[Crime-related amnesia: real or feigned?]. / Tatbezogene Amnesien - authentisch oder vorgetäuscht?

In the context of criminal forensic evaluations, experts are often confronted with the problem of offenders' claims of crime-related amnesia. Because of the far-reaching legal consequences of the expert opinion, the nature of the suspected memory disorder has to be investigated with special care and due consideration of differential diagnoses. While the diagnosis of organic amnesia is comparatively easy to make, the same is not true for dissociative amnesia. Despite existing theoretical explanations such as stress, peritraumatic dissociation or repression, to date there is no sound, scientifically based and empirically supported explanation for the occurrence of genuine, non-organic crime-related amnesia. In the criminal context of claimed amnesia, secondary gain is usually obvious; thus, possible malingering of memory loss has to be carefully investigated by the forensic expert. To test this hypothesis, the expert has to resort to methods based on a high methodological level. The diagnosis of dissociative amnesia cannot be made by mere exclusion of evidence for organic amnesia; instead, malingering has to be ruled out on an explicit basis.

Kinetics of cytokine production by thymocytes during murine AIDS caused by LP-BM5 retrovirus infection.

C57BL 6 mice inoculated with the murine leukemia retrovirus mixture, LP-BM5, rapidly produce murine AIDS with many functional similarities to human AIDS. Human HIV infection has recently been shown to inhibit thymocyte maturation. Therefore, the kinetics of the proliferation of thymocytes induced by Con-canavalin A (ConA) and levels of cytokines produced by in vitro ConA-stimulated thymocytes were examined during the progression of murine AIDS. The proliferation of thymocytes induced by ConA was significantly enhanced by retrovirus infection at 4 weeks post-infection compared to control, but significantly inhibited during 8-12 weeks post-infection. Release of IL-2 by ConA-stimulated thymocytes was significantly increased by retrovirus infection during 2-5 weeks post-infection and 11-18 weeks post-infection compared to control, but significantly decreased during 7-9 weeks post-infection. Secretion of IL-4 by ConA-stimulated thymocytes was significantly enhanced by retrovirus infection from 5 to 18 weeks post-infection compared to control. The level of IL-6 produced by ConA-stimulated thymocytes was significantly inhibited by retrovirus infection at the beginning of retrovirus infection (2-9 weeks), but significantly elevated after 11 weeks post-infection compared to control. Release of IFNgamma by ConA-stimulated thymocytes, however, was significantly enhanced during the whole period of retrovirus infection compared to control, while it surged at 13 weeks post-infection. We conclude that retrovirus infection affects the thymus, producing altered T-cell differentiation via the dysregulation of thymocyte cytokine secretion.

Influence of chronic dietary ethanol on cytokine production by murine splenocytes and thymocytes.

Prolonged consumption of ethanol (ETOH) results in alterations of host defense via immune modulation, increasing susceptibility to infection. In the present study, effects of chronic dietary ETOH on cytokine production by splenocytes and thymocytes, splenocyte and thymocyte proliferation induced by mitogens, splenic natural killer cell activity, and antibody production (IgA and IgG) were examined. C57BL/6 mice were fed 5% ETOH v/v in the Lieber-DeCarli liquid diet for 11 weeks. Release of interleukin (IL)-2, IL-5, IL-6, IL-10, and interferon (IFN)-gamma produced by concanavalin A (Con A) stimulated splenocytes was significantly decreased, whereas secretion of IL-4 was slightly decreased by chronic dietary ETOH compared with controls. Production of tumor necrosis factor-alpha and IL-6 by lipopolysaccharide-stimulated splenocytes was significantly and slightly decreased by ETOH compared with controls, respectively. Splenocyte and thymocyte proliferation induced by Con A was significantly inhibited by ETOH, whereas splenocyte proliferation induced by lipopolysaccharide was not affected. Natural killer cell activity was significantly inhibited by ETOH compared with controls. The production of IgA and IgG by splenocytes were also significantly decreased by ETOH compared with controls. The levels of IL-2, IL-4, and IL-6 produced by Con A-stimulated thymocytes were significantly reduced by dietary ETOH compared with control, whereas production of IFN-gamma by thymocytes was not affected. Our results suggest that chronic dietary ETOH alters the cytokine release, thereby impairing immune response and T-cell maturation, which increase host susceptibility to infection.

Ethanol-induced modulation of cytokine production by splenocytes during murine retrovirus infection causing murine AIDS.

Ethanol (ETOH) consumption has been associated with general suppression of the immune response, resulting in increased susceptibility to infection. Chronic dietary ETOH consumption may be one of the cofactors accelerating development of human acquired immune deficiency syndrome (AIDS) after retrovirus infection. Chronic dietary ETOH [5% (v/v)] in the Lieber-DeCarli liquid diet was fed female C57BL/6 mice inoculated with LP-BM5 retrovirus causing murine AIDS for 11 weeks. Because cytokines are key regulators of humoral and cellular immunity, their production by concanavalin A (ConA) and lipopolysaccharide (LPS)-induced splenocytes was measured by ELISA methods. Decreased levels of interleukin (IL)-2 caused by retrovirus infection remained unchanged. Elevated levels of IL-5 and IL-6 produced in vitro by ConA-stimulated spleen cells during retrovirus infection were significantly further increased by dietary ETOH. Elevated IL-4 due to retroviral infection were not affected by dietary ETOH. Increased production of IL-10 induced by retrovirus infection, however, was significantly reduced by dietary ETOH, whereas decreased release of interferon-tau induced by retrovirus infection was significantly enhanced. Elevated levels of tumor necrosis factor-alpha produced by LPS-stimulated splenocytes from retrovirus infected mice were significantly further increased by dietary ETOH, whereas levels of IL-6 by LPS-stimulated splenocytes were not affected. Suppressed T-cell proliferation caused by retrovirus infection was significantly reduced further by dietary ETOH. However, no effect of dietary ETOH was observed on decreased B-cell proliferation by retrovirus infection. These results suggest that dietary ETOH aggravates progression of immune dysfunction leading to AIDS, because dietary ETOH modifies production of immunological regulatory cytokines.

[Replacement of the anterior cruciate ligament combined with valgization osteotomy of the tibia in incipient medial gonarthrosis with anterior cruciate ligament insufficiency]. / Vorderer Kreuzbandersatz mit Tibiavalgisations-osteotomie kombiniert bei beginnender medialer Gonarthrose mit vorderer Kreuzbandinsuffizienz.

In 7 patients with chronic, primarily anteromedial instability and incipient medial gonarthrosis a procedure combining valgization osteotomy of the tibia with anterior cruciate ligament replacement was employed. Postoperative examinations after observation periods of between 6 months and 5 years revealed that the results were good to very good, both subjectively and objectively. There was either no recurrence or a definite alleviation of knee joint pain present preoperatively. In view of the good results the authors now regard a combination of valgization osteotomy and anterior cruciate ligament replacement as the treatment of choice in cases with clear insufficiency of the anterior cruciate ligament and simultaneous incipient medial gonarthrosis. The combined procedure improves chances of achieving the goal of therapy. A valgization osteotomy or an anterior cruciate ligament replacement alone ought to be regarded as inadequate treatment in such cases, especially in the longer term.