Diagnostic value of cerebrospinal fluid CXCL13 for acute Lyme neuroborreliosis. A systematic review and meta-analysis.

OBJECTIVES: The utility of cerebrospinal fluid (CSF) CXCL13 for diagnosis of acute Lyme neuroborreliosis (LNB) has been debated and the test is not yet routinely performed. This study's aim was to evaluate its overall diagnostic accuracy through meta-analysis. METHODS: Electronic searches in PubMed MEDLINE and Web of Science were performed to identify relevant articles published before January 2018. A summary receiver operating characteristic curve and an optimal cut-off were estimated modelling multiple cut-offs. Publication bias was evaluated using a funnel plot and the associated regression test. RESULTS: A total of 18 studies involving 618 individuals with acute LNB and 2326 individuals with other neurological disorders meeting the eligibility criteria were identified. The pooled sensitivity for CSF CXCL13 was 89% (95% CI 85%-93%) and the pooled specificity was 96% (95% CI 92%-98%), using the identified optimal cut-off value of 162 pg/mL. There was marked heterogeneity between studies, caused by differences in the designs of the study populations and age distribution. The optimal cut-off in the seven studies with a cross-sectional design was 91 pg/mL (sensitivity 96%, 95% CI 92%-98%; specificity 94%, 95% CI 86%-97%) and in the 11 case-control studies it was 164 pg/mL (sensitivity 85%, 95% CI 78%-91%; specificity 95%, 95% CI 90%-98%). CSF CXCL13 values above the optimal cut-off level (determined in this meta-analysis) were also detectable in some other central nervous system disorders, namely neurosyphilis and central nervous system lymphoma. CONCLUSIONS: Our meta-analysis shows that CSF CXCL13 has the potential to become a useful adjunct in the diagnosis of acute LNB.

The safety of paediatric dentistry procedures under general anaesthesia. A five-year experience of a tertiary care center.

AIM: Frequently general anaesthesia (GA) is used to treat noncompliant children. Especially in children with morbid diseases general anaesthesia can be a challenging procedure for anaesthetists. The aim of this paper was to evaluate the risks and adverse reactions with a special focus on the impact of existing medication conditions and syndromes. MATERIALS AND METHODS: and methods Records of children up to 10 years of age, who were admitted for paediatric dentistry procedures under GA from January 2011 to December 2016 at the University Hospital of the University of Aachen (Germany), were reviewed. A special attention was paid to the intra- and perioperative critical adverse reactions and concomitant systemic conditions and their impact on treatment outcome. RESULTS: Two hundred and twenty patients were admitted for dental restorations. Critical adverse reactions occurred in 4% of the treated patients and they were statistically significantly (p=0.004) related to the ASA classification above II. The use of a laryngeal mask airway was significantly associated (p<0.001) with a shorter duration of surgery. Most common concomitant medical conditions were congenital heart disease, mental retardation and inherited syndromes. CONCLUSION: Although the administration of general anaesthesia in infants and children can be regarded as a safe procedure, clinically significant adverse reactions can occur, especially in patients with an existing medical condition.

Clinical and neuroradiological differences of paediatric acute disseminating encephalomyelitis with and without antibodies to the myelin oligodendrocyte glycoprotein.

BACKGROUND: Myelin oligodendrocyte glycoprotein (MOG) antibodies have been recently described in children with acute disseminating encephalomyelitis (ADEM), but the clinical and neuroradiological characterisation of this subgroup is lacking. OBJECTIVE: To compare the clinical and neuroradiological features of paediatric ADEM with and without MOG antibodies. METHODS: Clinical course, cerebrospinal fluid (CSF)-, MRI studies, outcome and MOG status of 33 paediatric ADEM prospectively studied were reviewed. RESULTS: MOG antibodies (median 1:2560; range 1:160-1:20 480) were detected in 19 children with ADEM. The majority of children showed a decline of serum MOG-IgG titres over time. Children with MOG antibodies did not differ in their age at presentation, sex ratio, the presence of oligoclonal bands, clinical symptoms or initial severity, apart from a higher CSF cell count (p=0.038), compared with children without MOG antibodies. In addition, further relapsing demyelinating episodes associated with MOG antibodies were observed only in children with MOG antibodies. All 19 children with MOG antibodies had a uniform MRI pattern, characterised by large, hazy and bilateral lesions and the absence of atypical MRI features (eg, mainly small lesions, well-defined lesions), which was significantly different compared to that of children without MOG antibodies (p=0.003; and p=0.032, respectively). In addition, children with MOG antibodies had involvement of more anatomical areas (p=0.035) including the myelon characterised by a longitudinally extensive transverse myelitis (p=0.003), more often a complete resolution of lesions (p=0.036) and a better outcome (p=0.038). CONCLUSIONS: Patients with ADEM with MOG antibodies in our cohort had a uniform MRI characterised by large, bilateral and widespread lesions with an increased frequency of longitudinal extensive transverse myelitis and a favourable clinical outcome in contrast to children lacking MOG antibodies.

[CXCL13: a biomarker for acute Lyme neuroborreliosis: investigation of the predictive value in the clinical routine]. / CXCL13 als Biomarker der akuten Neuroborreliose : Überprüfung des prädiktiven Wertes in der klinischen Routine.

BACKGROUND: The level of CXCL13 is a cerebrospinal fluid (CSF) biomarker for acute Lyme neuroborreliosis (LNB) with a high sensitivity. As the concentration rapidly declines during antibiotic therapy CXCL13 can also be used as a follow-up parameter. However, CXCL13 is not yet in use as a routine parameter due to concerns about the specificity. OBJECTIVES: The sensitivity, specificity and predictive value of CXCL13 in the clinical routine work-up of suspected LNB was analyzed. MATERIAL AND METHODS: Since July 2010 the CSF of all patients (n = 204) with suspected acute LNB was not only analyzed for the routine parameters (i.e. pleocytosis and intrathecal production of Borrelia-specific antibodies, AI) but also for CXCL13. In cases of incongruent findings, a follow-up puncture after antibiotic therapy was carried out. The cut-off level for acute LNB was set at 250 pg/ml. RESULTS: This study included 179 patients who were not pretreated with antibiotics. Of these patients 15 suffered from definite LNB, 3 had a probable LNB and all had a CXCL13 value above the cut-off level. Only 2 of the 161 patients with a non-LNB diagnosis (both with a lymphoma) had a CXCL13 value in the CSF higher than 250 pg/ml. Especially noteworthy were two patients without pleocytosis in the CSF but with CXCL13 levels above the cut-off level in whom LNB could be confirmed in the follow-up CSF analysis. CONCLUSIONS: The biomarker CXCL13 has a higher sensitivity (100 % vs. 87 %) with a specificity (99 %) comparable with the established diagnostic markers for LNB, e.g. CSF pleocytosis and Borrelia-AI in the investigated patient population. The negative predictive value of CXCL13 is 100 %. Therefore, a normal CXCL13 level virtually excludes LNB. In the clinical routine CXCL13 is a valuable and practical diagnostic marker for LNB and can even detect an acute LNB in patients without CSF pleocytosis.

Generation of coherent 19- and 38-nm radiation at a free-electron laser directly seeded at 38 nm.

Initiating the gain process in a free-electron laser (FEL) from an external highly coherent source of radiation is a promising way to improve the pulse properties such as temporal coherence and synchronization performance in time-resolved pump-probe experiments at FEL facilities, but this so-called "seeding" suffers from the lack of adequate sources at short wavelengths. We report on the first successful seeding at a wavelength as short as 38.2 nm, resulting in GW-level, coherent FEL radiation pulses at this wavelength as well as significant second harmonic emission at 19.1 nm. The external seed pulses are about 1 order of magnitude shorter compared to previous experiments allowing an ultimate time resolution for the investigation of dynamic processes enabling breakthroughs in ultrafast science with FELs. The seeding pulse is the 21st harmonic of an 800-nm, 15-fs (rms) laser pulse generated in an argon medium. Methods for finding the overlap of seed pulses with electron bunches in spatial, longitudinal, and spectral dimensions are discussed and results are presented. The experiment was conducted at FLASH, the FEL user facility at DESY in Hamburg, Germany.

[The current value of percutaneous transhepatic biliary drainage]. / Gegenwärtiger Stellenwert der perkutanen transhepatischen Cholangiodrainage.

Percutaneous transhepatic biliary drainage (PTBD) is a well established method in the treatment of obstructive jaundice. Major indications are malignant diseases. PTBD may be necessary preoperatively in cases with severe jaundice or cholangitis or as part of palliative treatment concepts. In the past, it has been proposed that a period of preoperative PTBD may improve the morbidity rates of surgery. Various studies could not prove this theory. The significance of preoperative PTBD has changed, as observed during a 15 years period in our own institution, the indications for preoperative PTBD have decreased by half. At present, the majority of treatments with PTBD are palliative (almost 70 % of all procedures). The diagnostic opportunities of the transhepatic approach (intraductal sonography, cholangioscopy, biopsy) are exploited only in few selected cases. Since the radiological approach ist considered to be invasive and related to serious complications most patients are being referred to endoscopic drainage first. Radiologists are consulted in complicated cases of jaundice and when endoscopic approaches have failed. The retrospective evaluation of more than 1000 procedures over a period of 16 years demonstrates good results with a low rate of serious complications. During the two observed periods of nine and seven years, respectively, there occurred complications like sepsis in 1.9 %/0.5 %, peritonitis in 0.5 %/0.7 %, severe bleeding in 0.5 %/1.5 %, procedure-related death in 0.8 %/0.7 %. The overall rate of serious complications was 5 %/3.4 %. These results are comparable to those of the endoscopic approach with a complication rate of 3.6-14 % and a mortality rate of 0.5 %.

[Spontaneous perimesencephalic subarachnoid hemorrhage (PMH). A disease category with good prognosis?]. / Die spontane perimesenzephale Subarachnoidalblutung (PMH). Eine eigene Krankheitsentität mit guter Prognose?

Perimesencephalic subarachnoidal haemorrhage (PMH) is characterized by a typical blood distribution pattern in the basal cysterns in the CAT, missing evidence of an aneurysm in the panangiogram, a mild clinical course and a very positive prognosis. Between 1990 and 1995, 108 inpatients with non-traumatic subarachnoidal haemorrhage were treated in our clinic. Within this group 14 patients (13%) were identified retrospectively with a perimesencephalic haemorrhage distribution pattern in the CAT and a negative panangiogram. These patients experienced a mild clinical course with excellent outcome without rebleeding during the observation period of 2 to 50 months. All patients were fully able to work, and only two patients complained of frequent headaches. The mild clinical course, the negative panangiogram as well as the extremely positive outcome confirm the hypothesis of of a benign subgroup of non-traumatic subarachnoidal haemorrhages.

ERK6, a mitogen-activated protein kinase involved in C2C12 myoblast differentiation.

ERK6, a mitogen-activated protein (MAP) kinase-related serine/threonine kinase, is highly expressed in human skeletal muscle and appears to function as a signal transducer during differentiation of myoblasts to myotubes. In transfected 293 cells, activation of the 45-kDa enzyme results in tyrosine-phosphorylated 46- and 56-kDa forms, which phosphorylate myelin basic protein. Overexpression of wild-type ERK6 or the inactive mutant Y185F has no effect on fibroblast and myoblast proliferation, but it enhances or inhibits C2C12 cell differentiation to myotubes, respectively. Our findings suggest ERK6 to be a tissue-specific, differentiation signal-transducing factor that is connected to phosphotyrosine-mediated signaling pathways distinct from those activating other members of the MAP kinase family such as LRK1 and ERK2.

Intraoperative esophageal manometry and fundoplications: prospective study.

The purpose of this study was to validate the use of intraoperative manometry for assessing fundoplication and to search for predictive manometric criteria. This prospective study concerned 48 patients operated for gastroesophageal reflux. The manometry was carried out pre- and intraoperatively for all patients and postoperatively as well for 30 patients. The operative procedures were total fundoplication (n = 25) and posterior (partial) fundoplication (n = 5). The lower esophageal sphincter (LES) pressures and lengths were similar in the preoperative and intraoperative measurements before any esophageal mobilization, whereas the intraoperative LES pressure was significantly higher after fundoplication. The mean postoperative LES pressure decreased by 50 +/- 19% compared with the intraoperative pressure after fundoplication. The final intraoperative pressures of two dysphagic patients were not the highest of the study. More importantly, their final intraoperative pressures were 7.5 and 8.2 times the initial pressure, respectively, which was significantly greater than the intraoperative pressure increase of the nondysphagic patients (4.6 +/- 2.0 times). The final intraoperative pressure of the only patient with recurrence (18.2 mmHg) was the lowest of the study. In conclusion, intraoperative manometry is an effective method for evaluating the LES, and it could have predictive value for the surgical management of gastroesophageal reflux disease.

Laparoscopic cholecystectomy: an original three-trocar technique.

At present, laparoscopic cholecystectomy is the treatment of choice for gallbladder stones. The operating technique reported by most authors includes the use of four trocars. We report a group of 710 consecutive patients treated by an original three-trocar technique. The use of the fourth trocar was necessary in only 55 cases (8%). However, among 56 cases of acute cholecystitis the use of the fourth trocar was necessary in 14 cases (25%) (p < 0.01). Twenty-six laparoscopies were converted to open procedures (3.6%). Four common bile duct injuries were observed (0.5%): two of them among the 655 operations with three trocars (0.3%) and two after application of the fourth trocar at the beginning of the procedure because of dissection difficulties. Our results are similar to those using the "classic" four-trocar technique. Moreover, this technique is less expensive and allows one less scar.

[Heller's myotomy by laparoscopic approach for megaesophagus]. / La myotomie de Heller par voie coelioscopique pour mégaoesophage.

The development of laparoscopic surgery has allowed the indications of this technique to be extended to the management of achalasia. Four patients were operated for achalasia confirmed by esophageal manometry. The procedure consisted of laparoscopic Heller's myotomy. The purpose of this paper is to detail the technical principles of this procedure and to evaluate its feasibility. There were no intra-operative incident and no conversion to open procedure. The postoperative course was uneventful in every case. The mean postoperative stay was 5 days. The postoperative manometry (n = 3), performed an average of 14.5 months after the operation, showed a normal lower esophageal sphincter pressure in all cases. Only one patient complained of intermittent dysphagia without food restriction and with normal postoperative manometry. The feasibility of laparoscopic Heller's myotomy is therefore obvious. Consequently, this procedure could replace repeated balloon dilatations in the management of achalasia.

Prospective analysis of 40 initial laparoscopic colorectal resections: a plea for a randomized trial.

The experience reported herein is on our initial 40 cases of laparoscopic-assisted (LA) colorectal resection that were prospectively evaluated. The operations were performed for colonic tumors of the right segment (n = 4), sigmoid (n = 11), or rectum (n = 7), diverticular disease (n = 17), and chronic constipation (n = 1). Among 22 tumors, 11 were malignant. The operative procedures were 4 right hemicolectomies, 28 segmental left colectomies, 5 anterior resections, 2 abdominoperineal resections, and 1 total colectomy. Thirty-one patients (77.5%) had a successfully completed LA resection. The reasons for conversion in the majority of the cases (66.6%) were difficulties in dissection. In the entirely LA procedures, the mean flatus postoperative day was 3, the mean postoperative hospitalization was 10.7 days, and there were 8 complications (25%) in 7 patients. Two patients were reoperated 2 and 3 months later for adhesion and ischemic stenosis of the colon above the anastomosis. There was 1 death in the LA group (3.2%). The length of operative specimen was 19.6 cm, and the mean number of resected lymph node was six. In contrast to laparoscopic biliary surgery, the benefits of LA colorectal surgery are not obvious. A randomized trial comparing LA and open colorectal resection must be carried out.

Laparoscopic-assisted perineal rectosigmoidectomy with pullthrough.

We report for the first time the treatment of an early rectal cancer by laparoscopically assisted rectosigmoidectomy with pullthrough. The low colorectal anastomosis was constructed using a double-stapling technique. We believe that this procedure might offer a promising new option for the treatment of midrectal cancer with sphincter saving. Further investigation is recommended.

Acrosyndactyly with epidermoid inclusion cysts: evidence for the extrinsic theory.

A case of acrosyndactyly was treated with routine syndactyly release and full-thickness skin grafts. Two epidermoid inclusion cysts were found within the syndactylyzed index and middle fingers. This association is discussed along with the mechanism that best explains this unusual occurrence.

Variability in radiographic measurement of bowleg deformity in children.

The tibial metaphyseal-diaphyseal (MD) and tibial-femoral (TF) angles were measured on the radiographs of 33 knees in young children (aged 12-36 months) with bowleg deformity. Four observers of differing experience measured the films in a blinded fashion to determine the intraobserver and interobserver variability of these measurements. The clinical implications of these variabilities are described. Very little instruction and experience is necessary to make these measurements correctly and precisely. Measurement of the MD angle was superior to measurement of the TF angle. Contrary to published opinion, rotation can have a small but potentially significant effect on the measured MD angle.

Reversal of multi-drug resistance in human KB cell lines by structural analogs of verapamil.

Several structural analogs of verapamil were studied for their ability to reverse multi-drug resistance (MDR) in human KB cell lines. D595, D792 and verapamil completely reversed resistance to colchicine and adriamycin. D595 and D792 had a higher reversing potency than verapamil. Devapamil, gallopamil, emopamil and D528 partially reversed MDR. The reversing potency of a drug did not correlate with its calcium antagonistic activity. No differences in reversing potency between (R)-isomers, (L)-isomers and the racemic forms were observed in the case of both verapamil and emopamil. (R)-verapamil, which has less calcium antagonistic activity and less in vivo toxicity than racemic verapamil, and D792, which has higher reversing potency and less in vivo toxicity than racemic verapamil, should be suitable for clinical applications to overcome drug resistance in cancer patients.

[Hepatitis contagiosa canis (H.c.c.)--2 cases in Austria]. / Hepatitis contagiosa canis (H.c.c.)--2 Fälle in Osterreich.

Two cases of H.c.c. which occurred in winter 1987 in Vienna are described. Case one was a female Chow-Chow, 8 weeks of age, that died from the peracute form of the disease. The diagnosis was confirmed by histology and direct immunofluorescence. Case two, a 9-month old female Kuvacz, showed clinical signs of the subacute form of H.c.c. She was hospitalized and therapy was successful. The disease was diagnosed by the typical clinical signs and the raise of antibodies in paired serum samples. Etiology, clinical signs and immunology of H.c.c. are discussed.

Expression of a multidrug resistance gene in blast crisis of chronic myelogenous leukemia.

Three of four patients with chronic myelogenous leukemia in blast crisis were found to express the multidrug resistance (MDR1) gene in their blast cells. Expression of the MDR1 gene may contribute to the poor response of these patients to chemotherapy.

Cerebral tumors induced by transplacental ENU: study of the different tumoral stages, particularly of early proliferations.

Experimental cerebral tumors have been induced by transplacental ENU. A systematic diachronic study of the brains has been performed starting from the 15th day of extrauterine life. The tumoral lesions firstly appear as "early stage proliferations" or oligodendroglial foci and develop as glial micro- and macrotumors or as isomorphic and polymorphic oligodendrogliomas respectively. Neurinomas appear later than glial tumors. The duration of the different lesions is sketched out. The usefulness of the model for chemotherapy studies is discussed.