[Inflammatory spinal cord diseases and transverse myelitis]. / Entzündliche Rückenmarkerkrankungen und Querschnittsmyelitis.

BACKGROUND: Inflammatory spinal cord diseases are difficult to differentiate based on magnetic resonance (MR) morphological properties. However, correct diagnosis is crucial for treatment and outcome. OBJECTIVES: What MR characteristics allow correct classification? MATERIALS AND METHODS: A literature search for articles published in PubMed about various forms of transverse myelitis was performed. RESULTS: The length of the lesions, the level and location in the cross-section, and the enhancement pattern gives good clues for the correct diagnosis. The most important characteristics have been summarized in a table. CONCLUSIONS: In most cases, it is not possible to make a conclusive diagnosis, because many diseases overlap.

[Damages to the central nervous system due to illicit drug use]. / Schäden des Zentralnervensystems bei Drogenkonsum.

CLINICAL ISSUE: Illicit drugs can cause a myriad of CNS damages. The toxicity might be caused by the drug itself or by diverse contaminants. The most common changes are ischemic and hemorrhagic stroke as well as subarachnoid hemorrhage and leukoencephalopathies. This article gives a review of the most important morphological imaging findings of the CNS in illicit drug users. PRACTICAL RECOMMENDATIONS: In cases of stroke or unclear leukoencephalopathies in young adults, the differential diagnosis of illicit drug use should be considered.

Translation of the 'time is brain' concept into clinical practice: focus on prehospital stroke management.

Acute stroke is one of the main causes of death and chronic disability. Thrombolysis with recombinant tissue plasminogen activator within the first hours after onset of symptoms is an effective therapeutic option for ischemic stroke. However, fewer than 2% to 7% of patients receive this treatment, primarily because most patients reach the hospital too late for the initiation of successful therapy. Several measures can reduce detrimental delay until treatment. It is of importance to use continual public awareness campaigns to reduce delays in patients' alarm of emergency medical services. Further relevant measures are repetitive education of emergency medical services teams to ensure the systematic use of scales designed for recognition of stroke symptoms and the proper triage of patients to stroke centers. A most important time-saving measure is prenotification of the receiving hospital by the emergency medical services team. In the future, treatment already at the emergency site may allow more than a small minority of patients to benefit from available treatment.

[Cerebellar syndrome in Gaucher's disease]. / Zerebelläres Syndrom bei Morbus Gaucher.

This is a report on a 37-year-old female patient with enzymatically verified Gaucher's disease. The clinical symptoms corresponded to the neuronopathic form of the disease (type 3). A progressive cerebellar syndrome had been developing for 1 year. So far, there have been no records of complex cerebellar symptoms in connection with Gaucher's disease in the literature. After ruling out other differential diagnoses Gaucher's disease was considered to be the cause of such cerebellar symptoms, which could be attributed to toxic glucocerebroside deposits in the cerebellum.

[Botulinum toxin treatment : therapy success in cases of depression and ongoing pension applications]. / Botulinum-Toxin-Behandlung : Einfluss von Depression und laufendem Rentenverfahren auf den Therapieerfolg.

INTRODUCTION: A discrepancy is often observed between the presence of botulinum toxin antibodies (Btx-Ab) and successful therapy. We studied whether depression and an ongoing pension application explain this contradiction. METHOD: Sixty-five patients treated with Btx were questioned for subjective therapy failure (TF). The extensor digitorum brevis test (EDB test) indicated the presence of Btx-Ab. The Beck Depression Inventory and an exploration investigated for a depressive disturbance as well as an ongoing application for pension. We correlated the EDB test and the TF with a depressive disturbance and the wish for a pension. RESULTS: Forty-three patients had TF, from which 22 Btx-Ab were positive. A depressive disturbance was found in 25 patients, and an ongoing application for pension in 21. The EDB test and TF did not however correlate TF with a depressive disturbance (P=0.003) and a pension desire (P=0.021). The TF mostly appeared at the beginning of treatment. DISCUSSION: A depressive disturbance and an ongoing application for a pension influence the therapeutic success more strongly initially than the development of Btx-Ab. CONCLUSION: Besides Btx-Ab a depressive disturbance and an ongoing application for pension influences the therapeutic success.

[Proof of botulinum toxin antibodies with the Extensor Digitorum Brevis Test]. / Nachweis von Botulinum-Toxin-Antikörper. Korrelation des Extensor-digitorum-brevis-Test mit dem Mouse Diaphragma Bioassay.

INTRODUCTION: Some patients treated with botulinum toxin (btx) develop neutralizing btx antibodies (btx-ab). The expensive Mouse Diaphragm Bioassay (MDB) is considered as the gold standard by many authors. We wanted to examine whether the Extensor Digitorum Brevis Test (EDB test) is a reliable method to test for btx-ab. METHOD: We performed an electroneurography of the m. extensor digitorum brevis on both feet of 23 patients with known MDB. Afterwards the right feet were injected with 25 U of btx, and 21-28 days later the electroneurography was performed on both sides again. Finally we correlated the measured values (muscular wave latency, amplitude, area, and duration) intraindividually and with the MDB results. RESULTS: The parameters area and amplitude correlated highly significantly with the MDB (P<0.001 for both tests). Decreasing the amplitude to at least 65% of its initial value indicated the presence of btx-ab. In that way 22 of 23 EDB classifications were identical to those of the MDB, yielding a sensitivity of 92.86% and a specificity of 100%. CONCLUSION: The EDB test is a reliable technique for detecting btx-ab with high sensitivity and specificity. The EDB test can replace the MDB.

p53 expression and resistance against paclitaxel in patients with metastatic breast cancer.

PURPOSE: Paclitaxel is an important agent in the pharmacological treatment of metastatic breast cancer. Despite its efficacy in selected patients, the majority of patients have a resistance against paclitaxel. The aim of this study was to identify the responding patients and hence prevent the other patients from ineffective treatment. Identifying these patients could spare them an ineffective treatment and could in turn characterize a subgroup of patients with a higher response rate. MATERIAL AND METHODS: Thirty-three patients with metastatic breast cancer received paclitaxel 175 mg/m(2 )either as first- (15 patients) or as second-line (18 patients) treatment. Immunohistochemistry was performed on the blocks of the primary tumors with monoclonal antibodies against p53, HER-2/ neu, P-glycoprotein, Glutathione-S-Transferase-pi, and beta-tubulin II. The expression of those factors was then correlated with the objective response to paclitaxel. RESULTS: Ten of 33 patients had an objective response to treatment. A significant correlation with the objective response was found for the expression of p53. None of the tumors with p53 expression ( n=11) responded to paclitaxel. In contrast, 10 of the 22 patients without p53 expression showed an objective response ( P=0.013). Expression of HER-2/ neu, P-glycoprotein, Glutathione-S-Transferase-pi, and beta-tubulin II did not show a correlation with the response to paclitaxel. CONCLUSION: The immunohistochemical detection of p53 characterizes patients with metastatic breast cancer unlikely to respond to paclitaxel.

Relationship of mammary tumor susceptibility, mammary cell-mediated mutagenesis, and metabolism of polycyclic aromatic hydrocarbons in four types of rats.

Mammary tumorigenesis by 7,12-dimethylbenz(a)anthracene (DMBA) was tested in two rat stocks and two rat strains: outbred Sprague-Dawley and Long-Evans and inbred Wistar/Furth (WF) and Fischer F344 (F344) rats. Both Sprague-Dawley and WF rats showed comparably high susceptibility to tumorigenesis, whereas Long-Evans and F344 rats proved relatively resistant to tumorigenesis. Cultured mammary stromal and parenchymal cell populations from these four types of rats were used in a cell-mediated mutagenesis assay, and all were found to produce comparable levels of mutagenic metabolites from DMBA. Metabolisms of DMBA and benzo(a)pyrene (BP) were also examined in these cell populations, and similar patterns were found in mammary cells from both susceptible and resistant rat types. The stromal cell populations metabolized both carcinogens at a faster rate than the epithelial cells, but high-pressure liquid chromatographic analysis of ethyl acetate-soluble BP metabolites indicated that both cell types produced similar profiles of BP metabolites in all four rat types. Epithelial cells generally maintained higher intracellular concentrations of carcinogen compared to those of stromal cell populations. The four types were indistinguishable in the amounts and identities of glucuronic acid conjugates of BP that were formed by the mammary cells. The data demonstrate that the rat type-specific susceptibility to polycyclic aromatic hydrocarbon-induced tumorigenesis does not reside in the ability of the mammary cells to metabolically activate these carcinogens.