Transition from the locked in to the completely locked-in state: a physiological analysis.

OBJECTIVE: To clarify the physiological and behavioral boundaries between locked-in (LIS) and the completely locked-in state (CLIS) (no voluntary eye movements, no communication possible) through electrophysiological data and to secure brain-computer-interface (BCI) communication. METHODS: Electromyography from facial muscles, external anal sphincter (EAS), electrooculography and electrocorticographic data during different psychophysiological tests were acquired to define electrophysiological differences in an amyotrophic lateral sclerosis (ALS) patient with an intracranially implanted grid of 112 electrodes for nine months while the patient passed from the LIS to the CLIS. RESULTS: At the very end of the LIS there was no facial muscle activity, nor external anal sphincter but eye control. Eye movements were slow and lasted for short periods only. During CLIS event related brain potentials (ERP) to passive limb movements and auditory stimuli were recorded, vibrotactile stimulation of different body parts resulted in no ERP response. CONCLUSIONS: The results presented contradict the commonly accepted assumption that the EAS is the last remaining muscle under voluntary control and demonstrate complete loss of eye movements in CLIS. The eye muscle was shown to be the last muscle group under voluntary control. The findings suggest ALS as a multisystem disorder, even affecting afferent sensory pathways. SIGNIFICANCE: Auditory and proprioceptive brain-computer-interface (BCI) systems are the only remaining communication channels in CLIS.

Histological changes in neonatal kidneys after cardiopulmonary bypass and deep hypothermic circulatory arrest.

BACKGROUND: Renal failure after open-heart surgery is a serious complication resulting in increased mortality and morbidity. The aim of the study was to find out whether different strategies for open-heart surgery would result in renal histological differences in a neonatal animal model. METHODS: The renal tissue of newborn piglets was examined after mild hypothermic cardiopulmonary bypass (CPB group; n = 10), deep hypothermic circulatory arrest (DHCA group; n = 8), instrumentation without extracorporeal circulation (sham; n = 3), and the data were compared with those of normal porcine neonatal kidneys (control; n = 6). The severity of tissue damage was graded using a 4-point scoring system (0: normal morphology, 3: severe damage). Apoptotic cells and granulocytes were counted. RESULTS: The histological score was higher in all groups compared with controls ( P < 0.05) and higher in the CPB group compared with the DHCA group ( P < 0.05). More apoptotic cells and granulocytes were found in the CPB group compared with controls and the DHCA group ( P < 0.05). CONCLUSIONS: Although changes in the kidney tissue of newborn piglets are detectable after any cardiac procedure, changes are more profound after cardiopulmonary bypass with mild hypothermia.

Management of poststernotomy mediastinitis: experience and results of different therapy modalities.

BACKGROUND: Different primary treatment modalities have been utilized to treat poststernotomy mediastinitis (PM) following cardiac surgery. METHODS: A literature survey using the key phrases "treatment of deep sternal wound infection" and "poststernotomy-mediastinitis" was performed. Furthermore, a questionnaire regarding the primary treatment of PM was distributed to all 79 German heart surgery centers. RESULTS: The review of the literature shows that the current understanding is based purely on retrospective studies, not on evidence-based medicine. All 79 German heart centers replied to the questionnaire. Vacuum-assisted closure therapy (V. A. C.(R)) is used in 28/79 (35 %) heart centers as the "first-line" treatment, 22/79 (28 %) perform primary reclosure in conjunction with a double-tube irrigation/suction system, and in 29/79 (37 %) German heart centers both treatment options were used according to the intraoperative conditions. CONCLUSIONS: As a primary treatment for PM two treatment modalities are currently in use: primary reclosure coupled with a double-tube suction/irrigation system versus V. A. C.(R) therapy. Since prospective randomized studies have not yet been performed, controlled clinical trials comparing both treatment modalities are pivotal to define the evidence for patients presenting with PM.

[Gingival fibromatosis (hereditary hyperplastic gingivitis) in a wild European red fox (Vulpes vulpes)]. / Gingivafibromatose (hereditäre hyperplastische Gingivitis) bei einem europäischen Wildrotfuchs (Vulpes vulpes).

This report describes a case of gingival fibromatosis in an otherwise healthy and well nourished wild European red fox (Vulpes vulpes), which was shot by a hunter and submitted to the state laboratory in the context of the rabies monitoring program of the federal state of Brandenburg, Germany. At necropsy, a severe papillomatous proliferation of the complete gingival tissue of the upper and lower jaw was present. This gingival proliferation had already resulted in malocclusion, loosening and loss of several incisival, premolar and molar teeth. Histologically, the primary lesion was a massive increase in the amount of collagen rich and relatively avascular connective tissue within the gingival lamina propria mucosae. A papillomavirus infection was excluded by electron microscopy, immunohistochemistry and molecular biological methods. The gingival lesions in the red fox are identical to those seen in hereditary hyperplastic gingivitis in farmed silver foxes and hereditary gingival fibromatosis in man. It is presumed that, in analogy to the genetic diseases in silver foxes and man, a still unidentified genetic defect is responsible for the development of the disease in the red fox, too.

Successful reconstruction of stripped superficial femoral vein.

A 69-year-old man who had hemorrhagic shock after inadvertent stripping of the right superficial femoral-popliteal vein during surgery for greater saphenous vein varicosis in another hospital was referred to us. Phlebography revealed a ruptured popliteal vein with intact profunda femoris and common femoral veins. The stripped superficial femoral-popliteal vein brought in a jar was reimplanted. Phlebography performed during the patient's follow-up visits in our outpatient clinic 11 months postoperatively showed a patent femoral vein.

Effects of hexadecylphosphocholine on thrombocytopoiesis.

Hexadecylphosphocholine (HePC) is the first representative of the alkylphosphocholines, a novel group derived from the cytotoxic etherlysophospholipids. HePC shows a broad spectrum of antiproliferative effects in neoplastic cells in vitro and in vivo. HePC has been tested successfully in several clinical studies. One of the remarkable features of this compound has been the induction of a leucocytosis and a thrombocytosis in most of the patients receiving HePC systemically. In this paper, we have investigated the biological and molecular mechanisms by which HePC exerts this interesting effect. We found that HePC acts as an unspecific costimulator on human megakaryocytic proliferation in a soft agar assay system predominantly together with thrombopoietin (TPO). Furthermore, HePC leads to the synthesis and secretion of several haematopoietic growth factors in monocytes and bone marrow fibroblasts, determined by the direct measurement of growth factors in cellular supernatants and by the measurement of growth factor mRNA in cell extracts. Thus, HePC seems to produce the increase of blood platelets in tumour patients by two different mechanisms.

Female delinquent recidivism and the P greater than V sign on the WISC-R.

Examined the Performance-Verbal (P-V) discrepancy on the Wechsler Intelligence Scale for Children-Revised as a predictor for recidivism among 78 adjudicated white female delinquents. The P greater than V sign was displayed significantly more frequently among recidivists than among nonrecidivists. No significant relationship was found between amount of P-V difference and number of offenses for which an individual may be adjudicated. The findings support the view that cognitive differences differentiate recidivists from nonrecidivists.