Parkinson's disease in twins.

Among nine monozygotic (MZ) and 12 dizygotic (DZ) twin pairs in which an index case had typical Parkinson's disease (PD) or PD with associated dementia, three MZ and three DZ pairs were concordant. Three of the six affected co-twins were first diagnosed during the study. Occurrence of PD in families of MZ and DZ index cases was more frequent than expected from population rates. The study underlines the need for personal examination using defined criteria in a cross-sectional twin study on PD. Although the study did not establish a major genetic impact in the etiology of PD, a genetic predisposition for the disease cannot be ruled out for some individuals.

Intermittent regional therapy with rt-PA is not superior to systemic thrombolysis in deep vein thrombosis (DVT)--a German multicenter trial.

In a prospective and randomized multicenter trial the efficacy of intermittent regional and systemic thrombolytic therapy for DVT was evaluated. 137 patients with phlebographically confirmed acute DVT above the calf region were treated with 20 mg of rt-PA for 4 h each day. Thrombolysis was applied either locally via a dorsal pedal vein of the firmly bandaged affected leg or systemically using a cubital vein. Treatment lasted for 4-7 days, and during this time unfractionated heparin was applied continuously with the dosage adjusted according to aPTT (1.5-2.0 times the normal value). A second phlebography was performed within 24 h after the end of treatment. Results were evaluated by an independent radiologist who was unaware of the treatment given. Significant thrombolytic results (e.g. lysis of more than 50% of the original thrombus and complete recanalization of all affected veins) were reached in only 1/3 of all patients. Rates of recanalization did not differ in both groups and bleeding complications occurred in 26.5%. We conclude that intermittent local or systemic application of 20 mg rt-PA seems to be ineffective in the treatment of DVT.

Life-style and dietary factors early and late in Parkinson's disease.

The study investigated features of life-style and dietary habits early and late in life of patients with idiopathic Parkinson's disease (IPD). Seventy-one patients and 103 controls were interviewed personally with a structured questionnaire. Living in villages during primary school time was significantly more frequent among patients, and in the urban environment patients had lived less frequently in larger-sized towns. Mushroom harvesting during childhood was more frequent among patients. No difference between patients and controls was found in childhood water supply, habits of fishing in the countryside or at the seaside, and eating such fish. Actual food preference in patients was greater for almonds and plums, while no difference was found in the actual intake of mushrooms, peanuts, oil-dressed salad, fish and animal offals. The study did not indicate a higher consumption of foods known to harbour heavy metals and pesticides in IPD patients either long before or during the disease. Reduced consumption of foodstuffs rich in vitamin E, as reported previously for premorbid patients, is no longer observed in patients with overt disease.

Correlation of drug-related aluminum intake and dialysis treatment with deposition of argyrophilic aluminum-containing inclusions in CNS and in organ systems of patients with dialysis-associated encephalopathy.

CNS tissue and peripheral organs of 50 autopsy cases with chronic renal failure (CRF) and dialysis treatment were evaluated for aluminum- (Al) containing argyrophilic inclusions using the Howell and Black method modified by Reusche. Morphological alterations were correlated with the duration of hemodialysis (HD) and to the amount of prescribed Al-containing drugs for better control of hyperphosphatemia. Significant correlations were found between the degree of morphological alterations and Al intake up to 2.5 kg (p = 0.0003), as well as for morphology and duration of longterm HD up to 178 months (p = 0.001). Most sensitive structure for CNS deposits were choroid epithelia, followed by glial cells and neurons. Autonomic ganglia, heart, ovary/testis, parathyroid, adrenal, and pituitary demonstrated reliably peripheral deposits. Al-containing drugs, administered preferentially during HD, explain the additional significance of Al uptake and duration of dialysis (R-Qu. = 0.6697). The deposition of Al-containing proteinaceous inclusions is apparently irreversible. After renal transplantation, with termination of drug-related Al intake and normalized renal Al excretion, the Al-induced argyrophilic degradation products remained in the cellular cytoplasm in unchanged fashion up to 10 years.

Time of drug elimination in chronic drug abusers. Case study of 52 patients in a "low-step" detoxification ward.

The elimination time of illicit drugs and their metabolites is of both clinical and forensic interest. In order to determine the elimination time for various drugs and their metabolites we recruited 52 volunteers in a protected, low-step detoxification program. Blood samples were taken from each volunteer for the first 7 days, daily, urine sample for the first 3 weeks, daily. Urine was analyzed using a fluorescence-polarization immunoassay (FPIA) and gas chromatography/mass spectrometry (GC/MS), serum using GC/MS. The elimination times of the drugs and/or their metabolites in urine and serum as well as the tolerance intervals/confidence intervals were determined. Due to the sometimes extremely high initial concentrations and low cut-off values, a few of the volunteers had markedly longer elimination times than those described in the literature. The cut-off values were as follows: barbiturates II (200ng/ml), cannabinoids (20ng/ml), cocaine metabolites (300ng/ml), opiates (200ng/ml). GC/MS detected the following maximum elimination times: total morphine in urine up to 270.3h, total morphine and free morphine in serum up to 121.3h, monoacetylmorphine in urine up to 34.5h, 11-nor-9-carboxy-delta-9-tetrahydrocannabinol (THC-COOH) in urine up to 433.5h, THC-COOH in serum up to 74.3h, total codeine in urine up to 123h, free codeine in urine up to 97.5h, total codeine in serum up to 29h, free codeine in serum up to 6.3h, total dihydrocodeine (DHC) in urine up to 314.8h, free DHC in urine up to 273.3h, total and free DHC in serum up to 50.1h. Cocaine and its metabolites were largely undetectable in the present study.

[Initial therapy of acute unilateral epididymitis using ofloxacin. I. Clinical and microbiological findings]. / Initiale Therapie der akuten einseitigen Epididymitis mit Ofloxacin. I. Klinische und mikrobiologische Befunde.

In a prospective study, 70 men suffering from uncomplicated acute unilateral epididymitis were treated initially with 2 x 200 mg ofloxacin p.o. per day for 14 days. Patients were reexamined at the end of therapy and again after 6 and 12 weeks. Patients were retreated when the pathogens had not been eliminated. Aetiologically epididymitis was caused in one-third of cases each by C. trachomatis (n = 20) and common urinary tract pathogens (n = 20); in the remaining one-third we found N. gonorrhoeae (n = 1). U. urealyticum (n = 3), or no pathogens (n = 26). At the first check-up examination, in 64/70 patients no pathogens were found. Relevant bacteria were still detected in 6 patients: C. trachomatis in 5 and E. aerogenes in 1. After 12 weeks, infection still persisted in 3 patients (E. coli, P. aeruginosa, enterococci). In vitro the microorganisms were invariably sensitive to ofloxacin. Due to abscess formation, surgical intervention became necessary in 6 patients. In 3 of these cases the causative agent was C. trachomatis. Regardless of the aetiology, after 12 weeks, in 20% of our patients the epididymis was still infiltrated and 14% complained of persistent symptoms.

[Initial therapy of acute unilateral epididymitis using ofloxacin. II. Andrological findings]. / Initiale Therapie der akuten einseitigen Epididymitis mit Ofloxacin. II. Andrologische Befunde.

A total of 70 men suffering from uncomplicated acute unilateral epididymitis were enrolled in a prospective study. They were treated initially with 2 x 200 mg ofloxacin p.o. per day for 14 days, after which the spermatological examination was repeated for each. Ejaculate quality, i.e. density, motility, and morphology of spermatozoa, was determined on the last day of therapy, i.e. after 14 days, and again after 6 and 12 weeks. In most patients, initially decreased sperm counts increased significantly and global motility improved, while the numbers of abnormal spermatozoa decreased. Only in a few cases were azoospermia, kryptozoospermia, consistently reduced motility, and constant or even increasing numbers of deformed spermatozoa observed.

[Autologous blood transfusion in breast reduction]. / Autologe Bluttransfusion bei Mammareduktionsplastiken.

Minimal risk blood transfusion is possible using autologous blood. When excessive blood loss is expected in reduction mammaplasty, autologous blood transfusion is recommended. Only three of eighty-one patients who underwent reduction mammaplasty in our department received homologous blood transfusions. Patients suffering from glandular hypertrophy are likely to loose significantly more blood during operation than patients with predominantly fatty breast tissue. Autologous blood transfusion should be recommended in cases of excessive breast hypertrophy, in patients afraid of transfusion-associated infections, and for forensic reasons.

Balloon kyphoplasty improves back pain but does not result in a permanent realignment of the thoracolumbar spine.

INTRODUCTION: Balloon kyphoplasty (BKP) has been established as a standard procedure for treatment of osteoporotic compression fractures of the spine in elderly patients, as it results in pain relief for most of the patients. Moreover, BKP may result in a partial realignment of the sagittal shape of the vertebra and the spine. However, it is unclear whether BKP may result in long-term improvement of the sagittal alignment of the spine. The aim of the current study was to investigate if there is a significant loss of correction of the sagittal alignment of the thoracolumbar spine following BKP. METHODS: A prospective, noncontrolled, nonrandomized study, consisting of 71 patients treated for single level osteoporotic compression fracture by BKP at 1 institution and by 1 surgeon, was done. We checked the following radiographic outcome parameters: Beck's ratio, the kyphosis angle of the treated vertebra, the angle of kyphosis including the treated vertebra and the adjacent disc (monosegmental angle), the angle of kyphosis, including the treated segment, the adjacent disc as well as the adjacent vertebra (bisegmental angle). RESULTS: BKP resulted in significant pain relief with a score decreasing from 7.11 to 1.73 on a visual analogue scale immediately after the procedure. The effekt persisted after 1 year with a score of 1.58 VAS points. BKP also led to an improvement of each radiographic outcome parameter immediately after surgery. Beck's ratio was improved from 0.71 to 0.83. The Cobb's angle of the relevant vertebral bodies decreased from 11.4° to 6.8°. Monosegmental and bisegmental kyphosis angles decreased from 8.12° to 4.9° and from 6.9° to 4.5° respectively. Within 1 year, however, there was a significant loss of correction in each radiographic parameter analyzed. Beck's ratio decreased to 0.72, Cobb's angle increased to 10.8°, and the mono- and bisegmental kyphosis angles to 8.8° and 8.3°, respectively.BKP does not result in a permanent realignment of the thoracolumbar spine following treatment of single level osteoporotic compression fractures.

[Bolus geometry in various central and peripheral contrast medium applications: study with serial CT using non-ionic contrast media]. / Bolusgeometrie bei unterschiedlicher zentraler und peripherer Kontrastmittelapplikation: Studie mittels Serio-CT unter Verwendung nichtionischen Kontrastmittels.

Measurements of concentration in 27 patients with a calibrated Serio-CT yielded for the intravasal contrast medium bolus maximum a value of approx. 23 mg I/ml for the a. carotis with central injection and approx. 14 mg I/ml for the a. iliaca with peripheral injection. 7 invasive measurements were performed at the bifurcation of the aorta, yielding a value of 12.5 mg I/ml with peripheral injection. In all these cases, 40 ml nonionic contrast medium (Iohexol) with an iodine content of 350 mg I/ml were applied. The average bolus half-life was 9.5 sec. measured at the carotid artery, 11.5 sec. at the a. iliaca, and 7 sec. at the bifurcation of the aorta. Differences in bolus geometry were not seen on comparing arterial injection with cava superior injection; likewise, there were no differences between peripheral injections at various speeds. Animal experiments reported in literature show that these observations can be mainly ascribed to vascular dilatation in the minor circulation produced by the contrast medium.

[A contribution to the classification of seborrheic keratoses (author's transl)]. / Ein Beitrag zur Systematik der seborrhoischen Warzen

A clinico-statistical study is reported, basing on a material of 639 excised tumours which were defined histologically as seborrheic keratoses. All statements concerning clinical diagnoses and differential diagnoses, localization, development, age and sex of patients were transferred to punch cards. By means of a suitable EDA program, basic counts and a multidimensional analysis of conditioned frequencies [14] were performed. The results indicate, that the different clinical forms of seborrheic warts, often discriminated in the literature, are variants of the same entity.

Ultrastructural and ultrahistochemical investigations of lead-induced intranuclear inclusion bodies in rat kidney.

The morphogenesis of intranuclear inclusion bodies in the proximal convoluted tubules of rat kidney is studied in chronic lead poisoning. In early stages electron dense particles and fibrillar structures in connection with interchromatin granules were observed. The fully developed inclusion bodies showed an electron dense core from which fibrils project outwards forming an irregular coronal framework. By the sulphide silver method for the demonstration of heavy metals an intense reaction was observed in the outer areas of the fibrillar corona after digestion using DNase.

The relevance of clinical subtypes for disease course, family history and epidemiological variables in Parkinson's disease.

Clinical outcome and relevance of genetic and epidemiological factors were evaluated in 161 patients with idiopathic Parkinson's disease (PD) with regard to onset symptoms [tremor (T) vs non-tremor (NT)], to clinical classification into tremor-dominant (TD), alkineto-rigid (AR), and equivalent (EQ) subtypes, and to disease onset before the 45th year of age (EO) and after age 69 (LO). Patients were investigated by questionnaire-based personal interview and clinical examination. Allegedly symptomatic first-degree relatives were examined personally or had sufficient medical documentation to allow neurological diagnosis. Disease course was more favorable in T than in NT, in TD than in AR or EQ, and in EO compared with LO. Among EO and LO patients, clinical subtypes TD, AR and EQ were not differently distributed. Frequency of first-degree relatives with PD or essential tremor and any epidemiological variable tested were not elicited differently between TD, AR and EQ patients, with the exception that TD reported more frequent premorbid travelling. EO patients reported higher frequencies of premorbid head trauma and rural living than LO patients. The more favorable disease prognosis of patients with predominant tremor at presentation and of patients with early disease onset is corroborated. Clinical subgroups do not differ in genetic and epidemiological factors.

[Surgical complications after radioenterocolitis (author's transl)]. / Zur Problematik chirurgischer Komplikationen bei Radio-Enterokolitis.

The paper reports on 14 patients with surgical complications following radioenterocolitis. The most serious complications are peritonitis after perforation and manifest intestinal ileus. Pathogenesis, symptomatics and therapeutical possibilities are discussed. The own cases are analysed and conclusions are drawn for the practice.

Stride parameters in healthy young and old women--measurement variability on a simple walkway.

Gait analysis in disabled and old probands may be considerably altered by applied devices and the artificial surrounding of a gait laboratory. To circumvent distractions from such factors, we evaluated the gait pattern of healthy women on a simple walkway and supplemented the analysis by reliability measurements. In order to consider age-related changes of gait parameters in health, healthy young (YHW) and old women (OHW) were investigated. Five gait parameters were assessed during 10 independent runs of each individual on the walkway. Multiple-regression analysis revealed a significant relationship between age and gait velocity, stride length, and the coefficient of variation (CV) of step width. Standard errors of mean were uniformly low across all parameters and groups, except for some increase in step width (OHW) and cadence (YHW). Across groups, CV was small for stride length, larger for foot angle, and largest for step width. An acceptably low within-session variability of the stride parameters was found.

[Health promotion and prevention as responsibilities of the established physician--status and current deficits]. / Gesundheitsförderung und Prävention als Aufgaben des niedergelassenen Arztes--Stellenwert und aktuelle Defizite.

General practitioners have been questioned by the Society of panel doctors of Bavaria about the status, deficiencies and the future focus of prevention in the medical office. The results of this questionnaire was compared to similar studies from Niedersachsen and Switzerland. From these results, conclusions should be drawn for initiatives of the medical self-administration to improve the preventive out-patient care. Written questionnaires with a semi-structured form for all of the 1067 general practitioners in the district Oberfranken of the Society of panel doctors of Bavaria. Response 33.7%. Descriptive analysis of the answers and development of a list of priorities of further education in preventive medicine. Comparison of the results with questionnaires in German language. Preventive care plays an important role in the medical practice. However, the status of prevention has currently a lower importance as it would be appropriate. This is caused by unsatisfactory honorary, lack of further education, and lack of time for an adequate consultation. It was recommended that the medical self-administration should offer more further education about preventive medicine. In all three cited studies, first of many topics, where there was a need for further education, was nutrition followed by withdrawing from smoking and protection from infections.

Nonrandomized comparison of open flank versus laparoscopic nephrectomy in 249 patients with benign renal disease.

OBJECTIVES: We report the results from a nonrandomized comparison of open flank versus laparoscopic nephrectomy in patients with benign renal disease. METHODS: From January 1993 to December 1997, 249 nephrectomies for benign renal disease were performed at our institution. There were 118 patients in the open flank nephrectomy group (median age 58.5, range 8-89 years) and 131 patients in the laparoscopic nephrectomy group (median age 40, range 16-73 years). Clinical parameters such as operative times, blood loss, transfusion rates, conversion and complication rates, start of oral intake, analgesic consumption, duration of hospitalization and convalescence and short-term mortality were compared among both groups. RESULTS: Median operative time in the open flank nephrectomy group was 90 (range 30-240) min and also 90 (range 41-210) min in the laparoscopic nephrectomy group. In the laparoscopy group 8 patients were converted to open surgery (6.1%). There were 27 complications (20.6%) in the laparoscopic nephrectomy group compared to 30 complications (25.4%) in the open flank nephrectomy group. Postoperatively, patients in the laparoscopic nephrectomy group required less morphine sulfate equivalent (12 vs. 20 mg) for pain control and they had a shorter hospital stay (4 vs. 10 days) and convalescence (24 vs. 36 days). The postoperative parameters are given as medians and reached statistically significant differences in favor of laparoscopic nephrectomy. CONCLUSIONS: Laparoscopic nephrectomy results in a significantly briefer postoperative course when compared to open flank nephrectomy. As a matter of fact laparoscopy in urology is still a center-related procedure and even in these centers only a minority of urologists practice laparoscopy. However, in experienced centers the laparoscopic technique should be offered to patients with benign renal disease who are scheduled for elective nephrectomy.

[Accuracy of the clinical diagnosis in malignant melanomas]. / Treffsicherheit der klinischen Diagnose bei malignen Melanomen.

Histologic findings and clinical data of 411 patients with malignant melanomas treated in 1952 up to june 1977 reveal an improvement of diagnostic accuracy. Within the last years, fewer patients were referred to the clinic with extensive tumor growth or with metastases. A change from the levels of invasion V and IV to III is evident. Further improvement to level II and I with a corresponding smaller tumor thickness is appearing in outlines.