The association between white matter lesions, stroke and activities of daily living--the MEMO study on the KORA platform Augsburg.

Modern brain imaging methods have shown that vascular brain changes are a frequent finding in elderly individuals. The clinical relevance of subcortical white matter lesions is subject of debate, their impact on the functional status of those affected unclear. We assessed the prevalence of large white matter lesions and stroke, defined by Magnetic Resonance (MRI) criteria and by questionnaire reports, among 268 participants of the Memory and Morbidity in Augsburg Elderly Study, a 1997/98 follow up project of the MONICA survey S2 (1989/90), and evaluated the association of both types of brain changes with limitations in activities of daily living. The prevalence of large white matter lesions was 37 % (n = 69), that of any stroke or TIA 19.4 % (n = 52) and 12 % (n = 32) were affected by both brain changes. The latter group performed significantly worse in geriatric performance tests and had considerable impairments in their daily functioning. Vascular brain changes are very prevalent in older populations and have a measurable and considerable impact on functional capabilities of those affected.

Degenerative diseases of the spine. The role of myelography and myelo-CT.

The role of myelography combined with myelo-CT in the evaluation of degenerative disease of the spine is judged differently. If MRI cannot be performed at a technically 'state of the art' standard, myelography combined with CT is the most informative link in the diagnostic chain, providing additional information to plain CT or technically inadequate MRI examinations, contributing to the final diagnosis and substantially directing the therapeutic strategy. For the preoperative evaluation of spinal stenoses, any compression of the nerve roots or the spinal cord by osseous spurs or soft tissue structures is best assessed after intrathecal administration of contrast medium.

[Value of computerized tomography and magnetic resonance tomography in psychiatric diagnosis]. / Stellenwert von Computertomographie und Magnetresonanztomographie in der psychiatrischen Diagnostik.

This paper evaluates the role of computed tomography (CT) and magnetic resonance imaging (MRI) in the diagnosis of psychiatric disorders according to the "International Classification of Diseases" (ICD-10). Indications for CT/MRI can be derived from ICD-10 for the identification or exclusion of defined cerebral lesions resp. for the etiology in organic disorders. Due to the lack of specific morphological findings, CT/MRI do not contribute to the classification of all other diagnoses. CT/ MRI can only exclude causal organic factors. However, ICD-10 provides only few guidelines for ruling out cerebral pathology (e.g. tumors in bulimic anorexia). Therefore, recommendations for routine CT/MRI-investigations for the exclusion of organic disorders are required and might be developed by the quality assurance. Application of CT or MRI: CT plays an important role in diagnostic imaging in routine as well as in emergency situations (haemorraghe, hamatoma, infaction, head injury, tumour, vascular malformation). MRI on the other hand, is more sensitive in the diagnosis of inflammatory diseases, skull base lesions, degenerative changes of the white matter and in the imaging of hydrocephalus and epilepsy.

Intrathymically expressed c-kit ligand (stem cell factor) is a major factor driving expansion of very immature thymocytes in vivo.

To investigate the role of the receptor-type tyrosine kinase, c-kit and its ligand, stem cell factor (SCF) in T cell development, we analyzed c-kit (W/W) and SCF (SI/SI) deficient mice. We also engrafted wild-type or SCF-deficient fetal thymi onto wild-type recipient mice and analyzed the rate of proliferation by in vivo bromodeoxyuridine labeling. The results show that the most immature thymocyte compartment defined as CD3-CD4-CD8- is significantly reduced in SI/SI grafts and W/W thymi compared with wild-type counterparts. Also, the expansion rate of these immature thymocytes in SI/SI graft is reduced by -50%. These experiments provide direct evidence for an important role for c-kit-SCF interactions in expansion of very early thymocytes.

Laboratory scale production of monoclonal antibodies in a tumbling chamber.

A simple device for laboratory scale production of monoclonal antibodies has been developed. Hybridomas were cultured in four individual dialysis tubes containing 40-50 ml medium with 10% foetal calf serum, surrounded by 1.5-2 litres supply medium without any serum supplement. Once placed on a roller the special design of the apparatus leads to an eccentric rotation, thus keeping the cells in a stable homogeneous suspension. The system is automatically gassed, and this makes long term cultivation possible. Several hybridomas were tested over a culture period of at least 3 weeks, with supply medium changes every 3-4 days. Cell densities of up to 2.5 x 10(7)/ml and antibody concentrations of 0.3-1.9 mg/ml after purification were obtained. Results with this in vitro system allow a complete renunciation of the established in vivo method. The so called 'tumbling chamber' apparatus is easy to handle and to sterilize, is economic and universally adaptable in any research laboratory.

Identification of pro-thymocytes in murine fetal blood: T lineage commitment can precede thymus colonization.

Phenotype and commitment of thymus-colonizing precursors are unknown. Here we report the identification of T lineage-committed precursors (designated prothymocytes) in murine fetal blood at day 15.5 of development. Fetal blood pro-thymocytes are Thy-1+c-kit(low)CD3- in contrast to fetal blood-derived pluripotent hematopoietic progenitors which are Thy-1-c-kit+. Upon transfer into the thymus, fetal blood pro-thymocytes generate a single wave of CD4+CD8+ thymocytes and subsequently mature TCR alpha beta+ peripheral T cells. However, fetal blood pro-thymocytes lack multipotent progenitor potential since they fail to reconstitute B lymphocytes and myeloid and erythroid lineages. In contrast, T and B lymphocytes as well as myeloid and erythroid lineages are reconstituted from fetal blood-derived pluripotent progenitors. Pro-thymocytes are equally present in peripheral blood of athymic fetal mice, suggesting that this novel precursor population is T lineage-committed prior to thymus colonization and represents the earliest T lineage precursor identified.

[Depressive disorders after cerebral infarct. Relations to infarct site, brain atrophy and cognitive deficits]. / Depressive Störungen nach Hirninfarkt. Beziehungen zu Infarktlage, Hirnatrophie und kognitiven Defiziten.

We studied the effects of the localisation and size of ischemic brain infarcts and the influence of potential covariates (gender, age, time since infarction, physical handicap, cognitive impairment, aphasia, cortical atrophy and ventricular size) on 'post-stroke depression'. During an 18-months period all patients who underwent a CT-scan at the Central Institute of Mental Health and who had a single unilateral ischemic hemisphere infarct were initially included. Patients with severe aphasia or cognitive impairment who could not communicate well enough for the administration of depression rating scales were excluded. This led to a selection bias towards larger infarct sizes in the right hemisphere. In order to overcome this potentially critical selection artefact all patients with infarct sizes over 23 cm2 and/or with 'mini Mental State Scores' under 20 were excluded. The data from the remaining 30 patients (mean age 68 years; 15 male; 13 left hemisphere infarcts were used for the analysis. Their scores on the Hamilton depression rating scale, the Zung self rating depression scale and the von Zerssen clinical self-rating depression scale correlated significantly with one another (r greater than 0.73; p less than 0.001). Backward stepwise regression analysis carried out on the covariates mentioned above demonstrated a significant relationship only between cognitive impairment or cortical atrophy and a higher depression score.(ABSTRACT TRUNCATED AT 250 WORDS)

Computed tomography in depression: association between ventricular size and psychopathology.

The relationship between psychopathology and brain alterations, measured by computed tomography (CT), was investigated in 44 depressed patients. Comparisons of ventricle-brain ratio (VBR) between "endogenous" vs. "nonendogenous" subgroups, classified by six distinct diagnostic systems, revealed no significant differences. The VBR and the width of the third ventricle correlated significantly with scores on the Brief Psychiatric Rating Scale, the Global Assessment Scale, the Bech-Rafaelsen Melancholia Scale, the Rating for Emotional Blunting, and the Scale for the Assessment of Negative Symptoms, but not with scores on the Hamilton Rating Scale for Depression and the Hamilton Rating Scale for Anxiety. Item analyses of the Bech-Rafaelsen Melancholia Scale revealed that retardation-related items were most significantly correlated with ventricular size. The wider diameter of the third ventricle in psychotic patients was associated with higher scores on retardation in the psychotic subgroup, whereas the greater distances of both Sylvian fissures showed no relationship to psychomotor retardation. No significant correlations were found between CT values and anxiety, suicidal impulses, somatic complaints, and sleep disturbances.

[The risk of endocrine activation in interventional procedures on paraganglioma of the head and neck]. / Das Risiko der endokrinen Aktivierung bei interventionellen Eingriffen an Paragangliomen des Kopf-Hals-Bereiches.

In the literature on paragangliomas or glomus tumors of the head and neck, the question rarely arises as to whether in endocrine inactive paragangliomas the tumor necrosis resulting from the embolization can release the stored substances. Based on 34 paragangliomas after surgical treatment, the angiographic and immunohistological characteristics of the paraganglionic, angiomatous and adenomatous tumors are presented. No catecholamine secretion occurred as a result of interventional or surgical treatment.

Computed tomography in affective disorders. Part II. Brain density.

The attenuation values of brain density were investigated in 53 patients with affective disorder and 53 individually age- and sex-matched controls by computed tomography (CT). Asymmetry of density distribution, with higher values in most regions of the left hemisphere, was found in patients as well as in controls. Patients tended to display higher attenuation values than controls. In patients, an association between higher density of the parenchyma and smaller ventricular size was observed, but not in controls. Corresponding greater density in patients, compared to controls, was found in those subgroups (women, nonpsychotics, and bipolars) that did not differ in ventricle size from controls. Comparisons within subgroups of patients revealed lower attenuation values in psychotic than in nonpsychotic subjects, lower values in men than in women, lower values in lithium-treated than in non-lithium-treated patients, and lower values in unipolar than in bipolar patients. No differences were observed between older and younger patients or Dexamethasone Suppression Test (DST) normal versus DST-abnormal patients. No correlations between age and density were obtained in patients and controls.

Advantage of magnetic resonance imaging in the diagnosis of cerebral infections.

18 patients with cerebral infections were investigated with a 1.5 Tesla-Magnetom. The results are compared to CT-findings obtained at the same time. In the majority of cases (n = 11) MR is superior to CT because it allows earlier detection of the disease, a more exact definition of the spread and a more detailed representation of complex inflammatory processes. MRI should rank first among all examination methods, especially in the determination of herpes simplex-encephalitis as it allows earlier detection and treatment of this disease.

Computed tomography in affective disorders. Part I. Ventricular and sulcal measurements.

Sixty patients with affective illness were examined by computed tomography (CT) and compared to 60 age- and sex-matched controls. Using three different methods of measurement, no differences in ventricular brain ratio (VBR) between patients and controls could be detected. However, linear ventricular values of the frontal horns plus the bicaudate distance (Huckmann number) and the third ventricle were enlarged in the total group of patients. This was also found in subgroups of older, male, psychotic, unipolar, Dexamethasone Suppression Test (DST) positive, and lithium-treated patients when compared to individually matched controls. Younger, nonpsychotic, female, bipolar, DST-normal and non-lithium-treated patients did not differ from controls. The Huckmann number correlated with the duration of illness, as measured by the first episode and the number of episodes. The comparison between the subgroups of patients yielded higher linear and VBR values in older subjects, in men, and in psychotic subjects, whereas no differences were found in comparisons between unipolar versus bipolar, DST-positive versus DST-negative, and lithium-treated versus non-lithium-treated patients.

Sonography and computed tomography in the diagnosis of orbitocranial malformations and tumors.

Standardized sonography and CT scanning have distinct advantages and disadvantages in the evaluation of patients with orbital diseases. Echography provides an efficient screening examination in patients presenting with signs and symptoms of orbital pathology. It allows the detection, localization, measurement and in almost 80% differentiation of orbital lesions. High resolution CT scanning gives an excellent topographic display of masses in the orbit. In visualization of intracranial causes of orbital processes and demonstration of changes in the posterior third of the orbit, in the orbital bones and the periorbital sinuses it is superior to ultrasonography.

Bilateral lesions of the putamina.

13 cases of bilateral necrosis of the putamina in children and adults are reported. CT shows similar parenchymal defects, though clinical data reveal different histories, causes and circumstances of the damage. The relationship between CT findings and clinical symptoms is investigated, and the neurological dysfunctions resulting from symmetrical areas of necrosis in each putamen are discussed.

[Efficiency and efficacy of neuroradiologic diagnosis of brain tumors]. / Leistungsfähigkeit und Auswirkungen der neuroradiologischen Hirntumor-Diagnostik.

Working as neuroradiologists for many years permits us to discuss the development of neuroradiological diagnosis in intracranial disease in adults measuring efficacy and efficiency by critical comparison with therapeutic results.