Risk for transmission of Naegleria fowleri from solid organ transplantation.

Primary amebic meningoencephalitis (PAM) caused by the free-living ameba (FLA) Naegleria fowleri is a rare but rapidly fatal disease of the central nervous system (CNS) affecting predominantly young, previously healthy persons. No effective chemotherapeutic prophylaxis or treatment has been identified. Recently, three transplant-associated clusters of encephalitis caused by another FLA, Balamuthia mandrillaris, have occurred, prompting questions regarding the suitability of extra-CNS solid organ transplantation from donors with PAM. During 1995-2012, 21 transplant recipients of solid organs donated by five patients with fatal cases of PAM were reported in the United States. None of the recipients developed PAM, and several recipients tested negative for N. fowleri by serology. However, historical PAM case reports and animal experiments with N. fowleri, combined with new postmortem findings from four patients with PAM, suggest that extra-CNS dissemination of N. fowleri can occur and might pose a risk for disease transmission via transplantation. The risks of transplantation with an organ possibly harboring N. fowleri should be carefully weighed for each individual recipient against the potentially greater risk of delaying transplantation while waiting for another suitable organ. In this article, we present a case series and review existing data to inform such risk assessments.

Surgical treatment of primary locally advanced rectal cancer in Norway.

AIMS: Most reports on locally advanced rectal cancer come from specialized centres, with a selected patient material. The purpose of this study was to examine the results after surgical treatment of patients with locally advanced rectal cancer at a population level. METHODS: National cohort study of 896 patients undergoing surgery for a locally advanced primary adenocarcinoma of the rectum from November 1993 to December 2001. RESULTS: Surgery with resection was undertaken in 724 patients and 172 patients underwent palliative procedures. Of 557 patients treated for cure, a R0 resection was achieved in 342 (61%). In a multivariate analysis, pre-operative radiotherapy was the only factor with a positive association with R0 status (odds ratio 3.7, 95% confidence interval (CI) 2.1-6.4). Five-year local recurrence rates were 18% (CI 14-23) for R0 resections and 40% (CI 26-52) for R1 resections. Overall 5-year survival rate was 23%; for the group of patients with a R0 resection the survival rate was 49%. CONCLUSION: The radical resection rate and survival rates in this national study were similar to those reported from specialized centres.

Volumetric alterations in the heteromodal association cortex in children with autism spectrum disorder.

BACKGROUND: We investigated if alterations in higher-order association areas related to schizophrenia, namely the heteromodal association cortex (HASC), are also observable in subjects with autism spectrum disorder (ASD). METHODS: A group of 18 children with ASD and 18 healthy controls (HC) underwent magnetic resonance imaging (MRI). The examination comprised an analysis of group differences in gray matter (GM) volume, surface area (SA) and hemispheric lateralization. RESULTS: Differences in GM volumes in children with ASD and HC were detected in frontal and parietal areas related to the HASC. No HASC structure that showed changes in GM volume exhibited differences in SA. Alterations in hemispheric lateralization between ASD and HC are seen in a frontal area of the HASC. CONCLUSIONS: Our results indicate that changes in HASC areas are not restricted to schizophrenia, but extend to other psychiatric disorders, namely ASD. The lacking group differences in SA indicate that changes in GM volume are possibly evoked by other variables than SA in children with ASD.

The potential of collagenase as a new therapy for separation of human retained placenta: hydrolytic potency on human, equine and bovine placentae.

The purpose of this study was to determine to what degree bacterial collagenase may digest human placentae compared to equine and bovine placentae. Placenta samples from human, equine and bovine were incubated with bacterial collagenase solution at various concentrations. The degree of hydrolysis and collagen breakdown was measured by the release of total proteins and hydroxyproline into the incubation media. Also, whole placentae were injected via umbilical cord arteries with collagenase solution (200 U/ml, 200 ml total volume in human and 1000 ml in equine) and hydrolysis determined chemically and subjectively. Human and equine placental collagens were the most sensitive to collagenase digestion. Overall mean collagenase activity determined by the release of hydroxyproline from human placenta was 1.6 times and in equine placenta three times greater than in bovine placenta, while the breakdown of non-collagenous proteins remained negligible. When injected into whole placenta, the collagenase digested placentae evenly within 6-12 h. At 24 h, placentae were liquefied, although, umbilical blood vessels resisted collagenase digestion. Bacterial collagenase was highly effective in breaking down human placenta collagen. Intraplacental injections of collagenase via umbilical cord arteries may help to detach retained placenta in women as it does in mares and cows.

The technology-dependent child.

Improvements in the provision of oxygen, mechanical ventilation, tracheostomy care, enteral and parenteral nutrition, and dialysis have expanded the population of technology-dependent children. This article attempts to review pertinent points regarding these services, including common complications. Primary care and subspecialty physicians must smooth the transition of these children to the home environment, but a comprehensive team approach is necessary for the recognition of medical complications and provision of appropriate family teaching and psychosocial supports.

The effect of gamma-irradiation on drug release from bioerodible microparticles: a quantitative treatment.

The two major objectives of this study were: (i) to monitor the effect of different gamma-irradiation doses (4-33 kGy) on the release kinetics from 5-fluorouracil (5-FU)-loaded poly(D,L-lactide-co-glycolide) (PLGA)-based microparticles, and (ii) to analyze the obtained experimental data with a new mathematical model giving insight into the occurring mass transport phenomena. Drug release was found to depend significantly on the applied gamma-irradiation dose. Interestingly, the obtained release profiles were all biphasic: a rapid initial drug release phase ("burst") was followed by a slower, approximately constant drug release phase. Surprisingly, only the initial rapid drug release was accelerated by gamma-irradiation; the subsequent zero-order phase was almost unaffected. Importantly, the new mathematical model which is based on Fick's second law of diffusion and which considers polymer degradation was applicable to all the investigated systems. In addition, the gamma-irradiation dose could be quantitatively related to the resulting drug release rate. In conclusion, diffusion seems to be the dominating release rate controlling mechanism in all cases, with a significant contribution of the polymer degradation process.

Equine retained placenta: technique for and tolerance to umbilical artery injections of collagenase.

Under laboratory conditions and in clinical experiments, bacterial collagenase has proven to be effective in hydrolyzing placenta and detaching cotyledon from caruncle in the bovine species. Laboratory studies in which placental samples were incubated with collagenase have also demonstrated that collagenase is 3.7 times more effective in hydrolyzing equine placenta than bovine placenta. This led to the hypothesis that collagenase may be a potential treatment for mares with retained placenta. However, that collagenase may hydrolyze the uterine wall and perforate the uterus was a concern. It was the purpose of this study thus to determine any adverse effects of collagenase on the equine uterus and to develop a method for intraplacental injection of collagenase. Three normally expelled intact placentas from Arabian mares, 10 cyclic mixed-breed mares, and 4 mares of various breeds with retained placenta were used. Fluoroscein dye and latex were used to study the placental vasculature and to determine a suitable dose of collagenase; placentas were hydrolyzed by collagenase solution in vitro. Bacterial collagenase solution (40,000 units, 200 ml) was infused into the uterine lumen of each cyclic mare. Uterine biopsies were obtained from the mares before collagenase infusion and again at 16 h and 26 d after infusion. In the mares with retained placenta, each placenta was infused via its umbilical cord vessels with 200,000 units of bacterial collagenase in 1 L of saline. Results showed that none of the uteri from cyclic mares were damaged by collagenase treatment. During a 4-wk period of monitoring (including endoscopy) mares with retained placenta did not show any abnormalities. Retained placentas were expelled in less than 6 h after collagenase treatment. It was concluded that intraplacental injections of collagenase are a safe and potentially effective treatment for retained placenta in mares.

Testing the hypothesis of the relationships between laterality and ability according to Annett's right-shift theory: findings in an epidemiological sample of young adults.

In a large epidemiological sample of young adults, predictions of the right-shift (RS) theory of Annett that cognitive abilities will vary with right-left hand skill were tested. Presenting a theory of a genetic balanced polymorphism with heterozygote advantage for laterality and ability, Annett & Manning (1989, 1990a) and Annett (1993c) claimed that probands at the right end of the R-L hand skill continuum would show lower general intelligence in IQ testing and that specific verbal abilities and educational success would be lower at both extremes of the R-L distribution, taking the form of an inverted U. Most of these predictions could not be confirmed by our study. In particular, our data contrast with the important and specific prediction of the RS theory that strong dextrals will be the most disfavoured group. In our sample, probands at the left end of the R-L continuum had significantly lower scores in spelling and educational success and showed a tendency to have lower non-verbal IQ scores, while strong dextrals tended to have average or even marginally higher ability scores. The effects, however, are small and decrease when controlling for other variables. Implications of these empirical findings for the right-shift theory are discussed.

[Possible definitions and subsequent incidence of circumscribed reading and spelling disorders--theoretical considerations and empirical findings in a representative sample of young adults]. / Definitionsmöglichkeiten und sich daraus ergebende Häufigkeit der umschriebenen Lese- bzw. Rechtschreibstörung--theoretische Uberlegungen und empirische Befunde an einer repräsentativen Stichprobe junger Erwachsener.

OBJECTIVES: With reference to an epidemiological sample of adolescents and young adults the impact of different models on the number of children classified as having specific reading and spelling problems is investigated. METHODS: Using the same set of data, the effects of alternative measurement models, definitions and methodological procedures on the prevalence of specific spelling problems are shown. The virtual consequences of various norm-oriented definitions of cases are discussed with reference to external empirical criteria. RESULTS: In the present study case definitions of specific spelling retardation based on substantial criteria result in prevalence rates between six and nine percent.

[Handedness and cognitive abilities: findings in a representative sample of adolescents and young adults]. / Händigkeit und kognitive Fähigkeiten: Befunde an einer repräsentativen Stichprobe Jugendlicher und junger Erwachsener.

Handedness and cognitive abilities in a representative sample of adolescents and young adults. The relationship between laterality and cognitive ability was examined in a representative sample of adolescents and young adults between 16 and 30 years of age. The study was designed as a possible replication of Annett's data supporting her right-shift theory (rst), but included other measures of laterality as well. We found, as Annett did, that strong right-handedness was associated with a weak left hand rather than a strong right hand. However, we could not confirm two other predictions of the rst with our data: The nonverbal IQ was significantly lower in both extreme groups of handedness than in the two middle groups. Because of the sample size this rather small effect, explaining only 1.9% of the variance, is significant, but it disappears with other kinds of grouping for handedness. We could not find the linear decline in nonverbal IQ from the left to the right extreme of handedness as predicted by the rst. In spelling, too, there was a rather small, but significant effect of handedness, explaining 2.4% of the variance. Spelling in the first (left most) quartile of handedness was worse than in quartiles two and four. The predicted poorer spelling in the extreme groups than in the middle groups (inverted U) was not found in our sample. In multivariate analysis with variables explaining larger proportions of the variance in spelling (education, nonverbal IQ and sex) the small effect of handedness on spelling completely disappeared. A weak relationship between left-handedness and dyslexia was evident only with the strictest definition of dyslexia, regardless of how handedness was defined. The implications of these data for the rst are discussed.

[Concentrating on weaknesses or compensating by strengths? Comparison of 2 strategies for remediation of children with comprehensive reading-spelling disorder]. / An Schwächen üben oder durch Stärken ausgleichen? Vergleich zweier Strategien in der Förderung von Kindern mit einer umschriebenen Lese-Rechtschreib-Schwäche.

Our study compares the efficiency and acceptance of two different methods of treating dyslexia in children. The first method addresses the most commonly encountered deficits in sequential processing. It relies primarly upon the "Kieler Lese-Rechtschreibaufbau". The second proceeds from the child's relative resources with regard to simultaneous processing as described by Kaufman. Training materials are those prescribed by Kaufman. Normally gifted primary school third-graders were trained in two groups (n = 13 and n = 12) and achieved a mean SIF score of SW = 101 on the K-ABC. As expected, the children scored significantly lower on the SED scale (SW = 95) than on the SGD scale (SW = 105). At the beginning of the respective training program their spelling ability fell 1.5 SD below the class mean. One year of regular weekly one-hour training according to the simultaneous processing method was significantly more successful than training in sequential processing, whereas girls improved significantly more than boys regardless of the method used. Acceptance of the methods did not vary. This result requires careful consideration and should be replicated in younger samples such as first- and second-graders in the early stages of learning to read and write, and/or in children whose dyslexia is more severe than that encountered in the current sample. It underscores that determination of an adequate method of remediation entails more than the mere identification of the underlying deficits.

[Test construction, analysis and trial of the Heidelberg Sound Discrimination Test for measuring auditory-kinesthetic perceptual discrimination acuity]. / Testkonstruktion, -analyse und Erprobung des Heidelberger Lautdifferenzierungstests zur auditiv-kinästhetischen Wahrnehmungstrennschärfe (HD-LT).

The provisional trial was carried out in a sample of 133 second- and 139 fourth-graders from the Heidelberg area. The HD-LT was subjected to an item selection, test criteria were ascertained and temporary percentile norms for the second and fourth grades were established. High item difficulty resulted for both grades, i.e. the test was relatively easy. Test criteria were generally satisfactory. Significant correlations were found in both grades between the HD-LT and the children's spelling ability. The HD-LT accounted for 30% of the spelling variance among second-graders as compared to 10% of that among fourth-graders. This reflects the specific significance of phonetic discrimination ability in the first years of elementary school. Children with spelling difficulties were compared to those with good spelling abilities in respect to their ability to discriminate sound. Spelling-impaired children in both grades exhibited a significantly lower overall HD-LT score. No significant sex differences were found with regard to the auditory and kinesthetic phonetic discrimination ability. Since the HD-LT turns out to be well-suited to indicate a phonetic discrimination disability during the initial phases of acquisition of written language, its further development and extension of its application to the pre-school level are recommended.

[Effects and significance of specific spelling problems in young adults--empirical studies in an epidemiologic patient sample]. / Auswirkungen und Bedeutung spezifischer Rechtschreibprobleme bei jungen Erwachsenen--empirische Befunde in einer epidemiologischen Stichprobe.

OBJECTIVE: With reference to an epidemiological sample of adolescents and young adults the impact of different models on the number of children classified as having specific spelling problems is investigated. METHOD: Using the same set of data, the effect of alternative definitions and methodological procedures on the prevalence of specific spelling retardation is shown. The virtual consequences of various norm-orientated definitions of cases is discussed with reference to external empirical criteria. RESULTS: Particularly, obsolete norms lead to a large overestimation of cases. In the present study case definitions of specific spelling retardation based on substantial criteria result in prevalence rates between 6 and 9 percent. Academic achievement is considerably affected by persisting specific spelling problems and the attendance of secondary schools is rare, in spite of sufficient nonverbal intelligence. CONCLUSIONS: Because of the high impact of spelling ability for educational success, dyslexic children need help by early intervention. Furthermore scholastic promotion is necessary to enable a school carer appropriate to the intellectual possibilities of the child.

[Reliability, trainability and stability of auditory discrimination performance in 2 computer-assisted assessment and training methods]. / Reliabilität, Trainierbarkeit und Stabilität auditiv diskriminativer Leistungen bei zwei computergestützten Mess- und Trainingsverfahren.

OBJECTIVES: The present study focuses on the possibilities and effects of training dyslexic children in tone and phoneme discrimination tasks. METHODS: A computer program was developed to train dyslexic children to discriminate between tone and speech stimuli. The correlation between auditory discrimination and reading and orthography performance was then tested in a preliminary study of n = 63 children. In a prospective study 44 children were assigned to one of three paralyzed groups: tone training, phoneme training or a control group. Upon completion of the initial diagnostics for all groups, the two training groups received four weeks of discrimination training, after which all three groups were immediately re-tested for the first time. Parallel thereto all children underwent specific training in reading and orthography at their school. Six months later all were re-tested a second time. RESULTS: Both test methods showed a high reliability (rn = .94; .95). Significant correlations between auditory discrimination and reading and orthography performance were confirmed. Auditory discrimination was significantly trainable. Specific training effects, as well as independent developmental effects were found. While the training effects of phoneme discrimination were stable over six months, those of tone discrimination were not. CONCLUSION: The central auditory discrimination between tone and phoneme stimuli can be trained successfully in dyslexic children and might also affect their reading and orthography performance.

[Experiences with the revisions of the classification systems for psychiatric disorders (ICD-10 and Axis 5 MAS)]. / Erfahrungen mit den Neufassungen der Klassifikationssysteme für psychische Störungen (ICD-10 und 5.Achse MAS).

In our study clinical experiences in 1990 and 1991 with the new installed ICD-10 and the new version of the fifth axis of the MAS for registering abnormal psychosocial conditions are presented. The strictly descriptive proceeding of these two new systems meets problems of acceptance in a department, whose tradition emphasizes strongly the importance of individually etiological relevant factors in the "Biographische Anamnese" for the psychiatric diagnosis.

[Course and prognosis of anorexia nervosa: catamnesis of 41 patients]. / Zu Verlauf und Prognose der Anorexia nervosa: Katamnese von 41 Patienten.

The purpose of the following study was a multidimensional assessment of the course of anorexia nervosa. In our follow-up-study we were able to examine 41 out of 51 patients meeting DMS-111 R criteria for anorexia nervosa in our department at a mean follow-up of 5.3 years. At the first evaluation the patients were characterized by an early age of onset (mean 14.2 years), no or very little previous psychiatric treatment, and restrictive eating habits (72.5%); the mean age was 15.2 years. At the time of follow-up, the physical outcome was unfavourable for 50% of the patients; one patient had died. The psychosocial outcome was less favourable for 60%. Against the background of a neurotic structure, social and sexual disturbances were found although the patient's weight was often normal. Depressive symptoms and a "slimness ideal" were found among a large number of patients, just as much as the fear of gaining weight--which prove to be a reliable indicator for the continuation of an eating disorder. A multidimensional evaluation facilitates an assessment of the determinants of prognosis. Previous psychiatric treatment and low body weight were associated with an unfavourable, mention of problems/disturbances in the family environment with a good somatic outcome. Outpatient treatment indicates a favourable psychosocial outcome.

[Culture specific or universal depressive diseases? Comparison of depressive symptoms of WHO/SADD (Standardized Assessment of Depressive Disorders) in Mannheim, West Germany and Addis Abeba, Ethiopia]. / Kulturspezifische oder universelle depressive Erkrankungen? Vergleich der depressiven Symptomatik des WHO/SADD in Mannheim/BRD und Addis Abeba/Athiopien.

In an international comparative study the symptomatology of depressive patients from psychiatric services in Addis Ababa, Ethiopia (N = 52) and in Mannheim, Federal Republic of Germany (N = 136) was investigated with the WHO Schedule for Standardized Assessment of Depressive Disorders (WHO/SADD). Controlled for differences in the sex-, age- and diagnostic-distribution of the two samples, depressive patients in Addis Ababa showed significantly more somatic symptoms, hypochondrias, psychomotor restlessness and delusions of reference and persecution, but markedly less feelings of guilt. Nevertheless, the same core of symptomatology was found to build in both samples the first and most important factor of 17, mainly psychological complaints. Only "feelings of guilt" did not belong to this core in Addis Ababa. In contrast to what is often believed to be the case in African patients, the more frequently expressed somatic complaints came in addition to, but did not replace the core-psychological symptomatology. The investigators stress the importance of a separate analysis of the frequencies of symptoms and of dimensions these symptoms build.