[Compression of the median nerve by chronic palmar dislocation of the lunate due to carpal collapse]. / Die Kompression des Nervus medianus durch ein luxiertes Mondbein aufgrund eines karpalen Kollapses.

Carpal tunnel syndrome is among the most frequently diagnosed forms of peripheral nerve compression. Carpal tunnel syndrome due to carpal collapse that had progressed over decades, with a palmarly dislocated lunate, is rare. Hints of past trauma to the wrist going back decades should prompt further radiological examination in case of recurrent median nerve compression. With sufficient preoperative evaluation, the causes can be accurately detected and treated. Therefore, precise and complete history-taking is mandatory. Conclusions on further diagnostics that can be drawn from the latter must be consistently implemented to enable adequate therapy.

The Safety and Effectiveness of Intravenous Lacosamide for Refractory Status Epilepticus in the Critically Ill.

BACKGROUND: Status epilepticus (SE) often does not respond to initial treatment. A second-line agent with a less established safety and efficacy profile is then required. This study examined the safety of intravenous (IV) lacosamide (LCM) in a critically ill population and obtained an estimate of effectiveness in patients with refractory SE on continuous video EEG monitoring (cEEG). METHODS: Retrospective review of critically ill patients in SE on cEEG treated with IV LCM from June 2009 to April 2011. RESULTS: Eighty-four patients in SE (43 F/41 M), mean age 59.6 years, were identified; and 59.5 % had nonconvulsive SE. The most common etiologies were ischemic and hemorrhagic strokes. There were no significant changes in serial blood pressure monitoring, PR prolongation, aspartate aminotransferase (AST), or creatinine pre- and post-LCM. There was a significant increase in alanine aminotransferase (ALT) from days 1-7 (p = 0.031). Fifty-one patients were LCM-naïve. In these patients, cessation of SE on cEEG after LCM occurred in 15.7, 25.5, 58.8, and 82.4 % by 4, 12, 24, and 48 h, respectively. CONCLUSION: IV LCM appears safe short term in critically ill patients with SE. The retrospective estimate of effectiveness for LCM appears promising for management in SE. Prospective, randomized controlled studies are needed to better determine the role of LCM in treating SE.

[Carpus and distal radioulnar joint : Clinical and radiological examination]. / Carpus und distales Radioulnargelenk : Klinische und röntgenologische Untersuchung.

A precise medical history and specific symptom-oriented clinical tests of the wrist joint should always precede any radiological, computed tomography (CT) or magnetic resonance imaging (MRI) diagnostics. In many cases, specific clinical tests of the wrist joint allow at least a preliminary diagnosis, which can be supported by standard radiography using correct projections. A systematic approach is recommended covering the radiocarpal, midcarpal, ulnocarpal and distal radioulnar joints. Exact identification of the palpable anatomic landmarks is mandatory for correct application and interpretation of the various clinical tests. The results of the clinical tests in combination with radiological imaging can often detect precisely ruptures of distinct wrist joint ligaments and localized arthritis.

[Perioperative Anticoagulation in Elective Hand Surgery: A Literature Review]. / Die perioperative Handhabung von Antikoagulantien in der elektiven Handchirurgie - eine Literaturübersicht.

This review highlights pathways regarding the handling of anticoagulation in elective hand surgery based on current literature.

[Fractures of the proximal interphalangeal joint: Diagnostic and operative therapy options]. / Fingermittelgelenkfrakturen : Diagnostik und operative Therapiemöglichkeiten.

Joint fractures of the fingers often entail operative interventions in contrast to extra-articular fractures. These types of fracture are inclined to dislocate in addition to the actual fracture. The proximal interphalangeal (PIP) joint in particular often shows comminuted fractures due to the long leverage of the finger and a relatively small diameter of the joint. The clinical examination, X-ray diagnostics and if necessary computed tomography allow the classification into stable and unstable fractures. Unstable fractures must be treated by surgical reduction and fixation. A multitude of operative techniques are available for these mostly complicated fractures. The foremost goal is a stable osteosynthesis of the fracture with repositioning of the dislocation, which enables early physiotherapy in order to prevent tendon adhesion and contracture. This article presents the different types of PIP joint fractures, their specific surgical treatment and postoperative treatment regimens.

Therapeutic drug monitoring of cerebrospinal fluid vancomycin concentration during intraventricular administration.

Limited data are available on intraventricular vancomycin dosing for meningitis. This study explored clinical characteristics that correlated with cerebrospinal fluid (CSF) concentrations. Over a nine-year period, 13 patients with 34 CSF vancomycin concentrations were evaluated. CSF output and time from dose correlated with CSF vancomycin concentration. No relationship was seen with regards to CSF protein, white blood cell count or glucose.

[Symptomatic carpal coalition of scaphoid, trapezium and trapezoid with coexisting ipsilateral hypoplasia of the thumb]. / Symptomatische karpale Koalition zwischen Os scaphoideum, Os trapezium und Os trapezoideum mit ipsilateraler Daumenhypoplasie.

We present the case of a 54-year-old woman with symptomatic coalition of scaphoid, trapezium and trapezoid as well as a coexisting ipsilateral hypoplasia of the thumb.

[Cytokines in psychoneuroendocrine immunological context of nonspecific musculoskeletal pain]. / Zytokine im psychoneuroendokrin-immunologischen Kontext unspezifischer muskuloskeletaler Schmerzen.

Cytokines are coordinators of immune homeostasis. Evidence for the participation of cytokines in neurogenic inflammation, peripheral and central sensitization and hyperalgesia as well as for induction of inflammatory immune responses by pain-related catastrophizing is well documented. A disproportion of proinflammatory and anti-inflammatory cytokines is known to be a contributory cause of pain and pain behavior. Embedded into psychoneuroendocrine immunological feedback control systems cytokines are able to perpetuate a virtuous circle between local inflammation and systemic pain behavior (pain/sickness behavior) thus contributing to chronification of nonspecific musculoskeletal pain.In this model avoidance and pain-related nonrecognition as key components of systemic pain behavior lead to maintenance of the virtuous circle by generating of a local inflammation with local and systemic consequences. This model can explain the success of established therapy concepts from the point of view of psychoneuroimmunology, such as fear avoidance, which are effectively used as principal components in multimodal pain therapy.

[Health-related quality of life (SF-36) in chronic low back pain and comorbid depression]. / Gesundheitsbezogene Lebensqualität (SF-36) bei chronischen Rückenschmerzen und gleichzeitiger Depression.

The purpose is to clarify if comorbidity of depression reduces health-related quality of life (SF-36) in patients with chronic low back pain (CR) and if those comorbid patients (CR+DE) benefit from multimodal pain treatment. Two groups (CR and CR+DE) each with 29 patients are compared over 6 months on study days 0, 21 (inpatient) and 180 (outpatient). Differences exist only at days 0 and 21, not at day 180, with group CR exhibiting higher SF-36 values in each case. Group CR+DE improves in the inpatient phase and especially in the outpatient phase and therefore over the entire study period more than group CR which increases solely in the inpatient phase. The comorbid group is more severely affected by their illness, but improves very constantly. The outpatient improvement suggests a good long-term prognosis.

WNT1 inducible signaling pathway protein 3, WISP-3, a novel target gene in colorectal carcinomas with microsatellite instability.

BACKGROUND & AIMS: Microsatellite instability (MSI) is the phenotype of colorectal carcinomas with defect mismatch repair. Genes with repetitive sequences within their coding regions are targets for mutations in these tumors. We have evaluated 2 novel candidate genes for potential involvement in development of MSI colorectal carcinomas and compared them with alterations in known target genes. METHODS: The MSI status was determined by multiplex polymerase chain reactions (PCRs) of 5-17 markers in a Norwegian series of 275 colorectal carcinomas. All MSI tumors were analyzed for gene mutations using fluorescence PCR followed by capillary electrophoresis. Two novel candidate genes, WNT1-inducible signaling pathway protein 3 (WISP-3) and caspase-1, and 9 known target genes were analyzed. RESULTS: Thirteen percent of the tumors were MSI-high (H) and 12% were MSI-low (L). Thirty-three of 37 MSI-H vs. 1 of 34 MSI-L tumors showed mutations in the target genes (P < 0.001). WISP-3 was mutated in 31% of the MSI-H tumors. The frequencies of frameshift mutations in the known target genes were comparable with other studies. CONCLUSIONS: The relative high frequency of mutation, higher than those seen for other known target genes, the predicted truncation of the protein product, and the homology with WISP-1 and WISP-2, 2 proteins induced downstream of WNT1 signaling, strongly suggest WISP-3 as a novel target in development of MSI-H colorectal carcinomas.

Social reactions to rape victims: healing and hurtful effects on psychological and physical health outcomes.

In this study, 102 rape survivors were interviewed about the social reactions they received from family and friends post-rape. Results supported Ullman's (1996b) conclusion that the overall contribution of positive social reaction (e.g., providing support, listening, believing) on victims' recovery is negligible, but that negative social reactions (e.g., blaming) hinder recovery. In contrast to Ullman's (1996b) work, this research also examined whether rape victims have similar perceptions as to what constitutes a "positive" and "negative" social reaction. Results indicated that victims often agree as to what reactions are healing (positive), but that they do not agree as to what is hurtful (negative). By taking victims' perceptions into account, this study was able to compare the relative contributions of social reactions that were considered healing, social reactions that were considered hurtful, and the absence of social reactions. Results indicated that survivors who had someone believe their account of what happened or were allowed to talk about the assault--and considered these reactions to be healing-had fewer emotional and physical health problems than victims who considered these reactions hurtful, or victims who did not experience these reactions at all. Implications for future research on social reactions are discussed.

Measuring interference with employment and education reported by women with abusive partners: preliminary data.

This study examines the reliability and convergent validity of the Work/School Abuse Scale (W/SAS), a measure of the ways that abusive men interfere with women's participation in education and employment. Results indicate good reliability as measured by coefficient alpha and significant correlations with both a revised version of the Conflict Tactics Scale and the Psychological Abuse Index. The W/SAS is a useful measure of the ways in which physical force and other means of interfering with women's lives isolate them from activities that might provide income, social contacts, and a sense of accomplishment. It may also be used to examine whether changes in welfare policies affect levels of physical force and nonviolent interference in women's employment and education, as suggested by the Family Violence Option to the 1996 revisions in federal welfare policies.

Neonatal dexamethasone treatment increases the risk for pulmonary hypertension in adult rats.

Dexamethasone (Dex) treatment during a critical period of lung development causes lung hypoplasia in infant rats. However, the effects of Dex on the pulmonary circulation are unknown. To determine whether Dex increases the risk for development of pulmonary hypertension, we treated newborn Sprague-Dawley rats with Dex (0.25 microg/day, days 3-13). Litters were divided equally between Dex-treated and vehicle control (ethanol) rats. Rats were raised in either room air until 10 wk of age (normoxic groups) or room air until 7 wk of age and then in a hypoxia chamber (inspired O(2) fraction = 0.10; hypoxic groups) for 3 wk to induce pulmonary hypertension. Compared with vehicle control rats, Dex treatment of neonatal rats reduced alveolarization (by 42%; P < 0.05) and barium-filled pulmonary artery counts (by 37%; P < 0.05) in 10-wk-old adults. Pulmonary arterial pressure and the ratio of right ventricle to left ventricle plus septum weights (RV/LV+S) were higher in 10-wk-old Dex-treated normoxic rats compared with those in normoxic control rats (by 16 and 16% respectively; P < 0.05). Small pulmonary arteries of adult normoxic Dex-treated rats showed increased vessel wall thickness compared with that in control rats (by 15%; P < 0.05). After 3 wk of hypoxia, RV/LV+S values were 36% higher in rats treated with Dex in the neonatal period compared with those in hypoxic control rats (P < 0.05). RV/LV+S was 42% higher in hypoxic control rats compared with those in normoxic control rats (P < 0.05). We conclude that Dex treatment of neonatal rats caused sustained lung hypoplasia and increased pulmonary arterial pressures and augmented the severity of hypoxia-induced pulmonary hypertension in adult rats.

[Presternal verrucous carcinoma]. / Prästernales verruköses Karzinom.

Verrucous carcinomas represent rare, highly differentiated variants of squamous cell carcinoma. They preferentially develop on the oropharyngeal mucosa (Ackerman tumor), the urogenital mucosa (Buschke-Loewenstein tumors), and the soles of the feet (epitheliomata cuniculata). Various synonyma have been coined for these tumors. We report the uncommon occurrence of a large verrucous carcinoma on apparently uninvolved chest skin of a 79-year old patient. The tumor was excised radically. Complete extirpation was confirmed histologically and there was no sign of recurrence during a 3 month observation period. The clinical appearance, histomorphological features, epidemiological aspects, differential diagnosis, therapy, and nomenclature of verrucous carcinomas are discussed.

Prognostic significance of apoptosis and associated factors in oral squamous cell carcinoma.

Tumour progression is characterised by an imbalance between cell proliferation and apoptosis. The aim of our study was to estimate the importance of proliferation and apoptosis associated parameters in primary squamous cell carcinomas (SCCs) of the oral cavity and oropharynx. For determination of apoptosis, the enzymatic labelling of DNA fragmentation with a terminal transferase reaction was used in 156 tissue samples of 107 patients, including corresponding lymph-node metastases in nine cases. P53, bcl-2, and Ki-67 were determined immunohistologically. P53 was detectable in 50.5% of the cases. Positive staining was associated significantly with decreased apoptosis (P<0.003). Bcl-2 was upregulated in 31.8% of the cases depending on the tumour grading (P<0.001) and correlated negatively with apoptosis (P<0.001). Proliferation (P<0.006) and apoptosis (P<0.03) were enhanced in larger tumours, though a direct correlation between these two parameters was not proven. Nevertheless, in contrast to the conventional tumour staging and grading, neither the expression of p53 or bcl-2 nor the apoptosis or Ki-67 measurements were able to predict survival or recurrence-free survival of the patients suffering from a SCC in the oral cavity or oropharynx. Our observations suggest that the function of wild-type p53 to induce apoptosis is lost in at least half of the SCCs under study and that the physiological function of bcl-2 as potent inhibitor of apoptosis is widely preserved in oral SCC.

Community services for rape survivors: enhancing psychological well-being or increasing trauma?

This research examined how contact with the legal, medical, and mental health systems affects rape survivors' psychological well-being. Although community services may be beneficial for some victims, there is increasing evidence that they can add trauma, rather than alleviate distress (termed secondary victimization). This study examined how secondary victimization affects rape survivors' posttraumatic stress (PTS) symptoms. Adaptive and snowball sampling were used to recruit a sample of 102 rape survivors. Victims of nonstranger rape who received minimal assistance from either the legal or medical system, and encountered victim-blaming behaviors from system personnel, had significantly elevated levels of PTS. This high-risk group of rape survivors had PTS levels significantly higher than all other victims in this study, including those who did not seek community assistance postrape. However, for these high-risk rape survivors, receiving sustained mental health services after these negative experiences was associated with a significant decrease in PTS.

During treatment changes in substance abuse patients with posttraumatic stress disorder. The influence of specific interventions and program environments.

Male substance abuse patients with posttraumatic stress disorder (PTSD) (SA-PTSD; N = 140) were compared to patients with only substance use disorders (SA-only; N = 1,262), and those with other Axis I diagnoses (SA-PSY; N = 228) on changes during substance abuse treatment. Diagnoses were determined by chart review, and patients completed questionnaires assessing coping, cognitions, and psychological distress. Although SA-PTSD patients improved on outcomes during treatment, they showed less benefit relative to SA-only patients. At discharge, SA-PTSD patients reported less use of effective coping styles, and endorsed more positive beliefs about substance use than SA-only patients. They had more psychological distress than SA-only and SA-PSY patients. More counseling sessions devoted to substance abuse and family problems, and increased involvement in 12-step activities partially counteracted the negative effects of having a PTSD diagnosis on several outcomes. SA-PTSD patients reported fewer psychological symptoms at discharge in programs that were high in support and order/organization.

Innovative community services for rape victims: an application of multiple case study methodology.

A qualitative multiple case study design was used to examine communities across the United States that have developed coordinated community-based programs to assist rape victims. Previous studies have suggested that coordinated community programs help victims obtain needed resources and services. This study provided a follow-up examination of how and why these programs are helpful to rape victims. In-depth interviews were conducted with rape victim advocates, rape crisis center directors, police officers, prosecutors, doctors, nurses, and rape survivors from 22 communities with coordinated programs. A comparison sample of 22 communities with fewer coordinated programs was also obtained. Results indicated that the high coordination communities had three types of programs to address sexual assault: coordinated service programs, interagency training programs, and community-level reform groups. Although not all of these programs directly address service delivery for rape victims, they help create a community culture that is more responsive to victims' needs. The research team and participants developed an explanatory model of why these program are effective in addressing rape victims' needs. This model hypothesizes that coordinated programs reflect an understanding of the multiple contexts of service delivery and embody that knowledge in services that are consistent with victims' needs. Narrative data from the interviews with service providers and rape survivors are used to develop and support this model.

Evidence that singlet oxygen-induced human T helper cell apoptosis is the basic mechanism of ultraviolet-A radiation phototherapy.

Ultraviolet A (UVA) irradiation is effectively used to treat patients with atopic dermatitis and other T cell mediated, inflammatory skin diseases. In the present study, successful phototherapy of atopic dermatitis was found to result from UVA radiation-induced apoptosis in skin-infiltrating T helper cells, leading to T cell depletion from eczematous skin. In vitro, UVA radiation-induced human T helper cell apoptosis was mediated through the FAS/FAS-ligand system, which was activated in irradiated T cells as a consequence of singlet oxygen generation. These studies demonstrate that singlet oxygen is a potent trigger for the induction of human T cell apoptosis. They also identify singlet oxygen generation as a fundamental mechanism of action operative in phototherapy.

Photocarcinogenesis and inhibition of intercellular adhesion molecule 1 expression in cells of DNA-repair-defective individuals.

Cells from patients with xeroderma pigmentosum complementation group D (XP-D) and most patients with trichothiodystrophy (TTD) are deficient in excision repair of ultraviolet (UV) radiation-induced DNA damage. Although in both syndromes this defect is based on mutations in the same gene, XPD, only XP-D, not TTD, individuals have an increased risk of skin cancer. Since the reduction in DNA repair capacity is similar in XP-D and TTD patients, it cannot account for the difference in skin cancer risk. The features of XP-D and TTD might therefore be attributable to differences in the immune response following UV-irradiation, a factor which is presumed to be important for photocarcinogenesis. We have measured the capacity of UVB radiation to inhibit expression of the immunological key molecule intercellular adhesion molecule 1 (ICAM-1) in cells from three healthy individuals in comparison to cells from three XP-D and three TTD patients. Cells from XP-D patients, but not from TTD patients, exhibited an increased susceptibility to UVB radiation-induced inhibition of ICAM-1 expression. Transfection of XP-D cells with the wild-type XPD cDNA, but not with XPC cDNA, corrected this abnormal phenotype. Thus, the skin cancer risk in DNA repair-defective individuals correlated with the susceptibility of their cells to UVB radiation-induced inhibition of ICAM-1 expression, rather than with their defect in DNA repair. The XPD protein has dual roles: in DNA repair and transcription. The transcriptional role might be important for the control of expression of immunologically relevant genes and thereby contribute to the skin cancer risk of a DNA-repair-deficient individual.