Observation of p-wave threshold behavior in electron attachment to F2 molecules

Using the high resolution laser photoelectron attachment method, we demonstrate that the cross section for F- formation due to electron capture by F2(X{1}Sigma{g}{+}) molecules at very low energies exhibits p-wave threshold behavior. This finding confirms the theoretical expectation that low-energy attachment to F2 proceeds through the F2{-}(2Sigma{u}{+}) p-wave shape resonance in contrast with previous experimental claims for s-wave threshold behavior.

Giant cystic widening of Virchow-Robin spaces: an anatomofunctional study

We describe 2 patients with unusual white matter cystic dilations, which could correspond to widening of the perivascular spaces. They underwent morphologic MR imaging with tractography, functional MR imaging (fMRI), and neuropsychological evaluation. fMRI examination showed no functional reorganization of cortical areas. Tractography showed an apparent decrease of white matter tract vectors into the regions of concern. Findings of the neuropsychological examination were normal. It seems that even an extensive cystic dilation of white matter does not deteriorate brain function.

Sexuelle Dysfunktion bei Harninkontinenz

BACKGROUND

The progress of science in the field of male sexuality stimulated the interest to investigate female sexual function and dysfunction. The understanding of sexuality as a central part of life quality and satisfaction of humans, opened the doors for research of sexuality and sexual disorders. The aim of the study was to evaluate the prevalence of female sexual dysfunction ("FSD") and erectile dysfunction ("ED") in a community population and the relation to urinary incontinence.

MATERIAL AND METHODS

We developed 2 questionnaires (men 53 questions, women 55). The IPSS and KEED (Kölner Erfassungsbogen der erektilen Dysfunktion) were integrated in the male questionnaire and the FSFI (Female Sexual Function Index) in the female questionnaire. The questionnaire was send to each 10,000 women and men (age 20-80 years). The response rate in women was 41 and in men 46%, the mean age 43 in women and 53 in men.

RESULTS

The prevalence of female sexual dysfunction was 38.2%, and it was 19.6% for male sexual dysfunction. 26% of the women and 41.4% of men suffered from urinary incontinence/lower urinary tract symptoms ("LUTS"). The prevalence increased significantly with age. 46.5% of the incontinent women suffered from FSD versus 35.2% of the continent women. 34% of women, who had consulted a physician because of sexual problems in the past, suffered from FSD and urine incontinence. The therapy necessity in general is around 18.4%. There was a statistically significant correlation between LUTS and ED. 31.8% of the men with LUTS suffered from ED versus 10.3% of continent men (p=0.001).

CONCLUSION

Up to now this is the largest single center, community based, study of FSD and ED. We could demonstrate a high prevalence of FSD and ED in general and particular in urinary incontinent persons.

Magnetic resonance imaging versus mammography for diagnosing ductal carcinoma in situ

1504

Background: Mammographic screening is considered the mainstay for diagnosing pre-invasive breast cancer (DCIS). However, (over)diagnosis of DCIS has become a major concern. We investigated the sensitivities of high-resolution MRI and of state-of-the-art mammography (Mx) for diagnosing pure DCIS, and compared the biologic profile of MRI-detected versus Mx-detected DCIS. Methods: Prospective study on 5960 consecutive women who were referred to a dedicated breast unit for screening or for diagnostic assessment. Women underwent bilateral mammography with at least 2 views, plus spot compression views where appropriate, and high-resolution bilateral MRI. A total 137 women received the final pathologic diagnosis of having DCIS (no invasion). Of these, 108 (79%) had been referred for regular screening, 14 (10%) for high risk screening, 10 (7%) for follow up after breast cancer, and 5 (4%) for clinical symptoms. We investigated the mode of detection, and the biologic profile of the DCIS (size, nuclear grading, ER/PR and HER2-receptor status). Results: Overall, Mx was positive in 79/137 patients (58%), MRI was positive in 123/137 (90%). In 68/137 (50%), Mx and MRI were concordantly positive. In 3/137 (2%), Mx and MRI were both false-negative. In 11/137 (8%), only Mx was positive, MRI was false- negative. In 55/137 (40%), only MRI was positive, Mx was false negative. Of the 11 DCIS which were only detected by Mx, 1 was high grade, none was ER negative or HER2 positive. Mean VNPI was 4.2. Of the 55 DCIS which were only MRI detected, 41 (78%) were high grade, 14 (27%) were ER negative, 17(33%) HER-2 positive. Mean VNPI was 6.5. Conclusions: Compared to mammography, MRI offers a significantly higher sensitivity for DCIS, in particular for DCIS with adverse biologic profile: Half of the high grade or HER2-positive DCIS were only MRI detected. In turn, DCIS which was only mammography detected had a relatively benign biologic profile. We propose that MRI is helpful for diagnosing biologically (i.e. possibly prognostically) relevant DCIS

[Table: see text]

No significant financial relationships to disclose.

Ultrafast changes of molecular crystal structure induced by dipole solvation

Femtosecond photoexcitation of organic chromophores in a molecular crystal induces strong changes of the electronic dipole moment via intramolecular charge transfer as is evident from transient vibrational spectra. The structural response of the crystal to the dipole change is mapped directly for the first time by ultrafast x-ray diffraction or diffuse scattering. Changes of diffracted and transmitted x-ray intensity demonstrate an angular rearrangement of molecules around excited dipoles following the 10 ps kinetics of charge transfer and leaving lattice plane spacings unchanged. Transient x-ray scattering is governed by solvation, masking changes of the chromophore molecular structure.

Investigation by bioassay of the efficacy of sodium hydroxide treatment on the inactivation of mouse-adapted scrapie

Sodium hydroxide (NaOH) has been shown to reduce the infectivity of transmissible spongiform encephalopathy (TSE) agents. This study investigated the efficacy of sodium hydroxide at 0.1M, 0.25M and 0.5M concentrations for the inactivation of mouse-adapted scrapie strain ME7. Times and temperatures modelled conditions used in an industrial plasma fractionation plant for sanitisation of ultrafilters, and the sodium hydroxide component of Clean In Place sanitisation. The concentration of scrapie ME7 brain homogenate in NaOH test solutions was 1% (w/v). At the end of incubation periods, the samples were adjusted to neutral pH prior to intracerebral inoculation into mice for bioassay. The conditions of 0.1M NaOH at 60 degrees C for 2min and 0.25M NaOH at 30 degrees C for 60min were found to inactivate 3.96 and 3.93logs of scrapie, respectively. Use of 0.5M NaOH at 30 degrees C for 60 or 75min was found to inactivate >or=4.23 and 4.15logs of scrapie. This indicates that the use of these conditions in an industrial process would substantially reduce prion infectivity.

Precision in stitches: Radius Surgical System

BACKGROUND

The Radius Surgical System is a manual manipulator with two additional degrees of freedom compared with conventional laparoscopic instruments (CLIs). This study aimed to compare the performance of laparoscopic suturing tasks with the use of the Radius Surgical System and CLIs, respectively.

METHODS

Five experienced laparoscopic surgeons performed laparoscopic surgical tasks in a training box. The tasks consisted of knot-tying, suturing, and needle control tasks. The needle control task was performed to evaluate the precision of the needle drive by analysis of the needle exit point on a suture pad. In the knot-tying and suturing tasks, required time and accuracy value were measured. Needle control tasks were performed on three different angulations of plane. The angles between the instrument plane and the target plane (AIT) were 30 degrees, 60 degrees, and 90 degrees. The distance of the exit point to the center of the target field, the number of actions needed to fulfill a single task, and the required time were recorded and analyzed.

RESULTS

In the knot-tying and frontal suturing tasks, there were no significant differences between the two groups. In the sagittal suturing task, the required time in the Radius group was significantly shorter than in the CLI group. In the needle control tasks on 30 degree and 60 degree AIT, the distance was significantly shorter in the Radius group than in the CLI group. There were no significant differences in the number of actions or the required time. In the frontal and sagittal needle control task on 90 degree AIT, the distance was significantly shorter in the Radius group than in the CLI group. The number of actions and the required time were significantly less in the Radius group than in the CLI group.

CONCLUSIONS

The two additional degrees of freedom contributed to accurate and controlled needle guidance, especially in difficult spatial situations.

[Crossed aphasia or dysexecutive syndrome? A case report]

The case of a female dextral patient (MN) is reported. MN sustained a partial frontotemporal infarction in the right hemisphere. Clinically, MN presented herself mainly with aphasic symptoms. The dextrality of the patient and the laterality of the lesion as well as the nature of language deficits would legitimate the diagnosis of a crossed aphasia, implying paradoxical lateralization of language in MN. However, comprehensive neuropsychological assessment revealed the presence of a global dysexecutive syndrome in MN, suggesting a general cognitive impairment, part of which must be the aphasic symptoms. General issues regarding the relationship between language and cognition and the lateralization of cognitive functions are discussed.

Spatial localization of EEG electrodes

AIM OF THE STUDY

An important goal for EEG-based functional brain studies is to estimate the location of brain sources that produce the scalp-recorded signals. Such source localization requires locating precisely the position of the EEG sensors. This review describes and compares different methods that are used for localizing EEG sensors.

RESULTS

Five different methods have been described in literature. Manual methods consist in manual measurements to calculate the 3D coordinates of the sensors. Electromagnetic and ultrasound digitization permit localization by using trade devices. The photogrammetry system consists in taking pictures of the patient's head with the sensors. The last method consists in directly localizing the EEG sensors in the MRI volume.

DISCUSSION AND CONCLUSIONS

The spatial localization of EEG sensors is an important step in performing source localization. This method should be accurate, fast, reproducible, and cheap. Currently, electromagnetic digitization is the most currently used method but MRI localization could be an interesting way because no additional method or device needs to be used to locate the EEG sensors.

Advanced glycation end-product pentosidine is not a relevant marker of disease activity in patients with rheumatoid arthritis

Advanced glycation end-product (AGE) pentosidine has previously been demonstrated in different tissues and body fluids. It was suggested as a novel marker for evaluating the pathologic activity in rheumatoid arthritis (RA). In this study we analyzed the relation between pentosidine and markers of inflammation, cartilage turnover, immune response, and disease status of RA. Using HPLC, we analyzed pentosidine in serum and synovial fluid from 39 patients with RA and in serum from 38 healthy controls. Cartilage oligomeric matrix protein (COMP) and antibodies to CCP (anti-CCP) were measured by ELISA. Clinical disease status was assessed by Disease Activity Score 28 (DAS 28) and functional status by Health Assessment Questionnaire (HAQ). We demonstrated significantly higher serum levels of pentosidine in RA patients in comparison with controls. Pentosidine in serum significantly correlated with pentosidine in synovial fluid. Serum pentosidine levels were associated with erythrocyte sedimentation rate (p<0.03) but not with CRP, COMP, anti-CCP antibodies, DAS 28, or HAQ. In contrast to previous studies, we could not show any correlation of pentosidine levels with inflammatory status, clinical disease activity, markers of immune response, or cartilage breakdown. However, AGEs can be suggested as important players participating in joint destruction rather than markers of disease activity.

Collagen degradation products and proinflammatory cytokines in systemic and localized scleroderma

The aim of this study was to assess the degradation of collagen type I and proinflammatory cytokines in systemic and localized scleroderma compared with psoriasis and healthy controls. Total 99 individuals were examined - 24 with SSc, 22 with LSc, 39 patients with PsV and 14 healthy controls. U-PD and U-DPD were measured using a sensitive isocratic HPLC method. Serum levels of IL-6 and soluble IL-2R were assayed using commercial ELISA kits. In the SSc group U-PD and U-DPD levels (nmol/mmol creatinine) were increased compared with controls (P = 0.001) and with PsV (P = 0.006). IL-6 levels were increased compared with controls (P = 0.004) and with PsV (P = 0.002). IL-2R concentrations were insignificantly increased in comparison with controls and were lower than in PsV, but the difference was not significant. In the LSc group excretion of U-PD and U-DPD did not differ from controls, but was insignificantly decreased compared with PsV. IL-6 levels were increased compared with controls (P = 0.001) and also with PsV (P = 0.03). IL-2R concentrations were significantly increased in comparison with controls only (P = 0.03). In patients with SSc our data have shown the most intensive collagen degradation and simultaneously an active inflammation, as documented by IL-6, which reflects the pathological processes in the skin and visceral organs compared with PsV patients and healthy individuals. In the LSc group collagen degradation was similar to that in control groups, but a certain inflammatory activity was observed.

Good manufacturing practice-compliant validation and preparation of BM cells for the therapy of acute myocardial infarction

BACKGROUND

Intracoronary application of BM-derived cells for the treatment of acute myocardial infarction (AMI) is currently being studied intensively. Simultaneously, strict legal requirements surround the production of cells for clinical studies. Thus good manufacturing practice (GMP)-compliant collection and preparation of BM for patients with AMI was established by the Cytonet group.

METHODS

As well as fulfillment of standard GMP requirements, including a manufacturing license, validation of the preparation process and the final product was performed. Whole blood (n=6) and BM (n=3) validation samples were processed under GMP conditions by gelafundin or hydroxyethylstarch sedimentation in order to reduce erythrocytes/platelets and volume and to achieve specifications defined in advance. Special attention was paid to the free potassium (<6 mmol/L), some rheologically relevant cellular characteristics (hematocrit <0.45, platelets <450 x 10(6)/mL) and the sterility of the final product.

RESULTS

The data were reviewed and GMP compliance was confirmed by the German authorities (Paul-Ehrlich Institute). Forty-five BM cell preparations for clinical use were carried out following the validated methodology and standards. Additionally three selections of CD34+ BM cells for infusion were performed. All specification limits were met. Discussion In conclusion, preparation of BM cells for intracoronary application is feasible under GMP conditions. As the results of sterility testing may not be available at the time of intracoronary application, the highest possible standards to avoid bacterial and other contaminations have to be applied. The increased expense of the GMP-compliant process can be justified by higher safety for patients and better control of the final product.

Rhizoids and protonemata of characean algae: model cells for research on polarized growth and plant gravity sensing

Gravitropically tip-growing rhizoids and protonemata of characean algae are well-established unicellular plant model systems for research on gravitropism. In recent years, considerable progress has been made in the understanding of the cellular and molecular mechanisms underlying gravity sensing and gravity-oriented growth. While in higher-plant statocytes the role of cytoskeletal elements, especially the actin cytoskeleton, in the mechanisms of gravity sensing is still enigmatic, there is clear evidence that in the characean cells actin is intimately involved in polarized growth, gravity sensing, and the gravitropic response mechanisms. The multiple functions of actin are orchestrated by a variety of actin-binding proteins which control actin polymerisation, regulate the dynamic remodelling of the actin filament architecture, and mediate the transport of vesicles and organelles. Actin and a steep gradient of cytoplasmic free calcium are crucial components of a feedback mechanism that controls polarized growth. Experiments performed in microgravity provided evidence that actomyosin is a key player for gravity sensing: it coordinates the position of statoliths and, upon a change in the cell's orientation, directs sedimenting statoliths to specific areas of the plasma membrane, where contact with membrane-bound gravisensor molecules elicits short gravitropic pathways. In rhizoids, gravitropic signalling leads to a local reduction of cytoplasmic free calcium and results in differential growth of the opposite subapical cell flanks. The negative gravitropic response of protonemata involves actin-dependent relocation of the calcium gradient and displacement of the centre of maximal growth towards the upper flank. On the basis of the results obtained from the gravitropic model cells, a similar fine-tuning function of the actomyosin system is discussed for the early steps of gravity sensing in higher-plant statocytes.

Rhizoids and protonemata of characean algae: model cells for research on polarized growth and plant gravity sensing

Gravitropically tip-growing rhizoids and protonemata of characean algae are well-established unicellular plant model systems for research on gravitropism. In recent years, considerable progress has been made in the understanding of the cellular and molecular mechanisms underlying gravity sensing and gravity-oriented growth. While in higher-plant statocytes the role of cytoskeletal elements, especially the actin cytoskeleton, in the mechanisms of gravity sensing is still enigmatic, there is clear evidence that in the characean cells actin is intimately involved in polarized growth, gravity sensing, and the gravitropic response mechanisms. The multiple functions of actin are orchestrated by a variety of actin-binding proteins which control actin polymerisation, regulate the dynamic remodelling of the actin filament architecture, and mediate the transport of vesicles and organelles. Actin and a steep gradient of cytoplasmic free calcium are crucial components of a feedback mechanism that controls polarized growth. Experiments performed in microgravity provided evidence that actomyosin is a key player for gravity sensing: it coordinates the position of statoliths and, upon a change in the cell's orientation, directs sedimenting statoliths to specific areas of the plasma membrane, where contact with membrane-bound gravisensor molecules elicits short gravitropic pathways. In rhizoids, gravitropic signalling leads to a local reduction of cytoplasmic free calcium and results in differential growth of the opposite subapical cell flanks. The negative gravitropic response of protonemata involves actin-dependent relocation of the calcium gradient and displacement of the centre of maximal growth towards the upper flank. On the basis of the results obtained from the gravitropic model cells, a similar fine-tuning function of the actomyosin system is discussed for the early steps of gravity sensing in higher-plant statocytes.

Experimental results of mesh fixation by a manual manipulator in a laparoscopic inguinal hernia repair model

BACKGROUND

Laparoscopic mesh fixation using a stapler can lead to complications such as nerve injury and bowel injury. However, mesh fixation by suturing with conventional laparoscopic instruments (CLI) is difficult because of limited degrees of freedom. A manual manipulator--Radius Surgical System (Radius)--whose tip can deflect and rotate, gives the surgeon two additional degrees of freedom. The aim of this study is to evaluate the introduction of Radius to mesh fixation in laparoscopic inguinal hernia repair.

METHODS

A model for inguinal hernia repair was prepared using animal organs in a trainer. Mesh fixation was performed using Radius, stapler, and CLI. Tensile strength during extraction of mesh toward the vertical direction, and execution time, were measured.

RESULTS

The mean number of fixation points of Radius, stapler, and CLI was 9.3 +/- 1.5, 8.5 +/- 1.4, and 9.0 +/- 1.0, respectively. The mean tensile strength of fixation of mesh of Radius, stapler, and CLI was 140.7 +/- 48.9, 73.1 +/- 23.4, and 53.6 +/- 31.5 (N), respectively. The mean tensile strength per one fixation point by Radius, stapler, and CLI was 16.5 +/- 5.3, 8.7 +/- 2.8, and 6.3 +/- 3.6 (N), respectively. The mean execution time of Radius, stapler, and CLI was 479 +/- 108, 54 +/- 31, and 431 +/- 77 (sec), respectively.

CONCLUSIONS

The mesh fixation by Radius was stronger than that by staples and CLI. Two additional degrees of freedom were useful in difficult angles. The introduction of Radius is feasible and facilitates the fixation of mesh with sutures in laparoscopic inguinal hernia repair.

[Postoperative problems and after-care in post-radical-prostatectomy patients]

Essential components of tumor follow-up in prostate cancer patients are considered to be the determination of PSA in combination with digital rectal examination, and abdominal together with transurethral ultrasonography. Depending upon the symptoms presenting, additional specialist urological examinations, such as urine flow measurement and cystoscopy may be indicated. The follow-up should be carried out every three months in the first postoperative year, every 6 months in the following years, and annually thereafter.

Investigation of prion removal/inactivation from chromatographic gel

BACKGROUND AND OBJECTIVES

Concerns about the potential for prions to be retained on chromatography gels during the manufacture of plasma products prompted development of an investigational strategy for detecting infectious prions bound to gels. The objective was to firstly examine methods of implanting gels intracerebrally (IC) in mice, then to examine prion cleaning from a scaled-down version of the DEAE Sepharose column used in a production process to fractionate immunoglobulins and albumin from human plasma.

MATERIALS AND METHODS

The study consisted of two parts: (i) the pathophysiological impact by IC inoculation of ground gel beads was compared to whole gel beads; (ii) the feedstreams to two DEAE Sepharose columns were spiked with scrapie ME7. One column was subjected to the protein loading and elution portions of the chromatography cycle. The other column was subjected to the full cycle of protein loading and elution, followed by regeneration with 0.5 m NaCl, 1 m NaOH and solvent/detergent washes. The gels were unpacked and bioassayed by IC implantation in mice to quantify infectivity.

RESULTS

IC inoculation of ground gel beads resulted in unacceptably high pathological impact in the mice whereas whole gel bead inoculation resulted in a reduced affect. Accordingly, the whole bead model system was used to assess prion removal/inactivation from chromatography gels at the pre- and postcleaning stage of the chromatography cycle. Infectious prions were detected on the DEAE Sepharose prior to the cleaning step; however, the gel cleaning cycle reduced infectivity by a log reduction factor (LRF) of > or = 2.75, thus reducing infectivity by bioassay to below detectable limits.

CONCLUSIONS

A model system for assessment of prion inactivation/removal from chromatography gels has been established. Spiked prion infectivity does bind to DEAE Sepharose gel; however, the cleaning cycle removed infectivity to levels below that detectable by bioassay.

[Imaging follow-up of post-traumatic myelomalacia]

The authors report a case of secondary worsening of neurological symptoms in a patient 2 months after cord injury at T5 causing paraplegia. The MRI showed myeolomalacia, which appears as cord oedema, located in the grey matter, extending increasingly from the initial lesion (eighth thoracic vertebra) to the bulb. This cord lesion known as grey matter cytotoxic oedema, evolved into a syringomyelic cavity.

Detection of bovine viral diarrhea virus by amplification on polycation-treated cells followed by enzyme immunoassay

A bovine viral diarrhea virus (BVDV) amplification method combined with an enzyme immunoassay was developed to detect BVDV antigens in seropositive cattle. Reconstitution assays conducted by adding decreasing amounts of BVDV (Singer strain) to Madin-Darby bovine kidney (MDBK) cells showed that the sensitivity threshold of the combined assay was 10(-7) TCID50. BVDV amplification was carried out in polycation (DEAE-Dextran and polybrene)-treated MDBK cells. Treated cells were able to replicate both ether-treated virus and neutralizing antibody-coated virus. Ammonium chloride decreased virus replication in polycation-treated cells, suggesting viral penetration by endocytosis. BVDV detection was tested in leukocytes from 104 seropositive cattle from 2 unvaccinated commercial closed dairy herds with high seroprevalence. Lysates and co-cultures of peripheral blood leukocytes (PBL) were tested, directly or after up to 6 blind passages in normal or polycation-treated cells. BVDV was detected in 10/104 cattle after only one co-culture of PBL in treated cells. No virus was detected in whole blood or plasma samples. BVDV positive and negative cattle were retested three times, achieving consistent results. The finding of immune carriers supports the possibility that these animals may constitute an epidemiological risk.

Predictive value of serum globulin levels for the extent of hepatic fibrosis in patients with chronic hepatitis B infection

The mechanism underlying disease progression in hepatitis B virus (HBV) infection is unknown. Immunoglobulins stimulate the proliferative activity of rat hepatic stellate cells in vitro. A strong association was found between serum immunoglobulin levels and hepatic fibrosis in patients with hepatitis C virus infection. Our objective was to determine if the same index could also be used in patients with chronic HBV infection. The records of 100 patients with biochemical, serological, virological and histological evidence of chronic HBV infection were reviewed for background factors and serum globulin and immunoglobulin levels. Mean (+/-SD) patient age was 44.0 +/- 14.7 years; 80 (80%) were male. Of the factors found to be significant on univariate analysis, the only significant predictors of severe hepatic fibrosis (stage > or = 2) on multivariate analysis were serum globulin level [odds ratio (OR) 5.97, 95% confidence intervals (CI) 1.82-19.53, P = 0.0004], platelet count (OR 0.98, CI 0.97-0.99, P = 0.001), and immunoglobulin G (IgG) level (OR 1.003, CI 1.000-1.007, P < 0.042) but not IgA, alkaline phosphatase, albumin or international normalized ratio. For each increase of 0.33 mg/dL in serum globulin, there was a 0.5 point increase in the stage of hepatic fibrosis. There appears to be a strong association between levels of serum globulin and IgG and extent of hepatic fibrosis in patients with chronic HBV infection. They can serve as noninvasive markers of hepatic fibrosis and, if confirmed, have important implications for the management of patients with chronic HBV infection.

[Effects of the zinc oxide and cod liver oil containing ointment Zincojecol in an animal model of wound healing]

The effects of Zincojecol an ointment containing zinc oxide and cod liver oil on wound healing were compared with ointments that either contained no active ingredients or zinc oxide or cod liver oil alone. All formulations enhanced the epidermal proliferation after mechanical irritation of the tail skin. The combination of zinc oxide and cod liver oil was found to be superior to the vehicle control and formulations containing only one active ingredient. This combination was also found to be most efficient in accelerating wound healing being retarded by repeated dexamethasone treatment.

Bupropion Augmentation in the Treatment of Chronic Fatigue Syndrome with Coexistent Major Depression Episode

While psychoeducational strategies and general support are always indicated for the treatment of chronic fatigue syndrome (CFS), pharmacological strategies are yet not well established. Antidepressants such as selective serotonin re-uptake inhibitors have been shown to influence positively symptoms and immunological parameters. However, a considerable part of CFS patients do not satisfactorily respond to them. Bupropion, a centrally acting catecholamine-transporter blocker without classic psycho-analeptic properties, shows theoretical potential to improve fatigue symptoms. In the reported case paroxetine was augmented with bupropion at high dosage, a strategy which consecutively led to a rapid relief of CFS-symptoms.