Anti-Müllerian hormone concentrations in female rabbits and its relation to spay status, pseudopregnancy and ovarian follicle numbers

Anti-Müllerian hormone (AMH), known for its role during fetal sexual differentiation, is secreted by the Sertoli cells in males and the granulosa cells in females during postnatal life. As serum AMH concentrations correlate with follicle numbers, AMH is utilised as a marker of ovarian reserve in many species. In dogs and cats, AMH is used as a diagnostic tool to determine spay or neuter status. In the available literature, no research regarding serum AMH levels in rabbits has been published yet. The objectives of the present study were to 1) measure serum AMH concentrations in female rabbits and investigate the value of AMH as a diagnostic tool to differentiate between spayed and intact does, and 2) relate measured AMH levels to pseudopregnancy and ovarian follicle numbers. For AMH measurement, serum samples were obtained from sexually intact (n = 64) and spayed (n = 22) female rabbits. Spayed does were of various breeds; intact rabbits were Zika hybrid rabbits. In the intact does, AMH measurement was complemented by determination of progesterone levels, gynaecological examination, and histopathologic evaluation of the uterus and ovaries, including follicle counts. Serum AMH and progesterone concentrations were measured using a human-based chemiluminescence immunoassay (CLIA) and an enzyme-linked fluorescence assay (ELFA), respectively. Depending on progesterone levels, sexually intact does were classified into follicular (n = 52) or luteal phase (n = 12). Median serum AMH levels were 1.53 ng/ml (range 0.77 - 3.36 ng/ml) in intact and 0.06 ng/ml (range ≤ 0.01 - 0.23 ng/ml) in spayed does. AMH concentrations between the intact and spayed rabbits differed significantly and did not overlap (p < 0.001). Receiver operating characteristic (ROC) curve analysis yielded a sensitivity and specificity of 100% for a cut-off level of 0.50 ng/ml. Follicular or luteal phase had no significant influence on measured AMH levels (t = 0.061, df = 62, p = 0.951). While the number of secondary follicles correlated significantly with AMH concentrations (r_s = 0.410, p = 0.001), the number of primary or antral follicles did not (r_s = 0.241, p = 0.055 and r_s = 0.137, p = 0.281, respectively). In conclusion, a single determination of serum AMH concentrations was adequate to distinguish spayed from intact female rabbits. Among sexually intact individuals, whether does were in follicular or luteal phase had no significant influence on measured serum AMH concentrations. The relationship between small growing follicles and AMH levels as described in other species could be partially confirmed, as secondary follicles correlated significantly with AMH.

Increased soluble transferrin receptor in a case of hypernephroma accompanied by polycythaemia and elevated erythropoietin

An increased level of soluble transferrin receptor (sTfR) has been recognized as a useful indicator of iron deficiency, especially in tumour anaemia and in chronic diseases. In cases of erythropoietin substitution, however, it indicates a successful stimulation of erythropoiesis. We report an "unusual" increase in sTfR in a 60-year-old man who suffered from end-stage hypernephroma with extended lung metastases. He showed pulmonal hypertension, polycythaemia and a high serum level of erythropoietin. We assume that, in this case, the increased sTfR originates not only from bone marrow but could be partly contributed also by the malignant tissue of the hypernephroma.

[Responsibilities of prevention in gerontology]

Multimorbidity is one of the main characteristics of a geriatric patient and not only should, but MUST find utmost consideration in every diagnosis and therapy. Strategies should be developed or those already in use, should be improved, to support a healthy growing into seniority and to prevent the need of nursing care. Examples of measures of primary, secondary and tertiary prevention, which are relevant for the elderly patient are mentioned. In tertiary prevention the emphasizing is focused on fall prevention and the importance of minimizing the fall risk. The five dimensions of health are aims to be achieved in all age periods but above all in old age.

Site-selective dephosphorylation of the platelet-derived growth factor beta-receptor by the receptor-like protein-tyrosine phosphatase DEP-1

Ligand stimulation of PDGF beta-receptors leads to autophosphorylation of the regulatory tyrosine 857 and of tyrosine residues that in their phosphorylated form serve as docking sites for Src homology 2 domain-containing proteins. Regulation of the PDGF beta-receptor by protein-tyrosine phosphatases is poorly understood. We have investigated PDGF beta-receptor dephosphorylation by receptor-like protein-tyrosine phosphatase DEP-1 using a cell line with inducible DEP-1 expression and by characterizing in vitro dephosphorylation of the PDGF beta-receptor and of receptor-derived phosphopeptides by DEP-1. After DEP-1 induction PDGF beta-receptor.DEP-1 complexes and reduced receptor tyrosine phosphorylation were observed. Phosphopeptide analysis of the PDGF beta-receptors from DEP-1-expressing cells and of the receptors dephosphorylated in vitro by DEP-1 demonstrated that dephosphorylation of autophosphorylation sites of the receptor differed and revealed that the regulatory Tyr(P)(857) was not a preferred site for DEP-1 dephosphorylation. When dephosphorylation of synthetic receptor-derived peptides was analyzed, the selectivity was reproduced, indicating that amino acid sequence surrounding the phosphorylation sites is the major determinant of selectivity. This notion is supported by the observation that the poorly dephosphorylated Tyr(P)(562) and Tyr(P)(857), in contrast to other analyzed phosphorylation sites, are surrounded by basic amino acid residues at positions -4 and +3 relative to the tyrosine residue. Our study demonstrates that DEP-1 dephosphorylation of the PDGF beta-receptor is site-selective and may lead to modulation, rather than general attenuation, of signaling.

[Improvement of rehabilitation outcomes of hip fractures: discharge assessment by patient care team, case management and wound healing]

Fall related hip fractures in elderly persons may substantially deteriorate a previously worthwhile life. Anxiety, isolation, depression and the immediate need for help jeopardize surgery and successful rehabilitation. It was therefore of interest to evaluate the impact of a comprehensive case management guided by a discharge assessment which included medical and social criteria. In a prospective, open study, conducted by a community hospital in Vienna and the Research Department of the Red Cross, 124 carefully selected patients (117 female, 7 male, mean age 81.8 +/- 7.0 years) over a period of six months were assessed one week before hospital discharge by a multiprofessional team. Patients were excluded for mental illness, dementia, disabling neurological diseases and noteworthy surgical complications. Thirty-four patients (mean age 83.7 +/- 7.6 years) were considered as intervention group. Ninety essentially independent patients (mean age 81.1 +/- 6.6 years) were considered as control group. A specialised nurse from the Community of Vienna was responsible for the link between the patients of the intervention group, the rehabilitation unit and the Social Services, for the discharge check lists and the feed back questionnaires (2, 6 and 12 weeks after discharge). All patients were asked for a check up 12 weeks after discharge in order to investigate needs and substantial changes in the ADL or required care. In the control group, nearly all patients reached the pre-traumatic level, whereas in the intervention group a drop out rate of 1/5th and a higher over all need of Social Services care was observed. However, in respect of the higher age, the more compromised health and activities, even this group of patients obviously profits by this case management strategy. In conclusion, surgery and rehabilitation need a thoroughly performed discharge assessment followed by a network of comprehensive Social Services measures to treat successfully high risk elderly patients after fall related hip fractures.

[Laboratory findings in elderly patients: a forgotten aspect of laboratory medicine?]

Reference values, which would be related to the individual "biological age" and which would be needed for laboratory investigations of geriatric patients, are at the moment not usual. Thereafter, for rational interpretation of laboratory results, the knowledge of "preanalytical variations" is of crucial importance. These are systematically discussed in the present contribution. In principle, one distinguish between "biological variations" and "preanalytical errors". The first are characterized by the following "factors": "permanent" (age, genetics), "long time" (age), "intermediate" (life style, climate, nutrition), and "short time" (circadian, postprandial, and orthostatic effects). The significance of "preanalytical errors" is accentuated by the fact that many of "geriatric institutions" are serviced by the laboratories, which are not situated close to them.

[Rehabilitation--nursing care: commonalities, limits, transitions]

In geriatrics there results a necessity of rehabilitative treatment in opinion on some important facts and it is always orientating on the individual patients. As basic condition for a successful rehabilitation on appropriate "therapeutic milieu" is required. Rehabilitation and nursing are inseparably connected in geriatrics as two elements of geriatrical intervention. Nursing is firmly included in decisive processes and has diagnostic and therapeutic functions. For the patients common competence it is not so important what sort of illness he suffers from but the effect on functional efficiency.

[Validation of the German version of the 20-item Toronto Alexithymia Scale in normal persons and psychiatric patients]

This paper describes the cross-validation of the German version of the 20-Item Toronto Alexithymia Scale (TAS-20) in normal adults (n = 306) as well as in a psychiatric inpatients sample (n = 101). The scale showed adequate estimates of internal consistency, split-half and test-retest reliability, and a three-factor structure comparable to that obtained for the English version of the TAS-20 which was found to be consistent with the main features of the alexithymia construct. Evidence of convergent validity of the German TAS-20 was demonstrated by significant positive correlations with conceptual related psychometric scales. The finding of significantly higher alexithymia scores in the psychiatric patients sample as compared to normal adults underlined the clinical validity of the German version of the TAS-20.

Reactivating occupational therapy: a method to improve cognitive performance in geriatric patients

In this prospective treatment study, the effects of two different occupational therapy strategies were compared in two samples of long-term geriatric inpatients (n = 22 in each group) with slight to moderate dementia according to DSM-III-R. Psychometric ratings after 12 weeks and 24 weeks of treatment have demonstrated that the application of a reactivating occupational therapy programme in addition to functional rehabilitation is significantly more efficient than the application of functional rehabilitation alone on levels of cognitive performance, psychosocial functioning, and the degree of contentedness with life. These results support the assumption that geriatric patients, if stimulated for a longer time, are able to mobilize latent resources of cognitive and psychosocial performance. Reactivating occupational therapy has a place in the treatment of long-term geriatric patients.

Alexithymia and somatization: relationship to DSM-III-R diagnoses

In previous studies, results from psychometric measures suggested an association between alexithymia and somatization. However, alexithymia has not been examined in relation to somatoform disorders and other standard psychiatric diagnoses. In the present study, the prevalence of DSM-III-R diagnoses was determined by SCID interviews among 45 psychiatric inpatients with functional somatic syndromes. In addition, the Toronto Alexithymia Scale (TAS) and the SCL-90-R were administered. Of the sample, 42.2% scored in the alexithymic range of the TAS. The alexithymic patients presented significantly more psychological turmoil and overall psychopathology on the SCL-90-R, as well as a significantly higher number of current DSM-III-R diagnoses. However, alexithymia was unrelated to DSM-III-R somatoform disorders and other DSM-III-R diagnoses, as well as the course of illness. These results suggest that assessing clinical features in addition to psychometric measures seems to be necessary for further validating the potential role of the alexithymia construct in somatic symptom formation.

Paroxetine in the elderly depressed patient: randomized comparison with fluoxetine of efficacy, cognitive and behavioural effects

The efficacy of paroxetine and fluoxetine and their effects on cognitive and behavioural function were compared in a 6 week, double-blind, randomized study of 106 elderly depressed patients (aged 61 to 85 years). Antidepressant efficacy was assessed using the Hamilton depression rating scale (HAMD), Montgomery-Asberg Depression Rating Scale (MADRS) and Clinical Global Impression (CGI) scale. The Sandoz Clinical Assessment Geriatric scale (SCAG), the Mini-Mental State Examination (MMSE), and HAMD cognitive factor scores were used to assess cognitive and behavioural function. Paroxetine demonstrated comparable efficacy to fluoxetine in the treatment of elderly depressed patients, but at the end of treatment, there was a significantly higher proportion of responders to paroxetine than to fluoxetine. Both treatments produced improvements in all measures of cognitive and behavioural function, but paroxetine was significantly superior to fluoxetine from Week 3, indicating a possible early effect. There was no difference between the two agents in either the tolerability or safety of treatment.

[Activating ergotherapy--a method for increasing cognitive performance in geriatric patients]

A study was performed in two groups of multimorbid longterm geriatric inpatients (n = 22 in each group). This compared the effects of re-activating occupational therapy (= study-group) on cognitive functions, subjective well-being, affectivity and social integration. The control group was monitored with a normal program of functional rehabilitation. The assessment of psychometric variables after 12 weeks and after 24 weeks of treatment revealed a significant (p < 0.01) improvement in cognitive functioning and subjective well-being in the study group. These results demonstrate the therapeutic benefit of re-activating occupational therapy in the treatment of cognitive impairment of geriatric patients, which is often aggravated by hospitalization.

EEG mapping and psychopharmacological studies with denbufylline in SDAT and MID

Computed tomography (CT), electroencephalograms (EEG), clinical and psychometric data were obtained in 96 mildly to moderately demented patients (72 women, 24 men), aged 61-96 years (mean 82), diagnosed according to DSM-III criteria. Patients were off drugs for at least 2 weeks and subdiagnosed according to the modified Marshall-Hachinski ischemic score and CT in 45 senile dementia of the Alzheimer type (SDAT) and 51 multiinfarct dementia (MID) patients. Evaluations were carried out before and 12 weeks after treatment with either 100 mg denbufylline BID or placebo and included EEG mapping, the Sandoz Clinical Assessment Geriatric (SCAG) score/factors, the Clinical Global Impression (CGI), the Digit Symbol Substitution Test (DSST), the Trail-Making Test (TMT) and the Digit Span Test (DS). Descriptive data analysis including confirmatory statements found delta/theta activity enhanced, alpha and beta activity reduced, total power augmented, and the centroid slowed down over various brain regions in patients as compared with controls. The two subtypes of dementia could be differentiated in some conventional EEG variables but mostly by means of power asymmetry indices. Denbufylline induced a statistically significant and clinically relevant improvement in both SDAT and MID patients, whereas after placebo this was not the case in CGI, the TMT, and the DS, with interdrug differences being significant in all primary target variables such as the CGI, MMS, SCAG, and DSST. Thus, both the degenerative and vascular type of dementia exhibited a therapeutic benefit that could be objectified at the neurophysiological level by EEG mapping in an improvement of vigilance.

[Gliclazide in the non-insulin-dependent diabetic patient in geriatrics]

In the present open clinical pilot study of 12 months duration we tested the metabolic and hemato-biological efficacy as well as the clinical tolerance of the oral antidiabetic agent gliclazide, a second-generation sulfonylurea derivate, on a group of 20 hospitalized geriatric patients (mean age 80.5 +/- 10.2 years). Gliclazide was proven to be a reliable blood-sugar lowering agent with a generally good subjective tolerance. There were no undesired side-effects on the renal, hepatic and hematopoietic systems.

[Therapy of multi-infarct dementia with nicergoline: double-blind, clinical, psychometric and EEG imaging studies with 2 dosage schedules]

In a double-blind study, clinical, psychometric and neurophysiological changes were investigated in patients with MID treated by two different drug administration schedules of nicergoline (20 mg evenings versus 10 mg b.i.d.). 24 hospitalized patients (4 males, 20 females) with a mean age of 78 years were included according to the criteria of DSM-III, an Ischemic-Score of at least 7 points and a specific computed tomogram (CT). After a placebo-period of 2 weeks all patients were randomly assigned to an 8-weeks-treatment with either 20 mg nicergoline h.s. or 2 x 10 mg b.i.d. The evaluation of the detailed psychopathology by means of SCAG, CGI, NOSIE, Hamilton-Depressions-Scale and Mini-Mental-Status, as well as psychometric investigations by means of the Nuremberg-Aging-Inventory (NAI), thymophysic and psychophysiological measurements showed a significant improvement in both groups as compared with pre-treatment. This improvement was observed slightly earlier in patients with 20 mg h.s. than in those on the b.i.d. schedule. However inter-group-differences reached the level of statistical significance in only 2 variables. Neurophysiological investigations by means of topographic brain-mapping showed interesting relations between functional EEG-images and morphological CT-images. Vigilance-improving patients showed a better therapeutic response than those who did not show neurophysiological changes indicative of improvement in vigilance. Our findings suggest, that a single dose once daily was at least equal to the b.i.d. administration as far as therapeutic efficacy was concerned, even more so in the light of an expected improvement of compliance.

[Ergotherapy within the scope of rehabilitation in geriatrics]

Occupational therapy in geriatric rehabilitation must take into account the multimorbidity of the patients. Thus a more complex treatment is called for that takes into consideration the affective disturbances accompanying the organic lesions.

[Should elderly hypertensive patients be treated with a beta-blocker-diuretic combination?]

30 hypertensive patients aged over 60 years underwent an antihypertensive treatment for a time of 3 months with Viskaldix . There was an excellent hypotensive effect in supine and standing position and no bradycardia or orthostatic dysregulation occurred. Metabolic parameters were not influenced, and this is of great importance in elderly patients. It seems notable that elderly patients may benefit from a beta-blocker therapy, as there is clinical or subclinical coronary heart disease.

[Diagnosis of functional disorders of the gallbladder and bile ducts]

The technique of hepatobiliary function scintigraphy (HBFS) is described and the different stages of filling are analyzed. Continuous observation and registration of the flow of the administered test dose is undertaken so that any possible anomalies can be noted. After the administration of contraction agents (Biloptin stimulus), the function of the involuntary muscles of the gall bladder and bile ducts is examined. In this way irregularities of tone can be registered. The place of HBFS within the field of gall bladder and biliary tract diagnostics is defined.