[Transpupillary thermotherapy (TTT) for uveal melanomas. Long term results of a single TTT with an adapter for a conventional infrared laser]. / Transpupillare Thermotherapie (TTT) von Aderhautmelanomen. Langzeitergebnisse einer alleinigen TTT mit einem Adapter für einen konventionellen Infrarotlaser.

BACKGROUND: An increasing number of orbital recurrences after TTT have been reported; the aim of our paper was to present our long-term results after a maximum follow-up of 8 years and 2 months. PATIENTS AND METHOD: Among 18 eyes, 10 tumors were classified as small, and 8 as medium sized (with a maximum prominence of 5.6 mm): 5 melanomas had a juxtapapillary location, 6 a macular (or juxtamacular) location, and 7 were located in the midperiphery of the fundus. RESULTS: After a median follow-up of 7 years in seven tumors a complete regression (scar formation) could be achieved, and in six a partial regression (with a maximum residual prominence of 2.9 mm) could be seen. In three patients a recurrence was treated either by another TTT or a Ruthenium-106 plaque; in another two recurrences, enucleation had to be performed. In none of the cases has an orbital recurrence occurred so far. CONCLUSION: To prevent recurrences, adequate technique and appropriate selection of patients are mandatory in our opinion (no tumors higher than 3 mm). The higher the tumor prominence, the greater the chance of recurrences. Amelanotic melanomas and macular melanomas seem to respond poorly to thermotherapy.

Effect of electrical stimulation-induced cycling on bone mineral density in spinal cord-injured patients.

BACKGROUND: Bone atrophy in spinal cord-injured people (SCI) is, among other factors, caused by immobilization and is initiated shortly after the injury. The present study measured the effect of an functional electrical stimulation (FES)-cycling intervention on bone mineral density (BMD) of the tibia in recently injured SCI people. METHODS: As soon as possible after the injury (mean 4.5 weeks), para- and tetraplegic patients were recruited into an intervention and control group comparable with regard to gender, age, and lesion level. The intervention consisted of 30-min functional electrical stimulation-cycling three times a week for the duration of their primary rehabilitation (mean = 6 months). Computed tomography (CT) scans of the right tibia diaphysis were taken at the beginning and at the end of the intervention. Bone mineral density of cortical bone was calculated from the CT scans. RESULTS: A total of 38 subjects (19 in each group) were included in the study. Both groups showed a reduction in tibial cortical BMD of 0-10% of initial values within 3-10 months. The mean decrease in BMD was 0.3% (+/- 0.6) per month in the intervention group and 0.7% (+/- 0.8) in the control group. This difference did not reach statistical significance. Decrease of BMD was linearly correlated to initial BMD and age in the pooled data of both groups; subjects who had a high initial BMD and/or were older lost more bone. In neither group was bone loss associated with duration of immobilization nor lesion level. CONCLUSIONS: Functional electrical stimulation-cycling applied shortly after SCI did not significantly attenuate bone loss.

[Psychological aspects of bariatric surgery]. / Psychologische Aspekte in der Adipositaschirurgie.

Experience with gastro-restrictive obesity showed the necessity of detailed research in three main tasks: 1. characteristics of morbidly obese people 2. psychological effects of surgery 3. interaction of these characteristics and effects of surgery. We carried out 7 studies with a total of 650 participants. Clinical interviews and tests measuring personality, eating behaviour, self esteem, addiction factors and quality of life were performed. Morbidly obese differ significantly from normal weight people with the exception of most personality scales. Effects of surgery can be summarized that patients learn to avoid overeating but they do not learn to nourish on healthy solid nutrition and they do not learn to exercise more than before. By paradox learning process 30-50 % of gastric banding patients establish vomiting behaviour or eating pulp and sweets. These who show low self esteem, high addiction score and high disinhibition behaviour are more at risk. Different psychological, nutritional as well as physiotherapeutic interventions are needed to help these patients.

[Prevalence and risk factors in the population of Graz (Austrian Stroke Prevention Study)]. / Prävalenz von Risikofaktoren in der Grazer Bevölkerung (Austrian Stroke Prevention Study).

The Austrian Stroke Prevention Study recruited 1960 randomly selected subjects aged 50 to 75 years during a 3-year period of enrollment. The response rate of the study was 32.4%. A telephone interview with 200 randomly selected non-responders yielded no differences to responders regarding the frequency of major vascular risk factors known to the subjects. Besides demographics, the study assessed arterial hypertension, diabetes mellitus, cardiac disease, smoking, a complete lipid status including the apolipoprotein-E genotype, serum fibrinogen and anticardiolipin antibodies as well as various natural antioxidants such as vitamins A, C, E and beta-carotene. Arterial hypertension, diabetes mellitus, cardiac disease and hypercholesterolemia > 200 mg/dl were strikingly common and occurred in 38%, 7.6%, 32% and 76%, respectively. Suboptimal plasma concentrations of vitamin A, E, and beta-carotene were noted in 77.2%, 56.1% and in 53.2% of study participants. The rate of treatment of major risk factors known to the subjects prior to study entry were 60.3% and 70% for arterial hypertension and diabetes mellitus, but only 37.1% and 6.3% for cardiac disease and hypercholesterolemia > 250 mg/dl. Diet was commonly used to treat diabetes but was almost neglected in the treatment of other vascular risk factors. These data provide an orientation on the prevalence of risk factors and the use of primary preventive measures for stroke treatment in our community.

Regulation of CD95 (APO-1) expression and the induction of apoptosis in human T cells: changes in old age.

CD95 (APO-1) is a member of the TNF/nerve growth factor receptor superfamily, which is expressed on the surface of different types of cells. Cross-linking of CD95 leads to the induction of apoptosis. This may be of importance in many physiological systems, but seems to play a special role for the maintenance of immunological homeostasis. In view of the known decline of immune function in old age it seemed of interest to study the expression and inducibility of CD95 in peripheral blood T lymphocytes from young and old healthy subjects selected according to the guidelines laid down in the Senieur protocol of the European Community's Concerted Action Programme on Aging. Resting T cells did not express CD95. T cell activation by anti-CD3 monoclonal antibody (OKT3) did, however, lead to a rapid increase in the number of CD95 expressing cells. This increase was slower and less pronounced in old healthy subjects than in young ones. The activation-induced increase in CD95 expression was followed by a decrease, which was observed in both age groups, but was less pronounced in old subjects. Under long-term culture conditions T cell lines derived from both young and old individuals progressively lost the capacity to decrease the expression of CD95 at the end of their activation cycle and an increasing susceptibility to activation-driven programmed cell death was noted. The latter change was more pronounced in T cell lines derived from aged donors. The results suggest that a lowered sensitivity in the regulation of CD95 as well as an increased susceptibility to apoptosis-inducing mechanisms during clonal expansion are features of T cell senescence.

Hyperthermia inhibits proliferation and stimulates the expression of differentiation markers in cultured thyroid carcinoma cells.

In the last two decades hyperthermia has increasingly been used as adjuvant therapy for the treatment of malignant tumours. The effects of heat were therefore analysed on cultured thyroid epithelial cells from patients with thyroid cancer and from non-malignant control thyroids. Purified thyroid cells were subjected to heat treatment (42.5 degrees C; 90 min). After 24 h [3H]thymidine incorporation was assessed and the expression of heat shock protein 72 (hsp72), thyroglobulin, CD54 (ICAM-I) and MHC class-Il were analysed by immunofluorescence staining. Additionally mRNA analysis was performed by Northern blotting. Whereas hyperthermia inhibited the proliferation of thyroid cells, it significantly increased the expression of hsp72, thyroglobulin, CD54 and HLA-DR (P < 0.05). Our results suggest that hyperthermia may suppress growth while supporting differentiation and immune recognition in thyroid cancer. It may therefore be beneficial as a treatment for patients with thyroid carcinoma.

Assessment of cerebrovascular risk profiles in healthy persons: definition of research goals and the Austrian Stroke Prevention Study (ASPS).

The advent of new laboratory methods and noninvasive imaging modalities has extended the diagnostic possibilities in normal individuals. This article elaborates the new options for the assessment of stroke risk offered by these techniques. In this context we present the Austrian Stroke Prevention Study, which is the first prospective long-term investigation of normals that includes Doppler sonography, magnetic resonance imaging and single photon emission computed tomography. The design, utility and limitations of this study are discussed.

White matter lesions on magnetic resonance imaging in a healthy elderly population: Correlations to vascular risk factors and carotid atherosclerosis.

We performed magnetic resonance imaging (MRI) and extensive risk factor evaluation on 196 randomly selected, clinically asymptomatic participants of the Austrian Stroke Prevention Study to determine the clinical correlates of MRI white matter lesions (WML) in normals. WML were present in 103 (52.6%) individuals. There were 69 (35.2%) subjects with Grade 1 (punctate), 26 (13.3%) with Grade 2 (beginning confluent), and 8 (4.1%) with Grade 3 (confluent) WML Multivariate stepwise forward regression analysis created a model of independent predictors of the WML score including arterial hypertension (p = 0.001) and age (p = 0.04). Only 24.7% of WML score variance could be explained by the two variables, however. No other demographic or clinical factors, such as cardiac disease, diabetes mellitus, smoking, lipid status, serum fibrinogen, hematocrit, antiphospholipid antibody titer, or ultrasound results of the carotid arteries entered the model. These data imply the presence of yet undetermined factors in the pathogenesis of WML, probably independent of those known to be associated with atherothrombotic brain infarction.

First experiences with the heparin-induced extracorporeal low-density lipoprotein precipitation in the treatment of critical limb ischaemia: a new therapeutical approach?

The heparin-induced extracorporeal low-density lipoprotein (LDL) precipitation (HELP) system is based on the fact that besides lipoproteins even fibrinogen, which seems to be a very important factor in pathogenesis of peripheral arterial disease, is precipitated by high-dose heparin at acid pH values. The elimination of excess fibrinogen and lipoproteins, in particular LDL, leads to a markedly improved microcirculation. The restoration of the latter obviously enabled us to perform limb-saving surgical procedures instead of mutilating amputations. 12 patients suffering from peripheral arterial disease were submitted to 18 HELP treatments in each case instead of having their critically ischaemic legs removed. Surgery could be limited to necrosectomy only and the wounds were either primarily sutured or covered with skin grafts. We were able to avoid 13 amputations in these 12 patients who could finally walk out of the hospital. HELP treatment was free of side effects in all of them.

Brain magnetic resonance imaging in coronary artery bypass grafts: a pre- and postoperative assessment.

We undertook a study to determine (1) the frequency and prognostic significance of preexisting MRI brain abnormalities in patients undergoing coronary artery bypass grafts (CABG) and (2) whether MRI can detect surgery-related brain damage in 31 neurologically asymptomatic CABG patients (mean age, 61.0 +/- 6.6 years). MRIs were performed within 7 days before and 8 to 17 days after surgery. When we compared the preoperative images with those of 31 age- and risk factor-matched neurologically asymptomatic controls free of cardiac disease (mean age, 60.3 +/- 6.1 years), higher rates of thromboembolic infarcts (16% versus 0%), lacunes (58.1% versus 32.3%), and brainstem lesions (22.6% versus 3.8%) were noted. Subjective rating demonstrated significantly larger ventricles in patients than in controls (p = 0.002). CABG candidates also had significantly increased ventricular-to-intracranial cavity ratios (VICR) as determined by semiquantitative volumetric measurements (6.9 +/- 2.5% versus 4.9 +/- 1.6%; p = 0.0004). Eleven patients had postsurgical complications, with eight having symptoms consistent with diffuse encephalopathy. The only MRI finding that separated encephalopathic from complication-free patients was ventricular size (VICR 9.0 +/- 2.5% versus 4.9 +/- 1.6%; p = 0.006). This difference remained statistically significant after adjustment for the effects of age (p = 0.04). Postoperative MRI consistently failed to demonstrate surgery-related brain damage responsible for the encephalopathy.

Cerebrovascular risk factors in an elderly Austrian population: first year results of the Austrian Stroke Prevention Study (ASPS).

During the first year the Austrian Stroke Prevention Study enrolled 599 volunteers without clinical signs or symptoms of cerebrovascular disease aged 50 to 70 years. Study participants were randomly selected from the official register of the city of Graz. The rate of positive response was 26.9 percent. All subjects underwent an extensive risk factor screening with Duplex scanning of the carotid arteries obtained from a subset of 176 individuals. The prevalence of well-documented cerebrovascular risk factors was 40.6% for arterial hypertension, 35.4% for cardiac disease, 8.5% for diabetes mellitus und 3% for elevated haematocrit. The less well-documented cerebrovascular risk factors dyslipidemia, overweight, physical inactivity, hyperfibrinogenemia and smoking were noted in 75%, 33.7%, 27.2%, 14.9% and 12.2% of subjects, respectively. Multiple well-documented risk factors were noted in 23.7% of the examined volunteers. Multiple linear regression analysis revealed body mass index (p < 0.0001) and age (p < 0.0001) as independent predictors of the frequency of well-documented risk factors observed in any individual. Atherosclerotic carotid disease occurred in 61.9% of study participants investigated by Doppler sonography and was significantly associated with age (p < 0.00001), life-time tobacco consumption (p < 0.0001) and the concentration of apolipoprotein B (p < 0.05). This study demonstrates high prevalence rates of vascular risk factors in an elderly Austrian community. Implications for stroke prevention result from the conjunction of overweight and frequency of risk factors noted in any study participant, as well as from the relationship of carotid atherosclerosis to smoking and dyslipidemia.

[A comparison of EEG mapping with and without visual artefact control in focal cerebral lesions]. / Vergleich des EEG-Mapping mit und ohne visuelle Artefakt-Kontrolle bei fokalen zerebralen Läsionen.

In 163 patients with focal cerebral lesions, 43 of them with completed stroke, 43 patients with TIA, 33 patients with ICH and 29 patients with malignant and 15 patients with benign tumors EEG mapping and CT was performed. The results of EEG mapping obtained using automated artifact detection were compared to those achieved by means of visual control of raw EEG. Furthermore the impact of long (850 +/- 250s) or short (32s) analysis time was studied. Eliminating artifacts by means of visual control of raw EEG significantly more positive results were obtained than using automated artifact detection. That was found in patients with as well as in patients without lesions in CT. In relation to etiology a significant difference was found only in cerebrovascular diseases but not in the other patients-groups. Corresponding results were found in 75% of the patients. The visual control provided additional lateralization especially in patients with CS (37%) and TIA (26%). A longer duration of analysed EEG epochs did not increase the number of focal changes in EEG mapping.

Possibilities of evaluating vascular risk

MRI and Doppler Sonography allow to study the effects of risk factors on brain parenchyma and vessels walls already in clinically silent stages of cerebrovascular disease and almost one third of normal volunteers reveal minimal to moderate carotid arterioclerosis at the presence of cerevasacular risk factors. However, it is yet unclear whether the detection of such abnormalities will also improve our predictive reliability in respect to the individual risk for stroke or vascular dementia. Basedon the similarity of white matter lesions with the MRI appearance of arteriosclerotic encephalopathy and neuropsychologic test results a tumely evolution of these changes towards dementia seems to be conceivable. Follow-up studies on the fate of white matter lesions will clarify, whether or not the appearence of such changes implies additional risk for vascular dementia than could be expected by the presence of risk factors alone. Serum fibrinogen has been indentified as the major predictor of extracranial arteriosclerosis in normals besides age. Increasing levels correlate with increasing probability of vessels wall damage. These data are of special interest since a previous study demostrate a higher risk for stroke and myocardial infarction in individuals with elevated serum fibrinogen levels than in those without. However. at the moment it can not be decided, if rheologic changes are the cause or sequence of vessels disease. Moreover future research has to determine, if serum fibrinogen increases the risk for stroke per se or may at least help to identify individuals at a high risk

The importance of MRI in stroke

It could be shown that MRI has capability of demostrating parenchymal damage due to cerebrovascular disease even in asymptomatic individuals. In ischemic stroke MRI is superior to CT because of the earlier detection of the lesion, a More precise delineation of lacunes, of brainstem infarcts, and of hemorrhagic components. Evidence of confluent white matter damage is helpful in differentiating vascualr dementia from degenerative forms. Is hemorrhagic stroke CT remains the preferred imaging technique during the acute phase but MRI will detect remnants of a cerebral hemorrhage for lifetime

Nuclear magnetic resonance image white matter lesions and risk factors for stroke in normal individuals.

The incidence, average number, and localization of lesions of the white matter detected by the T2-weighted nuclear magnetic resonance images among volunteers without cerebrovascular symptoms have been correlated with the number of risk factors for stroke. Accepted risk factors were arterial hypertension, diabetes mellitus, smoking, hypercholesterolemia, and cardiac disease. The 42 subjects examined were divided into Group A (0-1 risk factor, mean age 59.36 +/- 5.73 years), Group B (2 risk factors, mean age 61.54 +/- 8.33 years), and Group C (greater than or equal to 3 risk factors, mean age 62.57 +/- 9.83 years). Multiple risk factors among the age-matched groups was accompanied by a highly significant increase (p less than 0.001, Group A versus Group B; p less than 0.01, Group A versus Group C) of the incidence of white matter lesions. The average number of white matter lesions was increased (p less than 0.001) when Group A was compared with Groups B and C. Ninety-two percent of the white matter lesions were localized in watershed zones. Only 11 of the 155 abnormalities of the white matter detected by nuclear magnetic resonance imaging could be detected by computed tomography. White matter lesions in T2-weighted images appear to be an early stage of cerebrovascular disease.

[Rolandic spikes as an electroencephalography manifestation of oligodendroglioma]. / Rolandic Spikes als elektroenzephalographische Manifestation eines Oligodendroglioms.

A 10 5/12 year old boy was presented with seizures of uncertain origin on to the psychosomatic ward of our University Children's Hospital. The question and problem was the distinction of psychogenic versus epileptogenic origin (repeatedly performed EEG's had shown normal findings, the seizures did not response to anticonvulsive therapy). The exploration of a psychodynamic causes of the presenting problem was excluded by family therapeutic and psychoanalytical case history and psychodynamic interview. The first pathological finding was seen with registration of a long term EEG with typical findings of temporal central spikes and waves as seen in the benign rolandic-epilepsia. The following diagnostic considerations were discussed and differentiated. a) benign rolandi epilepsia b) malign rolandi epilepsia c) psychomotoric seizures d) rolandic spikes as symptomatic finding of a brain tumor. The definite diagnosis was finally confirmed by a cerebral computer-tomography which showed a large expensive process in the interferior right regio temporalis, which was identified histologically after operation as a oligodendrogliom grad-I. The tumor was removed successfully as a whole without any neurological defects.

Parkinson con alto riesgo hemodinámico / Parkinson with high haemodinamic risk

Dentro de los pacientes con enfermedad de Parkinson existen algunos que tienen especial frecuencia de factores de riesgo hemodinámico (hipertensión, diabetes, hipertrigliceridemia, agregación plaquetaria aumentada, disminución del flujo sanguíneo cerebral y anormalidades tomográficas). Estos pacientes tienen iguales síntomas que los demás, salvo en que los síntomas progresan más rápidamente. Es posible que una mejoría terapéutica de su estado vascular les sea útil

[Parkinsonism with a high vascular risk--Lechner-Ott syndrome]. / Parkinsonismus mit hohem vaskulärem Risiko--Lechner-Ott-Syndrom.

A syndrome described as Parkinsonism with high hemodynamic risk was represented. The clinical symptomatology was characterized by late onset, high incidence of diabetes mellitus, increased blood viscosity, enhanced platelet aggregation spontaneously as well as induced by adenosine diphosphate (ADP). The EEG shows reduction of alpha frequency and appearance of slow waves in the theta range located in the temporal region. A reduced in cerebral blood flow and a poor respond to L-Dopa treatment was observed. Focal changes was demonstrable in Computertomography and magnetic resonance imaging as well.

Evidence of enhanced platelet aggregation and platelet sensitivity in migraine patients.

In fourteen untreated migraine patients with a mean age of 40 years platelet sensitivity to 5HT, EN and ADP was investigated during the prodromal phase (three patients), 12-48 h after headache (three patients) and during the headache-free period (eight patients). Platelet sensitivity was tested using an optical density method and was calculated by the percentage of disaggregation (%DA) occurring 3 min after the peak aggregation. Platelet release reaction was assessed using beta-thromboglobulin (beta-TG) as an indicator. Platelet sensitivity to low concentrations of 5HT, EN and ADP (0.3 X 10(-9) M/ml) was most marked during the headache and prodromal phases. The least platelet sensitivity in migraineurs was detected during the headache-free interval, but was still higher than in the control group. beta-TG levels were increased during the headache phase indicating platelet release reaction. A general hyperaggregability of platelets in migraineurs has been demonstrated and in addition a varying sensibility of platelets to low concentrations of 5HT, EN and ADP has been established.