Changes in cortical evoked potentials as correlates of the efficacy of weak analgesics.

The relationship between subjective measurements of pain (pain report and threshold of sensation) and evoked potentials following painful electrical stimulation of tooth pulp was evaluated after intake of different weak analgesics. These time-response curves for the dolorimetric parameters were correlated to the in vivo drug levels obtained in corresponding experiments by analyzing saliva. Based on the comparison between the drug levels of analgesics in saliva on the one hand and the threshold of sensation, the pain rating and changes in the amplitude of the cortical EP on the other hand, the sensitivity of the EP to changes in drug concentration was superior than to subjective pain judgement. The data were correlated to clinical pain relief investigations. The results support the suggestion of earlier research that EP evaluation may well serve as a correlate for laboratory pain.

[Hypereosinophilic syndrome. Case report of the differential diagnosis of eosinophilic leukemia]. / Das hypereosinophile Syndrom. Fallbericht zur Differentialdiagnose der Eosinophilenleukämie.

We report on a 48 years old patient with chronic eosinophilic leukemia. The diagnosis is based on changes of the blood picture with leukocytosis, deviation to the left to promyelocytes and sometimes normoblasts in the differential smear in with eosinophilia of up to 90%. A hepatosplenomegaly with an extensive extramedullary blood formation could be observed. Endocarditis parietalis fibroplastica was found on autopsy. The problem whether the organ changes observed are due to the eosinophilia existing for more than two years is discussed.

[Quantification of the attenuation of pain sensation through evoked potentials after the application of mild analgesics (author's transl)]. / Quantifizierung der Dämpfung in der Schmerzempfindung mit Hilfe evozierter Potentiale nach Gabe schwacher Analgetika.

Evoked potentials resulting from stimulation of tooth pulp with rectangular impulses were chosen for the indication of the analgesic activity of mild analgesics. If the stimuli were perceived subjectively as equally painful, the amplitudes of the evoked potentials were intraindividually well reproducible. The results are reproducible within one day as well as on different days. According to the large interindividual variation in the amplitude of the evoked potentials, the percentual reduction of the amplitude was a better measure for the analgesic action than the absolute height of the signal. Interindividually, the latencies have shown clear differences whereas they were reproducible for the individuum. The curves for: 1. The percentual reduction of the evoked potentials 2. The diminuation of the subjective pain response 3. The increase in the sensitivity threshold after the application of the drug were principally similar. The results indicate, that the evoked potentials may represent a more sensitive measure of experimentally induced pain in subjective methods.

Detection of uremic neuropathy by reflex response latency.

Dialysis time necessary for treatment of terminal renal failure is very different in different patients. Adequacy of therapy cannot be controlled by laboratory measures but only clinical means. Uremic peripheral neuropathy is regarded as the most reliable indicator of insufficient dialysis treatment. Serial measurements of peripheral nerve function therefore make individual adjustment of dialysis schedule possible. In some cases motor nerve conduction velocity is not sensitive enough for this purpose, as conduction velocity in afferent nerve fibers is disturbed at an earlier stage of uremic intoxication. Measurement of sensory nerve conduction velocity is time consuming and afferent fibers can also be examined in proprioceptive reflexes. Ths suitability of H-reflex response latency (RRL) for detection of slight uremic neuropathy was analysed. The wide range of RRL in healthy subjects can be explained by the different length of neural pathway in different subjects. A strong correlation between RRL and body height was found in healthy subjects. Relating RRL to the body height gives a highly sensitive measure of peripheral nerve function. Asymptomatic uremic neuropathy was detected very much earlier by RRL than by motor nerve conduction velocity. The method proved to be well suited for routine monitoring of uremic neuropathy in patients on dialysis.

Aluminum, zinc and copper concentrations in plasma in chronic renal insufficiency.

Plasma aluminium, zinc and copper were determined in 68 patients with chronic renal insufficiency and in 20 healthy individuals. In the renal insufficiency group 16 patients had received aluminium containing substances particularly phosphate binding drugs (aluminium hydroxide) for a long time. We observed that only the patients taking aluminium hydroxide showed elevated aluminium levels in plasma (controls: 0.86 +/- 0.27 mumoles/l; renal insufficiency: 3.05 +/- 1.63 mumoles/l). In two of these patients with symptoms of "dialysis dementia", plasma aluminium concentrations were markedly increased. The zinc concentrations in plasma of patients with renal insufficiency were slightly decreased (controls: 14.48 +/- 2.65 mumoles/l; renal insufficiency: 11.77 +/- 2.35 mumoles/l); the plasma copper concentrations were slightly increased (controls: 17.3 +/- 2.83 mumoles/l; renal insufficiency: 22.98 +/- 4.7 mumoles/l). There was a distinct decrease of plasma zinc concentrations in patients with raised aluminium levels. The clinical aspects of these changes are discussed.

[Long-time observation of a case of retroperitoneal fibrosis with Klinefelter's syndrome (author's transl)]. / Langzeitverlauf bei einem Fall von retroperitonealer Fibrose (M. Ormond) mit Klinefelter-Syndrom.

The etiology of retroperitoneal fibrosis still is largely unknown. Autoimmunologic mechanisms, traumata, systemic diseases, and drugs have been discussed as possible etiologic factors. The presented case was found to have a Klinefelter's syndrome besides retroperitoneal fibrosis. We do not believe that there is a relation between the two diseases. The retroperitoneal fibrosis of this case responded well to glucocorticosteroid therapy and the severly reduced renal function became normal.