Spinal dementia: Don't miss it, it's treatable.

BACKGROUND & PURPOSE: Around 5% of dementia patients have a treatable cause. To estimate the prevalence of two rare diseases, in which the treatable cause is at the spinal level. METHODS: A radiology information system was searched using the terms CT myelography and the operation and classification system (OPS) code 3-241. The clinical charts of these patients were reviewed to identify patients with a significant cognitive decline. RESULTS: Among 205 patients with spontaneous intracranial hypotension (SIH) and proven CSF leaks we identified five patients with a so-called frontotemporal brain sagging syndrome: Four of those had CSF venous fistulas and significantly improved by occluding them either by surgery or transvenous embolization. Another 11 patients had infratentorial hemosiderosis and hearing problems and ataxia as guiding symptoms. Some cognitive decline was present in at least two of them. Ten patients had ventral dural tears in the thoracic spine and one patient a lateral dural tear at C2/3 respectively. Eight patients showed some improvement after surgery. DISCUSSION: It is mandatory to study the (thoracic) spine in cognitively impaired patients with brain sagging and/ or infratentorial hemosiderosis on MRI. We propose the term spinal dementia to draw attention to this region, which in turn is evaluated with dynamic digital subtraction and CT myelography.

Effect of tibial plateau angle < 5° on ground reaction forces in dogs treated with tibial plateau leveling osteotomy for cranial cruciate ligament rupture up to 6 months postoperatively.

Tibial plateau leveling osteotomy (TPLO) has been commonly performed in dogs with cranial cruciate ligament disease (CCLD) since the introduction by Slocum and Slocum (1993). To reduce cranial tibial thrust the TPLO technique aims for a postoperative tibial plateau angle (TPA) of 5-6.5°. In recent years studies have shown that a postoperative TPA below 5° could be beneficial regarding stifle stability or meniscal load. Dogs with CCLD that were treated with TPLO, were examined preoperatively, six weeks, three and six months postoperatively with gait analysis and grouped according to their postoperative TPA. The aims of study was (1) to evaluate if dogs with a postoperative TPA below 5° would have a faster limb function recovery up to six months postoperatively as measured objectively with ground reaction forces (GRFs) and (2) to determine whether the postoperative TPA correlates with the outcome measurements. Dogs with TPA <5° showed no faster limb function recovery postoperatively up to six months as measured with peak vertical force (PVF) or vertical impulse (VI) (p > 0.05). No correlation for the postoperative TPA <5° on GRFs was demonstrated. But the postoperative TPA showed a significant correlation with the symmetry indices of PVF (SIPVF) and VI (SIVI) for all dogs (>5° and <5° TPA together), indicating that with lower postoperative TPA dogs had a more symmetrical gait in hindlimbs SIPVF (r = 0.144, p < 0.05) and SIVI (r = 0.189, p < 0.01). The study indicates that a lower postoperative TPA could be beneficial regarding hindlimb symmetry indices of GRFs.

Effect of intra-articular platelet-rich plasma or hyaluronic acid on limb function recovery in dogs with TPLO for cranial cruciate ligament rupture: a randomised controlled trial.

OBJECTIVES: This study aimed to investigate the recovery of limb function following a single intra-articular injection of platelet-rich plasma or hyaluronic acid in dogs with cranial cruciate ligament rupture treated with tibial plateau levelling osteotomy compared to dogs receiving no injection intraoperatively. MATERIALS AND METHODS: Sixty-two dogs with cranial cruciate ligament rupture, body weights of 20 to 40 kg, and no other orthopaedic conditions were enrolled in this prospective, randomised, double-blind, controlled study at the small animal clinic at LMU Munich. All dogs underwent tibial plateau levelling osteotomy. Based on random allocation, they received either a single intra-articular injection of platelet-rich plasma, hyaluronic acid or no injection intraoperatively. Gait analysis, clinical examinations, radiography of the stifle joint for osteoarthritis progression and two validated owner questionnaires were compared among groups at three timepoints postoperatively (6 weeks, 3 and 6 months). Limb function was primarily assessed by measuring the ground reaction forces. RESULTS: At all times postoperatively, no differences were observed among groups regarding clinical examinations, osteoarthritis score values, ground reaction forces or owner questionnaires. All dogs showed significant improvement in limb function clinically, in all ground reaction forces and in the validated questionnaires. Osteoarthritis progressed minimally during rechecks in all dogs regardless of the additional injection or not. CLINICAL SIGNIFICANCE: All dogs treated with tibial plateau levelling osteotomy for cranial cruciate ligament rupture showed improvements in limb function. No additive effect on faster recovery was demonstrated with the additional intra-articular injection of platelet-rich plasma or hyaluronic acid. Addition of platelet-rich plasma/hyaluronic acid injections during tibial plateau levelling osteotomy is unnecessary considering the lack of benefit observed up to 6 months postoperatively.

Conebeam CT as an Additional Tool in Digital Subtraction Myelography for the Detection of Spinal Lateral Dural Tears.

Lateral dural tears as a cause spontaneous intracranial hypotension occur in ∼20% of patients. Common imaging modalities for their detection are lateral decubitus digital subtraction myelography or dynamic CT myelography. Reports on the use of conebeam CT are scarce. We show 3 patients in whom the targeted use of conebeam CT during digital subtraction myelography was helpful in confirming the site of the leak.

[IQWiG's methods for the cost-benefit assessment : Comparison with an international reference scenario]. / Wo steht die Kosten-Nutzen-Bewertung des IQWiG : Abgleich mit einem internationalen Referenzszenario?

Standardization of international health economic guidelines has been repeatedly requested. In this context, an international reference case was proposed, which constitutes an agreed approach for the key elements of health economic evaluation including study perspective, comparators, source of effectiveness data, role of modeling, main (economic) outcome, source of utilities, characterizing uncertainty. It is, however, questionable whether such a reference scenario can reasonably be applied across all health care systems. Our analysis pursues the question to which degree the Institute for Quality and Efficiency in Health Care's (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen, IQWiG) "General methods for evaluating the relation between cost and benefit" comply with the key elements of the reference case. In case of divergences, they will be described and discussed in light of the German social legislation and in consideration of current scientific evidence. In conclusion, the analysis revealed that IQWiG complied with the reference case in almost all aspects. Differences were found only with respect to the choice of main (economic) outcome and the source of utilities. These differences seem justified and well explained in the context of the German social legislation as well as in view of the weaknesses of the quality-adjusted life year (QALY) concept.

Volcanic twilights from the fuego eruption.

Striated twilight glows have been observed since 26 November 1974 in New England, indicating the spread of stratospheric dust earlier observed over Arizona. Similar photometric results were obtained from New Mexico and Florida, and twilights in Puerto Rico showed features not hitherto measured. Letters and verbal reports indicate the source to be eruptions of Fuego Volcano in Guatemala between 13 and 23 October 1974.

Anionic- and lipophilic-mediated surface binding inhibitors of human leukocyte elastase.

We report the synthesis of a series of diphenylmethane-based oligomers containing anionic and lipophilic functionalities that are potent inhibitors of human leukocyte elastase (HLE). The enzyme inhibition is regulated by the size of the oligomer, as well as, the number of charges. Lipophilicity is an important element in determining potency and specificity against other basic enzymes. Compounds whose scaffolds contain three phenoxyacetic acid groups and three alkyl ethers are competitive and specific inhibitors of HLE with Ki = 20 nM. The mechanism of action of this class of compounds is believed to involve multidendate interactions with the surface of HLE near the active site which prevents substrate access to the catalytic site.

Depth and Shape of the 0.94-microm Water Vapor Absorption Band for Clear and Cloudy Skies.

Sky radiation near zenith and solar radiation in the rhosigmatau band region were recorded by means of a rotating interference filter (lambda0.98-0.88 microm) and a silicon detector. Although the spectral resolution of the simple spectrometer was not high, the water vapor content of the cloud free atmosphere was obtained with reasonable accuracy. The band depth of the radiation from thin, bright clouds was only slightly greater than that of the cloud free atmosphere, but dense and dark clouds showed deep bands mainly caused by increased path length as a result of multiple scattering. Considerable distortion of the band due to absorption by liquid water is observed in the radiation from very dark and dense clouds, and sometimes during snowfall. Some laboratory measurements are also discussed.

Twilights and stratospheric dust before and after the agung eruption.

Many absolute measurements of twilight sky radiance were made in six spectral ranges from lambda377 nm to lambda970 nm at 20 degrees elevation in the solar vertical, and mostly from sunset to 6 degrees -10 degrees sun depression (sd) in southern Germany, from fall 1962 to summer 1967, and at Bedford, Massachusetts, during winter 1967-1968. A strong change of twilight radiance, especially a large increase in the amplitude of the red/green color ratio between 4.5 degrees (main purple light) and 1 degrees sd, was observed in January 1964 following the explosive eruption of the Agung volcano in March 1963, but twilights were still abnormal and variable in early 1968. Dust mixing profiles of some typical twilight groups were derived, and the volcanic twilights show, as do other optical and direct soundings of the same period, a strong maximum near 20 km. A strong secondary red/green maximum (visually observed as secondary purple light) developed at sun depressions greater than 6 degrees of the volcanic twilights. This seems to have been caused by multiple scattering and not by mesospheric dust. A few twilight observations in 1964 from Australia indicate considerably more volcanic dust in accordance with transmission data, while no stratospheric dust is indicated in Arctic twilights of spring 1966. In order to verify the persistence of abnormal twilight conditions for more than five years, the dependence on red wavelength of the red/green color ratio is investigated, and some earlier twilight measurements are discussed. This persistence may have to be related to even higher amounts of dust in the tropical stratosphere.

Simple method for checking the beam path in reflective Fourier-transform infrared optics.

A simple method is described that yields, in reflective optics as well as in Fourier-transformin frared spectrometers,a beam of bright visible light coincident with the invisible infrared beam so that foci and beam locations can be checked easily.

Measurements of the skylight scattering function.

A small, handheld skylight photometer, incorporated into a sun photometer and capable of measuring sky radiation to within 2 degrees of the sun at lambda 0.50 and 0.93 microm is described. Calibration procedures are discussed; solar measurements in the wideband 0.93-microm channel show the expected influence of water vapor. Formulas to obtain the aerosol scattering function are presented. Samples of measured and theoretical aerosol scattering functions are discussed.

Infrared optical constants of aerosols at some locations.

Spectra of absorption indices and data on gross chemical composition for two size classes of water soluble and dust fractions of high-volume aerosol samples are presented for several locations (mainly Bedford, Massachusetts; Meppen in Germany; Riverside and San Nicolas Island in California and some maritime locations). The absorption data were obtained by the KBr-pressed disk method. It has been found that re-grinding of the pellets increases the absorption by salt samples considerably.

Zenith polarization and color ratio during twilight.

The excellent data of zenith polarization and color ratio (CR) during twilight obtained by Coulson at the Mauna Loa Observatory, Hawaii are subjected to a reinterpretation, especially with regard to the frequent deviations from the clear average. It is shown that a moderate lift of the earth's shadow by distant clouds (or by low level haze) will reduce the red/green CR, while greater lift shifts the CR peak to a smaller solar depression. The effect on zenith polarization at wavelengths >/=0.6 microm is seen to correspond to a slight reduction of overall polarization for a moderate lift, and for a large lift to a shift of the polarization minimum (depolarization by stratospheric aerosol) from 4 degrees solar depression angle to 2 degrees . A generally high level of polarization, but with a barely noticeable 4 degrees minimum, had also been observed earlier in Germany by Steinhorst when the stratospheric aerosol load was very small. The difference is explained by a higher and stronger aerosol layer in the tropics combined with a higher and cleaner troposphere.

Infrared optical constants of ammonium sulfate, sahara dust, volcanic pumice, and flyash.

Spectra of the real and imaginary parts of the refractive index m = n ' - in from 2.5 microm to 40 microm of ammonium sulfate, Sahara dust (as collected at Barbados), volcanic dust (pumice), and dust from a coalfired power plant are presented. With a peak absorption index n = 1.0 at 10 microm Sahara dust turns out to be the strongest absorber in the atmospheric window. The dispersion of n' is also very pronounced near 9 microm and 20 microm. Volcanic and coal-fire dust also absorb in the window region stronger than most of our earlier-investigated more normal aerosol fractions. The data for ammonium sulfate are compared with Remsberg's measurements on an aqueous solution.

Scattering functions near the Sun by large aerosols.

In the course of a lengthy series of observations since 1975, a large, continuous decrease of the brightness of the solar aureole has been found west of Boston, at Hanscom Air Force Base and at Lexington, Mass. This points to the virtual disappearance from the lower atmosphere of giant particles larger than ~ 10 microm. in size while total suspended particulates in Boston and other U.S. cities have barely decreased. Results of calculations to better understand the relation between forward scattering and aerosol mass distribution [coarse fraction (CF)] are presented. In addition, a method to modify steep scattering functions calculated for a plane-wave source (Sun treated as a star) to those of the actual (and limb-darkened) Sun is presented. The calculated wavelength dependence of extinction, which is lower than that observed, is found to be little affected by the CF, but seems, like forward scattering, to be sensitive to mass distribution of sizes of < 0.4 and ~ 0.6 microm because of the anomal scattering behavior of spheres.

Infrared refractive index of atmospheric aerosol substances.

The optical constants in the ir from lambda2.5 microm to 40 microm (4000-250 cm(-1)) of dry natural aerosol substances and of sea salt are presented. The aerosol substances were obtained from rain and snow water: dust and soot by sedimentation, and water soluble salts by evaporation. The spectra of the absorption index n' were derived from our published transmittance measurements of potassium bromide disks. The real part n of the refractive index was calculated from the specular reflectance at near normal incidence of disks of pure aerosol substance. The observed spectral features are being related to chemical constituents, notably sulfates and alcohol soluble organics. Optical constants of composite and wet aerosol are discussed. A simple model confirms the measured transmission of a coarse dry powder of water solubles and shows that the extinction by natural aerosol should have a minimum near 8 microm and a strong maximum near 9 microm.

Skylight and aerosol in Thailand during the dry winter season.

Solar and skylight measurements were made in southern Thailand from late February to early April of 1969. The aerosol optical density (basis 10) was rather large, ranging from 0.07 to 0.28 at lambda0.5 microm and varied with about lambda(-2) in the range 0.5 < lambda < 1.6 microm. The skylight scattering phase function was relatively flat and showed little spectral dependence. The log aerosol size distribution seems close to r(-4). The origin of the turbid low level air from the South China Sea and Philippine Sea poses the question of the nature of the aerosol.

Benzofuran based PDE4 inhibitors.

Replacement of the 3,4-dialkoxyphenyl substructure common to a number of PDE4 inhibitors with a 2-alkyl-7-methoxybenzofuran unit is described. This substitution can result in either enhancement or substantial reductions in PDE4 inhibitory activity depending on the system to which it is applied. An in vitro SAR study of a potent series of 4-(2-heteroaryl-ethyl)-benzoiurans 26 is also presented.