[Left ventricular projectile migration after an accidental close-range gunshot wound]

We report the case of a 24-year-old female after sustaining a shotgun wound in the left upper extremity and chest. Initial emergency diagnostics revealed numerous shotgun pellets scattered throughout the left-side soft tissue, chest and upper lung lobe with one pellet having migrated into the left ventricle of the heart.Due to the devastating injury pattern, gunshot wounds are interdisciplinarily challenging and should include extended initial diagnostics, such as contrast agent CT. The potential toxicity of elevated lead blood levels have to be taken into further account.

[Penetrating neck injury of a blacksmith by splitter projectile]

Laryngeal injuries are rare but potentially life-threatening injuries. Due to the topography of the neck, accompanying injuries of the greater blood vessels, cervical nerves, thoracic organs and spinal cord are common. Therefore in initial diagnostics, these must be excluded from injuries which determine the prognosis. A patient presented with ventral perforation of the larynx, initial dyspnea, hematemesis and left-sided emphysema of the neck. Cause of the findings, we treated the patient non-operatively in interdisciplinary consensus.

[Quality management in acute pain therapy: results from a survey of certified hospitals]

AIM

Systems for and methods of quality management are increasingly being implemented in public health services. The aim of our study was to analyze the current state of the integrated quality management concept "quality management acute pain therapy" of the TÜV Rheinland® (TÜV) after a 5-year project period.

MATERIAL AND METHODS

General characteristics of the participating hospitals, number of departments certified by the TÜV and implementation of structures and processes according to the TÜV guidelines were evaluated by a mail questionnaire. Furthermore, positive and negative aspects concerning the effects of certification were evaluated by the hospitals' representatives of certification.

RESULTS

A total of 36 questionnaires were returned. Since 2006 the number of certified hospitals (2011: n = 48) and surgical departments (2011: n = 202) has increased continuously. The number of certified medical departments is low (2011: n = 39); however, in the last 3 years, it has increased by about 200-300% annually. Standard operative procedures for pain therapy and measurement of pain intensity at regular intervals were implemented in all certified clinics (100%). Although 41% take part in the benchmarking project QUIPS (Quality Improvement in Postoperative Pain Therapy), 24% do not systematically check the quality of the outcome of pain management. Acceptance of the new pain therapy concepts among nursing staff was rated positively (ratio positive:negative 16:1); however, acceptance among physicians was rated negatively (1:15).

CONCLUSION

Certification by the TÜV leads to sustainable implementation of quality management principles. Future efforts should focus on better integration of physicians in acute pain therapy and the development of an integrated tool to measure patients' outcome.

The comparison of methods for determination of humoral and cell-mediated immunity in patients with breast cancer

We observed the immunological answer to antigens obtained from the human malignant breast tumor and from the blood of inbred mice strain C3H/H2K infected by LDH virus. We compared the modified ELISA method for humoral immunity with the leukocyte adherence inhibition (LAI) assay for cell-mediated immunity. The modified ELISA method is suitable for early diagnosing and monitoring antibodies in a malignant breast tumor simultaneously with senological examinations which include mammography and clinical examinations, because the antibodies are determined in a high number of samples by single application.

Cell-mediated immunity in cervical cancer evolution

Cell-mediated immunity (CMI) response to different antigens was examined in healthy women, in patients with cervical precancerous lesions, and in patients with cervical cancer. Cervical lesions were diagnosed by cytological (PAP) smears, from examination by colposcopy, and from "punch" biopsy material by histology. CMI response is related to specific processes in healthy and cancer cells. CMI was investigated by leukocyte adherence inhibition (LAI) assay using specific antigen (prepared from cervical carcinoma tissue) and non specific antigen (prepared from blood of mice infected by LDH--lactate dehydrogenase--virus). The CMI responses of healthy women and cancer patients to the antigens used are different: the majority of T lymphocytes display adherence and non adherence, respectively (but the CMI responses elicited by the antigens are not equal and small quantitative differences are observed). Regardless of the CIN (cervical intraepithelial neoplasia) grades, CMI responses correspond either to healthy women or to cervical carcinoma patients (at about similar ratio of cases in all the CIN groups). Effect of non specific antigen suggests that cervical carcinoma transformation may be connected with reduction of mitochondrial activity similar to processes in LDH virus infection.

The mechanism of butyrate-induced collagen biosynthesis in cultured fibroblasts

The data showing that butyrate may play an important role in cellular metabolism led us to study its effect on collagen biosynthesis in cultured fibroblasts. Since insulin-like growth factor-I (IGF-I) is the most potent stimulator of collagen biosynthesis in fibroblasts, the effect of butyrate on IGF-I receptor (IGF-IR) expression was evaluated. Confluent human dermal fibroblasts were treated with millimolar concentrations of sodium butyrate (NaB) for 48 hours. It was found that butyrate induced collagen biosynthesis and prolidase activity. It was found that the exposure of the cells to 4 mM butyrate contributed to a distinct increase in IGF-IR. It was accompanied by a parallel increase in the expression of Sos protein and MAP-kinases (ERK1, ERK2). It was found that the MEK inhibitor decreased collagen biosynthesis and expression of MAP-kinases (ERK1, ERK2), while NaB counteracted the process. The data suggests that butyrate-dependent stimulation of collagen biosynthesis in cultured human skin fibroblasts undergoes through IGF-IR signaling.

The mechanism of butyrate-induced collagen biosynthesis in cultured fibroblasts

The data showing that butyrate may play an important role in cellular metabolism led us to study its effect on collagen biosynthesis in cultured fibroblasts. Since insulin-like growth factor-I (IGF-I) is the most potent stimulator of collagen biosynthesis in fibroblasts, the effect of butyrate on IGF-I receptor (IGF-IR) expression was evaluated. Confluent human dermal fibroblasts were treated with millimolar concentrations of sodium butyrate (NaB) for 48 hours. It was found that butyrate induced collagen biosynthesis and prolidase activity. It was found that the exposure of the cells to 4 mM butyrate contributed to a distinct increase in IGF-IR. It was accompanied by a parallel increase in the expression of SOS protein and MAP-kinases (ERK1, ERK2). It was found that the MEK inhibitor decreased collagen biosynthesis and expression of MAP-kinases (ERK1, ERK2), while NaB counteracted the process. The data suggest that butyrate-dependent stimulation of collagen biosynthesis in cultured human skin fibroblasts undergoes through IGF-IR signaling.

Intraartikuläre Ketamingabe bei arthroskopischen Knieoperationen

BACKGROUND

Surgery of the knee can be very painful and sufficient postoperative pain treatment is often problematic. To optimize postoperative analgesia, application of local analgesics has been suggested. In the present study it was investigated whether intra-articular administration of ketamine reduces the level of pain after arthroscopic knee surgery.

MATERIAL AND METHODS

A total of 68 patients undergoing arthroscopic knee surgery were randomized into 4 groups. At the end of surgery the following pharmaceuticals were administered: 10 ml 0.25% bupivacaine intra-articular (i.a.), 0.25 mg S-(+)-ketamine/kg body weight to 10 ml in 0.9% NaCl i.a., 0.25 mg S-(+)-ketamine/kg body weight intravenous (i.v.), and 10 ml 0.9% NaCl i.a. as placebo. Postoperative pain therapy was performed as i.v. patient controlled analgesia (PCA) with piritramide. Postoperative opioid consumption and pain intensity were assessed as the main criteria in the postoperative course.

RESULTS

All 4 groups were comparable with respect to biometrical data. The scores of the visual analogue scale (VAS) showed a significantly (p<0.05) lower pain intensity in patients treated with ketamine i.a. or i.v. compared to the other groups. Shortly after surgery the highest reduction of pain was detected in the i.a. ketamine group compared to i.a. bupivacaine or placebo administration. The postoperative opioid consumption was always lowest in the i.a. ketamine group. A significant difference in piritramide consumption (p<0.05) was demonstrated in the first 20 min after operation in the i.a. ketamine group compared to the i.a. administration of placebo and bupivacaine.

CONCLUSIONS

The i.a. application of ketamine after arthroscopic knee surgery leads to a significant decrease of postoperative analgesic demand and decreases patients' subjective level of pain compared to i.a. application of bupivacaine or placebo. Likewise, the i.v. application of ketamine is similarly effective but the effect is of shorter duration.

Neuroendocrine cells in the nasal mucosa - preliminary report

The role of neuroendocrine cells (NC) in physiology and pathology of the human's respiratory tract is not fully understood. The aim of the study was the quantitative and morphometric assessment of NC in nasal mucosa in some pathological states.

PATIENTS AND METHOD

40 patients, aged 28-63 years, with clinical signs of chronic, hypertrophic rhinosinusitis were qualified for the study. Rhinitis chronica hypertrophica coexisted with aspirin triad or asthma in 10 patients (group I), with advanced obstructive sleep apnea syndrome (OSAS) in 10 patients (respiratory disturbance index, RDI>40, group II). Group III consisted of 10 patients with simple rhinitis chronica hypertrophica who habitually smoked cigarettes (at least 20 cigarettes a day) while 10 non-smoking patients with simple rhinitis chronica hypertrophica were qualified to the control group. Fragments of nasal mucosa of approximately 0.5 cm(2) were collected from medial or inferior turbinate during mucoplasty procedures. NC were detected immunohistochemically using antibodies against chromogranin A (DAKO). The microscopic sections were evaluated in the light microscopy.

RESULTS

The study did not reveal the increased number of NC in examined fragments of nasal mucosa. Scattered NC were detected in single preparations of nasal mucous membrane in some patients in all groups. The number of detected neuroendocrine cells did not differ statistically between groups.

Early rehabilitation model shows positive effects on neural degeneration and recovery from neuromotor deficits following traumatic brain injury

This study used an experimental early rehabilitation model combining an enriched environment, multisensory (visual, acoustic and olfactory) stimulation and motor training after traumatic brain injury (via fluid-percussion model) to simulate early multisensory rehabilitation. This therapy will be used by brain injured patients to improve neural plasticity and to restore brain integration functions. Motor dysfunction was evaluated using a composite neuroscore test. Direct structural effects of traumatic brain injury were examined using Fluoro-Jade staining, which allows identification of degenerating neural cell bodies and processes. Animals in the rehabilitation model group performed significantly better when tested for neuromotor function than the animals in standard housing in the 7-day and 15-day interval after injury (7d: p=0.005; 15d: p<0.05). Statistical analysis revealed significantly lower numbers of Fluoro-Jade positive cells (degenerating neurons) in the rehabilitation model group (n=5: mean 13.4) compared to the standard housing group (n=6: mean 123.8) (p<0.005). It appears that the housing of animals in the rehabilitation model led to a clear functional increase in neuromotor functions and to reduced neural loss compared with the animal group in standard housing.

[Respiratory sinus arrhythmia as predictor of blood pressure stability during anaesthetic induction in diabetics]

OBJECTIVE

Diabetics with cardiovascular autonomous neuropathy (CAN) can show severe hypotension during the course of anaesthesia. To improve the safety of anaesthesia, pre-operative evaluation of this concomitant disorder is recommended. The conventional test battery described by Ewing and Clarke to diagnose CAN is relatively time-consuming and complex. The aim of this study was to evaluate whether patients at risk could be reliably identified with less diagnostic effort.

METHODS

Fifty patients with diabetes mellitus undergoing an ophthalmosurgical procedure were investigated. To evaluate their cardiovascular reflex status, the following tests were performed one day before surgery: determination of heart rate variation (HRV) under deep respiration (6 breaths/min), and the response of heart rate (max/min 30:15 ratio) and blood pressure after getting up from a supine position. Anaesthesia was induced with thiopental and fentanyl and maintained with enflurane/N (2)0; vecuronium was administered for tracheal intubation. Patients whose systolic blood pressure fell below 90 mm Hg during the induction phase were assigned to Group H (hypotensive), the remaining patients to Group N (non-hypotensive). The groups were compared regarding the pre-operatively collected variables.

RESULTS

The demographic data were comparable in the two groups with exception of the length of diabetes. Regarding blood pressure reaction during orthostatic load, there was no significant difference between the groups. In contrast, the parameters of HRV under deep respiration (with exception of the "mean circular resultant") and the max/min 30 : 15 ratio were significantly lower in patients of Group H than in Group N. The best differentiation between the groups offered the E/I ratio (= quotient resulting from the longest R-R interval during expiration (E) and the shortest R-R interval during inspiration (I) under deep breathing) as a measure of respiratory sinus arrhythmia. The incidence of hypotension during anaesthetic induction in patients with a normal E/I ratio was 8.7 %, but in patients with a pathologically reduced E/I ratio 51.9 % ( P = 0.0019). The sensitivity of this test concerning hypotension that occurred was 87.5 %, the specificity 61.7 %.

CONCLUSION

The available results prove the close connection between the pre-operatively measured breadth of respiratory sinus arrhythmia and blood pressure response during anaesthetic induction. Patients at risk of hypotension can be identified reliably and quickly during pre-operative screening with the help of a single, simple test procedure.

Alcohol abuse in mothers during gravidity and breastfeeding brings changes of hippocampal neurons in their offspring

Neurotoxic effect of ethanol on the CNS of laboratory rats in the prenatal and postnatal period was studied. Another aim of the experiment was to analyse structure of the hippocampus after the prenatal and postnatal exposure to alcohol and to identify the most vulnerable hippocampal regions. Pregnant Wistar rats of our own breed received 20% alcohol p.o. ad libitum every day since the conception to the 18th day of postnatal life of their offspring. Since the birth (the day 1) till the age of 18 days offspring were kept together with their mother and were exposed to postnatal alcohol effect (alcohol in the breast milk). At the age of 18 days animals were perfused under deep thiopental anaesthesia with buffered solution of paraformaldehyde. Serial sections were stained with Fluoro-Jade B and DNA specific dye bis-benzimide (Hoechst No 33258). Brains of young rats aged 18 days were analysed under the light microscope Olympus Provis AX-70 with epifluorescence. In CA1 and CA3 areas and in Gyrus dentatus of the hippocampus, groups of degenerating cells were observed. In all offspring some cells with fine granulated karyons were identified, which were accompanied with high numbers of glial cells. Our results demonstrate the neurotoxic effects of alcohol and the high vulnerability of the developing CNS. The identification of cells with segmented karyons indicates the role of apoptotic mechanism in the cell death.

Effect of magnesium pre-treatment on the hippocampal NOS activity during long-lasting intermittent hypoxia

Influence of magnesium pre-treatment during repetitive hypoxia was studied in the hippocampus of rats by histochemical analysis (NADPH-diaphorase staining). NADPH-diaphorase occurs concurrently with NO-synthase that is responsible for NO synthesis. Rat pups were kept together with their mother for 8 hours a day in a hypobaric chamber at a simulated altitude of 7,000 m since the day of birth till the 17th day. The first group of animals was exposed to the repeated hypoxia; the second group under the same conditions was pre-treated by magnesium before the exposition to the hypoxia. Both groups were compared with intact control animals and intact animals treated with magnesium. The experimental and control animals were the transaortically perfused with 4% buffered neutral formaldehyde under thiopental anaesthesia at the age of 35 days. Brains were processed for NADPH-d staining. We estimated the density of NADPH-d positive neurons in CA1 and CA3 areas of the hippocampus and in the dentate gyrus. Intermittent hypoxia brings about higher numbers of NADPH-diaphorase positive neurons of CA1 and CA3 of the hippocampus and of the dorsal blade of dentate gyrus, in the comparison with either group of control animals. In the hilus and ventral blade of the dentate gyrus, on the contrary, the number of NADPH-d positive neurons was smaller. Magnesium pre-treatment during hypoxia decreased number of nitrergic neurons in all areas of the hippocampus except CA1 area, where the effect of magnesium was not significant. These results demonstrate that magnesium can probably have a neuroprotective effect.

Changes in the number of nitrergic neurons in rats hippocampus following nicotine administration

Nicotine is a very widely used drug of abuse, which exerts a number of neurovegetative behavioural effects by interacting with the neuronal nicotinic acetylcholine receptor. Using histochemical analysis (NADPH-diaphorase and Fluoro-Jade B dye), the influence of intraperitoneal administration of nicotine on neurons of the hippocampus in 35-day-old male rats of the Wistar strain was studied. At the age of 37 days, the animals were transcardially perfused with 4% paraformaldehyde under deep thiopental anaesthesia. Cryostat sections were stained to identify NADPH-diaphorase positive neurons that were then quantified in CA1 and CA3 areas of the hippocampus, in the dorsal and ventral blade of the dentate gyrus and in the hilus of the dentate gyrus. In the same areas, using Fluoro-Jade B dye, signs of neurodegeneration were classified, using Fluoro-Jade B dye. Nicotine administration increased the number of NADPH-diaphorase positive neurons in the CA3 area of the hippocampus and in the hilus of the dentate gyrus with no effect in the remaining areas studied. Fluoro-Jade staining did not reveal any degenerating neurons in the hippocampus as an effect of nicotine administration.

Präoperative Bestimmung der Herzfrequenzvariabilität bei Diabetikern zur Einschätzung des Blutdruckverhaltens während der Anästhesieeinleitung

BACKGROUND

In diabetics severe hyopotension can occur during anaesthesia as a consequence of cardiovascular autonomic neuropathy (CAN). A simple approach to recognize CAN is heart rate variability (HRV) measured at rest. The aim of this study was to determine the relationship between pre-operatively measured HRV and blood pressure stability during induction phase of anaesthesia.

PATIENTS AND METHODS

A total of 35 diabetics undergoing an ophthalmosurgical procedure under general anaesthesia were investigated. HRV was examined one day before surgery by the following parameters: coefficient of variation (CV), root mean squared successive difference (RMSSD), and power spectrum. Anaesthesia was induced with thiopental and fentanyl and maintained with enflurane/N(2)O; tracheal intubation was performed after relaxation with vecuronium. Patients who developed a drop in systolic blood pressure below 90 mmHg during anaesthesia induction were assigned to group H (hypotensive), the other patients to group N (normotensive). The groups were compared regarding HRV and other variables.

RESULTS

Of all patients 13 developed hypotension during anaesthesia induction (group H). The groups were comparable regarding the demographic data. Parameters of HRV, with the exception of spectral power in low frequency (LF) band of power spectrum, were significantly lower in group H. The groups differed mainly in relation to spectral power in the mid-frequency (MF) band of the power spectrum, and especially regarding CV. In patients with normal CV incidence of hypotension after anaesthesia induction was 11%, but in patients with abnormally reduced CV, 65% (p=0.002).

CONCLUSION

The results confirm a significant relationship between HRV pre-operatively measured at rest and blood pressure stability during anaesthesia induction in diabetics. Particularly examination of CV, a simple test feasible within few minutes, may be useful in pre-operative risk stratification of these patients. Application of the time consuming traditional test combination to identify CAN seems to be unnecessary.

Long-lasting changes in the density of nitrergic neurons following kainic acid administration and chronic hypoxia

Using histochemical analysis (NADPH-diaphorase) we have investigated the influence of intraperitoneal administration of kainic acid (KA), hypoxia and combination of both these factors on neurons of the hippocampus and on the primary auditory cortex (PAC) in male rats of the Wistar strain. Kainic acid was administered to 18-day-old animals, which were exposed to long-lasting repeated hypoxia from the 2nd till the 17th day of age in a hypobaric chamber (for 8 hours a day). At the age of 1 year, the animals were transcardially perfused with 4 % paraformaldehyde under deep thiopental anesthesia. Cryostate sections were stained to identify NADPH-diaphorase positive neurons that were then quantified in CA1 and CA3 areas of the hippocampus, in the dentate gyrus and in the PAC. Both, hypoxia and KA lowered the number of NADPH-diaphorase positive neurons in the hilus, dorsal and ventral blades of the dentate gyrus, CA1 and CA3 areas of the hippocampus. On the contrary, KA given to the hypoxic animals increased the number of NADPH-diaphorase positive neurons in the dorsal blade of the dentate gyrus and PAC.

Functional and morphological changes of the brain in rats exposed to intermittent hypobaric hypoxia after the repetitive magnesium administration

Intermittent hypobaric hypoxia induces functional and morphological changes of the brain in 25-day-old rats. Administration of magnesium has partial pro-convulsion effect in hypoxia not exposed rats and it practically does not influence the excitability of cortical neurones in rats exposed to intermittent hypoxia. Magnesium administration decreases the number of NADPH-diaphorase neurones in rats exposed to hypoxia in all studied areas of the hippocampus and dentate gyrus. In control rats this effect was only in CA1, CA3 and in the ventral blade of the dentate gyrus. Increased concentration of magnesium in cells of the hypoxia exposed rats after the repeated magnesium administration was found.

Effect of the perinatal alcohol abuse on the development of neuronal population in the hippocampus

The study deals with neurotoxic effects of alcohol on the CNS of laboratory rats in the prenatal period. The aim of the experiment is to analyse structure of the hippocampus after the prenatal exposure to alcohol and to identify the most vulnerable hippocampal regions. Pregnant Wistar rats of our own breed received alcohol (2 g per 100 g of body i.p.) each day since the first to the last day of pregnancy. Since the birth till the age of 34 days offsprings were kept together with their mother and were not exposed to alcohol. At the age of 35 days animals were perfused under the deep thiopental anaesthesia with buffered solution of paraformaldehyde. In the CA1 area of the hippocampus groups of degenerating cells were observed. In the CA3 area degenerating cells were also found. Some cells with fine granulated karyons were identified, which were accompanied with high number of glial cells. Our results demonstrate the neurotoxic effects of alcohol and the high vulnerability of the developing CNS. Remarkable is the observation of the high number of dying cells 35 days after the last exposition to alcohol. It suggests a long-term process of neuronal circuit remodelling in the juvenile tissue, probably triggered by apoptosis. The identification of cells with fine granulated karyons indicates the role of apoptotic mechanism in the cell death.

Serum endostatin levels in patients with lung carcinoma

The purpose of our study was to evaluate the clinical usefulness of serum endostatin levels during chemotherapy of lung cancer in relation to the histopathological type of the tumor, clinical stage and response to therapy.

MATERIALS AND METHODS

Serum concentrations of endostatin were determined in 37 patients (24 with non-small cell lung cancer and 13 with small cell lung cancer), 10 healthy subjects constituted controls. To determine endostatin levels (ELISA), venous blood samples were collected from each patient before treatment and after 4-6 courses of chemotherapy.

RESULTS

The serum concentrations of endostatin were found significantly higher in patients in comparison with controls (p=0.003). No statistically significant differences were established between the concentrations of endostatin with regard to such clinical features, as: performance status, clinical stage (III and IV) and histopathological type (non-small cell lung cancer and small cell lung cancer). The concentrations of endostatin did not change after chemotherapy. There was no change of endostatin concentration caused by the response to treatment.

CONCLUSIONS

The serum endostatin concentrations were elevated in lung cancer patients.

Long-lasting changes in the density of nitrergic neurons following kainic acid administration and chronic hypoxia

Using histochemical analysis (NADPH-diaphorase) we have investigated the influence of intraperitoneal administration of kainic acid (KA), hypoxia and combination of both these factors on neurons of the hippocampus and on the primary auditory cortex (PAC) in male rats of the Wistar strain. Kainic acid was administered to 18-day-old animals, which were exposed to long-lasting repeated hypoxia from the 2nd till the 17th day of age in a hypobaric chamber (for 8 hours a day). At the age of 1 year, the animals were transcardially perfused with 4 % paraformaldehyde under deep thiopental anesthesia. Cryostate sections were stained to identify NADPH-diaphorase positive neurons that were then quantified in CA1 and CA3 areas of the hippocampus, in the dentate gyrus and in the PAC. Both, hypoxia and KA lowered the number of NADPH-diaphorase positive neurons in the hilus, dorsal and ventral blades of the dentate gyrus, CA1 and CA3 areas of the hippocampus. On the contrary, KA given to the hypoxic animals increased the number of NADPH-diaphorase positive neurons in the dorsal blade of the dentate gyrus and PAC.

Repeated kainic acid administration and hippocampal neuronal degeneration

Many animal models have been established to study the mechanisms leading to excitotoxicity. One of the more commonly used models is kainic acid (KA) induced excitotoxicity. Upon administration of KA in rodents, KA produces acute status epilepticus and neuronal damage. The aim of the study was to examine the morphologic alteration in the hippocampus of mature rats, after repeated KA administration. The first group was given KA repeatedly in six doses (10 mg/1000 g), each second day. The second group was given KA i.p. repeatedly in six smaller doses (5 mg/1000 g), each second day. The third group (control animals) received corresponding volumes of the normal saline (5 or 10 mg/1000 g respectively). Animals were transcardially perfused; serial sections were stained with Fluoro-Jade B and DNA-specific dye bis-benzimide (Hoechst). In CA1 region of the first group many degenerating cells were observed. The CA2 region was not as much affected as CA1. In the CA3 region no degenerating cells were observed. In the second group the most prominent was the cell loss both in the CA3 region and in the hilus of the dentate gyrus.

[Purkinje's concept of a neuron]

With his experiments and findings J. Ev. Purkyne influenced 34 scientific disciplines; in some of them he is assumed to be their founder (embryophysiology, histology, pharmacological physiology, biophysics, comparative physiology). He was the pioneer in the field of neuroscience not only due to his neuroanatomical descriptions but namely due to his neurophysiological experiments. Beside the description of "Purkyne cells" and cells of other regions of the brain, Purkyne studied also the structure of neuronal processes and it is possible to attribute him the first description of dendrites. Existing material shows that Purkyne studied also the structure of hippocampus. Those and other papers prove that Purkyne recognised possible functional differences between various types of neurons and he speculated about their mutual relations. Only contemporary particularly detailed knowledge on the structure of hippocampal neuronal circuits, description of the mediator interaction and modulation together with the identification of neuroplastic processes in the hippocampus enable to accomplish the Purkyne's attempt to correlate the structure and function.

Changes in the number of nitrergic neurons following kainic acid administration and repeated long-term hypoxia

Using histochemical analysis (NADPH-diaphorase) we have been investigating the influence of intraperitoneal administration of kainic acid (KA), hypoxia and combination of both these factors on neurons of the hippocampus and on the primary auditory cortex (PAC) in male rats of the Wistar strain. Kainic acid was administered to 18-day-old animals, which were exposed to long-lasting repeated hypoxia from the 2nd till the 17th day of age in a hypobaric chamber (for 8 h a day). At the age of 22 or 90 days, the animals were transcardially perfused with 4 % paraformaldehyde under deep thiopental anesthesia. Cryostate sections were stained to identify NADPH-diaphorase positive neurons that were then quantified in the hippocampus, in the dentate gyrus and in the PAC. In 22-day-old animals both hypoxia and KA increased the number of NADPH-diaphorase positive neurons in the hilus, CA1, CA3 areas of the hippocampus and in the PAC. On the contrary, KA given to hypoxic animals lowered the number of NADPH-diaphorase positive neurons in the dentate gyrus. In 90-day-old animals, hypoxia and KA given to both normoxic and hypoxic animals lowered the number of NADPH-diaphorase positive neurons in some areas of the central nervous system.

Plasticity of the brain in neuroontogenesis

Plasticity is a specific endowment of the nervous system to develop, to react or to adjust to the internal and external 'environmental changes, both in the physiological and pathological conditions. Cumulative evidence has revealed the dynamism of the nervous system, based on the balance between the rigidity and plasticity. Different aspects of neuroplasticity can employ common general cellular mechanism. Effects of plasticity can be either positive or negative changes during the development (evolutional plasticity), after the short-term exposition (reactive plasticity), after the long-term or permanent stimuli (adaptational plasticity), and during functional or structural recovery of the damaged neuronal circuits (reparation plasticity). Manifestations of plasticity have probably the same basis, irrespective of a cause, which triggered them, or the brain region where they were accomplished. Activity of neuroplastic processes appears to be especially high in the immature nervous tissue.

Electrocardiographic body surface maps (BSM) in patients with ischemic heart disease examined by coronary angiography

ECG body surface maps (BSM) is one of the noninvasive methods for the detection of ischemic heart disease. In the present work we registered the BSM in 25 patients, 18 men, mean age 56.8 (31-83) years, 7 women, mean age 58.7 (43-72) years with coronary artery disease and in 23 healthy persons, 17 men, mean age 55 (46-60) years, 6 women, mean age 57 (42-70) years. Using diagnostic system Cardiag we measured 32 parameters of heart electric field (ECG, VCG, isopotential, isointegral, and isoarea maps). The results of BSM examination were compared with the results of coronary angiography (CAG) and other noninvasive methods. Twenty-four patients were BSM positive, 5 of them with negative CAG. In one case both BSM and CAG were negative. None of persons with positive CAG were BSM negative. The values of positive BSM in patients with negative CAG approached more to the values of positive CAG persons than to controls. Despite of small number of persons examined in our study one can conclude that the BSM method detects the damage of myocardium by another way than the CAG.

Changes in the number of nitrergic neurons following kainic acid administration and repeated long-term hypoxia

Using histochemical analysis (NADPH-diaphorase) we have been investigating the influence of intraperitoneal administration of kainic acid (KA), hypoxia and combination of both these factors on neurons of the hippocampus and on the primary auditory cortex (PAC) in male rats of the Wistar strain. Kainic acid was administered to 18-day-old animals, which were exposed to long-lasting repeated hypoxia from the 2nd till the 17th day of age in a hypobaric chamber (for 8 h a day). At the age of 22 or 90 days, the animals were transcardially perfused with 4 % paraformaldehyde under deep thiopental anesthesia. Cryostate sections were stained to identify NADPH-diaphorase positive neurons that were then quantified in the hippocampus, in the dentate gyrus and in the PAC. In 22-day-old animals both hypoxia and KA increased the number of NADPH-diaphorase positive neurons in the hilus, CA1, CA3 areas of the hippocampus and in the PAC. On the contrary, KA given to hypoxic animals lowered the number of NADPH-diaphorase positive neurons in the dentate gyrus. In 90-day-old animals, hypoxia and KA given to both normoxic and hypoxic animals lowered the number of NADPH-diaphorase positive neurons in some areas of the central nervous system.

Effect of selenium pre-treatment on evoked cortical afterdischarges in young rats

Prenatal or perinatal hypoxia is among the most frequent pathogenic factors of encephalopaties. It can induce wide-range of morphological, biochemical, energetic and functional alterations. Accordingly we tested changes of excitability of the sensorimotor cortex in 12, 25 and 35-day-old rats exposed and not exposed to short-term (1 hour) hypobaric and normobaric hypoxia. We studied whether sodium selenate (0,26 mg/kg b.w.) can influence character and/or intensity of evoked cortical afterdischarges or if a pre-treatment by selenium changes effects of hypoxia on such seizures. According to the results we can conclude that in our experiment arrangement sodium selenate only partially alters duration of evoked cortical afterdischarges.

[Regulation of receptor functions in the CNS]

The basic condition of life is capability to adapt not only to external but also to internal milieu conditions. I.e. receptors are able to change the intensity of signal transduction from the extracellular to the intracellular compartment in a short period. In a specific manner it concerns all receptor structures, both if they are located in cytoplasm or within the membrane. This review concentrates to the mechanisms existing in G protein-coupled receptors. Those protein structures can undergo a homologous or heterologous regulation. Homologous regulation means that only the properties of a receptor system influenced via extracellular signalling are changed. Heterologous regulation means, that receptor properties are changed despite that the extracellular signalling did not influence the receptor. It is possible to consider such changes as one of the level o homeostasis. Both homologous and heterologous regulations are essential for many physiological and pathophysiological processes. The most important examples of these processes, especially in the central nervous system, are reviewed here.

Model of spike propagation reliability along the myelinated axon corrupted by axonal intrinsic noise sources

We investigated how selected electromorphological parameters of myelinated axons influence the preservation of interspike intervals when the propagation of action potentials is corrupted by axonal intrinsic noise. Hereby we tried to determine how the intrinsic axonal noise influences the performance of axons serving as carriers for temporal coding. The strategy of this coding supposes that interspike intervals presented to higher order neurons would minimally be deprived of information included in interspike intervals at the axonal initial segment. Our experiments were conducted using a computer model of the myelinated axon constructed in a software environment GENESIS (GEneral NEural SImulation System). We varied the axonal diameter, myelin sheath thickness, axonal length, stimulation current and channel distribution to determine how these parameters influence the role of noise in spike propagation and hence in preserving the interspike intervals. Our results, expressed as the standard deviation of spike travel times, showed that by stimulating the axons with regular rectangular pulses the interspike intervals were preserved with a microsecond accuracy. Stimulating the axons with pulses imitating postsynaptic currents, greater changes of interspike intervals were found, but the influence of implemented noise on the jitter of interspike intervals was approximately the same.

Regulation of adrenoceptors and muscarinic receptors in the heart

Receptor activation results in homologous regulation and can also affect other types of receptors (a process that has been reported to heterologous regulation). Heart cells express subtypes of muscarinic receptors and adrenoceptors, almost antagonistic in their action (M2 muscarinic receptors and beta1-adrenoceptors). Therefore, they provide an excellent model of heterologous regulation. Moreover, the minor subtypes of adrenoceptors and muscarinic receptors have been identified in the heart cells. The physiological significance of the minor subtypes is now under keen investigation and their function can be considered as complementary to the major subtypes. Taken together, it seems that the minor subtypes may play an important role in the receptor-heart function homeostasis and that heterologous regulation seems to exist in many heart receptor types and in the above mentioned pair of receptors.

Model of spike propagation reliability along the myelinated axon corrupted by axonal intrinsic noise sources

We investigated how selected electromorphological parameters of myelinated axons influence the preservation of interspike intervals when the propagation of action potentials is corrupted by axonal intrinsic noise. Hereby we tried to determine how the intrinsic axonal noise influences the performance of axons serving as carriers for temporal coding. The strategy of this coding supposes that interspike intervals presented to higher order neurons would minimally be deprived of information included in interspike intervals at the axonal initial segment. Our experiments were conducted using a computer model of the myelinated axon constructed in a software environment GENESIS (GEneral NEural SImulation System). We varied the axonal diameter, myelin sheath thickness, axonal length, stimulation current and channel distribution to determine how these parameters influence the role of noise in spike propagation and hence in preserving the interspike intervals. Our results, expressed as the standard deviation of spike travel times, showed that by stimulating the axons with regular rectangular pulses the interspike intervals were preserved with a microsecond accuracy. Stimulation with pulses imitating postsynaptic currents, greater changes of interspike intervals were found, but the influence of implemented noise on the jitter of interspike intervals was approximately the same.

Perinatal complication: hypoxic-ischemic encephalopathy

The favourable development of foetus is connected with the sufficient oxygen requirement. The brain of the foetus is extraordinarily sensitive to the disorders of oxygen supply. Ischemic brain injury connected with perinatal asfyxia is a frequent cause of hypoxic encephalopathy. An increased tolerance of the brain could be achieved by using peptide grows factors, inhibition of nitric oxide or modifying the glutamate receptors activity. Cerebral hypoxia evolves mainly in the case interruption of the feto-placental circulation or cardiorespiratory failure in the neonate. For making the diagnosis of neonatal encephalopathy is important to determine clinical neurological and systemic deragements in the first few days of life. Assessment of prognosis is generally based on a combination of clinical features and abnormalities of examination methods (electroencephalography, computer tomography).

[Pathophysiology and clinical aspects of brain edema]

Brain oedema is defined as an abnormal accumulation of fluid in the brain tissue accompanied by an increased volume of the brain. It results in the intracranial hypertension directly endangering the patient's life. No causal treatment of the brain oedema is known at present. The brain oedema is not a disease, but it is a symptom of various clinical states. That is why experimental studies of its pathophysiology become the centre of attention. Though the classification of brain oedema according to the pathogenesis is still used (the vasogenic type--resulting from the increased permeability of blood-brain barrier; the cytotoxic type--caused by the cell metabolism impairment), recent papers has shown a definite retraction from such categorisation. It has been shown that neither type of brain oedema comes alone, but both can occur simultaneously during the development of the pathological state of the brain. The most important appears to be the primary insult. It affects the state of blood-brain barrier and brings about the vasogenic extracellular oedema or it can influence the cell metabolism with subsequent cytotoxic, cellular oedema. Categorisation of oedema into extracellular and cellular reflects more precisely the impairment of the homeostasis of the internal environment of the brain. Contemporary view on the classification and pathophysiological mechanisms of the brain oedema is discussed in our review.

Muscarinic receptor subtypes in the heart--how many and why?

Muscarinic receptors are coupled to G proteins and to date, five subtypes have been characterized. These subtypes differ in their effects on second messenger production. Odd-numbered subtypes activate phospholipase C beta, and then they increase the production of inositoltrisphosphate and diacylglycerol. Even-numbered subtypes inhibit adenylylcyclase. The expression of individual subtypes is quite tissue specific. The heart tissue is realized as M2 predominant organ (in mammals; the muscarinic population in birds consist of M2 and M4 receptors). This article focuses on the possibility of existence of further muscarinic receptor subtypes in avian and mammalian heart in consequences with activation of phosphoinositid metabolism in the heart.

Carnitine pretreatment can partially change the excitability of the immature nervous tissue

The possible protective action of L-carnitine on neuronal excitability was studied in 21-day-old male Wistar rats with implanted electrodes. Administration of L-carnitine did not change the elicitation and duration of the epileptic seizures (cortical afterdischarges, ADs) in rats under normobaric oxygen atmosphere conditions. However, in animals exposed to 30 min hypobaric hypoxia the duration of the ADs was shortened after the second, fourth and sixth stimulation (in comparison with the first evoked ADs) while carnitine-treated rats retained their neuronal excitability and the duration of ADs was shortened only after the third stimulation.

Excitability changes of cortical neurons during the postnatal period in rats exposed to prenatal hypobaric hypoxia

Pregnant rats were exposed to intermittent hypobaric hypoxia (at a simulated altitude of 7000 m or 5000 m) and the excitability of cortical neurons of their pups was tested. Stimulation of the sensorimotor cortex of rats prenatally exposed to hypoxia shortened the duration of cortical afterdischarges in 12-day-old rats, but did not change the excitability in 25-day-old animals. Shortening of the first afterdischarge in 35-day-old rats but the prolongation of the first afterdischarge in adult rats (as compared to the duration of cortical afterdischarges in rats not exposed to prenatal hypoxia) were registered. The possible mechanisms of different excitability of cortical neurons in rats prenatally exposed to hypobaric hypoxia are discussed.

Dehydrogenase activity in the blood and brain after adaptation to intermittent hypoxia

Activities of LDH (lactate dehydrogenase) and alpha-HBDH (alpha-hydroxybutyric dehydrogenase) were measured in rats after intermittent exposure to the aerogenic hypoxia at a simulated altitude of 7000 m during the postnatal period (since birth to the 18th day) or in adulthood (older than the 90th day), except days 6, 7, 13, and 14 of the experiment. Enzymatic activity was measured using standard test kit (Biochemical Test Combination, Boehringer). Twenty hours after the last exposure to hypoxia, the activity of both enzymes was elevated in the serum and in the brain of the young rats. In contrast, in adult rats, the exposure to hypoxia did not result in changes of the enzyme activity in the serum or in the brain. Our results indicate that, whereas in adults the biochemical adaptation to repeated aerogenic hypoxia has no effects on the enzymatic activities of dehydrogenases, the same stimulus during the early postnatal period brings about rising of the aerobic glycolysis contribution to the total energy balance. Such increase is enabled by the increase of LDH and alpha-HBDH activities.

[Effect of a 10-day animal fat-free diet on cholesterol and glucose serum levels, blood pressure and body weight in 50-year-old volunteers]

The morbidity and mortality of cardiovascular diseases is high in developed countries including Czech Republic. The lifestyle decreases it in 50%. The aim of this work was to ascertain if the short lasting stay without stress and with vegetarian diet (without eggs) and physical activity is able to decrease the main risk factors of cardiovascular diseases. In 106 volunteers, mean age 49.1 (+/- 14.1) years, 83 women and 23 men, the body weight, blood pressure, serum cholesterol and blood glucose (Accutrend GC, Boehringer, Mannheim, BRD) have been measured before and after the stay at the same conditions. Eighty persons were healthy, seven persons with essential hypertension, eight persons with ischemic heart disease, four persons with diabetes mellitus and seven persons with other than cardiovascular diseases. In some persons the lipid spectrum was measured. Cholesterol decreased in blood serum from 4.9 to 4.3 mmol/l (11%--p < 0.01), blood glucose decreased from 4.2 to 3.3 mmol/l (p < 0.05), blood pressure systolic from 121.5 to 117.4 mm Hg (p < 0.01) and diastolic from 76.5 to 73.8 mm Hg (p < 0.05), body weight was not significantly changed. Our results showed, that 10-days lasting stay containing vegetarian diet and physical activity decreased the risk factors of cardiovascular diseases in 50 years-old volunteers.

Airborne gram-negative bacterial flora in animal houses

The concentration and the species composition of airborne gram-negative bacteria were studied in four cattle houses, one pig house and one poultry barn. On average only between 0.02 and 5.2% of the total number of culturable aerobic bacteria were identified as gram-negative bacteria. Obligate anaerobic gram-negative bacteria were not isolated at all. In the airborne gram-negative bacterial flora the following bacterial families dominated: the Enterobacteriaceae, the Pseudomonadaceae and the Neisseriaceae. Within the family of the Enterobacteriaceae the species Escherichia coli and Enterobacter agglomerans were predominant. In animal houses using straw as bedding material Ent. agglomerans was most frequent, whereas in animal houses without litter E. coli was mainly found. Airborne Neisseriaceae were isolated very frequently in cow barns with Acinetobacter lowffii as the primary species. Airborne Pseudomonadaceae were found in high concentrations during periods of high air humidity. The results presented may also give some indications on the origin and sources of airborne endotoxins in animal housing.

Is the identification of antibodies against the nervous tissue an indicator of brain injury?

Using a modification of the ELISA method, auto-antibodies against the own nervous tissue have been identified in the serum of laboratory rats. The prevalence of the IgM class of antibodies suggests their physiological significance. Antibody levels are higher in females than in males. Brain hypoxic injury brings about a shift in the spectrum of antibodies towards the IgG class. It may thus serve as an indicator of brain impairment caused by a lack of oxygen.