[Chronic elevation of IGF-1 concentrations in a 54-year-old female with acromegalic appearance and somatoform disorder as a challenge to medical opinion]. / Chronisch erhohte IGF-1-Konzentrationen bei einer 54-jahrigen Patientin mit akromegalem Habitus und somatoformen Beschwerden als gutachtliche Herausforderung.

A 54-year-old woman was referred to the psychiatric clinic with complex somatic whole-body complaints. In absence of organic findings, the diagnosis of somatoform disorder (somatization disorder ICD 10 F45.0) was made. Additionally, due to the typical appearance and chronically elevated IGF-1 (somatomedin C) concentrations, the critical diagnosis of acromegaly was postulated, although no hypophyseal adenoma was detected. The patient was variously assessed and 16 medical and rehabilitation opinions were given with regard to invalidity, particularly by orthopaedic and neurologic specialists. The results varied, even diametrically opposed. However, somatoform disorders or acromegalic appearance and possible medical consequences were not considered sufficiently. The case report encourages experts to deal with complex psychosomatic complaints objectively and unemotionally in medical opinions.

[A clinical challenge. Pragmatic treatment of migraine and concomitant depression]. / Eine klinische Herausforderung. Pragmatische Migräneprophylaxe bei Depression.

The association of migraine and depression has been confirmed in numerous studies and it has been suggested that both diseases influence each other in a bidirectional way. As the conventional antidepressants mostly aggravate a pre-existing depression, treatment of both is a demanding task and should be planned in an interdisciplinary setting with neurologists and psychiatrists experienced in pain management. The pharmacological therapy is mainly based on a modulation of the serotonergic and noradrenergic systems and non-pharmacological treatment is also incorporated. The number of drugs should be kept to a minimum but drugs effective in the treatment of both migraine and depression should be used. Current data favours the use of amitriptylin, although newer studies justify the use of venlafaxin and fluoxetin as second choice drugs.A combination of several antidepressants with acute acting antimigraine drugs can provoke potentially threatening side effects, however, these possible side effects should not lead to suboptimal treatment of patients with depression and concomitant migraine. The current data on the antimigraine effects of common antidepressants are reviewed and advice for the preventive treatment of migraine with concomitant depression is given. Additionally, hazardous interactions and preferable drug combinations are listed.

Seasonal patterns of birth in patients with glioblastoma.

Seasonal distribution of birth rates was only recently described in patients with high-grade gliomas. We analyzed 501 cases from the database of a Regional Cancer Center in Bavaria to assess annual periodicity in the birth dates of glioma patients. Prior to analysis, the number of births per month was normalized [number of births x 100,000/total number of births in Germany] to obtain birth rates per month. The approximation of the time series data by a one-year cosine model found that the glioblastoma birth rate exhibits a statistically significant annual variation, with the peak rate in January. Vitamin intake, infections, and other as-yet-unknown factors and exposures during pre- and perinatal early life may contribute to the seasonality of birth rate in patients with brain tumors.

Relation between laterality and immune response after acute cerebral ischemia.

OBJECTIVE: During the last 2 decades, right/left hemisphere dominance was supposed to affect the immune system differently. Experimental and clinical observations indicate that the left hemisphere plays a crucial role in the development of the immune system. The true relationship between immune response and acute ischemic stroke laterality remains to be elucidated. METHODS: We studied acute right-handed stroke patients admitted to a single acute neurology department with a specialized stroke unit. Being part of our clinical protocol, blood samples were taken within the first 24 h after the onset of stroke symptoms. The medical record of each patient was reviewed, and demographic, clinical laboratory (key criteria: C-reactive protein, CRP, and white blood cell count, WBC) and neuroimaging information was retrieved. All data were presented descriptively, and bivariate test statistics, ANOVA (log-transformed data) or linear correlations were calculated. RESULTS: Fifty-six of the 187 patients admitted to our Stroke Unit between October 2003 and March 2004 with different stroke subtypes according to the TOAST criteria were retrospectively evaluated in order to characterize the impact of stroke laterality on immunoregulatory response measured by CRP levels and WBC. Correlation analysis revealed that left-sided ischemic stroke yielded a significantly higher correlation between CRP levels and WBC. Following left-sided stroke, a more marked variability in CRP and WBC was found compared to patients with right-sided ischemic stroke, although ANOVA did not show significant differences between immune response values as a function of stroke subtypes. CONCLUSIONS: We identified an association between stroke laterality and immunoregulatory response in patients with acute ischemic stroke. Left-sided stroke may be considered as a direct risk factor for infectious disease or immune deficits and should attract special attention. However, these preliminary results need be confirmed by controlled studies.

Influence of moderate altitude on blood lactate and heart rate in a standardized exercise test in healthy volunteers.

Nineteen healthy volunteers were exposed to a standardized exercise test at sea level (SLa), at an altitude of 1700 m before (1700a) and after a moderate 10-day mountain training (1700b), with a final control four weeks later at sea level (SLb). Vital signs, blood lactate and arterial oxygen saturation were determined prior, during or after the exercise test. Whereas systolic blood pressure and heart rate at rest did not change substantially, diastolic blood pressure decreased at the final control (SLb, p<0.05) and oxygen saturation was significantly lower at 1700 m (1700a, 1700b, p<0.01). Lactate at rest increased from 1.16 (SLa) to 1.97 (1700a) mmol/l after acute exposure followed by a slight reduction after adaptation (p<0.05). The mean maximum lactate levels were as follows: 6.03, 10.56, 6.22 and 8.75 (p<0.01). The mean maximum performance increased during the study (225.6, 223.3, 231.6, 248.1 Watt, p<0.01). Lactate versus workload curves did not show a marked shift to the right. No significant changes of maximum heart rates during the exercise test were found. In conclusion, a sojourn at 1700 m provokes an increase of lactate levels with subsequent reduction after acclimatization and has a significant positive impact on the mean maximum performance after moderate mountain training.

On the physiological relevance of muscarinic acetylcholine receptors in Alzheimer's disease.

The loss of cholinergic neurons, particularly in the forebrain, plays an important role in the pathophysiology of Alzheimer's disease (DAT). This concept has lead to the effective treatment of DAT by means of acetylcholine (Ach) esterase inhibitors. G-protein-coupled muscarinic acetylcholine receptors (mAchR) are classified in 5 subtypes, the M1 receptor stimulation and M2 inhibition being especially associated with cognitive skills. Modified cerebral muscarinic receptor profiles in patients with Alzheimer's disease in addition to loss of Ach releasing neurons help us to understand the pathophysiology of dementia and offer potential therapeutic approaches. Specific agonists and antagonists of muscarinic receptors are discussed as possible treatment options in DAT. Experimental results postulate a positive long lasting modulation of the pathological neuronal protein pattern in addition to their cholinomimetic effect.

Suicides and suicide ideation in the Bible: an empirical survey.

OBJECTIVE: The aim of this review is to summarize all data on suicidal behaviour reported in the Bible and to discuss basic implications for medical ethical positions. METHOD: All books of the Jerusalem Bible, including the apocrypha accepted in the Catholic canon, were searched for all cases of suicide, attempted suicide and suicidal ideation clearly identifiable as such. RESULTS: The Bible including the apocrypha reports about 10 completed suicides and 11 cases of suicide attempt or ideation. The Bible considers human life as a divine gift but suicide per se is neither condemned nor approved. Those suffering from suicidal thoughts are treated with respect and support is offered. CONCLUSION: Theological teaching on suicide was influenced for centuries by the biased negative opinion of the early fathers of the church and scholastic savants, but these opinions are not substantiated by a thorough reading of the Bible.

Correlation of MMSE, SKT and clock test scores in patients with mild and moderate dementia.

The objective of our study was to assess the correlation of routine neuropsychological test results in elderly patients referred to a gerontopsychiatric ward. MMSEs, Clocktests (CT) and SKTs were performed in 94 patients (Age: Median = 74 ys, Range = 54-89 ys; 64 f, 30 m; MMSE < 25:45 and MMSE > 25:37) with mild to moderate dementia and evaluated retrospectively. Linear and multiple regression was used. The scores of all 3 tests used were reciprocally correlated (p < 0.05). Multiple regression analysis showed a maximum correlation of 0.87 and marked standardized beta values, if SKT was chosen as dependent variable. In conclusion, results of SKT, CT or MMSE in patients with dementia showed marked pairwise or multiple correlations and therefore it is not necessary to include more than two reliable tests in clinical psychogeriatric studies.

[Normal psychiatric interview]. / Der psychiatrische Normalbefund.

The documentation of the normal psychiatric interview has been omitted in the ICD 10 classification. Particularly, psychiatric consultants have to deal with the practical problem of adequate classification of patients with normal psychopathology. To use unspecific codes or to omit the coding of the findings are no suitable solutions. Future revision of the ICD 10 classification should integrate the normal psychiatric interview.

Relation between pharmacodynamic and anthropometric parameters during ergometry at rest and after repeated intake of metoprolol in healthy volunteers: results of a pilot study.

Metoprolol is a widely used beta1-selective beta-blocker in hypertension and tachycardia. The influence on vital signs at rest and during ergometry (exercise heart rate or blood pressure, effect areas above baseline) was investigated in a pilot study with 18 healthy volunteers (mean age 29.1 years) by means of multiple and pairwise correlation analysis. At rest, the difference between predose and day 5 values were not associated with anthropometric characteristics. During ergometry for weight and height significant negative correlations were found corresponding to marked beta-values in the multiple regression models. Therefore heart rate decreases less markedly in slim persons which should be taken into consideration in exercise tests during metoprolol intake.

Influence of choking in Judo on vision in well-trained Judoka: an explorative field study.

The present study was designed to investigate the effects of a cross-choking-technique commonly used in Judo on visual acuity. In 156 Judokas, experienced in competition, visual acuity was examined before and after choking (Juji-Jime). The average age of the 46 female and 110 male subjects was 22.8 years (standard deviation 10.5 years). In all examined grades of distance (infinite, 0.55 m and 0.4 m), eye tests showed an improvement of visual acuity after choking on a highly significant scale. In quantitative terms, vision the far sight range was optimized more clearly than in the close ranges. The following mechanisms are discussed as possible causes of the present results: an increase of blinking frequency induced by stress, an optimized tear film covering the cornea, a stenopaeic gap induced by improved blinking, pupillomotor alterations and an improved cerebral processing of visual signals and information. From an evolutionary-biologic perspective, the benefit of this psychophysiological mechanism might consist in an improvement of visual acuity in moments of danger, approaching from a distance and, thus, better chances of survival.

Successful therapy of tardive dyskinesia in a 71-year-old woman with a combination of tetrabenazine, olanzapine and tiapride.

There is no generally accepted treatment for tardive dyskinesia following intake of neuroleptics. Many compounds with effects on serotonine, GABA, cholinergic or dopamine receptors have been clinically useful. We report on a 71-year-old female patient suffering from orofacial tardive dyskinesia after treatment with haloperidol, which did not respond to monotherapy with antidyskinetic drugs. The syndrome disappeared almost completely within two weeks after a multidrug approach consisting of tetrabenazine, olanzapine and tiapride. A combination of antidyskinetic drugs should be considered in patients with severe tardive dyskinesia.

[Seasonal variations in sudden death in sports clubs]. / Saisonale Schwankungen plötzlicher Todesfälle im Vereinssport.

2,825 cases of sudden deaths (2,669 men, 156 women) in sports-clubs between 1981 and 1999 were evaluated retrospectively by means of the cosinor method in order to detect a circannual distribution of occurrence. Deaths due to cardiovascular and traumatic events were additionally studied with regard to seasonal differences of frequency. The number of sudden deaths per month during a period of 19 years could be significantly fitted to a cosine model with a maximum in June, the absolute maximum value being observed in May (n = 317). In particular, accidents were more frequently found in spring and summer.