P6179Correlation of computed tomography-based fractional flow reserve with instantaneous wave free ratio to detect hemodynamically significant coronary stenoses

Background

Based on coronary computed tomography angiography (cCTA), stenoses can be detected but provides anatomical assessment solely. Fractional flow reserve based on coronary CT angiography (ML-cFFR) is gaining in importance for non-invasive hemodynamic assessment of obstructive coronary artery disease (CAD), as several large trials demonstrated significantly improvements in diagnostic accuracy to cCTA. Comparably instantaneous wave free ratio (iFR) is a novel resting index for the invasive determination of haemodynamic relevant stenoses, finds consideration in the ESC guideline on myocardial revascularization and is now of equal standing with FFR as a class IA recommendation.

Purpose

The aim of our study was to evaluate the on-site ML-cFFR in terms of diagnostic accuracy and clinical practicability in comparison to the iFR as the current invasive gold standard to detect hemodynamically significant coronary artery stenoses.

Methods

In our prospective, multi-center study, patients with CAD who had a clinically indicated cCTA and subsequent invasive coronary angiography with iFR-measurement were included. To analyse the acquired cCTA dataset we used a third-generation dual-source CT with on-site prototype ML-cFFR software that is based on a machine-learning algorithm, to determine the hemodynamic relevance of coronary stenoses.

Results

Between July 2017 and December 2018, in 40 of 42 cases (95%), the on-site ML-cFFR calculation was successful. Finally we enrolled 40 patients (72.5% males, mean age 66.7±11.9 years) with ML-cFFR calculation based on cCTA and iFR-measurement during ICA. The mean calculation time of the ML-cFFR values was 10.6±1.9minutes. 57 vessel specific lesions were analysed, of which 15 (26%) were determined as hemodynamically relevant stenoses by iFR (iFR≤0.89) whereas ML-cFFR classified only 14 (24.5%) as hemodynamic significant coronary stenoses (ML-cFFR≤0.80). We observed that cCTA overestimated the severity of stenoses in 27 of 40 cases, which might lead to unnecessary coronary angiographies. However, ML-cFFR detected no obstructive CAD in 26 of 40 patients (65%) and this would have resulted in a reduction of initially performed pure diagnostic coronary angiography. Estimated values sensitivity, specificity, PPV and NPV were 86.7%, 97.4%, 92.9% and 95.0%. The diagnostic accuracy of ML-cFFR in terms of iFR on a per-patient and per-lesion level was 95.0% and 96.5%. The area under the curve (AUC) on a per-lesion and per-patient basis by ML-cFFR to detect lesion specific ischemia was 0.97 and 0.96. The analysis of the correlation (Pearson's product-moment) on a per-lesion level was r=0.82 (p<0.0001) between the ML-cFFR algorithm and iFR.

Conclusion(s)

On-site ML-cFFR correlates excellently with the novel gold standard iFR to non-invasively detect hemodynamic significant coronary stenoses in routine clinical practice.

Acknowledgement/Funding

Doctor S. Baumann receives research support from Siemens and Philips Volcano. All other authors declare that they have no financial disclosure.

[Identification of an Unknown Person through the Bone Implant]

It is always a big challenge to identify unknown dead persons. All the more so if their body is found decomposed beyond recognition by effects of the environment and decay. Usually, layman and forensic methods (e.g. fingerprint identification) and, in case of the absence of evidence, also medical methods are used for post mortem identification. A method very rarely used in practice is the identification of the deceased through the implants. The described case concerned a finding of a decomposed body of an unidentified man. During the autopsy, apart from the signs of multiple surgeries, a dynamic hip screw implant with a well identifiable serial number was found. Based on this number, health care facilities were traced back in which such an implant had been used, and through studying the documentation of 117 cases, a male patient was finally identified whose other autopsy findings matched the clinical finding. Without the excellent cooperation of orthopaedists and medical examiners, the man would most likely remain unidentified. Key words: identification, autopsy for identification purposes, bone implants, dynamic hip screw.

A 'learning platform' approach to outcome measurement in fragile X syndrome: a preliminary psychometric study

BACKGROUND

Clinical trials of medications to alleviate the cognitive and behavioural symptoms of individuals with fragile X syndrome (FXS) are now underway. However, there are few reliable, valid and/or sensitive outcome measures available that can be directly administered to individuals with FXS. The majority of assessments employed in clinical trials may be suboptimal for individuals with intellectual disability (ID) because they require face-to-face interaction with an examiner, taxing administration periods, and do not provide reinforcement and/or feedback during the test. We therefore examined the psychometric properties of a new computerised 'learning platform' approach to outcome measurement in FXS.

METHOD

A brief computerised test, incorporated into the Discrete Trial Trainer©- a commercially available software program designed for children with ID - was administered to 13 girls with FXS, 12 boys with FXS and 15 matched ID controls aged 10 to 23 years (mental age = 4 to 12 years). The software delivered automated contingent access to reinforcement, feedback, token delivery and prompting procedures (if necessary) on each trial to facilitate responding. The primary outcome measure was the participant's learning rate, derived from the participant's cumulative record of correct responses.

RESULTS

All participants were able to complete the test and floor effects appeared to be minimal. Learning rates averaged approximately five correct responses per minute, ranging from one to eight correct responses per minute in each group. Test-retest reliability of the learning rates was 0.77 for girls with FXS, 0.90 for boys with FXS and 0.90 for matched ID controls. Concurrent validity with raw scores obtained on the Arithmetic subtest of the Wechsler Intelligence Scale for Children-III was 0.35 for girls with FXS, 0.80 for boys with FXS and 0.56 for matched ID controls. The learning rates were also highly sensitive to change, with effect sizes of 1.21, 0.89 and 1.47 in each group respectively following 15 to 20, 15-min sessions of intensive discrete trial training conducted over 1.5 days.

CONCLUSIONS

These results suggest that a learning platform approach to outcome measurement could provide investigators with a reliable, valid and highly sensitive measure to evaluate treatment efficacy, not only for individuals with FXS but also for individuals with other ID.

[Effect of windshield washer fluid on breathalyser results]

In this test were verify the possibility of the influence of windshield washer fluid containing ethanol on an alcohol breath test. The premise was that anti-freeze washer fluids used in automobiles contain ethanol, and that the use of such fluids results in ethanol vapour permeating the automobile's cabin. Tests were carried out on individuals seated on the front seats of an enclosed automobile cabin. Five different types of anti-freeze washer fluids suited for temperatures between -19 degrees C to -35 degrees C commonly available at a range of different petrol station chains throughout the Czech Republic were used. In total 34 measurements were taken. Not even in one instance could a measurement of zero be obtained within 60 seconds to 4 minutes of the use of ethanol-based washer fluid. The longest positive test lasted for 13 minutes. The highest measured value was 0.71% per hundred. Immediately after exiting the automobile and taking several breaths of fresh outside air tests were negative in all cases. All tests subjects described a clear odour of windscreen washer fluid in the cabin in all instances, which was evident even after breathalyzer tests showed zero values. It is hence verified that using ethanol-based windscreen washer fluid which is commonly accessible on our market to spray the windscreen can skew the results of breathalyzer tests in the sense of generating false positives. Due to the characteristic odour described, drivers should themselves be aware that any test undertaken could not be in his or her favour. To eliminate the apparent presence of alcohol, it is however enough to exit the cabin and to take several (2-3) breaths of fresh air to absolutely guarantee a fair test. A positive test at this stage points to a different underlying reason than ethanol-based windscreen washer fluid being used.

The effect of the home shooting percussion pistol on skull substitute bones

The aim of this paper was to determine if the saloon percussion pistol, considered to be a non-lethal weapon, can in fact be dangerous to life even if the neucranium is hit elsewhere than the so-called "locus minoris resistentiae" areas. In the face of specialist opinion that states that life-threatening or serious injury can occur only after a shot to the sensitive parts of the head (eyes, ears, sinus, nasal and oral cavity), it was experimentally determined on replacement materials that if the gun is loaded with just 100mg of gun powder a 4.5mm calibre bullet always penetrates the cranium. Saloon percussion pistols can be dangerous to life in situations that nobly expected till now.

[The correlation of results of breath analysers and laboratory blood examinations of blood-ethanol concentration (Czech and Slovak study)]

The target of this study was to compare the results of breath analysers and "lege artis" laboratory blood examinations when determining alcohol levels. This was then used to determine whether any differences exist between the two methods, and how large these differences are. 610 cases from 11 workplaces in the Czech Republic and Slovakia were analysed. The type of breath analyser was not taken into consideration. All cases had to be in the elimination phase. Difference of time between breath test and blood test were rectified through the use of reverse recomputation. It was detected that only 20.8% of the results of respiratory analyser tests correspond to the detected real alcohol level in blood. The maximum difference when a respiratory analyser measured more than a blood test was 1.34 g x kg(-1). and the maximum difference when the analyse measured less was 1.86 g x kg(-1).

[The most recent knowledge on the theory of genesis of diffuse axonal injury of the brain]

The paper presents the most recent knowledge related to the patophysiology of traumatic axonal injury and resulting forensic and clinical implications. The mechanistic idea is replaced by the idea of dynamic cascade of biochemical events on subcellular level, finally leading to axonotmesis. Interventions targeted to the cascade are discussed with respect to toxic drugs. Finally a necessity to consider the new knowledge in forensic problems is outlined.

[Fundamental biological model for trials of wound ballistics]

The aim of our experiment was the testing of effects of common ammunition on usable and slightly accessible biological tissue thereby to create fundamental simple biological model for trials of wounded ballistic. Like objective tissue was elected biological material - pork and beef hind-limbs, pork head, pork bodily cavity. It was discovered that objective tissue is able to react to singles types of shots in all spectrum results namely simple smooth penetration wound as well as splintery fracture in dependence on kind of using ammunition. Pork hind-limb was evaluated like the most suitable biological material for given object.

[The legal aspects of manipulation of dead body in the department of legal medicine and pathology]

Recent updates (novelizations) of Czech medical laws are very strict with regards to manipulation with corpses. The authors refer to several instances where healthcare personnel come to contact with corpses and state the relevant regulations (laws) including applicable penalties in case they are not adhered to.

Butane intoxication--three case reports

Three cases of butane intoxication with fatal outcome are described. Butane was applied as a gaseous spray from the lighter refill can. With the exception of non-specific signs of asphyxiation such as tiny subepicardial and subpleural haemorrhages and lung oedema, haemorrhagic microruptures of the myocardial fibres were found. The authors have no plausible explanation regarding this development. Any mechanical damage of the myocardium can clearly be excluded.

[Determination of AB0 blood group system from degraded blood stains on serological and molecular genetic level]

The AB0 blood group system typing remains one of the basic laboratory tasks in a forensic practice. However, problems arise when the analysed samples are seriously degraded. We took blood samples from six volunteers (three men, three women) and made blood stains on pieces of sterile cotton cloth. Blood stains were incubated at three different temperatures (22 degrees C, 37 degrees C, 56 degrees C) for various periods of time (1 day, 1 week, 14 days, 1 month, 3 months, 6 months, 1 year). For blood stains degraded at 22 degrees C we also analysed the samples after 3.5 hours of incubation. Moreover, we tried to determine the AB0 blood group system after thermal degradation at high temperature, accurately at 200 degrees C for 10 min. For the AB0 blood group system typing a Polymerase Chain Reaction method was used to amplify glycosyltransferase gene, when DNA had been isolated from artificially created blood stains, followed by their subsequent artificial thermal degradation. For serological AB0 typing the mixed agglutination and the Therkelsen method were used. The DNA analysis seemed to solve problems with seriously degraded blood stains but we found out that classical serological methods were even better in some cases.

[B0 aberrant genotype of AB0 blood group system]

The AB0 blood group system typing remains one of the basic laboratory tasks in a forensic practice. However, problems arise when the analysed samples are seriously degraded. The DNA analysis promised to solve this but an unexpected complication was encountered. For the AB0 blood group system typing a Polymerase Chain Reaction method was used to amplify glycosyltransferase gene, when DNA had been isolated from artificially created blood stains, followed by their subsequent artificial thermal degradation. In the B0 genotype an aberrant genotype was suprisingly found and its structure was confirmed by sequencing. This meant that a newly formed B00 (not the original BO) genotype was present. Such a finding, to our best knowledge, had not been observed yet and we were unable to find any references in the professional literature. The explanation of this result thus remains unclear.

Interaction of human immunoglobulin G with CD16 on natural killer cells: ligand clearance, FcgammaRIIIA turnover and effects of metalloproteinases on FcgammaRIIIA-mediated binding, signal transduction and killing

Human natural killer (NK) cells express low-affinity Fc immunoglobulin G (IgG) receptor (FcgammaRIIIA/CD16). The binding of monomeric IgG (mIgG) and F(ab')(2) fragments of 3G8 anti-CD16 monoclonal antibody (mAb) to FcgammaRIIIA was investigated by flow cytometry. Over 90% of NK cells bound endogenous IgG, and during incubation at 37 degrees C, the FcgammaRIIIA occupancy decreased slowly. Approximately 90% of NK cells bind mIgG or F(ab')(2) fragments of 3G8 anti-CD16 mAb. The calculated half-time (T(1/2)) of in vitro mIgG dissociation from FcgammaRIIIA was 130 min. By cross-linking the mIgG ligand with F(ab')(2) fragments of anti-human IgG antibody, the T(1/2) decreases to 85 min. In kinetics study, it has been shown that (125)I-mIgG bound to FcgammaRIIIA is slowly released in the culture supernatant, maybe eluted at acid pH, or partially internalized and degraded. The binding of IgG to FcgammaRIIIA was increased by 53.8% on cells cultured in the presence of RU36156, a matrix metalloproteinase (MMP) inhibitor. Furthermore, an increase in phosphorylation of Lyn tyrosine kinase, after cross-linking of mIgG-FcgammaRIIIA complex, was observed on NK cells treated with RU36156. When the FcgammaRIIIA was occupied by mIgG, the capacity of NK cells to kill K562 target cells was decreased by RU36156, because the MMP inhibitor protects CD16 from proteolysis. Our data demonstrate that binding of mIgG to human NK cells is followed by ligand dissociation and/or internalization, enzymatic degradation and exocytosis. The RU36156 MMP inhibitor protects FcgammaRIIIA from cleavage, augments NK-cell activation and may interfere in their killing capacity.

Phospholipase A2 modulates respiratory burst developed by neutrophils in patients with rheumatoid arthritis

Activated by bacterial peptides, phorbol esters, calcium ionophores and other agonists, neutrophils (PMNs) release the proinflammatory mediator, arachidonic acid (AA) via the intervention of phospholipase A(2) (PLA(2)). AA may play an essential role in activation of NADPH-oxidase, which is involved in the generation of superoxide anion by neutrophils. The present study is focused on the involvement of PLA(2) in the respiratory burst developed by PMNs isolated from patients with rheumatoid arthritis (RA). PLA(2) exists in very high levels in diseases such as rheumatoid arthritis and may cause acute inflammatory and proliferative changes in synovial structures. The respiratory burst was evaluated as superoxide anion release, using an amplified chemiluminescence method. The assays were performed using PMNs untreated or treated with different doses of stimulatory reagents (phorbol 12-myristate-13-acetate (PMA), calcium ionophore (A23187)). Our data suggested that PMA stimulated the production of superoxide anion in a dose-response manner, as compared with A23187, which did not induce a significant release of superoxide anion in PMNs-RA. The exogenous addition of AA significantly amplified the superoxide anion release by PMNs-RA stimulated with PMA and to a lesser extent, by PMNs stimulated with A23187. AA has also reversed the inhibitory effect of arachidonyl-trifluorometylketone and E-6-(bromomethylene)tetrahydro-3-(1-naphthalenyl)2H-pyran-2-one (BEL) on the superoxide anion release by PMNs-RA. In conclusion, the differential responses to these two agents suggested that different isoforms of PLA(2) were activated by A23187 or PMA, and support the idea that activation of these different PLA(2) served distinct functions of PMNs. Therefore, the inhibition of PLA(2) enzymes might be of great importance in the immunotherapy of rheumatoid arthritis.

[Findings in the detection of fibronectin in skin burns]

Occurrence of fibronectin was detected in paraffin sections of burn skin samples, excised from surviving patients, as well as skin samples removed from the death persons, who succumbed burn wounds. The other groups of samples, used for comparison with the previous one, consisted of the intact skin excisions and skin samples post-mortem exposed to thermic changes. Indirect immunoperoxidase reaction was the immunohistochemical method used in all examinations. In post-mortem burn skin samples there was a loss of fibronectin activity in the epidermo-dermal junction area as well as in the papillary dermis. In burn skin samples, excised from patients who only survived for very short time their (serious skin) burns, no evidence of any fibronectin activity was seen. Also in two other cases, when patients--due to their severe burns--survived for several hours only, there were no conspicuous differences in the intensity of fibronectin activity seen in comparison with features found in the intact skin samples. Fibronectin activity was, however, increased in all other burn skin samples, where the survival time of patients was from 30 minutes to 5 weeks and there were following differences in its intensity and also in its pattern of distribution. In the 1st-degree and in a superficial 2nd-degree skin burn wounds, fibronectin was also present in the epidermis. In the papillary dermis, fibronectin was distributed rather diffusely or in a spot-like pattern while in the reticular dermis, there was a tendency to form net-like structures among collagen fibers. In deeper 2nd-degree and in the 3rd-degree burn wounds, fibronectin was deposited in vicinity of blood vessels and skin appendages in a fibrillar pattern. In 6 out of 11 samples, where the survival time ranged from 7 to 21 days, fibroblasts were arranged among fine collagen fibers and some of these cells exhibited positive fibronectin activity on their surface. Numerous fibroblasts with finely scattered fibronectin spots and also a decrease of fibronectin activity were observed in more mature granulation tissue, present in burn skin samples where survival time of patients was five weeks.

[Comparison of the concept of forensic medicine in Southeastern Asia and Central Europe]

Differences in conception of forensic medicine in the central Europe and south-eastern Asia are consisted in both legislative difference and different view of religion as well in fact, that forensic medicine is a very young subject in Vietnam and in some nearby countries that dispose of not enough professional workplaces and specialists. In this point, an intense reverse is coming about, especially owning to possibility of an abroad study of this subject in countries that have longer tradition.

Zinc nasal gel for the treatment of common cold symptoms: a double-blind, placebo-controlled trial

Effective treatment for the common cold have been difficult to develop because so many different types of virus are responsible for this condition. Oral zinc has been studied as a possible means of preventing or alleviating symptoms, with mixed results. We studied a new approach to zinc therapy--an over-the-counter nasal gel formulation (Zicam)--to independently evaluate its efficacy as a treatment for the common cold. Our study was conducted at four sites over a 5-month period. The study group consisted of 213 patients with recent-onset(< or = 24) cold symptoms; 108 patients received zinc therapy, and 105 reviewed placebo. Symptom charts were used to track the duration and severity of each patient's symptoms. At study's end, the duration of symptoms was 2.3 days (+/-0.9)in the zinc group and 9.0 days (+/-2.5)in the control group--a statistically significant difference (p <0.05). These results provide evidence that zinc nasal gel is effective in shortening the duration of common cold symptoms off when taken within 24 hours of their onset.

[Fatal wounding of the journalist and writer, Rudolf Tĕsnohlídek in 1928 in the light of new findings]

Presented paper describes the tragic end of the writer Rudolf Tĕsnohlídek, the author of the well-known and congenial masterpiece Liska Bystrouska. In archives of the Brno municipal clinics new documents have been found which may bring a new light on the circumstances of his tragic death.

[Overview of the changes in alcohol content of beers produced in the Czech Republic]

Paper concerns the alcohol contents of beer now produced. The previous and contemporary ways of beer signing as well as a complete list of beer sorts produced in the Czech Republic is presented.

Fatal brain injury caused by the free-flying blade of a knife - case report and evaluation of the unusual weapon

A man suffered a fatal injury from a self-inflicted accident while handling a special type of knife. A spring in the shaft of the knife accelerated the blade, which perforated the orbital cavity and the frontal lobe at the right side. Death was due to central disregulation. The initial velocity of the blade was measured to be 15 m/s. In a total of 20 experimental shots to a fresh pig cadaver, the blade always penetrated the skin and 5-10 cm of soft tissue as long as the distance did not exceed 1 m. Thin layers of bone were also perforated. The free flight of the blade did not remain stable if the distance was more than 1 m, which resulted in superficial wounds only. So this unusual construction resembling a knife can be considered an effective combat weapon for close range fighting instead of a tool.

IgA monoclonal and polyclonal proteins as regulatory factors of the NK cytotoxic activity

The presence of receptors for IgA (IgAR) on natural killer (NK) cells was only indirectly suggested yet. To elucidate the presence of IgAR on NK cells and its possible role in modulation of the NK activity, was initiated a preliminary study carried out in a homologous system, using human non adherent lymphocytes (NAL) and human seric or secretory IgA. A proportion of over 20% NK cells (CD16+ CD56+) was determined by flow-cytometry in the NAL-cells population. Dose-dependent IgA-binding to NAL cells was determined, showing a limitation of the IgA+ NAL proportion for a cell population of 32% and a ligand concentration of 4 mg/ml/10(7) cells. The binding parameters of the IgA/IgAR system, calculated by Scatchard procedure, revealed values of the affinity constant (K) and of the maximum number of ligand molecules bound/cell (n) depending on the aggregation degree of the ligands: K-values of 1.0 and 0.4 x 10(7) M-1 for dimeric and respectively, monomeric IgA, and n-values of 0.8 and 1.7 molecules/cell, respectively. A proportion of 3% IgA molecules endowed with cytophilic property was also calculated. The turnover rate of secretory IgA (sIgA) on the NAL cells surface showed values of the ligand half time (T 1/2) of 1 h. The effect of polyclonal IgA, (sIgA and normal seric IgA) and of monoclonal IgA myeloma (monomeric and dimeric IgA) on the NK cytotoxicity target K562 cell line was of inhibition, depended on the ligand doses and varied with the IgA type. The possible relevance of immunoglobulins A and of the activity of natural killer cells in processing of some mechanisms of the antiviral protection was discussed.

[An outline for evaluating gunshot wounds from the International Council of the Red Cross]

Paper summarized a concise evaluation of short wounds according to the Red Cross Classification published in Geneva. It is supposed to attract the forensic physician's attention due to informative purpose.

[Detection of chlamydia in the intestines and lungs in pigeons and humans]

Attempts were made to detect Chlamydia sp. by direct immunofluorescence (IF) in intestinal and lung tissues collected from wild town pigeons, young reared pigeons, and human corpses. Chlamydia in any organ were detected in 86.6% of the 427 adult pigeons and 27.3% of 16 young pigeons. Positive IF results were in intestinal and lung samples, collected from 427 adult pigeons, in 34.3% and 40.05% of the birds, respectively. Human (n = 100) intestinal and lung tissues were positive in 22% and 20% of the corpses, respectively. Titres 1:20 and higher were demonstrated by CF in 53.86% of the 427 adult pigeons. The highest titre found was 1:5 120.

[Development of basocellular carcinoma of the skin as a result of injury or long-term local effect of a toxic substance]

The submitted cas-history deals with the possible development of basal-cell carcinoma of the skin in an elderly woman due to the local action of chemical substances (possibly of a cancerogenic nature) in the lead of indelible pencils, in combination with a chronic suppurative and cicatricial process/both in conjunction with an injury/. The authors do not attempt to find an unequivocal answer to the problem but feel that the problem should be "food for thought".

[Changes in ethanol metabolism in chronic alcoholics and genetic and ethnic factors affecting its metabolism]

Individual differences in the ethanol metabolism are a well established fact. Their explanation is still the subject of discussions. In the submitted paper the author describes different views on this problem which comprises individual as well as genetic and ethnic aspects.

[Forensic sequelae of changes in ethanol metabolism in chronic alcoholics]

The author summarizes some views on possible factors influencing ethanol metabolism. Ethanol metabolism can be affected by altered hepatic activity in chronic alcoholics and mentions also possible effect of some pharmacological preparations on ethanol metabolism.

[Present views on metabolism of ethanol]

The author summarizes some recent views on ethanol metabolism. He emphasizes the impact of different routes of the ethanol breakdown in the organism. Most important for alcohol metabolism is alcohol dehydrogenase and in chronic alcoholics also the microsomal ethanol oxidizing system. The role of catalase is practically negligible.

A history of tissue expansion. Concepts, controversies, and complications

BACKGROUND

Tissue expansion has become a widely used adjunct in reconstruction of the skin.

OBJECTIVE

To trace the history of the concept of tissue expansion from the ancient to the latest medical literature.

METHODS

We reviewed the technologic developments in the materials and methods of tissue expansion.

RESULTS

Tissue expansion is of clinical importance and can be understood by the biochemical, biomechanical, and histologic features of expanded skin.

CONCLUSION

Tissue expansion is becoming widely used and accepted and its continued use under many circumstances is justified by the experimental and clinical results.

[Is undirected liver biopsy a safe procedure?]

In the authors' group of 976 umaimed liver biopsies (ULB) 10 complications were recorded. The authors described them and compared them with reports from the world literature. Two patients from the group died after ULB. One as a result of biopsy from haemoperitoneum, the other patient died with delirium tremens after surgery called for by persisting peritoneal syndrome. In eight patients mild complications were involved. In five patients complications receded spontaneously, in three after administration of an analgetic. From the submitted paper ensues that ULB is not quite safe, even when used by an experienced physician and when all contraindications are respected. A smooth course is not ensured by a risk-free diagnosis, previous uncomplicated biopsies normal prebioptic haemocoagulation tests. It is essential to realize this with regard to every patient where we indicate ULB. It is better to omit it unless we are unequivocally convinced of its asset. The question thus is: What will be the benefit of ULB for the patient?

[The first public autopsy in the region which is now Czechoslovakia?]

An autopsy performed in 1600 by a Slovak Dr. Jesenius, professor of anatomy at the Charles University of Prague, was for long years taken for the first public postmortem in this country. According to our investigations, another autopsy for public was done by Dr. med. Simon Grynaeus 6 years earlier in Brno. The fact was verified by a notice in the Municipal Chronic of Brno preserved in basement of the Brno Municipal Archives. Its author was identified as Georg Ludwig von Liebeneck, official chronicler at that time.

[Mental therapy of headache]

In a group of patients with headache the authors found that mental therapy was very effective. It produced a better effect than previous therapeutic procedures. The authors discuss contemporary views of mechanisms of modern pharmacotherapy of headache and draw attention to its hazards, economic pretentiousness and frequently low availability. The authors mention also non-pharmacological methods used nowadays in the therapy of headache and their relationship to the endogenous opioid system. They explain mental therapy as the interaction and energy exchange between the aura of the emitor and percipient of the mental energy. The authors expressed the hypothetical idea on the basis of analgetic action of mental therapy. They recommend to extend research of mental energy in medical disciplines--theoretical and clinical--and to introduce mental therapy into practice on a professional level. Based on their own experience the authors decided to apply it already now where it gives hope of recovery or mitigation of the patients' suffering. They consider it their duty.

Phenotypic correlations between oculomotor functioning and schizophrenia-related characteristics in relatives of schizophrenic probands

Abnormalities of visual pursuit tracking are frequent in the first-degree relatives of probands with schizophrenia. The relationship between oculomotor abnormalities and schizophrenia-related characteristics in those family members, however, has received little attention. Fifty-three first-degree relatives of 24 probands with schizophrenia were evaluated for the presence of schizophrenia-related characteristics using both interview (Schedule for Schizotypal Personalities) and questionnaire (Chapman scales). The family members also had their eye movements recorded during pursuit tracking tasks and scored for gain in both the frequency and time domains, and saccadic intrusions. Social-interpersonal schizophrenia-related features were significantly related to both time- and frequency-domain gain calculations. It appears that abnormalities in the smooth-pursuit oculomotor system may be associated with symptoms conjectured to be most closely related to a genetic diathesis for schizophrenia. These findings provide further evidence that oculomotor abnormalities may be related to risk for this disorder.

[Professor Carl Sternberg and his years in Brno]

The report exploiting old materials in some archives in Brno is concentrated on 14 years (from 1906 till 1920) of prof. Sternberg's life and work in Brno. The most renowned head of Brno department of pathology is introduced as a man of assiduity and indefatigable diligence according to quoted authentic documents.

[Heart tumors in adulthood and advanced age]

The investigation is focused on the frequency and clinical symptomatology of primary heart tumours. The authors describe their own observation of four cases of these tumours in adult and advanced age: The first one--a myxoma surviving after accurate diagnosis and surgical treatment, and at present free from any cardiac complaints and three others (two fibromas, one mesothelioma) where the diagnosis was not established in time and which proved fatal.

Selective attention and levels of coding in schizophrenia

Traditional explanations of schizophrenics' cognitive deficits have considered faulty selective attention as a single stage, categorical phenomenon. This study examined selective attention as a process that operates with varying degrees of efficiency throughout information processing, including the recoding of stimuli from the perceptual register. The results suggested both a deficiency in the reservoir of attentional capacity for schizophrenics and a greater depletion of such capacity.