Treatment of panic disorder with bupropion in a patient with Parkinson's disease.

We report on a 57-year-old woman, diagnosed with Parkinson's disease, whose panic disorder showed marked improvement after introduction of bupropion, a norepinephrine-dopamine reuptake inhibitor. Additionally a comorbid major depression disappeared under this treatment. Bupropion may be useful for the treatment of patients with both panic disorder and Parkinson's disease.

[Questionable procedures in environmental medicine using an example of "multiple chemical sensitivity"]. / Umstrittene Verfahren in der Umweltmedizin am Beispiel der "Multiple Chemical Sensitivity".

"Multiple Chemical Sensitivity" (MCS) has to be regarded as a merely subjective concept without etiological and pathological background or objective criteria for diagnosis. Most of the "MCS" patients suffer from various psychiatric disorders; in a small minority somatic diseases can be found. The data recently won in the German multicenter study on MCS underline this point of view. The informal German "MCS network" consisting of patients' self-help groups, "therapists" with or without medical background and law firms specialised in compensation claims nevertheless strictly denies any psychogenic model. They do, however, propose a whole range of diagnostic and therapeutic procedures based on different theoretical concepts. Some of the procedures are derived from scientifically based medicine, others have an unconventional and esoteric background. Most of them are logically incompatible; however, they are applied in a polypragmatic manner. None of these so-called diagnostic or therapeutic procedures or health technologies can be regarded as evidence-based. Some of them, however, are extremely expensive and/or pose significant risks for patients' health. In any case, wrong subjective disease concepts are perpetuated iatrogenically. Additionally, those procedures make effective help for the real underlying medical and/or psychiatric conditions impossible.

[Acute psychiatric symptoms as the initial manifestation of HIV-infection: differential diagnosis, therapy and medico-legal issues]. / Psychiatrische Akutsymptomatik als Erstmanifestation einer HIV-Infektion. Differentialdiagnostische, therapeutische und medizinrechtliche Probleme.

The prevalence of psychiatric symptoms and disorders in HIV-infected patients is high. The differential diagnosis includes psychoreactive disorders, acute psychiatric symptoms of an HIV-associated encephalopathy, and symptomatic psychotic illnesses due to secondary neurologic manifestations such as opportunistic central nervous infections and intracerebral lymphoma. Clinical aspects and psychopathological findings are not sufficient for differential diagnosis and identification of primarily psychiatric disorders. Secondary neurologic manifestations causing a symptomatic psychosis must be excluded as soon as possible by brain imaging (CT, MRI) and analysis of the cerebrospinal fluid. In emergency situations, however, German law imposes strict regulations, especially in the case of sectioned patients. These medical and medicolegal questions are illustrated by case reports and propositions for an effective strategy are made.

[Cryptococcal meningoencephalitis in HIV infected immigrants. Diagnostic and therapeutic aspects with reference to evidence-based medicine"--an overview]. / Kryptokokkenmeningoenzephalitis von HIV-infizierten Immigranten. Diagnostische und therapeutische Aspekte unter Berücksichtigung der "evidence-based medicine"--Ein Uberblick.

Cryptococcal meningitis is one of the most frequent forms of meningoencephalitis in AIDS patients. Before the introduction of triazole antibiotics like difluconazole, the frequency of this meningitis among AIDS patients was 5-10%, yet declined during the last years. Clinically, nonspecific signs of a meningeal inflammation predominate while focal neurological signs are rare. Rapid institution of high-dose antimycotic therapy is the keystone to improve prognosis and decrease mortality. Antimycotics of choice are amphotericin B, fluconazole, and flucytosin. Diagnosis is established by detection of cryptococcal antigen in cerebrospinal fluid, microscopic demonstration of cryptococci using India-ink, and cryptococcal cultures. Recent developments aim to improve antimycotic therapies. During the last years, lifelong secondary prevention with difluconazole was established. Cryptococci which are resistant against fluconazole and amphotericin B are a special challenge, yet fortunately are rare. Longterm outcome of patients is determined by the progression of the underlying immunosuppression. Therefore, combination of secondary prophylaxis with modern antiviral substances is important. Clinical decision analysis in patients with suspected cryptococcal meningitis is presented using methods from evidence-based medicine.

Cycling S-phase cells in animal and spontaneous tumours. I. Comparison of the BrdUrd and 3H-thymidine techniques and flow cytometry for the estimation of S-phase frequency.

Evaluation of the proliferative activities of cell populations has mainly been restricted to the use of autoradiography and flow cytometric measurements. The introduction of a new BrdUrd specific antibody makes it possible to determine exactly the DNA synthesizing cells. The BrdUrd technique is safe with respect to handling and the results are obtained within five hours. The suitability of the BrdUrd labelling procedure has been studied in different cell lines and compared with 3H-thymidine autoradiography and flow cytometry.