Hirn-SPECT mit Tc-99m-Bicisat (ECD) bei rasch progredientem dementiellen Syndrom

Wir berichten über einen 61jährigen Patienten mit progredientem dementieilen Syndrom, der unter der Verdachtsdiagnose einer Demenz vom Alzheimer-Typ (DAT) zur Hirn-SPECT-Untersuchung mit Tc-99m-Bicisat (ECD) vorgestellt wurde. Zum Untersuchungszeitpunkt bestanden neben dem Vollbild einer Demenz eine ausgeprägte Apraxie und Aphasie bei unspezifischen Veränderungen im EEG sowie der neuroradiologischen Bildgebung. In der Hirn-SPECT-Untersuchung fanden sich für eine DAT untypische ausgedehnte, vorwiegend rechtshemisphärische Perfusionsstörungen. Im weiteren Verlauf rasche Progredienz des Krankheitsbildes mit Entwicklung eines akinetischen Mutismus sowie Nachweis erhöhter Werte der neuronspezifischen Enolase und des 14-3-3-Proteins im Liquor. Der Patient verstarb schließlich unter dem Bild einer Decortication. Aufgrund des klinischen Verlaufs sowie der Liquorbefunde wurde, da eine autoptische Befundsicherung nicht vorliegt, die Diagnose einer wahrscheinlichen Creutzfeldt-Jakob-Erkrankung gestellt. Die vorgestellte Kasuistik unterstreicht aus unserer Sicht den Wert der Hirn-SPECT in der differentialdiagnostischen Abgrenzung dementieller Zustandsbilder.

Changes in concentrations of hydrophilic organic contaminants and of endocrine-disrupting potential downstream of small communities located adjacent to headwaters

Endocrine-disruptive potential and concentrations of polar organic contaminants were measured in seven headwaters flowing through relatively unpolluted areas of the Czech Republic. Towns with Wastewater Treatment Plant (WWTP) discharges were the first known sources of anthropogenic pollution in the areas. River water was sampled several kilometers upstream (US) and several tens of meters downstream (DS) of the WWTP discharges, by use of Pesticide and Pharmaceutical Polar Organic Integrative Samplers (POCIS-Pest, POCIS-Pharm). Extracts of passive samplers were tested by use of a battery of in vitro bioassays to determine overall non-specific cytotoxicity, endocrine-disruptive (ED) potential and dioxin-like toxicity. The extracts were also used for quantification of polar organics. There was little toxicity to cells caused by most extracts of POCIS. Estrogenicity was detected in all types of samples even though US locations are considered to be background. At US locations, concentrations of estrogen equivalents (EEq) ranged from less than the detection limits (LOD) to 0.5 ng EEq/POCIS. Downstream concentrations of EEqs ranged from less than LOD to 4.8 ng EEq/POCIS. Concentrations of EEq in POCIS extracts from all DS locations were 1 to 14 times greater than those at US locations. Concentrations of EEq measured in extracts of POCIS-Pest and POCIS-Pharm were in a good agreement. Neither antiestrogenic nor anti/androgenic activities were detected. Concentrations of 2,3,7,8-TCDD equivalents (TEq(bio)) were detected in both types of POCIS at concentrations ranging from less than the LOD to 0.39 ng TEq(bio)/POCIS. Nearly all extracts of POCIS-Pharm contained greater concentrations of TEq(bio) activity than extracts of POCIS-Pest. Concentrations of pesticides and pharmaceuticals in extracts of POCIS were generally small at all sampling sites, but levels of some pharmaceuticals were significantly greater in both types of POCIS from DS locations. Chemical analyses along with the results of bioassays documented impacts of small towns with WWTPs on headwaters.

In vitro evaluation of the permeation of cytotoxic drugs through reconstructed human epidermis and oral epithelium

BACKGROUNDS

Occupational exposure to antineoplastic agents may represent a risk to health care workers, although the relevance of different exposure routes is not fully understood. The objectives of this study were to determine in vitro permeation of four widely used cytotoxic drugs (cisplatin, cyclophosphamide, doxorubicin, and fluorouracil) through two reconstituted tissue models representing human skin epidermis and oral mucosa.

MATERIALS AND METHODS

Experiments were conducted with reconstructed models of human epidermis and oral epithelium, cultured in a chemically-defined medium under conditions simulating possible exposure scenarios (6 h duration, three concentrations corresponding to commonly used application doses). The amounts of drugs permeated through the tissues into the receptor media were determined using ultra performance liquid chromatography with photospectrometric detection.

RESULTS

The highest epidermis permeations (P = 0.2 x 10(-3) - 1.5 x 10(-3) cm x h(-1)) were observed with three polar drugs (cisplatin, cyclophosphamide and fluorouracil), while permeation by more hydrophobic doxorubicin was minor (P(max) = 0.03 x 10(-3) cm x h(-1)). As expected, more pronounced tissue permeation was observed with the reconstructed oral epithelium having the maximum permeability coefficient (P = 180 x 10(-3) cm x h(-1)) for cisplatin and fluorouracil. Histological evaluation of the exposed tissues revealed cytotoxic effects at higher doses, especially for oral epithelium.

CONCLUSION

Although the skin epidermis with keratinised stratum corneum provided relatively good protection, uptake (of at least some investigated drugs) via both types of tissue should not be underestimated. Our results provide basic experimental data on the skin and oral epithelia permeation for further modelling of exposure and health risk assessment.

Web portal for management of bioindication methods and ecotoxicological tests in ecological risk assessment

The objective of this article is to inform about efforts to design and implement a data model that can parametrically describe and store information about a wide range of ecotoxicological tests and bioindication methods used in Ecological Risk Assessment (EcoRA). At the same time it describes comprehensive web-based portal built on this model that can be used to quickly find relevant biological assays (ecotoxicological biotests) for given situation and therefore support the decision-making process in EcoRA. The model structure, features of the corresponding website and its current content is described in detail and proposed development and possible collaboration is outlined. The portal (DATEST) is located at http://projects.cba.muni.cz/datest. The aim of this work is to complement existing EcoRA decision-support tools with a web-based engine for storing and searching biological tests and methods used in EcoRA as there is currently no similar informational source available on the Internet.

Psychometrische Schweregradbeurteilung bei dementiellen Erkrankungen: Ein Vergleich von MMST, ADAS, BCRS und SKT

Zusammenfassung: In einer multizentrischen Studie wurden mit MMST, ADAS, BCRS und SKT vier im Bereich der dementiellen Alterserkrankungen international eingesetzte Testverfahren miteinander verglichen. Es wurde überprüft, inwieweit die Verfahren zwischen Patientengruppen mit klinisch unterschiedlich schwer beurteilten kognitiven Einbußen differenzieren können, ob die mit den einzelnen Tests getroffenen Störungsgradzuordnungen übereinstimmen und welche Entsprechungen zwischen den Testscores bestehen. Weiterhin wurde die faktorielle Struktur der Testbatterie analysiert. Die Ergebnisse legen eine unterschiedliche Störungsgradsensitivität von MMST, ADAS, BCRS und SKT in verschiedenen Stadien der Demenz nahe. Die auf der Grundlage der vier Tests vorgenommenen Schweregradbeurteilungen des dementiellen Syndroms weichen voneinander ab. In einer Regressionsanalyse konnten dafür in erster Linie die zwischen den verschiedenen Testverfahren bestehenden Unterschiede in der Definition von Schweregraden kognitiver Beeinträchtigungen verantwortlich gemacht werden. Die Faktorenanalyse erbrachte eine Lösung, die die Kernsymptomatik der Demenz abbildet und damit auf die faktorielle Validität der eingesetzten Tests hinweist.

[Brain SPECT using Tc-99m-bicisate (ECD) in rapidly progressive dementia syndrome]

We present a 61-year-old male patient with progressive dementia. A brain SPECT with Tc-99m-bicisate was performed for confirmation of clinically suspected Alzheimer-dementia. At the time of the SPECT-investigation marked apraxia and aphasia besides severe dementia were present. Electrophysiological as well as anatomical neuroimaging findings showed non-diagnostic alterations. SPECT revealed distinct perfusion defects, which made Alzheimer Dementia unlikely. The further course of the patient was determined by rapidly progressive deterioration with development of akinetic mutism. Thereafter, increased levels of neuron-specific enolase as well as 14-3-3 proteins were found in the cerebro-spinal fluid (CSF). The patient finally died with signs of cerebral decortication. Due to the clinical course and the CSF-findings the patient's final diagnosis was Creutzfeldt-Jakob-disease, nevertheless no autopsy was performed. The presented case report underscores the clinical utility of perfusion brain SPECT in the differential diagnosis of dementias.

Reversion and immobilization of phage Mud1 cts (Apr lac) insertion mutations in Salmonella typhimurium

Phage Mud1 cts (Apr lac), or Mud1, insertion mutations may be accompanied by adjacent deletion formation which can complicate use of lac fusions generated with this phage for gene regulatory studies. As for phage Mu insertion mutations, phage Mud1 insertions fail to revert at significant frequency (whether or not accompanied by an adjacent deletion). We describe isolation of revertible (X mutant) derivatives of phage Mud1 in Salmonella typhimurium. The X mutant derivatives allow use of reversion as a simple test to determine whether a Mud1 insertion has occurred precisely without an adjacent deletion that may have fused the lac genes to a promoter outside of the gene of interest. In addition, a simple method for stabilizing Mud1 generated lac fusions against subsequent transposition is described.

[Therapy of acute schizophrenic attacks. High dosage haloperidol therapy compared with a two component treatment]

In a controlled open study 18 patients were treated with high doses of haloperidol (Haldol-Janssen) from 50 to 100 mg daily and 15 patients with a combined therapy of 10 mg haloperidol and 150 to 300 mg levomepromazin (Neurocil). The high-dosed sample a significantly rapid decrease of the productive symptoms and improvement of the general condition were found. The medians of the rating scales and self-rating scales showed similar courses. Within the high-dosage group especially after the beginning of therapy, there was an unexpected significant increase in extrapyramidal signs (dyskinesias), which did not appear any more after starting with an initial dose of at least 50 mg Haldol-Janssen. Other side effects could not be found, the tolerance was good.

A clinical view of clobazam

1 The results so far published in the literature, together with our own results, show that in clobazam (Frisium) we have a daytime tranquilizer which is comparable to the newest benzodiazepine derivatives. 2 It is particularly indicated in disorders of the sleeping-waking rhythm, and sometimes also in psychovegetative disorders associated with epilepsy. 3. Its tranquillizing profile of action, the low incidence of side-effects and the absence of interactions with other drugs mean that its applications are varied, not only in neuropsychiatry but also in other medical disciplines. 4 The fact that therapeutic doses do not seem to impair driving ability to render patients incapable of carrying on their profession, means that it is suitable for the treatment of outpatients.

[Psychopharmacologic drugs in the rehabilitation after myocardial infarct]

The specific use of psychotropic agents in myocardial infarction has become possible due to interdisciplinary cooperation. Especially the differentiated therapeutic application of benzodiazepine derivatives will take into better account the different psychopathologic states in the various phases. The medicamentous facilities are extended by using the central and peripheral effects of the beta-blockers. After a myocardial infarction there are various somatic and mental symptoms. This requires precise medical and psychological management with reference to a diagnostic and combined-therapeutic schedule of treatment. An intensive co-operation with all medical departments is a conditio sine qua non.

[Influence of oxprenolol on the affect level in an exam situation. A follow-up study under double-blind conditions (author's transl)]

In a double-blind study on student nurses the curves of three affectivity components and the pulse rate under exam conditions were observed. One group had received 1-(o-allyloxy-phenoxy)-3-isopropylamino-propan-2-ol hydrochloride (oxprenolol, Trasicor and the other group a placebo. In the examination stress the affectivity component "aggression" was particularly obvious. With placebo the states and actions of aggression were more extreme than in the oxprenolol group. It appeared that the severe affectivity inclinations resulted in a reduction of examination performance. Under oxprenolol, in accordance with recently published results, there was no decrease in performance under exam conditions. Quite the opposite: as it seems to curb extreme affectivity inclinations the decreases in performance connected with them are often prevented.