Emotional and cognitive empathy in patients with non-epileptic seizures.

OBJECTIVE: Evidence suggests that impairments in social cognition are associated with the occurrence of NES. Our aim was to investigate impairments in social cognition in the form of emotional and cognitive empathy in patients with NES compared to healthy controls. METHODS: For this purpose, we recruited 41 patients with video-EEG secured NES and compared them to 41 healthy controls matched by age, gender and educational level. Emotional and cognitive empathy were assessed using the Multifaceted Empathy Task (MET) and the Read the Mind in the Eye Test (RMET). Self-assessment questionnaires were used to record psychopathology in both groups. RESULTS: Patients with NES showed no differences in cognitive empathy compared to the healthy controls. Additionall, they seem to have less emotional empathy specifically towards positive emotions, compared to healthy controls. DISCUSSION: Our results are an indication of possible emotional empathy abnormalities in patients with NES. Those deviations, if replicated in large sample sizes, could implicate, that interventions for patients with NES should focus on improving empathy skills.

Fingers' vibration transmission and grip strength preservation performance of vibration reducing gloves.

The vibration isolation performances of vibration reducing (VR) gloves are invariably assessed in terms of power tools' handle vibration transmission to the palm of the hand using the method described in ISO 10819 (2013), while the nature of vibration transmitted to the fingers is ignored. Moreover, the VR gloves with relatively low stiffness viscoelastic materials affect the grip strength in an adverse manner. This study is aimed at performance assessments of 12 different VR gloves on the basis of handle vibration transmission to the palm and the fingers of the gloved hand, together with reduction in the grip strength. The gloves included 3 different air bladder, 3 gel, 3 hybrid, and 2 gel-foam gloves in addition to a leather glove. Two Velcro finger adapters, each instrumented with a three-axis accelerometer, were used to measure vibration responses of the index and middle fingers near the mid-phalanges. Vibration transmitted to the palm was measured using the standardized palm adapter. The vibration transmissibility responses of the VR gloves were measured in the laboratory using the instrumented cylindrical handle, also described in the standard, mounted on a vibration exciter. A total of 12 healthy male subjects participated in the study. The instrumented handle was also used to measure grip strength of the subjects with and without the VR gloves. The results of the study showed that the VR gloves, with only a few exceptions, attenuate handle vibration transmitted to the fingers only in the 10-200 Hz and amplify middle finger vibration at frequencies exceeding 200 Hz. Many of the gloves, however, provided considerable reduction in vibration transmitted to the palm, especially at higher frequencies. These suggest that the characteristics of vibration transmitted to fingers differ considerably from those at the palm. Four of the test gloves satisfied the screening criteria of the ISO 10819 (2013) based on the palm vibration alone, even though these caused amplification of handle vibration at the fingers. The fingers' vibration transmission performance of gloves were further evaluated using a proposed finger frequency-weighting Wf apart from the standardized Wh-weighting. It is shown that the Wh weighting generally overestimates the VR glove effectiveness in limiting the fingers vibration in the high (H: 200-1250 Hz) frequency range. Both the weightings, however, revealed comparable performance of gloves in the mid (M: 25-200 Hz) frequency range. The VR gloves, with the exception of the leather glove, showed considerable reductions in the grip strength (27-41%), while the grip strength reduction was not correlated with the glove material thickness. It is suggested that effectiveness of VR gloves should be assessed considering the vibration transmission to both the palm and fingers of the hand together with the hand grip strength reduction.

Sex differences in volume overload in skinned fibers.

BACKGROUND: The impact of sex on cardiac morphology and function in chronic volume overload has been described in detail. However, the relation between sex and contractile properties at the actin-myosin level has not been well defined. Therefore, we evaluated the influence of sex on the contractile capacities of patients with chronic volume overload. METHODS: In 36 patients (18 males, 65 ± 9 years; 18 females, 65 ± 13 years) scheduled for elective mitral valve surgery due to severe mitral regurgitation (MR) with preserved left ventricular function, right auricle samples were obtained prior to extracorporal circulation. The fibers were prepared and skinned and exposed to a gradual increase in the calcium concentration (from pCa of 6.5-4.0) for calcium-induced force-developing measurements. Calcium sensitivity was also measured and recorded. RESULTS: The pCa-force relationship of the fibers obtained from males and females was significantly different, with the force values of the female fibers greater than those of male fibers at maximum calcium concentrations (pCa of 4.0: 3.6 ± 0.3 mN versus 3.2 ± 0.4 mN, p 0.02) and pCa of 4.5 2.6 ± 0.6 versus 2.0 ± 0.5, p 0.002). In contrast, the force values of female fibers were lower at mean calcium concentrations compared to those of male fibers (at 5.5 and pCa of 6.0: 1.0 ± 0.3 mN versus 1.2 ± 0.5 mN, p 0.04; 0.61 ± 0.05 versus 0.88 ± 0.09, p 0.04). Calcium sensitivity was observed at pCa of 5.0 in females and pCa of 4.5 in males. CONCLUSION: This study demonstrated that female fibers from patients exposed to chronic volume overload developed higher force values at a given calcium concentration compared to fibers from male patients. We assume that female patients might tap the full force potential, which is required when exposed to the highest calcium concentrations in our experimental cycle. The calcium sensitivity among genders was significantly different, with the results suggesting that males have higher calcium sensitivity and might compensate for lower force values at maximal calcium concentrations by a higher affinity for calcium. Hence, female patients with MR seem to work more "energy efficient".

Osteolytic clear cell meningioma of the petrous bone occurring 36 years after posterior cranial fossa irradiation: Case report.

OBJECTIVE AND IMPORTANCE: While bone invasion and hyperostosis are frequent phenomena in meningiomas, primary intraosseous meningiomas are rare and their occurrence in the skull base is an extraordinary exception. Moreover, radiation-induced meningiomas represent a unique clinical dilemma given the fact that patients with these tumors had often received a prior full course of radiotherapy. CLINICAL PRESENTATION: A 42-year-old man presented with a 3-month history of progressively worsening facial asymmetry. His medical history was consistent for a posterior cranial fossa irradiation at the age of 6 years for a non-confirmed brain stem tumor. On admission his Karnofsky performance status was graded as 50% and his neurological examination showed a complete right facial nerve paralysis and hearing impairment. Computed tomography and magnetic resonance imaging demonstrated an osteolytic tumor invading the whole right petrous bone without intracranial involvement. INTERVENTION: As the tumor reached the external auditory canal, a tissue sample was obtained locally. Pathological examination of the lesion identified a grade II clear cell meningioma and the patient was consequently addressed for an intensity modulated radiation therapy. His condition remained unchanged till the most recent follow-up examination, 8 months later. CONCLUSIONS: To the best of our knowledge, a radiation induced osteolytic clear cell meningioma of the petrous bone has not been previously reported. As little literature exists regarding the use of adjuvant therapies for these tumors, intensity modulated radiation therapy remains an attractive treatment option in case of pervious irradiation and general status alteration.

[End-of-life decisions and practices in critically ill patients in the cardiac intensive care unit. A nationwide survey]. / Begrenzung und Abbruch lebenserhaltender Maßnahmen bei kritisch kranken kardiochirurgischen Patienten. Ergebnisse einer bundesweiten Umfrageaktion.

BACKGROUND: Ethical and medical criteria in the decision-making process of withholding or withdrawal of life support therapy in critically ill patients present a great challenge in intensive care medicine. OBJECTIVES: The purpose of this work was to assess medical and ethical criteria that influence the decision-making process for changing the aim of therapy in critically ill cardiac surgery patients. MATERIALS AND METHODS: A questionnaire was distributed to all German cardiac surgery centers (n = 79). All clinical directors, intensive care unit (ICU) consultants and ICU head nurses were asked to complete questionnaires (n = 237). RESULTS: In all, 86 of 237 (36.3 %) questionnaires were returned. Medical reasons which influence the decision-making process for changing the aim of therapy were cranial computed tomography (cCT) with poor prognosis (91.9 %), multi-organ failure (70.9 %), and failure of assist device therapy (69.8 %). Concerning ethical reasons, poor expected quality of life (48.8 %) and the presumed patient's wishes (40.7 %) were reported. There was a significant difference regarding the perception of the three different professional groups concerning medical and ethical criteria as well as the involvement in the decision-making process. CONCLUSION: In critically ill cardiac surgery patients, medical reasons which influence the decision-making process for changing the aim of therapy included cCT with poor prognosis, multi-organ failure, and failure of assist device therapy. Further studies are mandatory in order to be able to provide adequate answers to this difficult topic.

Influence of storage time and amount of red blood cell transfusion on postoperative renal function: an observational cohort study.

INTRODUCTION: To identify the impact of storage time and amount of transfused red blood cell units on renal function. METHODS: Consecutive transfused patients (n=492), undergoing cardiac surgery at a single centre and receiving at least one red blood cell unit, were pooled in different groups depending on storage time and amount of transfusion. RESULTS: Altogether 2,133 red blood cell units were transfused (mean age 21.87 days). Pre- and intraoperative data were similar between groups. Postoperative serum creatinine (p<0.01), glomerular filtration rate (p<0.01), and urea (p<0.01) showed a significant correlation with the amount of transfused red blood cell units, but not with storage time. Acute kidney insufficiency (creatinine values greater than 2.0 mg/dl or a duplication of the preoperative value) developed in 29% of patients and was associated with red blood cell mean age (p=0.042), absolute age (p=0.028), and amount of transfused (p<0.01) units. Acute kidney failure requiring renal replacement therapy occurred in 9.6% of patients and was associated with the amount of transfusion (p<0.01).  CONCLUSIONS: Worsening of renal function after cardiac surgery is associated with storage time and amount of transfused red blood cell units. Acute kidney insufficiency was defined as serum creatinine values greater than 2.0 mg/dl or a duplication of the preoperative value (baseline). Acute kidney failure was defined as becoming dependent upon dialysis.

[Chordoid meningioma. Two cases]. / Le méningiome chordoïde. A propos de deux cas.

Chordoid meningioma is an uncommon histopathological variant of meningioma frequently confused with chordoma. Recurrence is not uncommon. The aim of our study is to present the clinical and pathological characteristics of this entity and a review of the literature. We report two cases of chordoid meningioma occurring in two women aged 47 and 63 years. Both women presented neurological signs without systemic disease. Radiological findings were temporoparietal and temporofrontal lesions with intense enhancement after contrast injection. Complete surgical resection was performed. Histopathologic findings were consistent with chordoid meningioma.

[Pituitary apoplexy. Report of 25 patients]. / Apoplexies pituitaires. A propos de 25 patients.

A series of 25 patients with a clinical diagnosis of pituitary apoplexy (PA) is reviewed. It included 14 men and 11 women aged between 20 to 79 years (mean age: 54 years). Twenty-two patients did not know that they had a pituitary tumor when the apoplexy occurred. A precipitating event was found in 3 cases. Symptoms and signs ranged from isolated ocular paresis to a deep coma. Seventeen patients experienced a decrease in their visual acuity. CTscan and MRI showed a pituitary adenoma in all cases, a hemorrhage was also present in 10 out of the 24 CTscans, and in all the 8 MRI performed. Twenty patients underwent surgery; 18 of them by a transsphenoidal approach. A complete recovery of visual acuity was observed in 75% of patients operated within the week following the onset of symptoms, and in 56% of patients operated later on. There was no case of complete visual recovery among the blind patients. Pituitary apoplexy is a clinical concept. It applies only to symptomatic cases. It is generally a complication of a pituitary adenoma which is in most cases unknown. There are different degrees of severity; PA can even be life-threatening. The principal aim of surgery in the acute phase is the improvement of visual prognosis. In our series, blind patients or those with a history of visual loss for more than a week or with a blindness had a poorer prognosis.

[Aneurysmal bone cyst of the cranial base treated by partial resection and calcitonin injection. A case report]. / Kyste anevrysmal de la base du crane. à propos d'un cas traité par exérèse partielle et injection de calcitonine.

STUDY DESIGN: First published report of a cranial aneurysmal bone cyst (ABC) treated successfully with intralesional injection of calcitonin. OBJECTIVES: To describe a safe and effective treatment method for ABCs of the cranial base. SUMMARY OF BACKGROUND DATA: ABC is a rare form of dystrophic pseudotumor. Less than 100 cases involving the skull have been reported in the literature, most of them localised in the cranial vault. Cranial base locations are rare and difficult to treat. We selected this treatment after a very rapid recurrence of the lesion following a partial resection. Method. - After a partial resection of a 10 cm petro-occipital ABC that encased the vertebral artery and the lower cranial nerves, an Ommaya reservoir was implanted with a catheter tip inside the ABC. Repeated intralesional injections of calcitonin were performed through the reservoir. RESULTS: Shrinkage of the cyst occurred with disappearance of its heterogeneous cystic content and ossification of its walls. There was no complication and the lesion remains quiescent at a 3 year follow-up. CONCLUSION: We reviewed the pertinent literature concerning percutaneous treatment of ABC. The percutaneous intralesionnal injection of calcitonin was reported in the literature only in 3 publications reporting 9 cases that did not involve the skull. This treatment seems safe and effective, worthy in cranial base ABCs that are difficult to resect completely.