Stroke unit admission is associated with better outcome and lower mortality in patients with intracerebral hemorrhage.

BACKGROUND AND PURPOSE: There is no clear consensus among current guidelines on the preferred admission ward [i.e. intensive care unit (ICU) or stroke unit (SU)] for patients with intracerebral hemorrhage. Based on expert opinion, the American Heart Association and European Stroke Organization recommend treatment in neurological/neuroscience ICUs (NICUs) or SUs. The European Stroke Organization guideline states that there are no studies available directly comparing outcomes between ICUs and SUs. METHODS: We performed an observational study comparing outcomes of 10 811 consecutive non-comatose patients with intracerebral hemorrhage according to admission ward [ICUs, SUs and normal wards (NWs)]. Primary outcomes were the modified Rankin Scale score at discharge and intrahospital mortality. An additional analysis compared NICUs with SUs. RESULTS: Treatment outside an SU was associated with higher odds for an unfavorable outcome [ICU vs. SU: odds ratio (OR), 1.27; 95% confidence interval (CI), 1.09-1.46; NW vs. SU: OR, 1.28; 95% CI, 1.08-1.52] and higher odds for intrahospital mortality (ICU vs. SU: OR, 2.11; 95% CI, 1.75-2.55; NW vs. SU: OR, 1.52; 95% CI, 1.23-1.89). A subgroup analysis of severely affected patients treated in dedicated NICUs (vs. SUs) showed that they had a lower risk of a poor outcome (OR, 0.45; 95% CI, 0.26-0.79). CONCLUSIONS: Treatment in SUs was associated with better functional outcome and reduced mortality compared with ICUs and NWs. Our findings support the current guideline recommendations to treat patients with intracerebral hemorrhage in SUs or NICUs and suggest that some patients may further benefit from NICU treatment.

Intravenous thrombolysis for acute ischaemic stroke in the elderly: data from the Baden-Wuerttemberg stroke registry.

BACKGROUND AND PURPOSE: In Europe intravenous thrombolysis (IVT) for ischaemic stroke is still not approved for patients aged >80 years. However, elderly patients are frequently treated based on individual decision making. In a retrospective observational study a consecutive and prospective stroke registry in southwest Germany was analysed. METHODS: The data registry collected 101,349 patients with ischaemic stroke hospitalized from January 2008 to December 2012. Of these, 38,575 (38%) were aged 80 years and older and 10 286 (10.1%) underwent IVT. Favourable outcome at discharge was defined as modified Rankin Scale (mRS) ≤1 or not worse than prior to stroke. Multiple logistic regression models stratified by 10-year age groups were used to assess the relationship between IVT and mRS at discharge, adjusted for patient characteristics, admitting facility and length of hospital stay. RESULTS: The highest IVT rate was 15% in patients aged <50 years, with a continuous decline down to 8% in patients aged ≥90 years. Adjusted odds ratios and 95% confidence intervals for patients 80-89 years of age were 2.20 (1.95-2.47) (P < 0.0001) and 1.25 (0.88-1.78) (P = 0.21) for patients >90 years of age, compared to patients of the same age decade not treated with IVT. CONCLUSIONS: The evidence from routine hospital care in southwest Germany indicates that IVT is an effective treatment also for aged patients with ischaemic stroke in an age range between 80 and 89 years. Although no clear evidence for the effectiveness of IVT beyond 90 years was found, treatment should also be carefully considered in these patients. High age should not discourage from treatment.

A consecutive and prospective stroke database covers the state of Baden-Wuerttemberg with 10.8 million inhabitants in Germany.

BACKGROUND: In 1998 Baden-Wuerttemberg (BW), a federal state in southwest Germany with 10.8 million inhabitants, implemented a structured medical concept for the treatment of acute stroke. METHODS: Since 2004 participation in the BW stroke database is mandatory for all hospitals in BW involved in acute stroke care. The stroke database includes all inpatients ≥18 years of age who have suffered an ischemic or hemorrhagic stroke within 7 days before hospitalization. This article presents methodological aspects and first results of the BW stroke database in the time period from 2007 to 2011. RESULTS: Annual inclusion numbers increased continuously (29,422 vs. 35,724, p < 0.001). Median age of stroke onset was stable over time. The proportion of stroke patients ≥80 years increased from 36.9 to 38.8% (p < 0.001). Rates of patients treated in neurology departments rose from 50.7 to 60.9% (p < 0.001) and numbers of patients treated in stroke units rose from 59.1 to 68.4% (p < 0.001). Admission via emergency medical systems increased from 42.8 to 49.7% (p < 0.001) and arrival within 3 h increased from 29.8 to 34.4% (p < 0.001). CONCLUSION: We present results from a large, prospective and consecutive stroke patient database. This first analysis demonstrates a continuous increase of absolute and relative numbers of stroke patients who arrive within 3 h after onset, are hospitalized in neurology departments and treated in stroke units, and are aged ≥80 years.

Treatment during primary HIV infection does not lower viral set point but improves CD4 lymphocytes in an observational cohort.

OBJECTIVE: To investigate if early treatment of primary HIV-1 infection (PHI) reduces viral set point and/or increases CD4 lymphocytes. METHODS: Analysis of two prospective multi-centre PHI cohorts. HIV-1 RNA and CD4 lymphocytes in patients with transient treatment were compared to those in untreated patients. Time to CD4 lymphocyte decrease below 350/ microl after treatment stop or seroconversion was calculated using Kaplan-Meier and Cox-PH-regression analyses. RESULTS: 156 cases of PHI were included, of which 100 had received transient HAART (median treatment time 9.5 months) and 56 remained untreated. Median viral load (563000 cop/ml vs 240000 cop/ml; p<0.001) and median CD4 lymphocyte (449/ microl vs. 613/ microl; p<0.01) differed significantly between treated and untreated patients. Median viral load was 38056 copies/ml in treated patients (12 months after treatment stop) and 52880 copies/ml in untreated patients (12 months after seroconversion; ns). Median CD4 lymphocyte change was +60/ microl vs. -86/ microl (p = 0.01). Median time until CD4 lymphocytes decreased to <350/ microl (including all patients with CD4 lymphocytes <500/ microl during seroconversion) was 20.7 months in treated patients after treatment stop and 8.3 months in untreated patents after seroconversion (p<0.01). Cox-PH analyses adjusting for baseline VL, CD4 lymphocytes, stage of early infection and symptoms confirmed these differences. CONCLUSIONS: Treatment during PHI did not lower viral set point. However, patients treated during seroconversion had an increase in CD4 lymphocytes, whereas untreated patients experienced a decrease in CD4 lymphocytes. Time until reaching CD4 lymphocytes <350/ microl was significantly shorter in untreated than in treated patients including patients with CD4 lymphocytes <500/ microl during seroconversion.

Exacerbation of inflammation-associated colonic injury in rat through inhibition of cyclooxygenase-2.

Cyclooxygenase type 1 is constitutively expressed and accounts for synthesis of prostaglandins in the normal gastrointestinal tract. Cyclooxygenase-2 is expressed at sites of inflammation. Selective inhibitors of cyclooxygenase-2 have been suggested to spare gastrointestinal prostaglandin synthesis, and therefore lack the ulcerogenic effects associated with standard nonsteroidal antiinflammatory drugs. However, the effects of cyclooxygenase-2 inhibitors on inflamed gastrointestinal mucosa have not been examined. We examined cyclooxygenase-2 mRNA and protein expression before and after induction of colitis in the rat, the contribution of cyclooxygenase-2 to colonic prostaglandin synthesis during colitis and the effects of selective inhibitors of cyclooxygenase-2 on colonic injury in this model. Cyclooxygenase-2 mRNA expression increased three to sixfold during the period 24 h to 1 wk after induction of colitis, with marked increases in cyclooxygenase-2 protein expression in the lamina propria and muscularis of the colon during colitis. Cyclooxygenase-1 expression (mRNA and protein) was not affected by the induction of colitis. The prostaglandins produced during colitis were largely derived from cyclooxygenase-2. Treatment with selective cyclooxygenase-2 inhibitors resulted in exacerbation of colitis, with perforation occurring when the compounds were administered for a week. These studies demonstrate that suppression of cyclooxygenase-2 can result in exacerbation of inflammation-associated colonic injury.

Epidemiological and clinical features of travel-associated cryptosporidiosis.

Data concerning the clinical and epidemiological features of travel-associated cryptosporidiosis are lacking. In order to investigate the impact of this disease on travellers' health, a retrospective study was conducted at the Institute of Tropical Medicine, Berlin. In total, 57 cryptosporidial infections were identified between 2000 and 2004, resulting in a prevalence of 2.9% in patients with travel-associated diarrhoea. Travel to south-central Asia, especially India, was associated with a higher prevalence of infection than was travel to other destinations. Clinically, the disease resembled giardiasis, but fever and arthralgias seemed to occur more frequently.

Bronchogenic carcinoma mimicking metastatic thyroid carcinoma.

We present a case of a false-positive 131I scan in the follow-up of a patient with papillary thyroid carcinoma, which developed 24 yr after radiation therapy for Hodgkin's disease. In the primary evaluation of a neck mass, histology was typical for a papillary thyroid carcinoma and thyroglobulin staining was positive. After total thyroidectomy, 131I uptake was seen in the hilum and right lung. The initial interpretation of these foci as metastatic disease was not supported by the progressive clinical course despite radioiodine treatment. Hence, repeated bronchial brushings and cytology of the pleural effusion were obtained. These specimens were negative in thyroglobulin staining and positive for synoptophysin, a marker for small-cell bronchial carcinoma. Thereby a small to medium cell undifferentiated bronchial carcinoma was demonstrated, which apparently was actively taking up iodine. In conclusion, an atypical clinical course of a suspected metastatic thyroid carcinoma should lead to a reevaluation of the initial diagnosis to prevent an inappropriate therapeutic regimen.

Technetium-99m HM-PAO brain SPECT in epileptic patients before and during unilateral hemispheric anesthesia (Wada test): report of three cases.

The lipophilic brain SPECT agent [99mTc]hexamethyl propylene amine oxime (HM-PAO) was used in three cases before and during unilateral anesthesia of one hemisphere for lateralization of speech dominance (Wada test). This procedure led to a decrease of regional cerebral blood flow (rCBF) in each of the hemispheres to 55 and 90%, respectively. Diminution of rCBF was significantly more pronounced in the dominant hemisphere. A second phenomenon observed during the Wada test was crossed cerebellar diaschisis. These findings support the assumption that HM-PAO allows monitoring of brain perfusion, as rapid changes of rCBF due to decreased neuronal activity cause respective alterations of cerebral and cerebellar uptake of this new brain agent.

A diclofenac derivative without ulcerogenic properties.

In this study, we assessed the effects of addition of a nitroxybutyl moiety to diclofenac on its ulcerogenic properties. The diclofenac derivative, 'nitrofenac', was examined in terms of its ability to induce acute gastric erosions and chronic-type gastric ulcers in rats and rabbits, respectively. The effects of these compounds on prostaglandin synthesis in the stomach and at a site of peripheral inflammation were also assessed, as were their anti-inflammatory properties in a model of acute inflammation. Diclofenac dose-dependently caused acute gastric mucosal injury in the rat at all doses tested (10-40 mg/kg), that was significantly greater in severity than that observed with the same doses of nitrofenac. In rabbits, twice-daily administration of diclofenac induced penetrating antral ulcers and small intestinal damage. No damage was observed in the stomach or small intestine of rabbits receiving nitrofenac. Diclofenac and nitrofenac exerted similar inhibitory effects on prostaglandin E2 synthesis in the stomach and in a carrageenan-sponge model of peripheral inflammation. These compounds exerted similar inhibitory effects on carrageenan-induced paw edema. Nitrofenac, but not diclofenac, caused a significant increase in plasma levels of nitrate/nitrite. These results suggest that the addition of a nitroxybutyl moiety to diclofenac markedly reduces the ulcerogenic properties of this compound without interfering with its ability to inhibit cyclo-oxygenase activity or to reduce acute inflammation.

Severe negative emotional reactions in intracarotid sodium amytal procedures: further evidence for hemispheric asymmetries?

Intracarotid sodium amytal (ISA) procedures are commonly used to determine the lateralization of language and memory functions in presurgical evaluation of epileptic patients. Besides, they provide a means for studying putative hemispheric asymmetries in the organization of emotional behavior. In this study, we report the incidence of negative emotional reactions in eighty epileptic patients undergoing ISA procedures as a part of presurgical evaluation. There were only four such reactions in a total of 159 tests (2.5%), all in right-handed patients with left cerebral dominance for language functions. In one case, emotional outbursts occurred with barbiturization of the nondominant hemisphere. This observation invalidates the hypothesis that a loss of left-hemispheric functions generally leads to negative emotional reactions due to a right hemisphere specialization for the processing of negative emotions. Rather than pointing to fixed hemispheric asymmetries, our findings suggest that severe negative emotional reactions result from a flexible cognitive evaluation of the organism's overall situation.

Markedly reduced intestinal toxicity of a diclofenac derivative.

Addition of a nitroxybutyl moiety to diclofenac greatly reduces its damaging effects on the gastric mucosa without altering its ability to suppress prostaglandin synthesis and exert anti-inflammatory actions. The present study was performed in order to determine if this derivative of diclofenac, called nitrofenac, would also have less toxicity in the small and large intestine when administered repeatedly over a 1-2 week period. Healthy rats were given equimolar doses of diclofenac (10 mg/kg) or nitrofenac (15 mg/kg) twice daily for up to two weeks. All 10 rats receiving diclofenac died prior to completion of the study, exhibiting massive small intestinal ulceration and perforation. No deaths were observed in the rats treated with nitrofenac, and the only small intestinal abnormality observed was diffuse hyperemia. As nonsteroidal anti-inflammatory drugs have been shown to exacerbate colitis, we compared the effects of twice daily treatment with diclofenac (1-10 mg/kg) or nitrofenac (1.5-15 mg/kg) for 1 week in rats in which colitis had been induced with trinitrobenzene sulfonic acid. Diclofenac administration resulted in mortality which increased dose-dependently (e.g. 86% at 5 mg/kg) and was associated with perforation of the colon. Mortality was not observed with nitrofenac at doses of 1.5 or 7.5 mg/kg, while at 15 mg/kg the mortality rate was 33%. None of the doses of nitrofenac significantly augmented colonic injury or granulocyte infiltration (measured by myeloperoxidase activity). Suppression of colonic prostaglandin E2 synthesis was comparable with equimolar doses of diclofenac and nitrofenace. These studies demonstrate that nitrofenac has markedly reduced intestinal toxicity in healthy and colitic rats when compared to diclofenac.

[MR angiography of pelvic veins and the inferior vena cava using 0.5 tesla]. / MR-Angiographie der Beckenvenen und der Vena cava inferior bei 0,5 Tesla.

The pelvic veins and/or the inferior vena cava were examined in 15 patients with pelvic vein thrombosis or retroperitoneal tumours, using phlebography or cavography and MR angiography. The latter was carried out using 0.5 Tesla with an inflow technique TR/TE 30/8 ms, flip angle 70 degrees). 3-D projection angiograms were obtained from the 2-D angiograms in the coronary plane. Image quality was generally satisfactory and the veins up to the internal iliac could be demonstrated in all cases; below this, the examination was unreliable. Comparison of the methods with reference to information of therapeutic relevance has shown that in two-thirds of all examinations (8/13) MR angiography and phlebography were of equal diagnostic value. In the presence of a renal cell carcinoma, MR angiography was unable to distinguish between thrombosis and infiltration of the vena cava.

A profile of the clients of male sex workers in three Australian cities.

OBJECTIVE: This paper describes the profile of clients as reported by 186 male sex workers in three Australian cities. METHOD: The data were collected using a diary which was completed after each commercial sexual encounter with a male client over a two-week period. The data reported in this study are based on reports from 2,088 sex encounters and a profile of 1,776 clients. RESULTS: The findings reveal, for example, that the most common source used for recruiting clients was advertisements, followed by escort agencies, although there were differences between the three cities; the majority of the clients were in their 40s but clients of street workers were younger; clients were most often classified as 'middle class', with differences by source of client recruitment; less than half the clients were identified as being gay and a significant number were identified as bisexual or straight; alcohol and drug use took place in a small percentage of the encounters; most workers had some information about their clients, such as occupation and home number; violence was infrequent; and unsafe sex was requested in a minority of the encounters. CONCLUSION: Overall, the results reveal that clients of male sex workers are a highly heterogeneous group. IMPLICATIONS: The paper highlights a number of issues which can further promote safety and public accountability in male sex work.

Dietary antioxidants protect gut epithelial cells from oxidant-induced apoptosis.

BACKGROUND: The potential of ascorbic acid and two botanical decoctions, green tea and cat's claw, to limit cell death in response to oxidants were evaluated in vitro. METHODS: Cultured human gastric epithelial cells (AGS) or murine small intestinal epithelial cells (IEC-18) were exposed to oxidants - DPPH (3 microM), H2O2 (50 microM), peroxynitrite (300 microM) - followed by incubation for 24 hours, with antioxidants (10 microg/ml) administered as a 1 hour pretreatment. Cell number (MTT assay) and death via apoptosis or necrosis (ELISA, LDH release) was determined. The direct interactions between antioxidants and DPPH (100 microM) or H2O2 (50 microM) were evaluated by spectroscopy. RESULTS: The decoctions did not interact with H2O2, but quenched DPPH although less effectively than vitamin C. In contrast, vitamin C was significantly less effective in protecting human gastric epithelial cells (AGS) from apoptosis induced by DPPH, peroxynitrite and H2O2 (P < 0.001). Green tea and cat's claw were equally protective against peroxynitrite and H2O2, but green tea was more effective than cat's claw in reducing DPPH-induced apoptosis (P < 0.01). Necrotic cell death was marginally evident at these low concentrations of peroxynitrite and H2O2, and was attenuated both by cat's claw and green tea (P < 0.01). In IEC-18 cells, all antioxidants were equally effective as anti-apoptotic agents. CONCLUSIONS: These results indicate that dietary antioxidants can limit epithelial cell death in response to oxidant stress. In the case of green tea and cat's claw, the cytoprotective response exceed their inherent ability to interact with the injurious oxidant, suggestive of actions on intracellular pathways regulating cell death.

Mapping intramuscular tenderness variation in four major muscles of the beef round.

The objective of this study was to quantify intramuscular tenderness variation within four muscles from the beef round: biceps femoris (BF), semitendinosus (ST), semimembranosus (SM), and adductor (AD). At 48 h postmortem, the BF, ST, SM, and AD were dissected from either the left or right side of ten carcasses, vacuum packaged, and aged for an additional 8 d. Each muscle was then frozen and cut into 2.54-cm-thick steaks perpendicular to the long axis of the muscle. Steaks were broiled on electric broilers to an internal temperature of 71 degrees C. Location-specific cores were obtained from each cooked steak, and Warner-Bratzler shear force was evaluated. Definable intramuscular shear force variation (SD = 0.56 kg) was almost twice as large as between-animal shear force variation (SD = 0.29 kg) and 2.8 times as large as between-muscle variation (SD = 0.20 kg). The ranking of muscles from greatest to least definable intramuscular shear force variation was BF, SM, ST, and AD (SD = 1.09, 0.72, 0.29, and 0.15 kg, respectively). The BF had its lowest shear force values at the origin (sirloin end), intermediate shear force values at the insertion, and its highest shear force values in a middle region 7 to 10 cm posterior to the sirloin-round break point (P < 0.05). The BF had lower shear force values toward the ST side than toward the vastus lateralis side (P < 0.05). The ST had its lowest shear force values in a 10-cm region in the middle, and its highest shear force values toward each end (P < 0.05). The SM had its lowest shear force values in the first 10-cm from the ischial end (origin), and its highest shear force values in a 13-cm region at the insertion end (P < 0.05). Generally, shear force was lower toward the superficial (medial) side than toward the deep side of the SM (P < 0.05). There were no intramuscular differences in shear force values within the AD (P > 0.05). These data indicate that definable intramuscular tenderness variation is substantial and could be used to develop alternative fabrication and(or) merchandising methods for beef round muscles.

Evaluating the point of separation, during carcass fabrication, between the beef wholesale rib and the beef wholesale chuck.

This study determined whether there is a logical point of value change, related to either tenderness or consumer acceptance, at which to separate the beef carcass within the rib/chuck region. Rib/chuck rolls (RCR); (n = 30) consisting of the ribeye roll and chuck eye roll subprimals (2nd through 12th rib locations) were cut into 22 steaks each (two steaks per rib location), and Warner-Bratzler shear force and consumer purchase preference were evaluated for steaks at each rib location. Steaks from different locations of the RCR were composed of differing proportions of several muscles: longissimus muscle (LM), spinalis dorsi and multifidus dorsi (SM), and complexus (CO). The LM (4th to 12th rib) contained three tenderness regions: 7th through 12th rib, 5th and 6th ribs, and 4th rib regions (lowest, intermediate, and highest shear force values, respectively; P < 0.01). Shear force differed (P < 0.05) among rib locations for the SM (2nd to 9th rib), but no logical pattern was evident. The CO (2nd to 7th rib) was more tender toward the anterior end (P < 0.05). The region of the RCR represented by the 4th through 6th rib locations had steaks with higher weighted-average shear force (average shear force of each steak, weighted for surface area of each muscle) values than the remainder of the RCR (P < 0.05). Animal-to-animal variation in shear force was 36% greater than rib-to-rib variation in shear force; thus, statistically significant differences in tenderness among rib locations may be undetectable by consumers. Steaks (n = 330) were offered for sale at a retail supermarket and case time was monitored on each steak to determine consumer purchase preference. Steaks from the 2nd through 4th rib locations required more time to sell (P < 0.01) than steaks from the 5th through 12th rib locations. Two alternative locations for the rib/chuck separation point could be between the 6th and 7th ribs, yielding a ribeye subprimal useful in marketing a "premium quality" product, or between the 4th and 5th ribs, which would yield four more 2.5-cm ribeye steaks per carcass.

Increasing tenderness of beef round and sirloin muscles through prerigor skeletal separations.

Crossbred steers (n = 30) were used to explore and compare tenderness improvements in beef round and sirloin muscles resulting from various methods of prerigor skeletal separations. Animals were slaughtered according to industry procedures, and at 60 min postmortem one of six treatments was applied to each side: A) control, B) saw pelvis at the sirloin-round junction, C) separate the pelvic-femur joint, D) saw femur at mid-point, E) combination of B and C, and F) combination of B and D. After 48 h, the following muscles were excised from each side: semimembranosus, biceps femoris, semitendinosus, and adductor from the round; vastus lateralis and rectus femoris from the knuckle; and gluteus medius, biceps femoris and psoas major from the sirloin. Following a 10-d aging period, samples were removed from each muscle to determine the effect of treatment on sarcomere length and Warner-Bratzler shear force. Most skeletal separation treatments resulted in longer sarcomeres than controls for semimembranosus, adductor, semitendinosus, and gluteus medius muscles. All skeletal separation treatments yielded shorter sarcomeres for the psoas major as compared with controls. Warner-Bratzler shear force differed among treatments for rectus femoris, semitendinosus, and psoas major. For rectus femoris, treatments C, D, E, and F resulted in lower (P < 0.05) shear values than for controls. Treatments B, D, and F increased shear force of the semitendinosus relative to controls (P < 0.05) within muscle. Treatment F resulted in higher shear force values for the PM than controls (P < 0.05). Correlations between sarcomere length and shear force were found to be low and quite variable among muscles. In general, treatments increased sarcomere length of several muscles from the sirloin/round region, but had mixed effects on shear force values.

Male sex workers in three Australian cities: socio-demographic and sex work characteristics.

This article describes the socio-demographic and sex work characteristics of sex workers in Sydney, Melbourne, and Brisbane. A total of 185 male sex workers completed the questionnaire component of the study. The results of this study serve to debunk many of the myths surrounding the popular view of the male sex worker (MSW). The respondents in this study were on average 27 years old, and the majority had completed secondary education, with 30% having gained some form of tertiary qualification. Interestingly, those MSWs who had not completed secondary education were mostly street workers and were generally aged under 25 years. The majority of sex workers lived in rented accommodation, with only 6% reporting to be homeless. Half of all respondents identified as being "gay," 31% as "bisexual" and 5.5% as "straight." More than half of the respondents were in a permanent relationship. Only 7.3% of this group reported using heroin daily, although the majority consumed alcohol, tobacco, marijuana, and ecstasy. The majority of sex workers had been in the profession for less than six months, although some had been working in the industry for more than ten years. Most of the sex workers reported having taken an HIV test and a preference to offer safer sex. The article highlights ways in which the work context of MSW can be better understood and supported by education and public policy programs.

[Multimodal imaging exemplified by gluteal abscesses--a case report]. / Multimodale Bildgebung am Beispiel von Glutealabszessen--ein Fallbericht.

The detection of occult abscesses can draw a long chain of diagnostic procedures as the procedures as the presented case documents. Next to conventional X-ray studies and examination by ultrasound scintigraphy is available. Studies of the skeleton by the latter using phosphonates for osteomyelitis or 111-I-labeled neutrophils or 99m-Tc-labeled monoclonal antibodies against neutrophilic surface-antigens for the detection of abscesses in soft tissues are of recent interest. MR-imaging is used for preoperative planning after successful detection.

[A case of apraxia and global aphasia without apraxia for axial body movement]. / Ein Fall von Apraxie und globaler Aphasie bei fehlender Apraxie für Bewegungen der Körperachse.

The case of a right handed 58 year old woman is presented who suffered an ischemic stroke after angiography following a vasospasm in the left internal carotid artery. The neuropsychological examination revealed global aphasia and severe apraxia for movements of the face and the extremities. However, the patient was able to carry out adequately axial movements to imitation and also to verbal command. These particular findings are discussed and explained within the context of the existing literature.