doppler flowmetry (LDF) is a noninvasive method to study the microcirculation. We studied the feasibility of the clinical use of LDF in the intensive care unit by continuously recording different LDF parameters during the cessation of cerebral and cardiocirculatory function. The LDF-Conc (concentration of red blood cells) reflected biological phenomena correlated with the heart rate and microvibration that could not be detected with conventional means (systemic blood pressure, peripheral oxygen saturation).

[Near infrared spectroscopy. Limits and problems in the intensive care unit]

Near infrared spectroscopy is a non-invasive method of calculating changes in cerebral oxygenation. We have now evaluated a new near infrared spectroscope, the NIRO-500 (Hamamatsu Photonics, Japan), in an intensive care unit setting. The influence of extracerebral and intracerebral physical-technical, physiological and pathophysiological parameters was investigated. The results showed that the method is very sensitive to changes in oxygenation and perfusion in the cerebral vasculature. However, the influence of other factors can be considerable and not always easy to detect and interpret.

[Noninvasive monitoring of regional cerebral oxygen saturation--experiences in critical care medicine]

Regional cerebral oxygen saturation (rSO2) was studied in 15 healthy volunteers aged between 23 and 53 years (mean age: 34.2 +/- 8.7 years) and in 17 intensive care patients (mean age: 37.2 +/- 18.6 years; range 17-70). An infrared spectroscopy technique (INVOS 3100, Somanetics Co.) was used. The results were analysed in terms of age, heart rate, temperature at the recording site, blood pressure and peripheral oxygen saturation. The mean +/- SD of rSO2 was 69.4% +/- 7.0% in the healthy volunteers and 66.4% +/- 7.4% in intensive care patients (65.3% +/- 6.2% in 7 patients with a cerebral lesion, 67.1% +/- 8.4% in 10 patients with no cerebral lesion). Individual examples are presented to show that infrared spectroscopy is a useful non-invasive method of investigating cerebral oxygenation. However, regional pathological-anatomical limitations of the technique, and possible extracerebral artefacts make necessary a critical interpretation of the rSO2 values.

Cytoskeletal modulation of the response to mechanical stimulation in human vascular endothelial cells

Possible interactions of cytoskeletal elements with mechanically induced membrane currents and Ca2+ signals were studied in human endothelial cells by using a combined patch-clamp and Fura II technique. For mechanical stimulation, cells were exposed to hypotonic solution (HTS). The concomitant cell swelling activates a Cl- current, releases Ca2+ from intracellular stores and activates Ca2+ influx. To interfere with the cytoskeleton, cells were loaded either with the F-actin-stabilizing agent phalloidin (10 mumol/l), or the F-actin-depolymerizing substance cytochalasin B (50 mumol/l). These were administered either in the bath or the pipette solutions. The tubulin structure of the endothelial cells was modulated by taxol (50 mumol/l), which supports polymerization of tubulin, or by the depolymerizing agent colcemid (10 mumol/l) both applied to the bath. Immunofluorescence experiments show that under the chosen experimental conditions the cytoskeletal modifiers employed disintegrate the F-actin and microtubuli cytoskeleton. Neither of these cytoskeletal modifiers influenced the HTS-induced Cl- current. Ca2+ release was not affected by cytochalasin B, taxol or colcemid, but was suppressed if the cells were loaded with phalloidin. Depletion of intracellular Ca2+ stores by thapsigargin renders the intracellular [Ca2+] sensitive to the extracellular [Ca2+], which is indicative of a Ca2+ entry pathway activated by store depletion. Neither cytochalasin B nor phalloidin affected this Ca2+ entry. We conclude that F-actin turnover or depolymerization is necessary for Ca2+ release by mechanical activation. The tubulin network is not involved. The Ca2+ release- activated Ca2+ entry is not modulated by the F-actin cytoskeleton.

Computer-assisted neurovegetative monitoring in patients after heart transplantation

The effects of orthotopic heart transplantation on spontaneous fluctuations of the respiration rate and heart rate were studied with a computer-assisted system for neurovegetative monitoring in 22 patients (mean age +/- SD: 48.7 +/- 9.4 years) 19.5 +/- 14.4 months after transplantation. The control group consisted of 12 healthy volunteers (mean age +/- SD: 38.7 +/- 6.6 years). The mean (+/- SE) respiratory rate was higher in the transplantation group than in the control group (17.7 +/- 0.8/min vs. 14.6 +/- 1.1 breaths/min, P < 0.2). The mean variability of the respiratory rate was smaller in the transplant patients than in the controls (3.7 +/- 0.3 vs. 2.8 +/- 0.4, P < 0.2). The heart rate variability coefficient in the patients after transplantation was lower than that in the controls (1.3 +/- 0.1% vs. 6.9 +/- 0.5%, P < 0.001). Spectral analysis of heart rate variability showed a smaller decrease of variability of respiration (P < 0.05) than of blood pressure regulation (P < 0.001) or of the angiotensin-renin system (P < 0.001). A separate group of 7 transplant patients (mean age 51.0 +/- 7.7 years) had activated cardiac pacemakers and thus no spontaneous physiologic heart rate oscillations. The variability of the respiratory rate in these patients was lower than in the other 22 transplant patients (1.8 +/- 0.2 vs. 3.7 +/- 0.3, P < 0.001). The data provided by multiparametric neurovegetative monitoring support the evaluation of complex regulatory mechanisms of respiratory and cardiovascular function and their adaptability after orthotopic heart transplantation.

Sitting position for neurosurgery: experience with preoperative contrast echocardiography in 301 patients

A persisting foramen ovale (PFO) is the most common cause of paradoxical air embolism. To detect right-to-left shunting, transthoracic contrast echocardiography was performed preoperatively in 301 patients scheduled for neurosurgical procedures in the sitting position. Echocardiography yielded evaluable results in 285 patients (94.7%). In 72 of 285 patients (25.2%), a PFO was diagnosed on the basis of contrast echo signals appearing in the left atrium or ventricle within 5 heart cycles after application of contrast medium via a peripheral vein. If echo signals appeared in the left heart after more than 5 heart cycles, an intrapulmonary right-to-left shunt was considered (11 patients, 3.9%). Venous air embolism (VAE) occurred in 27.4% of 226 patients operated on in the sitting position and in none of the 59 patients operated on in a nonsitting position. We conclude that the sitting position during neurosurgery should be avoided in patients with preoperative evidence of a right-to-left shunt at contrast echocardiography to reduce the risk of paradoxical air embolism (PAE).

Multiple effects of SK&F 96365 on ionic currents and intracellular calcium in human endothelial cells

1. Multiple effects of the imidazole compound SK&F 96365 have been evaluated on endothelial cells from human umbilical vein using a combined patch clamp and Ca(2+)-microfluorimetric technique (Fura-2). 2. At concentrations of 100 mumol/l or higher of SK&F 96365, the block of the receptor-mediated Ca2+ entry overlaps with the activation of another Ca(2+)-entry mechanism, which is associated with a non selective cationic current. 3. This rise in [Ca2+]i depends on the extracellular Ca(2+)-concentration, and the entry pathway is in contrast with the receptor-mediated Ca(2+)-entry pathway permeable to Ni2+, as shown by quenching of the Fura-2 fluorescence signal. 4. The concentration of SK&F 96365 for half maximal increase in [Ca2+]i was 141 +/- 19 mumol/l (n = 16). 5. SK&F 96365 activated a current that reversed at +11.8 +/- 2.1 mV (n = 21) when measured using nystatin-perforated patches with either Cs+ or K+ in the pipette and 140 Na+, 1.5 Ca2+ in the bath (chloride equilibrium potential ECl = -36 mV). 6. SK&F 96365 (200 mumol/l) blocked an inwardly rectifying K+ current in endothelial cells independently of [Ca2+]i. This block caused depolarization of the endothelial cells from -55.3 +/- 2.57 mV (n = 33) to -10 +/- 5.5 mV (n = 6). This block was concentration-dependent, half maximal block occurred at a concentration of about 40 mumol/l SK&F 96365. 7. In cells which showed an outwardly rectifying current, this outward component was also completely blocked by 200 mumol/l SK&F 96365. 8. It is concluded that SK&F 96365 reversibly activates a non-selective cation channel at concentrations higher than 100 mumol/l, but also blocks K+ currents in endothelial cells independently of [Ca2+]i. These multiple effects overlap with the proposed block of receptor-mediated Ca2+ entry. The block of K(+)-channels may in unclamped cells reduce the driving force for Ca2+, and thereby interfere with the Ca(2+)-influx.

WIRELESS TRANSMISSION OF MUSCLE POTENTIALS DURING FREE FLIGHT OF A LOCUST

Scientists have long been interested in recording data from freely moving animals. For larger animals, several telemetric techniques are available not only for following the movement of unrestrained animals in the wild (White and Garrott, 1990) but also for transmitting measures of heartbeat, body temperature, wingbeat, respiration, etc. (e.g. Lord et al. 1962; Butler and Woakes, 1980; Funk et al. 1993; for an overview, see Amlaner and Macdonald, 1980). Because of the size of such transmission devices, however, data acquisition has been restricted to larger animals. The development of lightweight batteries and microchips has only recently facilitated efforts to transmit data from smaller animals such as insects. Such data should greatly enhance our understanding of the processes involved in the neuronal control of unrestricted behaviour. Eventually it should be possible to monitor the activity of individual units (neurones, muscles) under closed-loop conditions, which closely resemble free movement. It is to be expected that this new approach will surpass previous studies involving intact but surface-bound animals implanted with long flexible electrodes (for crickets, see Kutsch, 1969) or animals tethered in a windstream (for improvement of the flight balance device, compare Weis-Fogh, 1956, with Dombrowsky, 1991). Increased freedom has been achieved in experiments on ‘free flight’ of large insects (Mohl, 1988; Stolley, 1990), although even these animals were restricted to a short or stationary flight handicapped by several implanted flexible electrodes.

Modulation by histamine of an inwardly rectifying potassium channel in human endothelial cells

1. Whole-cell and single-channel currents were recorded together with intracellular Ca2+ in voltage clamped, single endothelial cells isolated from human umbilical vein. 2. The major current component under resting conditions in the whole-cell configuration was a strongly inwardly rectifying potassium current. 3. This current is due to activation of a K+ channel with an inward conductance of 29 +/- 3 pS (n = 7) with symmetrical 140 mM K+ on both sides of the membrane. This channel could be measured both in the cell-attached and in the inside-out configuration. At potentials below -110 mV both whole-cell and averaged single-channel currents showed a fast inactivation. 4. During stimulation of endothelial cells with histamine, whole-cell K+ currents initially increased but then substantially declined, despite the sustained increase in intracellular Ca2+ concentration ([Ca2+]i). 5. The blockade of the inwardly rectifying K+ channel by histamine could not be observed in cell-attached patches if histamine was added to the bath. 6. It is concluded that endothelial cells possess K+ channels that are directly inhibited by agonists, such as histamine. Blocking these channels may depolarize the cell membrane and thereby reduce the driving force for Ca2+ influx.

Control of intracellular calcium by membrane potential in human melanoma cells

The modulation of intracellular calcium ([Ca2+]i) by the membrane potential was investigated in human melanoma cells by combining the nystatin-perforated patch-clamp technique with Ca2+ measurements. Voltage steps to -100 mV induced a rise in [Ca2+]i and a creeping inward current. These effects were absent in Ca(2+)-free solution and could be blocked by Ni2+ or La3+. Voltage ramps revealed a close correlation between [Ca2+]i and voltage, with the strongest voltage dependence around the resting potential. Long-lasting tail currents, closely correlated with the rise in [Ca2+]i and a reversal potential close to the K+ equilibrium potential, occurred if the membrane potential was clamped back to 0 mV. They were absent if intracellular K+ was replaced by Cs+ and blocked by extracellular tetraethylammonium (5 mM), Ba2+ (1 mM), or a membrane-permeable adenosine 3',5'-cyclic monophosphate analogue. These observations are discussed in relation to cell proliferation. The enhanced expression of K+ channels during cell proliferation provides a positive-feedback mechanism resulting in long-term changes in [Ca2+]i required for the G1-S transition in the cell cycle.

[Computer controlled brain death documentation in the intensive care unit]

An interactive, knowledge-based computer system for brain death documentation is presented. The specific exponents BRAINDEX R and G were realised by the software tool Personal Consultant Plus and the programming language Clipper, respectively. The strategies of conclusion were forward chaining for approximate evaluation of coma stages and backward chaining for analysing the brain death syndrome. BRAINDEX was developed for use with an IBM personal computer or compatible equipment. Systemic analyses were compared retrospectively with the data from clinical brain death protocols (n = 132) of 128 comatose patients (mean age 35.1 +/- 15.8 years) with a Glasgow Coma Score of 3. Identical classifications (system vs physician) were found in all patients without diagnosis of brain death (n = 35). Differences related to the findings of the physician were evaluated in lower numbers of the systemic positive diagnosis of brain death (82 vs 89) and higher numbers of impossibility of systemic evaluation (11 vs 2). These results were obtained by conclusions of the computer system drawn by restrictive systemic mechanisms to avoid false-negative diagnoses. The system therefore seems to be useful for documentation, consultation, and as a teaching instrument and data bank in brain death.

Impairment of retinal increment thresholds in Huntington's disease

We have investigated detection thresholds for a foveal blue test light using a Maxwellian view system in 61 normal subjects, 19 patients with Huntington's chorea, 14 patients with Tourette's syndrome, and 20 patients with schizophrenia. Ten measurements were made: The blue test light (1 degree diameter, 500 msec duration) was presented either superimposed on a yellow adaptation field (5 degree diameter) or 500 msec after switching off this field (transient tritanopia effect). In both cases five different background intensities were presented. The only abnormality found was in patients with Huntington's chorea. During adaptation these patients' thresholds are significantly higher than normal (p < 0.005). No change was found in the transient tritanopia effect. Huntington's disease causes degeneration of several different transmitter systems in the brain. Increment threshold testing allows for noninvasive investigation of patients and confirms the involvement of the retina in the degenerative process in Huntington's chorea.

Microbial metabolism of quinoline and related compounds. XIX. Degradation of 4-methylquinoline and quinoline by Pseudomonas putida K1

A bacterial strain, designated K1, which utilizes 4-methylquinoline and quinoline as sole source of carbon, nitrogen and energy was isolated from soil. Based on its morphological and physiological characteristics, it was classified as Pseudomonas putida biovar B. Four metabolites of 4-methylquinoline degradation were isolated from the culture supernatant and identified as 4-methyl-2-oxo-1,2-dihydroquinoline, 8-hydroxy-4-methyl-2-oxo-1,2-dihydroquinoline, 7,8-dihydroxy-4-methyl-2-oxo-1,2-dihydroquinoline and 6-hydroxy-5-(2-carboxyethenyl)-4-methyl-1H-2-pyridone. Formation of the latter compound is suggested to proceed by decarbonylation of a putative meta-cleavage product of the 7,8-dihydroxy derivative. During growth on quinoline four compounds were released into the culture fluid, too. Upon isolation they were identified as 2-oxo-1,2-dihydroquinoline, 6-hydroxy-2-oxo-1,2-dihydroquinoline, 5-hydroxy-6-(3-carboxy-3-oxopropenyl)-1H-2-pyridone and 2H-pyran-2-on-[3,2b]-5H-6-pyridone. Thus it is proved, that Pseudomonas putida possesses two different catabolic pathways for various quinoline derivatives, which are induced selectively depending on the growth substrate.