[Nasal-air conditioning]. / Konditionierung der Atemluft in der Nase.

INTRODUCTION: We present a review of nasal-air conditioning, a process essential to undisturbed gas exchange and cleansing of the respiratory mucosa in the nose. METHODS: A selective literature review was made on the basis of in vivo measurements and computer simulation of the upper airways as well as the authors' own clinical and experimental data. RESULTS AND DISCUSSION: Healthy subjects normally breathe through the nose, although the nasal airways have significantly higher airway resistance compared to the oral cavity, which is opened for breathing during exercise, in the case of nasal airway blockage, or in allergic rhinitis. In addition to olfaction, the main tasks of nasal breathing include: cleansing, defense, and conditioning (i.e., humidification and heating). The current knowledge of nasal conditioning processes will be discussed. In addition, research activities of particular relevance for diagnosis and intervention in various pathologies of the upper airways will be presented.

Growth hormone responses to hypoglycemia in postmenopausal depressed women.

Human growth hormone (HGH) responses to insulin-induced hypoglycemia were measured in ten postmenopausal women suffering from primary unipolar depressive illness, and in ten age-matched normal postmenopausal women. The mean maximal HGH response in the depressed patients was 4.6 plus or minus 4.4 ng/ml, and in the normals 13.3 plus or minus 9.8 ng/ml (P less than .05). All of the normal subjects had clinically adequate HGH responses, in contrast to only four of the depressed patients (P less than .01). The blood glucose responses were virtually the same in the two groups. Since brain catecholamines play a major role in mediating HGH responses to hypoglycemia, the findings are consistent with the hypothesis of diminished functional catecholaminergic activity in the depressed patients.

Relation of plasma prolactin to clinical response in schizophrenic patients.

It has been suggested that, if dopamine antagonism is a necessary condition for the antischizophrenic action of neuroleptics, the prolactin response, as an index of dopamine blockade, would correlate with clinical response. Morning prolactin and clinical symptomatology were measured in 15 schizophrenic patients before neuroleptic therapy, and after three and six weeks of high-dose butaperazine or loxapine treatment. Prolactin levels were transiently elevated during the unmedicated admission period, probably reflecting a normal stress response. Prolactin increased in all patients during neuroleptic therapy. There was, however, no correlation between magnitude of prolactin changes and clinical response, probably because the prolactin response achieved a maximum at relatively low doses of neuroleptics.

Human growth hormone response to levodopa. Relation to menopause, depression, and plasma dopa concentration.

After ingestion of 500 mg of levodopa, postmenopausal women had significantly diminished human growth hormone (HGH) responses (mean, 4.6 ng/ml), as compared with those of age-matched men (mean, 9.1 ng/ml; P smaller than .05). The differences between the groups were not related to plasma dopa concentrations. The HGH responses to levodopa of age-matched unipolar and bipolar depressed men, and of unipolar depressed postmenopausal women, did not differ significantly from their respective normal control groups. Depressive illness of these types does not appear to affect the HGH response to levodopa, once the effect of the menopause is taken into account.

Thioridazine stimulates prolactin secretion in man.

Thioridazine, unlike most other effective antipsychotic drugs, appears to be only a weak dopamine antagonist in various regions of the brain. We decided to test, indirectly, thioridazine's effects on another brain dopaminergic system, the tuberoinfundibular tract, which regulates prolactin secretion by stimulating hypothalamic secretion of prolactin-inhibiting factor. Chlorpromazine and several other phenothiazines have been shown to stimulate prolactin secretion. Five healthy men ingested 50 mg of chlorpromazine concentrate on one occasion, and 50 mg of thioridazine concentrate on another. Both drugs noticeably stimulated prolactin secretion within two hours. It is concluded that thioridazine is a potent dopamine antagonist in the tuberoinfundibular system, and it is suggested that this system's regulation of prolactin secretion may provide a useful method for studying antipsychotic drug effects in man.

Prolactin responses to neuroleptics in normal and schizophrenic subjects.

The prolactin response to neuroleptics can serve as an index of dopamine blockade in humans. Plasma prolactin increments to single doses of chlorpromazine, and prolactin decrements to single doses of levodopa, were similar in normal and schizophrenic subjects. Antischizophrenic drugs of all chemical classes stimulated prolactin release,while chemically related drugs and other psychotropic agents ineffective in schizophrenia did not. The prolactin response to neuroleptic therapy occurred in all patients, and tolerance did not develop. Within subjects, prolactin responses were graded according to neuroleptic dose, but the upper limit of sensitivity of the response curve was achieved at doses below the therapeutic range. Relative prolactin-stimulating potency in humans of chlorpromazine, thioridazine, trifluoperazine, butaperazine, and haloperidol correlated well with their relative clinical potencies.

Thiethylperazine; clinical antipsychotic efficacy and correlation with potency in predictive systems.

A one-to-one relationship between clinical antipsychotic potency and pharmacologic dopaminergic antagonism is implicit in the dopamine hypothesis of neuroleptic action. Thiethylperazine maleate, a classical antiemetic phenothiazine, displays dopaminergic antagonism in behavioral, neurochemical, and neuroendocrine systems, but is paradoxical insofar as it is thought not to possess clinical neuroleptic activity. In three tests of dopaminergic antagonism--elevation of levels of CSF homovanillic acid in monkeys, striatal dihydroxyphenylacetic acid in rats, and prolactin in man--as well as in a clinical trial of neuroleptic efficacy in schizophrenics, thiethylperazine was fully active and approximately three times as potent as chlorpromazine. Differences in efficacy between this and earlier clinical studies can be accounted for on the basis of dosage.

Plasticity in cerebellar tactile maps in the adult rat.

We previously demonstrated that the fractured tactile cerebellar map within the crus IIa folia of the cerebellar hemispheres reorganizes after deafferentation of the upper lip in neonatal rats (postnatal day [PND] 1-30). The present study examined the capacity of this map to reorganize after deafferentation in adults and animals late in development (PND 30-89). Several months after cauterization of the infraorbital branch of the trigeminal nerve, the tactile map in the granule cell layer of crus IIa reorganized, with representations of intact structures expanding into the denervated area. The pattern of reorganization was similar to reorganization after neonatal lesions in that (1) all representations were from perioral structures, (2) the reorganized map maintained a fractured somatotopy, and (3) the denervated area was predominantly and consistently invaded by the upper incisor representation. We conclude that the spatial pattern of reorganization is essentially the same regardless of the age of deafferentation. However, we also observed developmental differences in reorganization. First, more areas of crus IIa were nonresponsive in animals lesioned later in development (PND 30-89). Second, we found a surprising degree of variability in the pattern of tactilely evoked cerebellar field potentials of PND 30-40 animals compared with neonates and adults, suggesting that this time period differs from other stages. The pattern of evoked potentials reflects the two primary inputs to the map. Our data show that, although both afferent pathways are capable of reorganization throughout development, their relative contribution to the map appears to differ, depending on the age at which lesion occurs.

Spinal epidural hematoma with subarachnoid hemorrhage caused by acupuncture.

Unintentional acupuncture needling of the thoracic spinal canal produced a spinal epidural hematoma and subarachnoid hemorrhage. This case demonstrates that patients are sometimes reluctant to disclose folk medical treatments to Western physicians, and the proper diagnosis may depend upon the prowess of the neuroradiologist.

Coccidioidomycosis brain abscess. Case report.

Coccidioidomycosis is an infection originating in the San Joaquin Valley of southern California, but is now seen with increasing frequency throughout southern California and the southwestern United States. A central nervous system involvement is usually manifested as meningitis. The authors present the case of a young man with pulmonary coccidioidomycosis who developed a brain lesion that proved to be a coccidioidal abscess. This manifestation may now be more frequently seen and therefore should be included in the differential diagnosis of any patient presenting with a brain mass who is from an area in which this disease is endemic.

Coccidioidomycotic brain abscess. Case report.

Coccidioidomycosis is an infection originating in the San Joaquim Valley of southern California, but now seen with increasing frequency throughout southern California and the southwestern United States. Central nervous system involvement is usually manifested as meningitis. The authors present the case of a young man with pulmonary coccidioidomycosis who developed a brain lesion that proved to be a coccidioidomycotic abscess. With the increasing incidence of the disease, this manifestation may be encountered more often and should therefore be included in the differential diagnosis of any patient from an endemic area who presents with a brain mass.

Current trends in the management of head injury.

The importance of cerebral perfusion pressure (CPP) optimization has been recognized in the neurosurgical community in the United States as part of the recently published Guidelines for Management of Severe Head Injury. Although further basic and clinical research is needed before a CPP-directed head injury management standard of care is formulated, optimization of CPP is practical with present personnel and equipment resources in many emergency departments. Emergency Department physicians should be familiar with CPP management principles to facilitate interactions with neurosurgical colleagues and improve patient outcomes.

[Reimbursement of patients with high costs in a department of otorhinolaryngology of maximum care and refinancing by the German DRG system]. / Analyse von Patienten mit hohen Fallkosten im Patientengut einer HNO-Klinik der Maximalversorgung und ihre Refinanzierung durch das G-DRG-System.

BACKGROUND: With the introduction of a diagnosis related groups (DRG)-system in Germany, the medical analysis of the total costs of caring for a given patient is of significance. The medical identification of cost intensive patients becomes of increasing importance for the financial perspective of a department, because the averaged lump sum system might not break even these treatments. PATIENTS AND METHODS: In the Department of Otorhinolaryngology, University Ulm, a tertiary referral center, the 56 most expensive patients from 3131 inpatients which were treated in 2002 were retrospectively identified and expenses for diagnostic tests, therapy and post-operative complications were analyzed. All patients' related costs, including all costs for personnel, were assigned to a DRG (Version 1.0 G-DRG and G-DRG 2004). RESULTS: The most expensive treatments included extensive tumor surgeries, surgery of the trachea, emergency procedures and reconstructive surgery. Costs increased with complications, prolonged stay in the intensive care unit and simultaneous internal diseases. The cost at our institution for an pharynocutaneous fistula added 3000 Euro. CONCLUSION: The assignment of treatment costs to a DRG is complex. Based on our data extensive surgeries for head and neck malignancies showed a homogeneous cost distribution in the DRG group of G-DRG 2004 which was however inadequately reimbursed. Detailed prospective analyses from multiple centers to identify expensive treatments in the field of otorhinolaryngology are necessary to incorporate modifications into the German DRG-system.

Cortisol's effects on human mental functioning.

Popularization of the dexamethasone suppression test has focused attention on the relation between cortisol metabolism and mood and behavior. This article considers the biochemistry, physiology, and pharmacology of cortisol and cortisol-like substances. In addition, the effects of external stresses on cortisol metabolism and circadian rhythmicity of secretory patterns are reviewed. Finally, managing exogenous cortisol excess in a clinical setting is discussed.

Reduced plasma LH concentration in postmenopausal depressed women.

Mean plasma LH concentration in postmenopausal women suffering unipolar depressive illness was 33% less than that of normal postmenopausal women (P less than 0.05). Since LH secretion after menopause is probably noradrenergically regulated, the finding provides support for the hypothesis of a functional noradrenaline deficit in depression.

Neuroendocrine studies of depressive illness.

Interest in possible neuroendocrine disturbances in endogenous depression is prompted by two lines of evidence: (1) clinical features of the illness suggest hypothalamic dysfunction; (2) the brain neurotransmitters implicated in depression also regulate neuroendocrine function. Our research reveals a marked, sustained hypersecretion in cortisol in severe depressive illness, which is apparently unrelated to stress and sleep disturbance, and which is associated with a distortion of the 24-hour cortisol secretory pattern. The hypersecretion is manifested primarily in the late afternoon, evening, and early morning hours, when cortisol secretion is normally inhibited. Growth hormone responses to hypoglycemia (but not to L-dopa) are also significantly reduced in endogenous depression, even when factors of age and the menopause are controlled. Postmenopausal depressed women appear to secret significantly less LH than normal postmenopausal women. Since all of these hormonal abnormalities can be reproduced by depletion of brain noradrenalin, the findings provide support for the the hypothesis of reduced functional noradrenergic activity in certain forms of depression.