[Intraoperative volumetry in ENT surgery. Objectivation of surgical success by the volume control system]. / Intraoperative Volumetrie in der HNO-Chirurgie. Objektivierung des Operationserfolgs mit Volume-Control-System.

PROBLEM: At present no procedure exists to measure distances or volumes in endoscopic or otherwise limited surgical approaches directly and with high accuracy. Here a laser measuring system is evaluated for the first time as a clinical application in ENT surgery. MATERIAL AND METHODS: The volume control system (VCS) measures with the help of automatic recognition of laser measuring points in the surgical situs. A lab test examines the accuracy and the precision at anatomically accurate paranasal sinus and tympanic cavity models under flexible endoscopic visualization. The true values are known in each case as calibrated distances. Thus 90 values were available for evaluation. The clinical trial serves as proof of the intraoperative applicability and includes 32 patients. RESULTS: The measurements in the lab test resulted in an average deviation from the true value at a maximum of 7.1%. The precision was between 0.2 and 0.5 mm. In the clinical setting the system could be used in all 32 patients. Altogether 97 measured values could be included. The VCS functioned without system failures. The additional time required for setting up amounted to less than 2 min. The manageability of the flexible endoscope was reduced because of the length and the difficulty in controlling the adjustment. The additional intraoperative time required for collection of the measured values was less than 4 min in each case. Many results led to clinically relevant interpretations with intraoperative consequences. DISCUSSION: The VCS shows for the first time an intraoperatively applicable measuring function for distances, surfaces and volumes. There is a multiplicity of meaningful applications in ENT and in other surgical disciplines. The available study has proved the concept.

Magneto-optical investigations of molecular nanomagnet monolayers.

We report field-dependent magnetization measurements on monolayers of [Dy(Pc)2] on quartz, prepared by the Langmuir-Blodgett technique. The films are thoroughly characterized by means of X-ray reflectivity and atomic force microscopy. The magnetisation of the sample is measured through the magnetic circular dichroism of a ligand-based electronic transition.

Processing of histamine-induced itch in the human cerebral cortex: a correlation analysis with dermal reactions.

The subjective sensation of itch is a complex emotional experience depending on a variety of factors. In this study, the central nervous processing of pruritus was investigated in a human model. Activation of involved cerebral areas was correlated to scales of nociception and skin reactions. Six healthy male right-handed subjects participated in a standardized epidermal stimulus model with nine increasing doses of histamine dihydrochloride (0.03%-8%) on their right forearms. Controls consisted of three NaCl stimuli. Cerebral activation patterns were determined by H(2)(15)O positron emission tomography 120 s after stimulation. Dermal reactions to the stimulus (wheal, flare, temperature) were coregistered during the procedure. Itch sensation was determined by visual analog scale rating. Pain was not reported during the study; all volunteers had localized itch from 0.03% histamine on. Subtraction analysis versus control revealed significant activation of the left primary sensory cortex and motor-associated areas (mainly primary motor cortex, supplementary motor area, premotor cortex). Predominantly left-sided activations of frontal, orbitofrontal, and superior temporal cortex and anterior cingulate were also observed. Correlation analysis revealed coactivation of dermal reactions and cerebral response to itch in the following Brodmann areas with a Z score greater than 5: wheal, areas 5 (bilateral) and 19 (right); flare, areas 2-5 (left); temperature, area 10 (left) and left insula. Itch intensity ratings were mainly correlated with activation of the left sensory and motor areas. Functional covariates of the itch sensation in the central nervous system were identified. The intention to pruritofensive movements is probably mirrored by the activation of motor areas in the cortex. Other areas may be involved in emotional processing of sensations. Skin reactions wheal and flare also had significantly activated covariate areas in the central nervous system.J Invest Dermatol 115:1029-1033 2000

Central activation by histamine-induced itch: analogies to pain processing: a correlational analysis of O-15 H2O positron emission tomography studies.

The aim of this study was to identify the functional cerebral network involved in the central processing of itch and to detect analogies and differences to previously identified cerebral activation patterns triggered by painful noxious stimuli. Repeated positron emission tomography regional cerebral blood flow (rCBF) measurements using O15-labeled water were performed in six healthy right-handed male subjects (mean age 32 +/- 2 years). Each subject underwent 12 sequential rCBF measurements. In all subjects a standardized skin prick test was performed on the right forearm 2 min before each rCBF measurement. For activation, histamine was applied in nine tests in logarithmically increasing concentrations from 0.03 to 8%. Three tests were performed with isotonic saline solution serving as a control condition. Itch intensity and unpleasantness were registered with a visual analogue scale during each test. Subtraction analysis between activation and control conditions as well as correlation analysis with covariates were performed. Itch induced a significant activation in the predominantly contralateral somatosensory cortex and in the ipsilateral and contralateral motor areas (supplementary motor area (SMA), premotor cortex, primary motor cortex). Additional significant activations were found in the prefrontal cortex and the cingulate gyrus, but not in subcortical structures nor in the secondary somatosensory cortex. In correlation analyses, several cortical areas showed a graded increase in rCBF with the logarithm of the histamine concentration (bilateral sensorimotor areas and cingulate cortex; contralateral insula, superior temporal cortex and prefrontal cortex) and with itch unpleasantness (contralateral sensorimotor cortex, prefrontal cortex and posterior insula; ipsilateral SMA). Induction of itch results in the activation of a distributed cerebral network. Itch and pain seem to share common pathways (a medial and a lateral processing pathway and a strong projection to the motor system). In contrast to pain activation studies, no subcortical (i.e. thalamic) activations were detected and correlation analyses suggest differences in subjective processing of the two sensations.

6-O-(2-[18F]fluoroethyl)-6-O-desmethyldiprenorphine ([18F]DPN): synthesis, biologic evaluation, and comparison with [11C]DPN in humans.

UNLABELLED: 6-O(2-[18F]fluoroethyl)-6- -desmethyldiprenorphine ([18F]DPN) was developed and biologically evaluated. Results of animal experiments, binding studies in vivo, and a human PET study are reported and compared with those of [11C]DPN. METHODS: [18F]DPN was obtained by 18F-fluoroethylation of 3-O-trityl-6-O-desmethyldiprenorphine and subsequent deprotection in good radiochemical yields (23% +/- 7%; 100 min; 37 TBq/mmol). Binding of [18F]DPN to mu, kappa, and delta opioid receptors was shown by autoradiography studies on rat brain slices. Quantification of cerebral opioid receptor binding in men was performed by spectral analysis of a dynamic PET scan (25 frames, 90 min) after intravenous application of 63 MBq [18F]DPN (36 GBq/micromol) and correction for metabolites. RESULTS: [18F]DPN shows high affinity to opioid receptors. Parametric images (impulse response function at 60 min) of this human study showed a binding pattern of [18F]DPN equal to that of a control group (n = 9 healthy volunteers) after administration of [11C]DPN. CONCLUSION: The advantage of the longer half-life of 18F will allow extended scanning periods, more flexible interventions (e.g., displacement studies), and DPN to be available to PET centers without an on-site cyclotron.

Central pain after pontine infarction is associated with changes in opioid receptor binding: a PET study with 11C-diprenorphine.

Using 18F-fluorodeoxyglucose and 11C-diprenorphine positron emission tomography (PET), we investigated alterations in glucose metabolism and opioid receptor binding in a patient with central poststroke pain, which developed after a small pontine hemorrhagic infarction. In comparison with normal databases, reduced 11C-diprenorphine binding was more accentuated than the hypometabolism on the lateral cortical surface contralateral to the symptoms, and a differential abnormal distribution between the tracers was seen in pain-related central structures. These results show that 11C-diprenorphine PET provides unique information for the understanding of central poststroke pain.

Human papillomavirus DNA in women without and with cytological abnormalities: results of a 5-year follow-up study.

To determine the prevalence of HPV 6, 11, 16, and 18 in a population without cytological or histological abnormalities, the cervical smears of women attending three clinics in Germany were screened over the past 5 years. The filter in situ hybridization method was used throughout. A total of 20,161 smears, taken from 11,667 women, were tested. When the results of only the first examination are considered, 8.8% (950/10,778) of women with normal cytology were positive for HPV DNA. If we divide the latter into age groups, 11% (852 HPV positive/7716) were below the age of 55 years and 3.2% (98 HPV positive/3062) were above this age. When the samples from patients who had undergone at least two examinations and remained cytologically negative during the 5-year period were examined (total, 2709 women), the HPV DNA positively increased to 34.7% (640/1862) for the sexually active age groups and to 9.0% (76/847) for those above 55 years of age. This study reveals that, although papillomaviral production is most pronounced in younger women, these infections are quite common in all age groups. During the period of investigation, 19 (0.65%) patients, who were diagnosed as cytologically negative at the first examination, progressed to carcinoma in situ or invasive carcinoma. Of these, 63.2% revealed a detectable HPV infection during the study period. The progression of HPV-positive women from normal cytology to CIN or cancer occurred at an annual frequency of 0.082%. With an infected lifespan of 45 years assumed, this results in a lifetime risk of 3.7%.

Sensory processing in Parkinson's and Huntington's disease: investigations with 3D H(2)(15)O-PET.

There is conjoining experimental and clinical evidence supporting a fundamental role of the basal ganglia as a sensory analyser engaged in central somatosensory control. This study was aimed at investigating the functional anatomy of sensory processing in two clinical conditions characterized by basal ganglia dysfunction, i.e. Parkinson's and Huntington's disease. Based on previously recorded data of somatosensory evoked potentials, we expected deficient sensory-evoked activation in cortical areas that receive modulatory somatosensory input via the basal ganglia. Eight Parkinson's disease patients, eight Huntington's disease patients and eight healthy controls underwent repetitive H(2)(15)O-PET activation scans during two experimental conditions in random order: (i) continuous unilateral high-frequency vibratory stimulation applied to the immobilized metacarpal joint of the index finger and (ii) rest (no vibratory stimulus). In the control cohort, the activation pattern was lateralized to the side opposite to stimulus presentation, including cortical [primary sensory cortex (S1); secondary sensory cortex (S2)] and subcortical (globus pallidus, ventrolateral thalamus) regional cerebral blood flow (rCBF) increases (P < 0.001). Between-group comparisons (P < 0.01) of vibration-induced rCBF changes between patients and controls revealed differences in central sensory processing: (i) in Parkinson's disease, decreased activation of contralateral sensorimotor (S1/M1) and lateral premotor cortex, contralateral S2, contralateral posterior cingulate, bilateral prefrontal cortex (Brodmann area 10) and contralateral basal ganglia; (ii) in Huntington's disease, decreased activation of contralateral S2, parietal areas 39 and 40, and lingual gyrus, bilateral prefrontal cortex (Brodmann areas 8, 9, 10 and 44), S1 (trend only) and contralateral basal ganglia; (iii) in both clinical conditions relative enhanced activation of ipsilateral sensory cortical areas, notably caudal S1, S2 and insular cortex. Our data show that Parkinson's disease and Huntington's disease, beyond well-established deficits in central motor control, are characterized by abnormal cortical and subcortical activation on passive sensory stimulation. Furthermore, the finding that activation increases in ipsilateral sensory cortical areas may be interpreted as an indication of either altered central focusing and gating of sensory impulses, or enhanced compensatory recruitment of associative sensory areas in the presence of basal ganglia dysfunction. Altered sensory processing is thought to contribute to pertinent motor deficits in both conditions.

Region-specific encoding of sensory and affective components of pain in the human brain: a positron emission tomography correlation analysis.

Brain imaging with positron emission tomography has identified some of the principal cerebral structures of a central network activated by pain. To discover whether the different cortical and subcortical areas process different components of the multidimensional nature of pain, we performed a regression analysis between noxious heat-related regional blood flow increases and experimental pain parameters reflecting detection of pain, encoding of pain intensity, as well as pain unpleasantness. The results of our activation study indicate that different functions in pain processing can be attributed to different brain regions; ie, the gating function reflected by the pain threshold appeared to be related to anterior cingulate cortex, the frontal inferior cortex, and the thalamus, the coding of pain intensity to the periventricular gray as well as to the posterior cingulate cortex, and the encoding of pain unpleasantness to the posterior sector of the anterior cingulate cortex.