Correction of symbrachydactyly: a systematic review of surgical options.

Symbrachydactyly is a rare congenital malformation of the hand characterized by short or even absent fingers with or without syndactyly, mostly unilaterally present. The hand condition can vary from a small hand to only nubbins on the distal forearm. This study aims to systematically review the surgical management options for symbrachydactyly and compare functional and aesthetic outcomes.The review was performed according to the PRISMA guidelines. Literature was systematically assessed searching the Cochrane Library, PubMed, Embase, and PROSPERO databases up to January 1, 2023. Studies were identified using synonyms for 'symbrachydactyly' and 'treatment'. Inclusion criteria were the report of outcomes after surgical treatment of symbrachydactyly in humans. Studies were excluded if they were written in another language than English, German, or French. Case reports, letters to the editor, studies on animals, cadaveric, in vitro studies, biomechanical reports, surgical technique description, and papers discussing traumatic or oncologic cases were excluded.Twenty-four studies published were included with 539 patients (1037 digit corrections). Only one study included and compared two surgical techniques. The quality of the included studies was assessed using the Modified Coleman Methodology Score and ranged from 25 to 47. The range of motion was the main reported outcome and demonstrated modest results in all surgical techniques. The report on aesthetics of the hand was limited in non-vascularized transfers to 2/8 studies and in vascularized transfers to 5/8 studies, both reporting satisfactory results. On average, there was a foot donor site complication rate of 22% in non-vascularized transfers, compared to 2% in vascularized transfers. The hand-related complication rate of 54% was much higher in the vascularized group than in the non-vascularized transfer with 16%.No uniform strategy to surgically improve symbrachydactyly exists. All discussed techniques show limited functional improvement with considerable complication rates, with the vascularized transfer showing relative high hand-related complications and the non-vascularized transfer showing relative high foot-related complications.There were no high-quality studies, and due to a lack of comparing studies, the data could only be analysed qualitatively. Systematic assessment of studies showed insufficient evidence to determine superiority of any procedure to treat symbrachydactyly due to inadequate study designs and comparative studies. This systematic review was registered at the National Institute for Health Research PROSPERO International Prospective Register of Systematic Reviews number: CRD42020153590 and received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.Level of evidenceI.Systematic review registrationPROSPERO CRD42020153590.

Management of acute periprosthetic knee infection: a comparison of arthroscopic and open debridement.

INTRODUCTION: In acute periprosthetic knee infections, debridement and implant retention (DAIR) is the preferred treatment prior to one- and two-stage revisions. The aim of this study is to compare the outcomes of arthroscopic and open debridement of infected primary total knee arthroplasties (TKA). MATERIAL AND METHODS: We analyzed clinical, laboratory, and antibiotic treatment data, collected in patients with periprosthetic knee infection treated with DAIR at a Swiss Level 1 orthopedic and trauma center over a 10-year period between January 2005 and May 2015. Inclusion criteria were primary total knee arthroplasty and early postoperative or acute hematogenous periprosthetic joint infection (PJI). The primary endpoint was the need for further revision surgery due to persistent infection. The secondary endpoint was the prosthesis salvage in further infection surgeries. RESULTS: Forty-two patients with 44 acute or hematogenous periprosthetic knee infections were included. We recorded 20 recurrent infections (45%) in our study population: 10 (77%) out of 13 in the arthroscopic DAIR group and 10 (32%) out of 31 in the open DAIR group. Two-stage revision, meaning complete removal of the TKA, insertion of a spacer and replantation at a second stage, had to be performed in three patients treated initially arthroscopically (23%) and in six patients treated initially with an open surgical procedure (21%). CONCLUSIONS: Open debridement for acute periprosthetic knee infection shows clear benefits in terms of infection eradication and prosthesis salvage compared to arthroscopic DAIR.

An Experimental Platform Generating Simulated Blunt Impacts to the Head Due to Rearward Falls.

Impacts to the back of the head due to rearward falls, also referred to as "backfall" events, represent a common source of TBI for athletes and soldiers. A new experimental apparatus is described for replicating the linear and rotational kinematics of the head during backfall events. An anthropomorphic test device (ATD) with a head-borne sensor suite was configured to fall backwards from a standing height, inducing contact between the rear of the head and a ground surface simulant. A pivoting swing arm and release strap were used to generate consistent and realistic head kinematics. Backfall experiments were performed with the ATD fitted with an American football helmet and the resulting linear and rotational head kinematics, as well as calculated injury metrics, compared favorably with those of football players undergoing similar impacts during games or play reconstructions. This test method complements existing blunt impact helmet performance experiments, such as drop tower and pneumatic ram test methods, which may not be able to fully reproduce head-neck-torso kinematics during a backfall event.

Vasogenic Brain Edema During Maintenance Hemodialysis : Preliminary Results from Tract-based Spatial Statistics and Voxel-based Morphometry.

BACKGROUND: Hemodialysis (HD), especially when first initiated, can cause neurological deterioration. Presumably this is due to transient cerebral edema, which has been observed using diffusion weighted magnetic resonance imaging (MRI) in experimental and human studies; however, this has not been investigated under maintenance hemodialysis (mHD). Moreover, there are no studies to date investigating regional effects of mHD on grey and white matter volumes. METHODS: In this study eight patients with end stage renal disease (ESRD) were examined immediately before and after mHD sessions with multimodal MRI, including diffusion tensor imaging (DTI) and high-resolution structural imaging. Additionally, eight healthy, age-matched and sex-matched controls were examined for comparison. Data were analyzed using tract-based spatial statistics and voxel-based morphometry. RESULTS: At baseline, ESRD patients had significantly reduced values of fractional anisotropy (FA) and axial diffusivity as well as bilaterally reduced grey matter volume in the insula, compared with controls. After the mHD session, FA further decreased while axial, radial, and mean diffusivity significantly increased ubiquitously throughout the white matter. Voxel-based morphometry revealed a corresponding significant increase in white matter volume in the central right hemisphere and splenium, as well as in cortical grey matter in the anterior medial frontal and cingulate cortex. None of the patients showed neurological deterioration. CONCLUSION: In this study ESRD patients showed white matter changes indicative of chronic microstructural damage when compared with healthy controls, as previously reported. In addition, patients showed signs of a transient extracellular cerebral edema, which has not yet been observed in the absence of neurological symptoms.

Point-of-care PT and aPTT in patients with suspected deficiencies of coagulation factors.

INTRODUCTION: There are several clinical settings and patient conditions especially in intensive care units, emergency departments, and operating theaters, where the coagulation status of a patient must be known immediately and point-of-care (POC) systems are beneficial due to low time to result. METHODS: This noninterventional, single-blinded, multicenter study with prospectively collected whole blood samples was performed to evaluate the diagnostic accuracy of the CoaguChek PT Test (POC PT) and CoaguChek aPTT Test (POC aPTT) compared to standard laboratory testing in patients with suspected deficiencies of coagulation factors. RESULTS: In total, 390 subjects were included. Both POC PT and POC aPTT showed concordance with the laboratory PT and aPTT. Lot-to-lot variation was below 2% both for POC PT and for POC aPTT. The mean relative difference of capillary blood compared to venous blood was 0.2 % with POC PT and 8.4% with POC aPTT. The coefficients of variation for repeatability of POC PT using whole blood were found to be between 2% and 3.6%. CONCLUSION: Our findings suggest reliable quantitative results with this POC system to support on-site decision-making for patients with suspected deficiencies of coagulation factors in acute and intensive care.

Estabilidad marginal de una resina condensable versus resina monoincremental activada sónicamente en restauraciones clase II: Estudio in vitro / Marginal stability of a condensable resin versus a bulk-fill resin with sonic activation in class II restorations: An in vitro study

Introducción: Recientemente se han introducido las resinas bulk-fill, las cuales pueden ser utilizadas con técnica monoincremental, disminuyendo el tiempo clínico y ofreciendo una técnica menos sensible. El objetivo de este estudio es evaluar la estabilidad marginal de una resina compuesta condensable, utilizando técnica incremental oblicua versus una resina monoincremental con activación sónica en restauraciones clase II. Materiales y método: A 16 terceros molares sanos se les realizó dos preparaciones cavitarias clase II. Las dimensiones de las preparaciones fueron estandarizadas: 3 mm de ancho vestibulolingual, 2 mm de profundidad y 1,5 mm en sentido mesiodistal para el cajón oclusal, y 3 mm de ancho vestibulolingual, 4 mm de profundidad y 1,5 mm en sentido mesiodistal para el cajón proximal, determinándose al azar restaurar una preparación con resina condensable FiltekTM P60 (3M(R) ESPE-USA) utilizando técnica incremental, y la segunda preparación con resina SonicFillTM (Kerr-USA) con técnica monoincremental y activación sónica. Las muestras se termociclaron en azul de metileno al 1%, se cortaron en sentido mesiodistal y analizaron mediante microscopio óptico. Se cuantificó el grado de penetración del agente infiltrador en el margen cavosuperficial oclusal y gingival de ambas resinas. Se realizó un test exacto de Fisher y posterior U de Mann-Whitney. Resultados: La profundidad de infiltración del borde cavosuperficial gingival fue significativamente menor para FiltekTM P60 comparado con SonicFillTM (p= 0,028). Discusión: Ambas técnicas presentaron valores similares de estabilidad marginal en el borde cavosuperficial oclusal, sin embargo la resinas FiltekTM P60 presenta una mayor estabilidad marginal en el borde cavosuperficial gingival (AU)

Introduction: Recently, bulk-fill resin shave been introduced, which can be used with a mono-incremental technique, shortening clinical time and offering a less sensitive technique. The purpose of this study was to evaluate the marginal stability of condensable composite resins by using incremental technique versus a bulkfill resin with sonic activation. Material and method: Two Black’s class II cavities preparations were performed on 16 healthy third molars. The overall dimensions and depth of cavities were standardized as follows: 3 mm wide, 2 mm deep and 1,5 mm of mesiodistal lenght at the occlusal box, and 3 mm wide, 4 mm deep and 1,5 mm of mesiodistal length at the proximal box. It was randomly determined to restore a preparation with condensable resin FiltekTM P60 (3M(R) ESPE-USA) using oblique incremental technique, while these cond preparation used SonicFillTM resin (Kerr- USA) with mono-incremental technique and sonic activation. These were thermocycled in methylene blue 1%, then cut in mesio-distal sense and analysed by optical microscope. The degree of penetration of the infiltrator agent in the oclusal cavosurface margin and gingival wall of both resins was measured. Fisher’s exact test and a subsequent Mann-Whitney U test were performed. Results: The amount of infiltration in gingival cavosurface margin was significantly lower for Filtek™ P60 compared with SonicFillTM (p= 0.028). Discussion: Both techniques presented similar values of marginal stability in the oclusal cavosurface margin, however, resinFiltekTM P60 has greater stability in the gingival cavosurface margin (AU)

Clinical Muscle Testing Compared with Whole-Body Magnetic Resonance Imaging in Facio-scapulo-humeral Muscular Dystrophy.

OBJECTIVE: The objective of this study was to evaluate the clinical usefulness of whole-body magnetic resonance imaging (MRI) in facio-scapulo-humeral muscular dystrophy (FSHD). METHODS: In 20 patients with genetically proven FSHD1, we prospectively assessed muscular involvement and correlated the results of semi-quantitative manual muscle testing and other parameters such as disease duration, creatine kinase (CK) levels and repeat length of the D4Z4 locus with whole-body MRI. RESULTS: Clinical muscle testing revealed the trapezius, pectoralis and infraspinatus as the most severely affected muscles in the shoulder, and the knee flexors and gluteus medius in the hip girdle. MRI revealed the trapezius and serratus anterior muscles in the shoulder, and the hamstrings and adductor muscles in the hip girdle, as the most severely affected muscle groups. Overall, degrees of fatty degeneration on MRI scans correlated significantly with clinical weakness. Moreover, we could detect clear affection of the trunk muscles. Corresponding to earlier reports, asymmetric involvement was frequent in both clinical examination and MRI scoring. Moreover, MRI revealed inhomogeneous muscle degeneration in a considerable proportion of both, muscles and patients. Both clinical and MRI scores significantly correlated to disease duration, but not to fragment size or CK levels. CONCLUSION: Fatty degeneration in whole-body MRI correlates well to clinical muscle testing of the extremities but gives more information on deeper or trunk muscles. It shows structural changes in muscular disorders and may become an excellent tool for assessment of muscle involvement and follow-up studies.

Responses of the Human Brain to Mild Dehydration and Rehydration Explored In Vivo by 1H-MR Imaging and Spectroscopy.

BACKGROUND AND PURPOSE: As yet, there are no in vivo data on tissue water changes and associated morphometric changes involved in the osmo-adaptation of normal brains. Our aim was to evaluate osmoadaptive responses of the healthy human brain to osmotic challenges of de- and rehydration by serial measurements of brain volume, tissue fluid, and metabolites. MATERIALS AND METHODS: Serial T1-weighted and (1)H-MR spectroscopy data were acquired in 15 healthy individuals at normohydration, on 12 hours of dehydration, and during 1 hour of oral rehydration. Osmotic challenges were monitored by serum measures, including osmolality and hematocrit. MR imaging data were analyzed by using FreeSurfer and LCModel. RESULTS: On dehydration, serum osmolality increased by 0.67% and brain tissue fluid decreased by 1.63%, on average. MR imaging morphometry demonstrated corresponding decreases of cortical thickness and volumes of the whole brain, cortex, white matter, and hypothalamus/thalamus. These changes reversed during rehydration. Continuous fluid ingestion of 1 L of water for 1 hour within the scanner lowered serum osmolality by 0.96% and increased brain tissue fluid by 0.43%, on average. Concomitantly, cortical thickness and volumes of the whole brain, cortex, white matter, and hypothalamus/thalamus increased. Changes in brain tissue fluid were related to volume changes of the whole brain, the white matter, and hypothalamus/thalamus. Only volume changes of the hypothalamus/thalamus significantly correlated with serum osmolality. CONCLUSIONS: This is the first study simultaneously evaluating changes in brain tissue fluid, metabolites, volume, and cortical thickness. Our results reflect cellular volume regulatory mechanisms at a macroscopic level and emphasize that it is essential to control for hydration levels in studies on brain morphometry and metabolism in order to avoid confounding the findings.

Filtration of sea louse, Lepeophtheirus salmonis, copepodids by the blue mussel, Mytilus edulis, and the Atlantic sea scallop, Placopecten magellanicus, under different flow, light and copepodid-density regimes.

Population management of Lepeophtheirus salmonis in Canada currently relies on chemotherapeutants to remove attached stages of the ectoparasite. However, some populations of L. salmonis are developing resistance to chemotherapeutants making alternate management measures necessary. This article explores the ability of filter-feeding shellfish [i.e. blue mussels (Mytilus edulis) and Atlantic sea scallops (Placopecten magellanicus)] to consume the copepodid stages of L. salmonis in the laboratory under static and flowing water conditions, with variable copepodid densities, and with the aid of a light attractant. Mytilus edulis consumed copepodids under both static and flowing water conditions, and the proportion of individuals ingested was similar at low and high copepodid densities, suggesting that M. edulis was not saturated at the concentrations tested. Also, M. edulis consumed more copepodids when a light attractant was present, suggesting that lights may be useful to concentrate widely dispersed copepodids around cultured shellfish in the field. Finally, P. magellanicus consumed the same number of copepodids as an equivalent total wet weight of M. edulis. During each of the four separate experiments, shellfish consumed between 18 and 38% of the copepodids presented per hour, suggesting that both species are well suited for low level removal of copepodids over time.

Magic angle effect: a relevant artifact in MR neurography at 3T?

BACKGROUND AND PURPOSE: MRN is an emerging diagnostic method for disorders of peripheral nerves. However, it is unclear whether the influence of the MA on intraneural T2 signal is severe enough to provoke false-positive findings. MATERIALS AND METHODS: Twenty-five healthy subjects underwent MRN of the sciatic nerve of the proximal thigh at 3T. The T2(app) was calculated from a DE-TSE sequence (TR = 3000 ms, TE1 = 12 ms, TE2 = 69 ms) at 7 angles of the sciatic nerve relative to B0 = 0°, 30°, 35°, 40°, 45°, 50°, and 55°. Precise angle adjustments were performed with a dedicated in-bore positioning aid. Qualitative evaluation of intraneural T2-weighted contrast between this group of healthy subjects and 14 patients with neuropathic lesions was performed by comparing CNRs of a TIRM sequence (TR = 5000 ms, TE = 76 ms, TI = 180 ms). RESULTS: In healthy subjects, the prolongation of T2(app) from 0° to 55° was from 74.5 ± 13.4 to 104.0 ± 16.9 ms (P < .001). The increase in T2(app) relative to baseline (0°) was 9.6% (30°), 18.4% (35°), 25% (40°), 27.6% (45°), and 37% (55°). Intraneural CNR increased by 1.98 ± 0.69 at 40° and 2.93 ± 0.46 at 55°. Nevertheless, the mean CNR of healthy subjects was substantially lower than that in patients at 40° (P < .0001) and even at the position of maximum MA (55°: 20.6 ± 5.11 versus 52.6 ± 7.12, P < .0001). CONCLUSIONS: Neuropathic lesions are clearly distinguishable from an artificial increase of intraneural T2 by the MA. Even at a maximum MA (55°), the false-positive determination of a neuropathic lesion is unlikely.

Rapid-onset central motor plasticity in multiple sclerosis.

OBJECTIVE: To study rapid-onset central motor plasticity, and its relationship to motor impairment and CNS injury in patients with multiple sclerosis (MS). METHODS: In this cross-sectional observational study, motor plasticity was examined neurophysiologically and behaviorally in 22 patients with moderately severe (median Expanded Disability Status Scale score 2.5 [0-6]) stable MS and matched healthy controls. First, plasticity was assessed using paired associative stimulation (PAS), a protocol modeling long-term synaptic potentiation in human cortex. PAS combines repetitive electric nerve stimulation with transcranial magnetic stimulation (TMS) of the contralateral motor cortex. Second, motor learning was tested by a force production task. Motor impairment was assessed by functional tests. CNS injury was evaluated by obtaining normalized N-acetyl-aspartate (NAA/Cr) spectra using magnetic resonance spectroscopy and by the corticomuscular latency (CML) to the abductor pollicis brevis muscle as tested by TMS. RESULTS: Patients with MS performed worse than controls in functional motor tests, CMLs were prolonged, and NAA/Cr was decreased. PAS-induced enhancement of corticospinal excitability and training-induced increments of motor performance were comparable between patients with MS and controls. Neither PAS-induced plasticity nor motor learning performance correlated with motor impairment or measures of CNS injury. Patients with high CNS injury and good motor performance did not differ significantly from those with high CNS injury and poor motor performance with respect to PAS-induced plasticity and motor learning success. CONCLUSIONS: Despite motor impairment and CNS injury in patients with multiple sclerosis (MS), rapid-onset motor plasticity is comparable to that in healthy subjects. Compensation of MS-related CNS injury is unlikely to be constrained by insufficient rapid-onset neuroplasticity.

Enhanced cortical reperfusion protects coagulation factor XII-deficient mice from ischemic stroke as revealed by high-field MRI.

Intrinsic coagulation factor XII deficient (FXII(-/-)) mice are protected from ischemic stroke. To elucidate underlying mechanisms we investigated the early ischemic period in vivo by multimodal magnetic resonance imaging (MRI) at 17.6 Tesla. Cerebral ischemia was induced by either transient (60 min) or permanent occlusion of the middle cerebral artery (t/pMCAO). 10 FXII(-/-) mice underwent t- , 10 FXII(-/-) mice p- and 10 Wildtype (Wt) mice tMCAO. Cerebral blood flow (CBF), diffusion-weighted-imaging (DWI) and T2-relaxometry were measured at 2 h and 24 h after MCAO. Outcome measures were evaluated after motion correction and normalization to atlas space. 2 h after tMCAO CBF reduction was similar in FXII(-/-) and Wt mice extending over cortical (CBF (ml/100 g/min) 33.6+/-6.9 vs. 35.3+/-4.6, p=0.42) and subcortical regions (25.7+/-4.5 vs. 31.6+/-4.0, p=0.17). At 24 h, recovery of cortical CBF by +36% was observed only in tMCAO FXII(-/-) mice contrasting a further decrease of -30% in Wt mice after tMCAO (p=0.02, F((1,18))=6.24). In FXII(-/-) mice in which patency of the MCA was not restored (pMCAO) a further decrease of -75% was observed. Cortical reperfusion in tMCAO FXII(-/-) mice was related to a lower risk of infarction of 59% vs. 93% in Wt mice (p=0.04). Subcortical CBF was similarly decreased in both tMCAO groups (Wt and FXII(-/-)) relating to a similar risk of infarction of 89% (Wt) vs. 99% (FXII(-/-), p=0.17). Deficiency of FXII allows neocortical reperfusion after tMCAO and rescues brain tissue by this mechanism. This study supports the concept of FXII as a promising new target for stroke prevention and therapy.

Global monitoring of wetlands--the value of ENVISAT ASAR Global mode.

This paper elaborates on recent advances in the use of ScanSAR technologies for wetland-related research. Applications of active satellite radar systems include the monitoring of inundation dynamics as well as time series analyses of surface soil wetness. For management purposes many wetlands, especially those in dry regions, need to be monitored for short and long-term changes. Another application of these technologies is monitoring the impact of climate change in permafrost transition zones where peatlands form one of the major land cover types. Therefore, examples from boreal and subtropical environments are presented using the analysed ENVISAT ASAR Global mode (GM, 1 km resolution) data acquired in 2005 and 2006. In the case of the ENVISAT ASAR instrument, data availability of the rather coarse Global Mode depends on request priorities of other competing modes, but acquisition frequency may still be on average fortnightly to monthly depending on latitude. Peatland types covering varying permafrost regimes of the West Siberian Lowlands can be distinguished from each other and other land cover by multi-temporal analyses. Up to 75% of oligotrophic bogs can be identified in the seasonal permafrost zone in both years. The high seasonal and inter-annual dynamics of the subtropic Okavango Delta can also be captured by GM time series. Response to increased precipitation in 2006 differs from flood propagation patterns. In addition, relative soil moisture maps may provide a valuable data source in order to account for external hydrological factors of such complex wetland ecosystems.

CT perfusion predicts secondary cerebral infarction after aneurysmal subarachnoid hemorrhage.

OBJECTIVE: To prospectively assess the diagnostic accuracy of CT perfusion (CTP) and transcranial Doppler sonography (TCD) for the prediction of secondary cerebral infarction (SCI) after aneurysmal subarachnoid hemorrhage (SAH). METHODS: During 2 weeks after SAH, 38 consecutive patients completed an average of 3.5 CT/CTP and 10.7 TCD examinations at regular intervals as required by the study protocol. SCI was defined as delayed infarction on native CT between 3 and 14 days after SAH and developed in n = 14 patients (n = 24 without SCI). Analysis was based on examination dates before SCI. Common measures of diagnostic accuracy were calculated for qualitative CTP (visual color-map ratings from two blinded observers) and TCD assessments (mean flow velocity >120 cm/s in anterior, middle, and posterior cerebral artery territories). Quantitative measures, which for CTP were obtained from cortical a priori regions of interest corresponding to the vascular territories, were analyzed by binary logistic regression. RESULTS: Time of prediction for SCI by CTP was at a median of 3 days (range 2 to 5 days) before manifestation of complete infarction on native CT. Visual assessment of time-to-peak (TTP) color maps performed best for the prediction of SCI with 0.93 sensitivity (95% CI: 0.7 to 1.0) and 0.67 specificity (95% CI: 0.53 to 0.7). On quantitative analysis, the odds ratio (OR) for 1 second of side-to-side delay in TTP was 1.4 (p = 0.01, Wald chi(2) = 8.57, CI: 1.07 to 1.82). Daily TCD measures were not significantly related to SCI at any time before complete infarction on native CT. CONCLUSIONS: Time to peak as indicated by CT perfusion is a sensitive and early predictor of secondary cerebral infarction.

[Neuroradiological imaging in patients with sensorineural hearing loss prior to cochlear implantation]. / Neuroradiologische Diagnostik bei Patienten mit sensorineuralem Hörverlust vor Cochlea-Implantation.

Cochlear implantation (CI) is an established technique for enabling speech perception in patients suffering from severe bilateral sensorineural hearing loss (SNHL). Thorough preoperative radiological assessment is essential for correctly evaluating the indication for surgery and safely performing cochlear implantation. CT and conventional and functional MRI are available for radiological assessment. Therefore, knowledge of the most frequent congenital syndromal, non-syndromal, and acquired malformations of inner ear structures is fundamental. This article provides information about imaging techniques prior to CI and relevant malformations of the inner ear. Safety aspects for patients with a cochlear implant undergoing MR imaging are also discussed.

[Cycloid psychoses as atypical manic-depressive disorders. Results of a family study]. / Sind zykloide Psychosen atypische manisch-depressive Erkrankungen? Ergebnisse einer Familienuntersuchung.

BACKGROUND: Whereas a growing body of evidence suggests that cycloid psychoses have to be separated from schizophrenic psychoses, their relations to bipolar affective disorder are less clear. PATIENTS AND METHODS: In a controlled family study, we recruited 46 patients with cycloid psychosis (CP), 33 with manic-depressive illness (MDI), and 27 controls. Three hundred fifty-six of 389 living first-degree relatives were personally examined by experienced psychiatrists blinded to the diagnosis of the index proband. RESULTS: The relatives of CP patients showed significantly lower morbidity risk of functional psychoses than relatives of patients with MDI in Kaplan-Meier life table calculation. The morbidity risk for functional psychoses in relatives of patients with CP did not differ significantly from that in relatives of controls. CONCLUSION: These results suggest that CP are etiologically different from bipolar affective psychoses and cannot be integrated into the spectrum of bipolar affective disorders. The findings provide further evidence for a nosological independence of CP.

Cycloid psychoses are not part of a bipolar affective spectrum: results of a controlled family study.

BACKGROUND: Whereas a growing body of evidence suggests that cycloid psychoses have to be separated from schizophrenic psychoses, their relations to bipolar affective disorder are less clear. To further clarify this issue a controlled family study was undertaken. METHODS: All living and traceable adult first-degree relatives of 45 cycloid psychotic, 32 manic-depressive and 27 control probands were personally examined by an experienced psychiatrist blind to the diagnosis of the index proband. Data about not traceable relatives were collected by the "Family-History"-Method. A catamnestic diagnosis was established for each of the 431 relatives blind to family data. Age-corrected morbidity risks were calculated using the life-table method. RESULTS: Relatives of cycloid psychotic patients showed a significantly lower morbidity risk for endogenous psychoses in general and manic-depressive illness compared to relatives of patients with manic-depressive illness. The familial morbidity risk for cycloid psychoses was low and did not differ significantly in both proband groups. Relatives of cycloid psychotic patients however did not differ significantly from relatives of controls regarding familial morbidity. LIMITATIONS: Our time-consuming methodical procedure implicated a relatively small number of participants due to restricted personnel resources. The restriction to hospitalised probands could possibly cause a limited representativity of the study sample. CONCLUSIONS: Our results suggest that cycloid psychoses are aetiologically different from manic-depressive illness and could not be integrated into a spectrum of bipolar affective disorders. The findings provide further evidence for a nosological independence of cycloid psychoses.

[Reversible loss of vision in severe preeclampsia: case report and review of the literature]. / Reversibler Visusverlust bei schwerer Präeklampsie - Fallbericht und Literaturübersicht.

Visual disturbances occur in up to 25 % of the patients with preeclampsia. However, blindness remains a rare phenomenon. A 39 year old primigravida was admitted for observation at 30 weeks gestation with signs of preeclampsia. After 11 days she suffered a complete loss of vision. The blindness reversed completely after cesarean section and antihypertensive treatment. Blindness in preeclamptic patients is mostly caused by hypertensive encephalopathy. We discuss pathophysiological aspects as well as diagnostic approaches and therapeutic options with respect to the available literature.

Cycloid psychoses -- from clinical concepts to biological foundations.

The modern concept of cycloid psychoses is primarily based upon the clinical delineation of their phenotypes according to Leonhard. By settling the dilemma of Kraepelinean "atypical psychoses", their description may be considered one of the major achievements of clinical psychiatry in the last century. In particular, this had been facilitated by the work of Wernicke and Kleist. Albeit not yet generally recognized, cycloid psychoses have already stimulated great efforts of research yielding remarkable results. In this article, we elucidate the concept of cycloid psychoses and present recent findings pertaining to their putative biological foundations. Finally, future perspectives for the field of biological psychiatry are proposed fostering the heuristics of Leonhard's nosology.