Disorders of human consciousness in the Tri-partite synapses.

Conscious Action Theory extends quantum theory to macroscopic phenomena and suggests physical correlates of consciousness occur at the intersection of external measurement signals and internally generated signals from memories that model the outside world. This physical theory predicts conscious phenomena happen at all scales and differ only by the size and complexity of material organizations involved. At the scale of the human "Brain" consciousness is predicted to happen where the processing loop of activity in the Glial network interfaces with the real world input-output processing loop of the Nuronal network. This happens at the Tripartite synapses creating an intersection plenum in biological systems that produces the experience of empty space and the objects it contains. Analysis of the transmitter-receptor strengths implementing the control and feedback between the Glial and Neuronal networks indicate imbalances can be directly related to schizophrenia, mania, epilepsy, and depression. This paper addresses three topics supporting the above mechanisms for normal consciousness functioning and its medical deviations. First we preset the architecture of a pan-psychic physical theory, which supports the hypothesis that tri-partite synapses are the location of human conscious experience. Second we discuss the inner workings of the Glial network to support long term memory and control functions corresponding to the inner feeling of the "I" self. Third, we consider the relation between psychiatric conditions and the balance states between the number of neuronal transmitters and astrocytic receptors.

Motion-stable flexor tendon repair with the Mantero technique in the distal part of the fingers.

Lacerated flexor digitorum profundus (FDP) tendons in zone 1 and distal zone 2 were reconstructed in 73 consecutive cases using the motion-stable Mantero technique during a 7-year period. Sixty-five (89%) of these patients were re-examined an average of 40 (26-82) months postoperatively. According to Moiemen and Elliot (2000) assessment by Strickland's original and modified criteria and in addition the Buck-Gramcko score showed excellent and good results of 54%, 72% and 91% respectively. In contrast, examination of the results measuring the range of movement of the distal interphalangeal (DIP) joint alone provided a more realistic assessment in DIP joint function after Mantero technique with excellent and good results of only 38%.

A cultured human neural network operates a robotic actuator.

The development of bio-electronic prostheses, hybrid human-electronics devices and bionic robots has been the aim of many researchers. Although neurophysiologic processes have been widely investigated and bio-electronics has developed rapidly, the dynamics of a biological neuronal network that receive sensory inputs, store and control information is not yet understood. Toward this end, we have taken an interdisciplinary approach to study the learning and response of biological neural networks to complex stimulation patterns. This paper describes the design, execution, and results of several experiments performed in order to investigate the behavior of complex interconnected structures found in biological neural networks. The experimental design consisted of biological human neurons stimulated by parallel signal patterns intended to simulate complex perceptions. The response patterns were analyzed with an innovative artificial neural network (ANN), called ITSOM (Inductive Tracing Self Organizing Map). This system allowed us to decode the complex neural responses from a mixture of different stimulations and learned memory patterns inherent in the cell colonies. In the experiment described in this work, neurons derived from human neural stem cells were connected to a robotic actuator through the ANN analyzer to demonstrate our ability to produce useful control from simulated perceptions stimulating the cells. Preliminary results showed that in vitro human neuron colonies can learn to reply selectively to different stimulation patterns and that response signals can effectively be decoded to operate a minirobot. Lastly the fascinating performance of the hybrid system is evaluated quantitatively and potential future work is discussed.

Antibacterial resistance of community-acquired respiratory tract pathogens recovered from patients in Germany and activity of the Ketolide Telithromycin: results from the PROTEKT surveillance study (1999-2000).

BACKGROUND: The Prospective Resistant Organism Tracking and Epidemiology for the Ketolide Telithromycin (PROTEKT) longitudinal global surveillance study examines the antibacterial susceptibility of community-acquired respiratory pathogens. METHODS AND RESULTS: Data from isolates collected in Germany in 1999-2000 in the PROTEKT study show that 8.3% of pneumococcal isolates (n = 325) had reduced susceptibility to penicillin and 2.2% were fully resistant. Erythromycin resistance was 15.7% overall and particularly high in Leipzig (31.6%). All penicillin- and erythromycin-resistant strains were inhibited by telithromycin (MIC < or =0.5 mg/l) and linezolid (MIC < or =2 mg/l). Beta-lactamase was produced by 3.2% of Haemophilus influenzae (9/284) and 89.5% of Moraxella catarrhalis strains (111/124). All Streptococcus pyogenes isolates (n = 87) were susceptible to penicillin, although 9.2% were resistant to macrolides. CONCLUSIONS: Penicillin resistance in Germany remains low; however, the prevalence of antimicrobial resistance among common respiratory pathogens is rising, particularly against macrolides. Continued surveillance is necessary to guide optimal empirical therapy, and new antimicrobials, like telithromycin, need to be developed with improved potency against target pathogens and low propensity for the development of resistance.

[Plantar fibromatosis: therapy by total plantarfasciectomy]. / Plantarfibromatose: Therapie mit totaler Plantarfasziektomie.

Morbus Ledderhose is a rare fibromatous disease of the plantar fascia. Clinical features include palpable solitary or multiple nodules and cords, mainly affecting the medial part of the plantar fascia. When clinical symptoms occur, conservative options include stretching, orthotics, nonsteroidal antirheumatic drugs, local cortisone-injections and physiotherapy. Operative treatment is indicated in case of persistent pain or if conservative measures fail. The standard procedure includes a partial fasciectomy of the plantar aponeurosis. There is a high recurrence rate with an increased risk of complications and more aggressive ingrowth into anatomical structures after partial resection. Therefore we recommend a complete fasciectomy not only in recurrent disease, but also as the primary procedure of choice.

[The Mantero technique for flexor tendon repair - an alternative?]. / Die Beugesehnennaht nach Mantero - eine Alternative?

PURPOSE: Regaining free tendon gliding after reconstruction of flexor tendons is essential to restore full function to the affected finger. Mantero et al. described a pull-out suture technique for the repair of flexor digitorum profundus (FDP) lesions in zone 1, allowing early postoperative active mobilisation and thus minimizing the risk of tendon adhesions. In a retrospective study we examined the results after Mantero tendon repair and compared these with the results after different reconstructive procedures in the literature. METHODS AND MATERIAL: Between 1995 and 2001, the FDP tendon in zone 1 and distal half of zone 2 distal to the chiasma respectively the flexor pollicis longus (FPL) tendon were reconstructed in 96 patients using the Mantero technique. 87 (90 %) patients, with a male to female ratio of 2 : 1, were re-examined an average of 43 (4 to 84) months postoperatively. We evaluated the isolated function of the finger joints, the total range of motion of the affected finger and grip strength and compared all values to the contralateral healthy side and assessed the functional results according to the Buck-Gramcko score and the patients' satisfaction according to the DASH score. Special attention was directed to the influence of the patients' age, gender, art of trauma, accompanying injuries or level of the lesion on the postoperative results. Furthermore, we evaluated whether clinical results depended on which finger was injured. RESULTS: 71 % (n = 62) of all injuries were found in the distal zone 2 or distal zone Th 2 in the thumb. While 81 % (n = 70) were caused by a clean cut, 10 % (n = 9) were due to a circular saw injury and 9 % (n = 8) due to a crush injury. The average DASH score value was 5.4 (0 to 37.5) with excellent and good results according to the Buck-Gramcko score in 90.8 % (n = 79) of all patients. Only the patients' age (> 50 years vs. < 20 years) and the digit involved (little finger vs. index, middle and ring fingers) had a significant influence on the postoperative results. Aside from superficial skin necrosis in 10 % of all cases, in which no further operative therapy was necessary, no other complications occurred. Interestingly, no ruptures of the sutured tendons were found, although active mobilisation was initiated immediately. Compared to the literature, the 90,8 % excellent and good results are equivalent to those of other studies concerning reconstruction after flexor tendon injuries using the Mantero technique and tend to be better than other reconstructive procedures. CONCLUSION: Based on our results, we consider the Mantero technique to be a good alternative to other forms of flexor tendon reconstruction in zone 1 and distal zone 2. Advantages include the possibility of immediate postoperative mobilisation and placing a secure tendon suture, even if the distal tendon stump is very short.

[Secondary reconstruction of extensor pollicis longus tendon]. / Die sekundäre Rekonstruktion der Sehne des Musculus extensor pollicis longus.

BACKGROUND: Secondary reconstruction of the extensor pollicis longus tendon (EPL) can be performed using an intercalated tendon graft (ITG) or a tendon transposition, preferably the extensor indicis transposition (EIT), since a secondary suture of the EPL tendon is not possible in most cases due to degenerative changes or defect injuries. A direct comparison of ITG and EIT in one single patient collective based on a standardized follow-up protocol has not been performed yet. PATIENTS AND METHOD: For the first time, these two operative procedures were directly compared in a retrospective analysis according to the follow-up protocol after Geldmacher et al. an average of 4.3 (2 to 11) years after reconstructive surgery. Out of 1469 extensor tendon lesions only 55 patients were identified in the course of secondary reconstruction of the EPL tendon in whom additional injuries, especially osseous lesions or other conditions that affected the mobility of the thumb, could be ruled out reliably. 45 (82 %) of these patients participated in a clinical follow-up examination. In 28 (62 %) patients an EIT and in 17 (38 %) an ITG was performed. RESULTS: Neither the range of motion in the metacarpophalangeal and interphalangeal joint of the thumb, the abduction and the adduction of the thumb as well as the extension deficit and the remaining pulp-to-pulp distance during thumb opposition, compared to the contralateral hand, nor the overall evaluation showed a significant difference (Students-t-test; p < 0.05) between the results of both procedures. CONCLUSION: The EIT and the ITG for the secondary reconstruction of the EPL tendon should be regarded as equal alternatives.

[Unrecognized and untreated rupture of the Achilles tendon-operative treatment in cases of unstable scar tissue]. / Die nicht erkannte und unbehandelte AchillessehnenrupturOperative Therapie bei insuffizienter Narbe.

Although the clinical picture of an acute rupture of the Achilles tendon is clear, it remains unrecognized or falsely evaluated in up to 10% of all cases. Wrong management without surgical intervention or adequate immobilization frequently leads to unstable scar tissue, requiring completely different therapy and rehabilitation than in the case of an acute injury. Between 6/2000 and 3/2002 11 patients (average age 53 years, M:F=9:2) with a neglected rupture of the Achilles tendon undergoing reconstruction of unstable scar tissue were evaluated in a prospective study. The preoperative cardinal symptoms were loss of strength and stress pain. The length of the unstable scar tissue measured 3.5 cm on average (2.0-6.0 cm). After resection of the scar lesion, a broad central gastrocnemius aponeurotic flap was performed in nine cases,whereas two cases underwent a central tendon shift. As a result of the surgical tendon reconstruction,we noted a 40% mean increase of strength in the final examination. This improvement was associated with less pain and a comparable range of motion. Protracted wound secretion and superficial wound necrosis were recorded on one and two occasions, respectively. Ultrasound and X-ray as preoperative imaging diagnostic tools in addition to the clinical picture appear to be sufficient for proper indication and planning of surgical intervention. The broad central aponeurotic flap has proven to be the most successful method in our patients. In cases of a short distal end, the "grip-box plasty" with a central tendon shift is indicated. Even lesions up to 6 cm can thus be repaired with autologous tissue.

[Diagnosis and therapy of necrotizing fasciitis]. / Diagnose und Therapie der nekrotisierenden Fasziitis.

Necrotizing fasciitis is a soft tissue infection with a lethality ranging up to 80%. Infection causes the activation of interleukin, tumor necrosis factor alpha, and gamma-interferon through a triggering mechanism. This results in a capillary thrombosis with necrosis of the fascia, cutis, and subcutis. The patient's history often reveals a triggering event in the form of a recent minimal trauma or operative procedure. In a fulminant necrotizing fasciitis, the development of sepsis with consecutive multiple-organ failure mainly determines the outcome of the disease. Diagnosis is made initially upon clinical findings with a rapid progression of the disease and confirmed later by histologic and microbiologic findings. Radical surgical debridement within the first 24 h with postoperative treatment in an intensive care unit represents the cornerstone of therapy. Between January 1992 and March 2001, we treated 15 patients with necrotizing fasciitis. Lethality was 33%. There was a significant correlation between risk factors (present in 86% of the patients) and morbidity. Diagnosis and therapy should be performed by an experienced surgeon. In this contribution, we discuss the most important criteria that lead to the diagnosis and the therapeutic consequences.

Spongy hydroxyapatite in hand surgery--a five year follow-up.

Twenty-two patients were treated for enchondromas or cysts of the hand by curettage and complete filling of the defect with hydroxyapatite. Postoperatively no complications occurred and marginal osseous integration was radiologically complete after 6 to 8 weeks. Patients were re-examined after a minimum of 5 years after operation and the functional and aesthetic results were excellent in all patients. Radionuclide imaging showed identical bone activity to that in the contralateral healthy hand and there were no signs of inflammation.

[Coincidence of Lipoma and Liposarcoma of the Right Hand in an 84-Year-Old Patient: A Case Report]. / Koinzidenz von Lipom und Liposarkom der rechten Hand bei einem 84-jährigen Patienten: Eine Falldarstellung.

Summary. We report the case of an 84-year-old patient presenting with a painless tumor between the thumb and the index finger. MRI showed a clearly defined tumor of the thenar eminence with a centrally localized more solid structure. There was a signal enhancement after intravenous administration of contrast medium. We performed a local resection of the tumor. Histologically, we found a lipoma with a centrally localized liposarcoma. We discuss the rare case of malignant transformation of a lipoma. In long-standing large lipomas we suggest regular controls by MR imaging.

Possibilities of non-viral gene transfer to improve cutaneous wound healing.

Enhancement of dermal and epidermal regeneration represents a crucial goal for the treatment of acute, e.g. burn and trauma wounds, and chronic wounds, e.g. diabetic, autoimmune, arterial and venous wounds. Studies defining molecular mechanisms of the complex cascade of wound healing have shown that growth factors represent a new therapeutic strategy. The clinical application of growth factors in the form of proteins has been shown to be of little benefit. Therefore new delivery systems and therapeutic strategies needed to be developed to improve dermal and epidermal regeneration, one of which is gene therapy. For successful gene delivery the selection of an appropriate vector has been shown to be paramount. Because Retroviruses, Adenoviruses and Adeno-Associated Viruses can cause immunologic reactions and mutations, non-viral delivery systems for gene therapy, such as liposomal gene transfer appear advantageous over viral gene therapy. This review discusses the success, potential and limitations of non-viral gene transfer to improve regeneration of dermal and epidermal structures.

[Timing of soft tissue reconstruction in severe crush injury of the upper extremity]. / Zeitpunkt der Weichteilrekonstruktion bei schweren Quetschtraumen im Bereich der oberen Extremität.

Complex injuries of the distal forearm and the hand by industrial machines often require extensive reconstructive procedures. Crush injuries with soft tissue damage extending over the limits of visible injury require a special approach. Large soft tissue defects often have to be covered by extensive flap procedures. The optimum point of time for plastic reconstruction is an essential question and represents a controversial issue in the literature. To be able to compare different patient cohorts in the future, we classify crush injuries into five clinically relevant categories. In the course of this review article, three different cases of severe crush injuries of the upper extremity are representatively discussed. Two patients were reconstructed in a secondary procedure, one patient in the acute phase. Definite coverage of soft tissue defects in severe crush injuries should be performed secondarily after 5-7 days since the extent of damage in this special form of trauma can often only be judged after a few days and the reconstruction of bones, vessels and tendons is completed.

[Plastic surgery coverage in the dorsal trunk area]. / Plastische Deckung im dorsalen Rumpfbereich.

Defects of the trunk are major plastic surgical challenges. In the posterior trunk these defects are congenital or acquired. Most of the defects are due to major tumor resections, rarely after trauma or burns. With regional or local flaps most of the defects can be covered adequately. Presently musculocutaneous and perforator flaps are favoured. An interdisciplinary cooperation is mandatory for a successful result.

Families' perception of the added value of hospice in the nursing home.

OBJECTIVE: To determine if family members perceive that hospice improves the care of dying nursing home residents during the last 3 months of life. DESIGN: Mailed survey. PARTICIPANTS: Family members for all nursing home hospice enrollees in North Carolina during a 6-month period. MEASUREMENTS: After residents' deaths, family members answered questions about the quality of care for symptoms before and after hospice, the added value of hospice, the effect of hospice on hospitalization, and special services provided by nursing home staff or by hospice staff. RESULTS: A total of 292 (73%) of 398 eligible family members completed surveys. The average age of the nursing home residents who had received hospice was 79.5 years; 50% had cancer and 76% were dependent for self-care. In their last 3 months, 70% of decedents had severe or moderate pain, 56% had severe or moderate dyspnea, and 61% had other symptoms. Quality of care for physical symptoms was rated good or excellent by 64% of family before hospice and 93% after hospice (P<.001). Dying residents' emotional needs included care for moderate or severe depression (47%), anxiety (50%), and loneliness (35%). Quality of care for emotional needs was rated good or excellent by 64% of family before hospice and 90% after hospice (P<.001). Fifty-three percent of respondents believed hospice prevented hospitalizations. Family estimated the median added value of hospice to be $75 per day and described distinct special services provided by hospice and by nursing home staff. CONCLUSIONS: Family members believe that nursing home hospice improves quality of care for symptoms, reduces hospitalizations, and adds value and services for dying nursing home residents.

Effects of substances inhibiting or uncoupling respiratory-chain phosphorylation of Helicobacter pylori.

The effects of electron transport inhibitors and uncoupling agents as well as of bismuth compounds on the respiratory activity and oxidative phosphorylation of Helicobacter pylori were investigated. Bismuth gallate and bismuth subsalicylate reduced the respiratory chain-dependent phosphorylation. Inhibition was of the same magnitude as that observed with other known inhibitors. It is concluded that bismuth displays an antibacterial effect by inhibiting the respiratory chain of H. pylori.

Effect of exogenous arachidonic acid metabolites applied on round window membrane on hearing and their levels in the perilymph.

Our previous studies revealed that treatment with sodium salicylate or indomethacin caused hearing loss, a decrease in prostaglandin (PG) levels, and an increase in leukotriene (LT) levels of the arachidonic acid (AA) cascade in the perilymph. We suspected that decreased PG-levels and/or elevated LT-levels in the inner ear may be responsible for the salicylate ototoxicity. In order to test this hypothesis, effects of exogenous treatments with PGs, PG-analog, LTs, and other lipoxygenase products on hearing and levels of AA metabolites in the perilymph were studied in chinchillas. Cyclooxygenase products, PGI2, 6-keto-PGF1 alpha, Iloprost (PGI2 analog), PGE2, and LTB4, LTC4, and 15-hydroxyeicosatetraenoic acid (15-HETE) in the lipoxygenase products in the dose of 150 ng were applied on the round window membrane (RWM); cochlear function tested by auditory brainstem response (ABR) and samples of perilymph were collected at 0.5, 1, 2, and 4 hours after the application. Samples of perilymph were assayed for all spectra of AA metabolites by high performance liquid chromatography (HPLC) and radioimmunoassay (RIA). PG-treated animals developed minimal or no hearing loss. LT-treated animals exhibited hearing loss of 20 to 40 dB, peaking at one hour after the treatment. Elevated levels of arachidonic acid metabolites were measured in the perilymph of the ears treated with respective AA metabolites, with peak levels at one hour from the application. The findings of this study indicate that hearing loss can be induced by altered levels of PGs or LTs in the perilymph. This is another strong evidence that salicylate induced ototoxicity can be mediated by abnormal arachidonic acid metabolism in the inner ear.

Effect of round window membrane application of salicylate and indomethacin on hearing and levels of arachidonic acid metabolites in perilymph.

Our previous studies revealed that systemic salicylate-induced ototoxicity is associated with altered levels of arachidonic acid metabolites (AAMs) in the perilymph. In order to eliminate the possibility of systemic toxic effects of salicylate when it is given parenterally, an animal model of salicylate-induced ototoxicity was developed by applying it on the round window membrane (RWM). Using chinchillas as experimental animals, sodium salicylate (150 micrograms) or another nonsteroidal anti-inflammatory drug (NSAID), indomethacin (20 micrograms) was applied on the RWM, cochlear function was determined by auditory brainstem response (ABR) and perilymph assayed for AAMs both prostaglandins (PGs) and leukotrienes (LTs) by high performance liquid chromatography (HPLC) and radioimmunoassay (RIA) at different time intervals. When salicylate or indomethacin was applied on the RWM, dose-dependent ABR threshold losses of 20 to 50 dB was observed in 1 to 2 hours associated with decreased concentrations of 6-keto-PGF1 alpha and elevated levels of LTs. The hearing loss recovered to normal threshold over a period of 8 hours. The control group showed no hearing loss or any change in PG or LT-levels in the prilymph. The results of this study suggest that the method of inducing ototoxicity by applying salicylate or indomethacin on the RWM seems to be a reliable method for avoiding systemic toxicity of the parenteral treatment method and that ototoxicity induced by salicylate or indomethacin may be mediated by decreased PGs and elevated LTs.

Atypical crusted "Norwegian" scabies: report of nosocomial transmission in a community hospital and an approach to control.

During August, 1981, a person with an unrecognized case of atypical Norwegian scabies was admitted to a community hospital in Chariton, Iowa. Twenty cases of symptomatic scabies were reported among hospital staff; mites were recovered from four. Subsequent evaluation confirmed scabies transmission to family and friends of this patient before hospitalization; twelve cases of symptomatic scabies, three of them slide positive, were identified in this group. The patient was treated sequentially with 1 percent lindane lotion, 10 percent crotamiton lotion, and 6 percent sulfur ointment to successfully eradicate the infestation. Secondary cases in the hospital and community were treated with 10 percent crotamiton which also was used to prophylactically treat exposed contacts. Control measures and patient management are presented.