Gene expression analysis of MAOA and the clock gene ARNTL in individuals with bipolar disorder compared to healthy controls.

INTRODUCTION: Circadian rhythms are associated with bipolar disorder (BD). This cross-sectional study aimed at investigating ARNTL and MAOA gene expression differences (1) between individuals with BD and controls, (2) between affective episodes, and (3) the relationship between ARNTL and MAOA expression. METHODS: ARNTL and MAOA gene expression in peripheral mononuclear blood cells were analysed from fasting blood samples (BD n = 81, controls n = 54) with quantitative real-time PCR operating on TaqMan® assays (normalised to 18S RNA expression). ANCOVAs corrected for age, sex, body mass index, and medication was used to evaluate expression differences and correlation analyses for the relation between ARNTL and MAOA expression. RESULTS: ARNTL gene expression differed between affective episodes (F(2,78) = 3.198, p = 0.047, Partial Eta2= 0.083), but not between BD and controls (n.s.). ARNTL and MAOA expression correlated positively in BD (r = 0.704, p < 0.001) and in controls (r = 0.932, p < 0.001). MAOA expression differed neither between BD and controls nor between affective episodes (n.s.). DISCUSSION: Clock gene expression changes were observed in different affective states of BD. More precisely, ARNTL gene expression was significantly higher in euthymia than in depression. ARNTL and MAOA gene expression correlated significantly in BD and in controls, which emphasises the strong concatenation between circadian rhythms and neurotransmitter breakdown.

[Surgical management of ruptured abdominal aortic aneurysm--diagnosis, risk factors and prognosis]. / Chirurgische Versorgung des rupturierten Bauchaortenaneurysmas--Diagnose, Risikofaktoren und Prognose.

It has been observed that the number of emergency operations for ruptured abdominal aortic aneurysms (AAA) is still high, as is the corresponding mortality. With the aim to determine how pre-clinical as well as clinical factors affect survival of patients with perforated AAA, we examined the course of patients admitted with perforated AAA in the last six years. Retrospectively we assessed the following documented parameters: patient's age, pre-clinical interval between onset of symptoms and hospitalization, the preoperative circulatory situation, hospital resuscitation period before surgery, the duration of aortic cross-clamping and the need of intraoperative blood transfusions in relation to the hospital mortality. In the period between 1.1.1990-31.12.1995, 39 patients with ruptured abdominal aortic aneurysms were operated on emergency basis in the Department of General Surgery of the University of Essen. There were 36 men and 3 women. The average age was 69.1 years. 25 patients (64%) died on admission, 4 of them intraoperatively. The most relevant observed prognostic factors were the preoperative circulatory status (systolic blood pressure p < 0.0001; hemoglobin p < 0.01) as well as the intraoperative blood transfusion requirement (p < 0.01) In view of the high mortality associated with surgical treatment of ruptured AAA and with the difficulty to decisively influence the relevant prognostic factors, early elective surgery of asymptomatic patients with AAA is highly recommended.

Impact of colour Doppler sonography on detection of thrombosis of the hepatic artery and the portal vein after liver transplantation.

Sixty patients who received 75 consecutive liver grafts and had routine Doppler sonography monitoring in the early postoperative period (three times a day) were reviewed for vascular complications. Thrombosis of the hepatic artery was detected in seven patients (3, 4, 20, 24, 48, 70 and 84 h after liver transplantation) and was then confirmed by emergency laparotomy in six cases. In one patient, thrombosis was verified by angiography before laparotomy. In two patients thrombectomy was successful, in five patients retransplantation had to be performed. Portal vein occlusion was detected in three patients (24, 26 and 90 h after transplantation) and all were successfully treated by thrombectomy and partial arterialization of the portal vein. Colour Doppler sonography was associated with no false-positive or -negative results. The specificity was 100% for the diagnosis of hepatic artery and portal vein thrombosis. In our opinion colour Doppler sonography will be able to replace time-consuming angiography in vascular diagnostics in the early postoperative phase after liver transplantation. Furthermore, there is evidence that frequent use of this non-invasive technique permits early detection of clinically unsuspected vascular complications and subsequent immediate relaparotomy, which is linked to a reduction in the rate of retransplantation.

Patient noncompliance in dermatomycosis. Results of a survey among dermatologists and general practitioners and patients.

Noncompliance among dermatomycosis patients exists in many forms and is widespread. Patients are noncompliant in two major areas: they reduce the number of necessary daily applications of the antifungal drug and they prematurely stop the therapy. A survey among 35 dermatologists and general practitioners as well as 230 dermatomycosis patients in Germany in 1982 showed that noncompliance is widespread: a total of 48% of patients neglected the proper daily dosage schedule, 44% reduced the number of daily applications, whereas 4% increased them. 25% of patients stopped treatment after the symptoms had disappeared. However, there is no such thing like the noncompliant patients personality. Depending on the kind of noncompliance, different personality structures appear. And based on the patient's overall attitude towards noncompliance - one third confesses to be noncompliant - the psychological picture becomes even more complex and multifaceted. Improving patient compliance seems to be most promising by better, i.e. more thorough, doctor-patient communication and antifungal drugs that minimize the risks of noncompliant behavior by requiring less daily applications and a shorter time of treatment.