[Video head impulse test or caloric irrigation? Contemporary diagnostic tests for vestibular schwannoma]

The video head impulse test (vHIT) is a new method for investigating vestibular function that is currently poorly studied in terms of its value for clinical diagnosis in otolaryngology. Both the caloric irrigation and vHIT serve to evaluate the horizontal vestibulo-ocular reflex. In the present study, caloric irrigation and vHIT were compared in 46 patients with vestibular schwannoma. Caloric irrigation exhibits a higher sensitivity than vHIT (72% versus 41%) and both tests show only a moderate correlation. Tumor size and hearing level was significantly correlated with caloric abnormalities but not with vHIT findings. Since caloric irrigation and vHIT measure the hVOR in low and high frequency ranges, respectively, these tests have to be considered complementary and are valuable in both diagnostics and therapeutic decisions.

[The video head impulse test: first clinical experiences]

BACKGROUND

Side-specific test procedures are mandatory in order to assess the function of peripheral vestibular receptors. Semicircular canals (SCC) and vestibulo-ocular reflex (VOR) can be tested by the Halmagyi and Curthoy head impulse test (HIT) and recently by means of the video head impulse test (vHIT). The vHIT procedure is a new method to measure eye and head velocity during brief and rapid head impulses. This method provides objective information of VOR and detects both overt and covert catch-up saccades.

MATERIALS AND METHODS

As clinical experiences with vHIT are limited, in this study the horizontal VOR (hVOR) was examined by means of the vHIT in 142 consecutive patients with acute or chronic vestibular syndrome.

RESULTS

A total of 20 healthy volunteers served as a control group and exhibited a normal average VOR gain of 0.97 ± 0.09 without re-fixation saccades. In patients, 47.6% showed a pathological vHIT whereas 52.4% revealed a normal test result. Covert catch-up saccades could be revealed in 13.7% by means of vHIT whereas in 86.3% overt catch-up saccades alone or in combination with covert catch-up saccades were found in the majority of catch-up saccades in peripheral vestibular disorders.

CONCLUSIONS

By means of the vHIT it is possible to obtain a side-specific and quantitative assessment of hVOR. Video-head impulse test is a reliable tool for vestibular testing even in bedside examinations of patients suffering from dizziness.

[Isolated functional loss of the lateral semicircular canal in vestibular neuritis]

Today, modern tools in vestibular testing are feasible to provide information about functional status of all five peripheral vestibular receptors. Isolated or combined loss of crista and macula receptor function can be determined in the diagnostic process. We describe a seldom case of isolated functional loss of lateral semicircular canal receptor function in a 55-year-old patient. Whereas there was no ispilateral caloric response and video head impulse test revealed a catch-up saccade, air-conducted (AC) cervical and ocular vestibular-evoked myogenic potentials (cVEMP, oVEMP), subjective visual vertical and MRI were normal.

Significant correlation between the breakpoints of rare clonal aberrations in benign solid tumors and the assignment of HMGIY retropseudogenes

Recently, we described a mechanism by which a retropseudogene, during evolution, becomes an exon of a pre-existing active gene. Similar mechanisms may account for the activation of processed genes by chromosomal rearrangements in neoplasms. Because genes of the high-mobility group protein family HMGI(Y) are known to be involved in the development of a variety of benign solid tumors, it was the aim of the present study to analyze breakpoints of clonal chromosome abnormalities in that group of benign tumors for a possible correlation with retropseudogenes of the HMGIY gene. Whereas the HMGIYL1 retrospeudogene has recently been mapped to Xp22.1, we assigned a further retropseudogene by FISH to 4q13, and database research allowed us to assign a third retropseudogene to 12q24.1. Sequence analyses of these retropseudogenes revealed high-identity indices to the HMGIY gene and no frame-shift divergences. Breakpoint information was obtained from cytogenetic aberrations in uterine leiomyomas, lipomas, pleomorphic adenomas, and pulmonary chondroid hamartomas because, in all of these tumor entities, cytogenetic subgroups involving genes of the HMGI(Y) family exist. Chromosomal bands harboring HMGIY retropseudogenes were affected with a significantly higher frequency than expected under the assumption of purely randomly occurring breakages. These results support our hypothesis that HMGIY-related retropseudogenes can be affected by chromosomal rearrangements in benign human tumors.

Effects of an antihypertensive medication on functional capacity under simulated flight-typical stress-conditions

A model to investigate the functional capacity (psychomental performance) under stressful conditions was developed. Twenty eight patients with mild hypertension receiving Nitrendipine (20 mg) for 30 days were tested under hypoxic (16% oxygen) and/or orthostatic (-30 mmHg lower body negative pressure) conditions using a subset of the AGARD battery. The main effect was a decreasing performance of the grammatical reasoning task (GRT) under hypoxia or the combination of hypoxia and orthostasis. A simultaneous application of stressors while performing psychometric test batteries may be useful to reveal pharmaceutical influences on human performance and may help to recommend the use of drugs in occupational medicine.

Laser pyrolysis products-genotoxic, clastogenic and mutagenic effects of the particulate aerosol fractions

Laser therapy has gained wide acceptance and application in many medical disciplines. Nevertheless, during surgical procedures, the thermal destruction of tissue creates a smoke plume. Recent research data indicate that pyrolysates liberated during vaporisation of tissue induce DNA damage. However, assessing potential health hazards during medical laser treatment requires comprehensive insight into the cytotoxic, genotoxic, clastogenic and mutagenic capacity of laser pyrolysis products (LPP). Therefore, the aim of this study was to evaluate the cytotoxic, genotoxic, clastogenic and mutagenic potential of substances resulting from laser irradiation. Four different types of porcine tissues were irradiated with a surgical CO2 laser, the aerosols were sampled under defined conditions and subjected to the SCE test, micronucleus test and the HPRT test. The results showed that the pyrolysis products are strong inducers of cytotoxic effects. The pyrolysis products induced positive effects in the SCE test, micronucleus test and the HPRT test. The ability and extent to induce genotoxic and mutagenic effects turned out to be dependent on the type of tissue that had been irradiated. In general, the effects were most pronounced with liver pyrolysate. In all test systems, a clear dose relationship could be established. In conclusion, we were able to prove that the particulate fraction of laser pyrolysis aerosols originating from biological tissues undoubtedly have to be classified as cytotoxic, genotoxic, clastogenic and mutagenic. Therefore, they could be potential health hazards for humans.

DNA effects in repair-deficient V79 Chinese hamster cells studied with the comet assay

Using the alkaline comet assay (single cell gel electrophoresis), we studied the induction and persistence of DNA damage induced by methyl methanesulfonate (MMS) and neocarzinostatin (NCS) in the repair-deficient Chinese hamster cell lines V-E5 and XR-V15B. Effects in the comet assay were analyzed directly after treatment as well as after a postincubation period in mutagen-free medium to gain insight into the DNA repair capacities of the mutant cell lines in relation to different primary DNA lesions. Both mutagens caused a concentration-related increase in DNA strand breakage in both mutant cell lines and in the normal parental cell lines. Repair of MMS-induced DNA damage during postincubation was similar in normal and mutant cell lines, while diminished repair was seen after NCS treatment in XR-V15B cells. Our data show that XR-V15B cells only repaired about 30% of NCS-induced DNA damage within 1 h, while the parental V79 cell line repaired about 70%. Since this cell line is defective in the repair of DNA double-strand breaks (DSB), the results indicate that NCS-induced DSB significantly contribute to the genotoxic effects seen in the comet assay. However, compared to previously studied induction of gene mutations and chromosome aberrations, detection of NCS-induced DNA effects with the comet assay was less sensitive and increased DNA migration only occurred under strong cytotoxic conditions.

A comparative investigation of DNA adducts, DNA strand breaks and gene mutations induced by benzo[a]pyrene and (+/-)-anti-benzo[a]pyrene-7,8-diol 9,10-oxide in cultured human cells

Genotoxic effects of benzo[a]pyrene (BP) and its reactive metabolites (+/-)-anti-benzo[a]pyrene-7,8-diol 9,10-oxide ((+/-)-anti-BPDE) were comparatively investigated in vitro with the permanent human fibroblast cell line MRC5CV1. Induced DNA adducts were measured by 32P-postlabeling, DNA strand breakage was determined by the comet assay and the HPRT gene mutation test was used to detect cytotoxicity and mutagenicity. Treatment of MRC5CV1 cells with S9 mix-activated BP or with (+/-)-anti-BPDE resulted in a concentration-dependent increase in DNA adducts and strand breaks. Genotoxic effects of BP and (+/-)-anti-BPDE were detected by 32P-postlabeling and the comet assay with similar sensitivity. However, under the same experimental conditions, a clear induction of gene mutations was only found after (+/-)-anti-BPDE treatment. The relationship between the induction of primary DNA alterations like DNA strand breaks and DNA adducts and the induction of gene mutations is discussed.

Micronucleus induction by neocarzinostatin and methyl methanesulfonate in ionizing radiation--sensitive Chinese hamster V79 cell mutants

Two mutant V79 Chinese hamster cell lines (V-E5, XR-V15B) which show hypersensitivities to DNA damage and their two parental cell lines (V79-LE, V79-B) were used for micronucleus studies. The characteristics of V-E5 strongly resemble those of cells derived from patients suffering from the genomic instability syndrome ataxia telangiectasia, whereas XR-V15B has a decreased ability to rejoin double-strand breaks. The two cell lines V-E5 and XR-V15B showed increased spontaneous micronucleus frequencies and higher sensitivity for micronucleus induction by methyl methanesulfonate (MMS) and neocarzinostatin (NCS) both with and without the use of cytochalasin B in the micronucleus assay. Thus, defects in cellular responses to DNA damage are modulating factors in micronucleus formation.

Detection of DNA effects in human cells with the comet assay and their relevance for mutagenesis

The single cell gel test (SCG-test or comet assay) is a rapid and sensitive method for measuring DNA damage and repair in individual cells. A wide variety of mutagens have been shown to cause DNA alterations detectable with the comet assay, but it is not yet clear whether a relationship exists between the DNA effects and the induction of mutations. We are therefore investigating in a cell culture system with human cells (MRC5CV1) the induction of DNA damage by environmental mutagens and the formation of mutations at the HPRT gene. In the present study we investigated benzo[a]pyrene (BP), an environmental mutagenic and carcinogenic polycyclic aromatic hydrocarbon, and its reactive metabolite (+)-anti-benzo[a]pyrene-7,8-diol 9, 10-oxide ((+)-anti-BPDE). S9 mix activated BP and the direct acting mutagen (+)-anti-BPDE caused a concentration-related increase in DNA migration in the comet assay. Postincubation experiments indicated that induced DNA effects are eliminated by DNA repair within 24 h. BP-treatment caused a strong genotoxic effect in the comet assay but had only a marginal effect on the frequency of gene mutations. When cells were treated with BP in the presence of cadmium sulphate, a clear increase in genotoxicity was observed while the effect on mutations was unchanged. Our results indicate that DNA alterations detected with the comet assay do not necessarily relate to mutagenesis. The absence of a close relationship between DNA migration in the comet assay and mutagenesis may be explained by the fact that some effects seen in the comet assay occur as a consequence of an error free DNA repair process.

The pattern of adriamycin-induced mutations in V-E5 Chinese hamster cells with chromosomal instability

The V-E5 cell line, a mutant V79 Chinese hamster cell line, was used to study the effect of chromosomal instability on the spectrum of gene mutations and chromosome aberrations induced by the anthracycline antibiotic adriamycin (AM). V-E5 cells showed hypersensitivity to the cytotoxic effects of AM when compared to the parental cell line. AM caused both, chromosome-type aberrations and chromatid-type aberrations in V-E5 cells. Under the same experimental conditions, gene mutations were induced at the hprt locus which mainly represented deletion mutations. The spectrum of AM-induced chromosomal aberrations and gene mutations did not show any peculiarities in comparison to normal V79 cells. It is concluded that the genomic instability in V-E5 cells does not influence the pathways leading to chromosome aberrations and gene mutations after AM treatment.

The effect of defective DNA double-strand break repair on mutations and chromosome aberrations in the Chinese hamster cell mutant XR-V15B

The radiosensitive Chinese hamster cell line XR-V15B was used to study the effect of decreased rejoining of DNA double-strand breaks (DSBs) on gene mutations and chromosome aberrations. XR-V15B cells are hypersensitive to the cytotoxic effects of neocarzinostatin (NCS) and methyl methanesulfonate (MMS). Both mutagens induced more chromosome aberrations in XR-V15B cells than in the parental cell strain. The clastogenic action of NCS was characterized by the induction of predominantly chromosome-type aberrations in cells of both strains, whereas MMS induced mainly chromatid aberrations. The frequency of induced gene mutations at the hprt locus was not increased compared to the parental V79 cells when considering the same survival level. Molecular analysis by multiplex polymerase chain reaction (PCR) of mutants induced by NCS revealed a high frequency of deletions in cells of both cell lines. Methyl methane-sulfonate induced mainly mutations without visible changes in the PCR pattern, which probably represent point mutations. Our findings suggest a link between a defect in DNA DSB repair and increased cytotoxic and clastogenic effects. However, a decreased ability to rejoin DNA DSBs does not seem to influence the incidence and types of gene mutations at the hprt locus induced by NCS and MMS.

The pattern of mutations induced by neocarzinostatin and methyl methanesulfonate in the ataxia telangiectasia-like Chinese hamster cell line V-E5

The Chinese hamster cell line V-E5 is a mutant cell line isolated from V79 cells. The phenotypic characteristics of V-E5 strongly resemble those of cells from patients suffering from the genomic instability syndrome ataxia telangiectasia. In order to further characterize the mutant cell line and to get insight into the underlying genetic defect we compared the clastogenic and mutagenic effects of neocarzinostatin (NCS) and methyl methanesulfonate (MMS) in V-E5 and V79 wild-type cells (V79-LE). V-E5 cells were 2-3 times more sensitive to the cytotoxic effect of NCS or MMS. The clastogenic action of NCS was characterized by the predominant induction of chromosome breaks and dicentrics in both cell lines, whereas MMS mainly induced chromatid-type aberrations. The frequency of mutations induced by NCS as well as MMS was slightly enhanced in V-E5 cells compared to V79 cells treated with the same dose. However, the mutant cell line was found to be hypomutable when considering the same survival level as in the parental cell line. Molecular analysis of mutants induced by NCS revealed a high frequency of total deletions of the hprt gene in both cell lines. In contrast, among MMS-induced mutations only 11% deletion mutations were found in V79-LE, whereas in V-E5 MMS-induced deletions were seen in 52% of the hprt-deficient mutants. These results are discussed with respect to a possible relation between genomic instability, cell cycle control and mutational spectra.

Differences in the response to mutagens between two V79 sublines

Two V79 Chinese hamster sublines (V79-UL and V79-MZ) which differed markedly with respect to their spontaneous pattern of mutations at the HPRT locus were comparatively investigated in genotoxicity tests with ethyl methanesulphonate (EMS). EMS-induced frequencies of HPRT mutations and sister chromatid exchanges (SCEs) were much higher in V79-MZ than in V79-UL. V79-MZ were not hypersensitive against EMS and had normal frequencies of spontaneous gene mutations and chromosome aberrations. Baseline SCE frequencies at various BrdUrd concentrations were slightly increased compared to V79-UL. EMS induced a similar amount of chromosome aberrations in both cell lines but exchange figures occurred with lower frequency in V79-MZ. The results indicate that specific and significant differences in the response to mutagens may exist between 'normal' Chinese hamster cell lines which might be relevant for genotoxicity testing.

The molecular nature of mutations induced by adriamycin at the hprt locus of V79 cells

Adriamycin (AM), a widely used chemotherapeutic drug, induced a broad spectrum of gene mutations at the hprt locus of V79 cells. The frequency and distribution of AM-induced deletions was analyzed with multiplex polymerase chain reaction in two V79 cell lines, which differed considerably in their spontaneous deletion frequency. Among AM-induced mutants, deletions predominated in both cell lines. Apart from total deletions of the hprt gene, partial deletions were found which were distributed all over the hprt gene with breakpoints in nearly all introns. Under the same experimental conditions, chromosome aberrations were induced by AM which mainly represented chromatid-type aberrations. Neither the induction of gene mutations nor the induction of chromosome aberrations was enhanced by the repair inhibitor 3-aminobenzamide. These results are discussed in the context with our earlier findings on bleomycin-induced mutations and it is suggested that at least two mechanisms lead to the formation of gene deletions. One of them seems to be associated with a misrepair process of frank DNA double-strand breaks and related to chromosome aberrations while the other is not.

Molecular characterization of methyl methanesulphonate (MMS)-induced HPRT mutations in V79 cells

Spontaneous and methyl methanesulphonate-induced HPRT-deficient mutants were analysed for changes in the hprt gene structure using multiplex polymerase chain reaction. The PCR amplification pattern of 21 MMS-induced mutations revealed one total deletion of the hprt coding exons and one small deletion within exon 5, while 19 mutants showed the V79 wild-type pattern. Molecular analysis of 30 spontaneous mutations revealed no mutants with amplification patterns which differed from those of wild-type cells. We further analysed MMS-induced mutants in a different V79 cell line with a high (40%) spontaneous deletion frequency. MMS caused a dose-dependent increase in the mutant frequency but the incidence of deletions was reduced to 6% at 2 x 10(-4) M and to 13% at 5 x 10(-4) M indicating that mainly point mutations were induced. The repair inhibitor cytosine arabinoside (araC) enhanced mutation induction by MMS but did not change the proportion of deletions in the mutation spectrum. The results indicate that different V79 cell lines spontaneously produce different amounts of deletion mutations. The frequency of MMS-induced deletions does not depend on the frequency of spontaneous deletions in a given cell line. The MMS-induced mutation spectrum seems to be unchanged even at high concentrations with a strong cytotoxic effect. Deletions are not increased as a consequence of araC-inhibited repair of MMS-induced lesions.

Effects of vibration on arm and shoulder muscles in three body postures

The electromyographic responses of arm and shoulder muscles to vibrations were studied in three postures similar to the postures of drilling in a ceiling, drilling in a wall and drilling in a floor. This experiment was performed within the defined parameters of: vibrational frequency at 30 Hz, acceleration level 40 m.s-2 (rms), pushing force expressed as percentage maximal voluntary contraction, and gripping force which was set at 100 N. The exposure time for each test was 5 min. The general findings from these three body postures show that all the examined muscles were affected by exposure to vibration. The EMG index increased as follows: trapezius muscle 39% (p less than 0.05), lower-arm flexor muscles 23% (p less than 0.05), infraspinatus muscle 14% (p less than 0.05), lower-arm extensor muscles 14% (p less than 0.1) and biceps muscle 6% (p less than 0.1). The muscle most affected by vibration was found to be the trapezius muscle. It should be taken into consideration that vibration can be a contributing factor in neck/shoulder disorders among power handtool operators. The general conclusion from this study is that changes in working posture give different transmissions of vibration in the upper extremities. It seems as if the prime movers and muscles with an increased muscle length or increased degree of contraction are most affected by vibration.

[Ergonomical studies about the superposition of control activity and mechanical vibration (author's transl)]

The effects of combined stresses due to control activity and vertical mechanical vibration on man are analysed. In the first part, the processes in the human being at those superposed stresses are shown in a deterministic way, starting from morphological and physiological facts, which leads to a division of the organismic data processing in the fields of information reception, central information processing and information output. Hypothesis of the effects of vibration in the parts of information reception and information output as well as indications to measurable variables at laboratory experiments can be deduced from the model formulation. In the experimental part about factorized laboratory experiments with combined stresses consisting of an ideal-typical compensatory-tracking-task and mechanical vibration is reported, which can be divided into short-time experiments with measurement of the statistical control-factor and perseverance experiments with additional measurements of physiological variables. As established in the first part, influences of vibration in the regions of information reception and information output were found as well as thresholds for the performance-reducing effects of mechanical vibrations. The magnitudes of the thresholds are dependent on the task difficulty.