Prävention des plötzlichen Herztodes mit dem implantierbaren Kardioverter-Defibrillator im fortgeschrittenen Lebensalter

Die vorliegende Arbeit beschäftigt sich mit der Prävention des plötzlichen Herztodes mittels implantierbarem Kardioverter-Defibrillator bei Patienten im fortgeschrittenen Lebensalter. Hierzu wurden der Nutzen der implantierten Geräte sowie die Komplikations- und Überlebensraten von 460 Patienten jünger als 75 Jahre mit 40 Patienten verglichen, die zum Zeitpunkt der ICD-Implantation 75 Jahre alt oder älter waren. Es hat sich herausgestellt, dass die ICD-Therapie für die Prävention des plötzlichen Herztodes bei älteren Patienten gleichermaßen effektiv ist. Das nach Kaplan-Meier geschätzte ereignisfreie Überleben der jüngeren und älteren Patienten bezüglich des plötzlichen Herztodes zeigte keinen signifikanten Unterschied. Die Komplikationsrate war in der Gruppe der älteren ICD-Patienten ebenfalls nicht erhöht. In der Gruppe der älteren Patienten fanden sich weder in Hinsicht auf die technischen Bestandteile des ICDs, noch in Bezug auf die operative Implantation des Kardioverter-Defibrillators signifikant erhöhte Komplikationsraten. Somit sind die operativen Eingriffe bei älteren Patienten kein Hindernis einer ICD-Therapie im höheren Alter. Die Gesamtmortalität der älteren Patienten ist signifikant höher als in der Gruppe der jüngeren Patienten. Dies lässt sich auf die vermehrte Anzahl von Todesfällen durch progressive Verschlechterung der Herzleistung im höheren Lebensalter zurückführen. Die Ergebnisse der Untersuchung sprechen dafür, dass die aktuellen Leitlinien basierend auf prospektiven Studien bei jüngeren Patienten auch auf alte Patienten übertragen werden können, sofern sich aus der Komorbidität der alten Patienten keine Kontraindikation für eine ICD-Therapie ergibt

Familien- und Seniorenpolitik in Belgien - Bericht anlässlich der belgischen EU-Ratspräsidentschaft 2010

Inhaltsverzeichnis: Einleitung; 1 Familien- und Seniorenpolitik in Belgien; 1.1 Hintergrundinformationen; 1.2 Demografische Entwicklung; 1.3 Politischer und rechtlicher Rahmen; 2 Programm der belgischen EU-Ratspräsidentschaft; 3 Aktuelle Herausforderungen und Fazit

A MATLAB-BASED GUI FOR REMOTE ELECTROOCULOGRAPHY VISUAL EXAMINATION

In this work, a MATLAB-based graphical user interface is proposed for the visual examination of several eye movements. The proposed solution is algorithm-based, which localizes the area of the eye movement, removes artifacts, and calculates the view trajectory in terms of direction and orb deviation. To compute the algorithm, a five-electrode configuration is needed. The goodness of the proposed MATLAB-based graphical user interface has been validated, at the Clinic of Child Neurology of University Hospital of Ostrava, through the EEG Wave Program, which was considered as “gold standard” test. The proposed solution can help physicians on studying cerebral diseases, or to be used for the development of human-machine interfaces useful for the improvement of the digital era that surrounds us today

The first experience with a mini-rating scale for the assessment of sexual dysfunction and life-satisfaction in depressed patients in the practice

Even though many scales for the assessment of sexual dysfunction have been recently developed, most of them are suitable rather for the research purpose in clinical trials than to routine interviews in a daily, private practice. We report here the first experience with a simple, semi-quantitative scale for parallel assessment of sexual dysfunction and life-satisfaction (considered to globally reflect the quality of life), which was tested in depressed patients treated in the psychiatric, private practice setting. A combined Sexual Dysfunction(SD-S) and Life-Satisfaction Scale (LS-S), was constructed based on previous interviews with patients. Both consisted of 4-items, assumed to represent core elements of sexual function and individual well-being. The scales were applied to depressed patients treated with any of the SSRIs or with moclobemide, a reversible and selective MAO-A inhibitor. These two treatments were selected for testing the scales because it is known that SSRIs can induce or exacerbate them and moclobemide does not seem to affect them. The selection of treatment modality in this study was, however, entirely at the discretion of the physician. The assessments were done during 3 visits (at baseline, after 2 months and after 4 months). The results of this exploratory trial, testing the applicability, acceptance and utility of a combined mini- SD-S- and LS-S- scale, in 62 depressed patients, showed that the scale: a) was simple to use and well accepted by physicians and patients, b) was a suitable instrument for the practicing physician to control the success of the treatment and c) was sensitively assessing the presence and severity of sexual dysfunction

Occupational Bladder Cancer in a 4,4′-Methylenebis(2-chloroaniline) (MBOCA)-Exposed Worker

A 52-year-old male chemical worker was admitted to the hospital with a history of paroxysmal microscopic hematuria for about 2 years and nocturia with gross hematuria about five times per night for 2 months. He was a nonsmoker and denied a history of any other bladder carcinogen exposure except for occasional pesticide application during agricultural work. Intravenous urogram imaging showed a mass occupying half of the bladder capacity. Cystoscopy revealed a mass over the left dome of the bladder. Cystoscopic biopsy revealed a grade 3 invasive transitional cell carcinoma with marked necrosis. From 1987 until hospital admission in 2001, the patient had worked in a company that produced the 4,4′-methylenebis(2-chloroaniline) (MBOCA) curing agent. He did not wear any personal protective equipment during work. Ambient air MBOCA levels in the purification process area (0.23–0.41 mg/m(3)) exceeded the U.S. Occupational Safety and Health Administration’s permissible exposure level. Urinary MBOCA levels (267.9–15701.1 μg/g creatinine) far exceeded the California Occupational Safety and Health Administration’s reference value of 100 μg/L. This patient worked in the purification process with occupational exposure to MBOCA for 14 years. According to the environmental and biologic monitoring data and latency period, and excluding other potential bladder carcinogen exposure, this worker was diagnosed as having occupational bladder cancer due to high exposure to MBOCA through inhalation or dermal absorption in the purification area. This case finding supports that MBOCA is a potential human carcinogen. Safe use of skin-protective equipment and respirators is required to prevent workers from MBOCA exposure

High baseline BDNF serum levels and early psychopathological improvement are predictive of treatment outcome in major depression

Rationale: Major depressive disorder has been associated with low serum levels of brain-derived neurotrophic factor (sBDNF), which is functionally involved in neuroplasticity. Although sBDNF levels tend to normalize following psychopathological improvement with antidepressant treatment, it is unclear how closely sBDNF changes are associated with treatment outcome. Objectives: To examine whether baseline sBDNF or early changes in sBDNF are predictive of response to therapy. Methods: Twenty-five patients with major depressive disorder underwent standardized treatment with duloxetine. Severity of depression, measured by the Hamilton Depression Rating Scale, and sBDNF were assessed at baseline, and after 1, 2, and 6weeks of treatment. Therapy outcome after 6weeks was defined as response (≥50% reduction in baseline Hamilton Depression Rating score) and remission (Hamilton Depression Rating score <8). The predictive values for treatment outcome of baseline sBDNF, and early (i.e., ≤2weeks) changes in sBDNF and Hamilton Depression Rating score were also assessed. Results: At baseline, sBDNF correlated with Hamilton Depression Rating scores. Treatment response was associated with a higher baseline sBDNF concentration, and a greater Hamilton Depression Rating score reduction after 1 and 2weeks. A greater early rise in sBDNF correlated with a decreased early Hamilton Depression Rating score reduction. Conclusions: Even though higher baseline sBDNF levels are associated with more severe depression, they may reflect an increased capacity to respond to treatment. In contrast, changes in sBDNF over the full course of treatment are not associated with psychopathological improvement

Case report of MR perfusion imaging in Sinking Skin Flap Syndrome: growing evidence for hemodynamic impairment

<p>Abstract</p> <p>Background</p> <p>The syndrome of the sinking skin flap (SSSF) with delayed sensorimotor deficits after craniectomy is not well known and often neglected. Among various postulated causes, there is evidence that disturbed brain perfusion may be related to the observed symptoms, and that cranioplasty reliably alleviates these symptoms. We report a case of sinking skin flap syndrome (SSFS) with recovery from neurological sensorimotor deficits after cranioplasty correlated with pre- and postsurgical MR brain perfusion studies.</p> <p>Case Presentation</p> <p>A 42-year-old woman presented with slowly progressive sensorimotor paresis of her left arm after decompressive extensive craniectomy due to subarachnoid hemorrhage four months ago. Her right cranium showed a "sinking skin flap". After cranioplastic repair of her skull defect, the patient fully recovered from her symptoms. Before cranioplasty, reduced brain perfusion in the right central cortical region was observed in MR-perfusion images. After cranioplasty, a marked increase in brain perfusion was observed which correlated with objective clinical recovery.</p> <p>Conclusion</p> <p>There is increasing evidence that impaired blood flow is responsible for delayed motor deficits in patients with sinking skin flap syndrome in the area of compressed brain regions. Symptoms should be evaluated by brain perfusion imaging complementing surgical decision-making.</p

Phosphocaveolin-1 is a mechanotransducer that induces caveola biogenesis via Egr1 transcriptional regulation

Caveolin-1 (Cav1) is an essential component of caveolae whose Src kinase-dependent phosphorylation on tyrosine 14 (Y14) is associated with regulation of focal adhesion dynamics. However, the relationship between these disparate functions remains to be elucidated. Caveola biogenesis requires expression of both Cav1 and cavin-1, but Cav1Y14 phosphorylation is dispensable. In this paper, we show that Cav1 tyrosine phosphorylation induces caveola biogenesis via actin-dependent mechanotransduction and inactivation of the Egr1 (early growth response-1) transcription factor, relieving inhibition of endogenous Cav1 and cavin-1 genes. Cav1 phosphorylation reduces Egr1 binding to Cav1 and cavin-1 promoters and stimulates their activity. In MDA-231 breast carcinoma cells that express elevated levels of Cav1 and caveolae, Egr1 regulated Cav1, and cavin-1 promoter activity was dependent on actin, Cav1, Src, and Rho-associated kinase as well as downstream protein kinase C (PKC) signaling. pCav1 is therefore a mechanotransducer that acts via PKC to relieve Egr1 transcriptional inhibition of Cav1 and cavin-1, defining a novel feedback regulatory loop to regulate caveola biogenesis

Bone autografting of the calvaria and craniofacial skeleton: Historical background, surgical results in a series of 15 patients, and review of the literature

BACKGROUND Although the use of autologous bone for reconstruction of the cranial and facial skeleton underwent a partial reappraisal following the introduction of a vast range of alloplastic materials for this purpose, it has demonstrated definite advantages over the last century and, particularly, during the last decade. METHODS Fifteen patients underwent cranial and/or cranio-facial reconstruction using autologous bone grafting in the Department of Neurologic Sciences-Neurosurgery and the Division of Maxillo-Facial Surgery of the Rome "La Sapienza" University between 1987 and 1995. This group of patients consisted of 8 females and 7 males whose average age was 29.5 years (range 7.5 to 59 years, mean age 30). In all these patients cranioplasty and/or cranio-facial reconstruction had been performed to repair bone defects secondary to benign tumors or tumor-like lesions (12 cases), trauma (2 cases), or, in the remaining case, to wound infection after craniotomy for a neurosurgical operation. RESULTS The results obtained in a series of 15 patients treated using this method are described with reference to the abundant data published on this topic. CONCLUSION The mechanical, immunologic, and technical-grafting properties of autologous bone, together with its superior esthetic and psychological effects, probably make it the best material for cranioplasty