Slow oscillatory transcranial direct current stimulation (so-tDCS) during slow wave sleep has no effects on declarative memory in healthy young subjects.

BACKGROUND: The manipulation of specific brain oscillations by applying transcranial electrical stimulation techniques in order to enhance memory processes during sleep has become an intriguing field of research. A seminal study found a positive effect of slow-oscillatory transcranial direct current stimulation (so-tDCS) on sleep-dependent consolidation of declarative memories. Since then several studies have tried to replicate this result with inconsistent findings. OBJECTIVE/HYPOTHESIS: This study aimed to reexamine effects of so-tDCS on declarative memory observed in young participants based on a previously described stimulation protocol used in elderly subjects. METHODS: 23 healthy participants (mean ±â€¯SD: 23.2 ±â€¯1.9 years; 13 women) completed a word-pair test and a sequential finger tapping test before and after sleep. Participants received anodal so-tDCS bifrontaly at a frequency of 0.75 Hz or sham stimulation during NREM sleep N2, following a double-blind, placebo controlled, counterbalanced, randomized crossover design. Data were analyzed with respect to possible effects of stimulation on memory performances, sleep staging, spindle densities and EEG power in eight frequency bands. RESULTS: Stimulation had no significant effect on sleep dependent memory consolidation or on sleep macro- and microstructure. Independent of stimulation, procedural memory performances increased and declarative memory performances decreased overnight. This decline was less pronounced when participants had more than one learning opportunity. Fast parietal but not slow frontal spindle densities diminished from baseline to stimulation-free intervals under both stimulation conditions. CONCLUSION: The present study could not reproduce the results of the seminal study in young subjects, but it is consistent with results observed in elderly subjects using the same protocol. Irrespective of stimulation, re-encoding opportunities in the word-pair test had an impact on memory strength and retrieval performance.

Children with migraine: Provocation of headache via pressure to myofascial trigger points in the trapezius muscle? - A prospective controlled observational study.

BACKGROUND: The objective was to evaluate a supposed clinical interdependency of myofascial trigger points and migraine in children. Such interdependency would support an interaction of spinal and trigeminal afferences in the trigemino-cervical complex as a contributing factor in migraine. METHODS: Children ≤18 years with the confirmed diagnosis of migraine were prospectively investigated. Comprehensive data on medical history, clinical neurological and psychological status were gathered. Trigger points in the trapezius muscle were identified by palpation and the threshold of pressure pain at these points was measured. Manual pressure was applied to the trigger points, and the occurrence and duration of induced headache were recorded. At a second consultation (4 weeks after the first), manual pressure with the detected pressure threshold was applied to non-trigger points within the same trapezius muscle (control). Headache and related parameters were again recorded and compared to the results of the first consultation. RESULTS: A total of 13 girls and 13 boys with migraine and a median age of 14.5 (Range 6.3-17.8) years took part in the study. Manual pressure to trigger points in the trapezius muscle led to lasting headache after termination of the manual pressure in 13 patients while no patient experienced headache when manual pressure was applied to non-trigger points at the control visit (p < 0.001). Headache was induced significantly more often in children ≥12 years and those with internalizing behavioural disorder. CONCLUSION: We found an association between trapezius muscle myofascial trigger points and migraine, which might underline the concept of the trigemino-cervical complex, especially in adolescents. SIGNIFICANCE: In children with migraine headache can often be induced by pressure to myofascial trigger points, but not by pressure to non-trigger points in the trapezius muscle. This supports the hypothesis of a trigemino-cervical-complex in the pathophysiology of migraine, which might have implications for innovative therapies in children with migraine.

[Value of real-time elastography to guide the systematic prostate biopsy in men with normal digital rectal exam]. / Stellenwert der Real-Time Elastografie zur Steuerung der systematischen Prostatabiopsie bei Männern mit unauffälligem digital-rektalen Tastbefund.

The aim of this study was to evaluate whether real-time elastography-guided biopsy in comparison to grey-scale ultrasound improves prostate cancer detection in patients with an unremarkable digital rectal exam.A total of 231 patients suspicious for prostate cancer were prospectively randomised to transrectal real-time elastography- (126) or grey-scale ultrasound (105)-guided biopsy. The peripheral zone was divided into 6 sectors from base, mid-gland to apex. Lesions with reduced elasticity during real-time elastography and hypoechoic areas during grey-scale ultrasound were defined as suspicious for prostate cancer. Prostate biopsy was guided by real-time elastography (RTE) or grey-scale ultrasound (GSU) using a systematic 10-core approach. Suspicious lesions on RTE or GSU in the corresponding randomised group were targeted within each sector. Accuracy of cancer prediction and histopathological cancer detection rates were evaluated and compared between the 2 imaging modalitiesBaseline characteristics of patients undergoing real-time elastography and grey-scale ultrasound, including age, prostate-specific antigen and prostate volume were not significantly different statistically (p>0.05). Overall, prostate cancer was detected in 76 of 231 cases (32.9%). The cancer detection rate was significantly higher (p=0.007) in patients who underwent a biopsy using real-time elastography (40.5%) compared to the grey-scale-guided group of men (23.8%). Sensitivity and specificity to detect prostate cancer in 1 386 prostate sectors was 53.5% and 70.5% for real-time elastography vs. 11.7% and 93.7% for grey-scale ultrasound, respectively.Compared to conventional grey-scale ultrasound, accuracy to detect prostate cancer using a systematic 10-core biopsy approach was significantly improved under the guidance of real-time elastography.

Disturbed vestibular-neck interaction in cerebellar disease.

Cerebellar dysfunction results in ataxia including postural deficits. Evidence from animal experiments suggests convergence of vestibular and neck-position related inputs in cerebellar midline structures. We investigated 20 ambulatory patients with cerebellar disease for disturbed postural control using posturography during static lateral head turns. Binaural bipolar sine-wave galvanic vestibular stimulation (GVS) was used to evoke specific body movements. The Klockgether clinical score was used to assess the severity of cerebellar dysfunction (4-17 of maximal 35 points). In 12 healthy controls and seven lightly affected patients (score <8), GVS elicited physiologic alternating body sway in the head-frontal plane in seven head-on-trunk positions (0°; 30°, 45° and 60° left and right). Body sway turning with head excursion was progressively attenuated or abolished in more severely affected patients (scores 9-17; r = 0.57, p = 0.008). With most severe impairment, body sway was always in the body-frontal plane irrespective of head turn. A simple clinical test with walking under maximal head turn and closed eyes correlated with posturography data (r = 0.87, p < 0.001) and with Klockgether scores (r = 0.71, p < 0.001). Thus in cerebellar disease, head on trunk position can have a pronounced effect on postural control.

Deficits of cortical oculomotor mechanisms in cerebellar atrophy patients.

Commonly, the cerebellum is not associated with cortical components of saccadic eye movement programming. The present study investigates cerebellar effects on visually guided saccades in reflexive tasks (step, gap, overlap) and on internally driven saccades in intentional tasks (anti, memory, short memory sequences of four targets) in five patients with isolated cerebellar atrophy. The cerebellar dysfunction led to impairments in both reflexive and intentional saccades. Cerebellar atrophy patients showed an increase in the gain variability and an increase in the saccade latency. Furthermore, in the memory and anti task, suppression and pro-saccade errors were more frequent in the atrophy group compared to the control group. In the sequence task, patients had difficulties reproducing all four target locations in the order of the displayed sequence. The high variability of the saccade gain is a common observation in cerebellar atrophy patients and can be explained by the general variability present in the saccadic system. The increase in the saccade latency could be due to a cerebellar contribution to cortical processes related to fixation and target selection preceding the initiation of a saccade. Furthermore, the frequent occurrence of saccade errors in the memory and anti task suggests a cerebellar involvement in frontal inhibition of unwanted reflexive saccades. The impaired reproduction of saccade sequences in atrophy patients points to a deficit in short-term memory processes. Thus, this study provides further evidence that the cerebellum is involved in different cortical mechanisms related to the control of saccadic eye movements.

Evaluation of antimicrobial effects of novel implant materials by testing the prevention of biofilm formation using a simple small scale medium-throughput growth inhibition assay.

Staphylococcal colonization of implants is a serious complication of orthopaedic surgery. Anti-infectious modification of implant surfaces may serve to prevent bacterial colonization. The authors set out to develop an in vitro test system for the analysis of prevention of biofilm formation by Staphylococcus epidermidis and Staphylococcus aureus on implant materials. Biofilm growth was monitored over 10 days on titanium disks in order to develop appropriate test parameters. Bacterial cell counts following ultrasonic treatment of the colonized samples were compared with scanning electron microscope images of the specimens. Copper ion containing surfaces (ie copper [Cu] and inter-metallic Ti-Cu films) were used for growth inhibition assays: copper ion releasing specimens led to reduced bacterial numbers in biofilms and decreased bacterial persistence in the model used. The assay used represents an inexpensive and quick in vitro screen for the antibacterial effects of novel implant surface materials.

Synergistic control of joint angle variability: influence of target shape.

Reaching movements are often used to study the effectiveness of motor control processes with respect to the final position of arm and hand. Empirical evidence shows that different targets can be grasped with similar final position accuracy. However, movements that achieve similar accuracy at their final position may nevertheless be controlled differently. In particular, control strategies may differ in the control of the abundant degrees of freedom with respect to the task-specific costs. The objective of the present study was to investigate whether the applied control strategy was influenced by the shape of the target to be grasped. It was investigated whether mechanical constraints, imposed on final hand orientation or final hand position by the shape of the targets, affected the synergistic coordination of the kinematic degrees of freedom of the arm. Subjects were asked to grasp either a cylindrical or a spherical target, which imposed different constraints on final hand orientation and position. Besides temporal movement aspects, variability of the joint angles of the arm, as well as variability of hand orientation and hand position was analyzed over the whole time course of movement execution, using the uncontrolled manifold method. Overall movement duration differed between cylindrical and spherical target condition, due to differences in deceleration duration. Reaching movements towards the cylindrical target, which was more constraint in final hand orientation and position, took longer than movements towards the spherical target. Analysis further revealed that the degrees of freedom of the arm were synergistically coordinated to stabilize both hand orientation and hand position, when grasping either the spherical or the cylindrical target. This suggests that the applied control strategy in natural reaching movements can simultaneously account for multiple task constraints. The analysis further revealed that stabilization of hand orientation was stronger when reaching towards a cylindrical target, which imposed more constraints on final hand orientation. In contrast, hand position was more strongly stabilized in the spherical target shape condition, where stronger constraints on final hand position were applied. This suggests that different target shapes do influence the control strategy of reaching movements even though variability at movement end was not affected.

Joint angle variability in the time course of reaching movements.

OBJECTIVE: Investigating motor control processes is of primary interest in a number of scientific and practical fields. Movement variability is of increasing interest in this context. However, until now little has been known about the time course of variability during movement execution. The objective of this study was to investigate the influence of visual information and task specification on the variability of joint angle motion in reaching movements. METHODS: Subjects repetitively reached for a handle. Movement variability was quantified by the within-subjects standard deviation of mean joint angle. The analysis focused on the time course of variability during movement execution. RESULTS: The availability of visual information did not influence the time course of joint angle variability whereas task specification on reaching accuracy did. Under high accuracy demand variability was reduced more strongly after reaching its maximum. CONCLUSIONS: Results suggest that the availability of visual information plays a minor role in the control of well-trained reaching movements. This suggests that proprioceptive information is the main feedback source to control these movements. SIGNIFICANCE: The analysis of the time course of movement variability might be a valuable method to investigate the central or peripheral causes of movement disorders for diagnostic and rehabilitation purposes.

[Rising PSA level and negative prostate biopsy. Can prostate elastography help?]. / Steigender PSA-Wert und negative Prostatabiopsie. Kann die Prostataelastographie helfen?

Previous studies investigated the clinical impact of elastography for preoperative staging and as an additional imaging modality to improve prostate cancer detection during prostate biopsy. This rapidly improving technique has facilitated progress toward feasibility and reproducibility of transrectal elastography. Recent studies show significant improvements using the latest generation of elastographic devices. Further studies are needed to evaluate on the one hand elastography-guided prostate biopsy schemes and results of saturation biopsies and on the other hand to compare sensitivity and specificity of elastographic detection of prostate cancer with different imaging techniques, especially magnetic resonance imaging and spectroscopy.

[Impact of elastography in clinical diagnosis of prostate cancer. A comparison of cancer detection between B-mode sonography and elastography-guided 10-core biopsies]. / Stellenwert der Elastographie in der klinischen Diagnostik des lokalisierten Prostatakarzinoms. Vergleich von Detektionsraten der B-Modus-Sonographie und der elastographieunterstützten systematischen 10fach-Biopsie.

BACKGROUND: To assess whether elastography guided prostate biopsies improve the cancer detection in men with suspected prostate cancer. PATIENTS AND METHODS: In this study, 351 prospectively randomized patients underwent prostate biopsies for the first time. The indication for biopsy was abnormal digital rectal examination (DRE) in 25% or suspicious prostate-specific antigen (PSA) elevation in 75%. In the elastography group (n=189) and the control group (n=162), we assessed PSA, DRE, and B-mode transrectal ultrasound (TRUS). Both groups underwent classic TRUS-guided 10-core biopsy. The elastography patients underwent additional elastographic examination prior to biopsy using a Voluson 730 ultrasound system (GE Medical). According to the ultrasound or elastographic findings for each biopsy location, the researcher tried to predict whether cancer was present. This prediction was correlated with histopathologic findings. The statistical power of this study was sufficient to detect a 15% difference in detection rate. RESULTS: The study groups did not differ in PSA, clinical stages, or prostate volume (p<0.05). The overall cancer detection rate was 39% (137/351): 40.2% (76/189) in the elastography group and 37.7% (61/189) in the control group, respectively. The difference in detection rate in clinical stages T2 and T3 between the elastography and the control groups was not statistically significant (p<0.05). Within the T1c subgroup, elastography showed a slightly higher detection rate of 55.6% versus 50% without reaching statistical significance (p>0.05). Histopathologic findings were adequately predicted by elastography in only 44.5%. CONCLUSIONS: Elastography did not improve the cancer detection rate in our collective.

Eye and head torsion is affected in patients with midbrain lesions.

The midbrain has been shown to contain crucial nuclei for the control of vertical and torsional eye movements. Recent studies in monkeys demonstrated that midbrain lesions also affect head movements during gaze saccades, but so far clinical reports on the matter have been missing. We measured 3D eye and head movements in two patients with oculomotor deficits due to unilateral midbrain lesions and in healthy control subjects. Subjects had (1) to perform head-free target directed gaze saccades (head-free task), and (2) to point to the target with a head-laser (head-only task). The patients had vertical eye movement deficits, which were not compensated by the head. Three-dimensional analysis revealed torsional deviations from the normal range of movements for both, the eye and the head movements.

Parkinsonian patients show impaired predictive smooth pursuit.

To determine if patients with Parkinson's disease (PD) are able to use a visual contextual cue to induce a predictive change in smooth pursuit direction and if this ability depends on the state of the dopaminergic system, we measured predictive smooth pursuit in nine patients with mild to moderate PD during OFF and ON medication. These values were compared with those of nine age-matched and sex-matched healthy controls.Our focus was on the horizontal smooth pursuit when subjects pursued a downward moving target entering a+/-90 deg curve. The target moved on a homogeneous background or on a static "street" that indicated the future trajectory of the target. Our main result is that PD patients were impaired in eliciting predictive smooth pursuit using the context information of the street compared to healthy subjects. The control group elicited predictive pursuit 250 ms before target onset. In contrast, PD patients showed significantly longer latency (100-120 ms) and reduced maximal pursuit velocity. However, without the street guiding pursuit, a delay of about 250 ms was seen in both groups. There was no significant difference in the smooth pursuit performance between OFF and ON medication in the patient group.These results show that early stage PD patients are impaired in the use of static visual information as a cue for predictive pursuit compared to controls and that this deficit does not depend on dopaminergic medication. In the context of predictive eye movement, the involvement of the striatal-frontal pathway and the spatial working memory is discussed.

Improving activity and stability of cutinase towards the anionic detergent AOT by complete saturation mutagenesis.

Cutinase is an enzyme suitable for detergent applications as well as for organic synthesis in non-aqueous solvents. However, its inactivation in the presence of anionic surfactants is a problem which we have addressed by creating a complete saturation library. For this, the cutinase gene from Fusarium solani pisi was mutated to incorporate all 19 possible amino acid exchanges at each of the 214 amino acid positions. The resulting library was screened for active variants with improved stability in the presence of the anionic surfactant dioctyl sulfosuccinate sodium salt (AOT). Twenty-four sites in cutinase were discovered where amino acid replacements resulted in a 2-11-fold stability increase as compared to the wild-type enzyme.

[Postoperative monitoring of anastomosis after radical retropubic prostatectomy Transrectal ultrasound can replace cystography?]. / Postoperative Anastomosenkontrolle nach radikaler retropubischer Prostatektomie. Kann der transrektale Ultraschall die Zystographie ersetzen?

OBJECTIVE: We determined if transrectal ultrasound (TRUS) is as reliable as cystography in detecting vesicourethral extravasates after radical retropubic prostatectomy (RRP). PATIENTS AND METHODS: Between October 2005 and February 2006 we prospectively investigated 100 consecutive patients undergoing RRP. The vesicourethral anastomosis was proven 6 days after operation by a combined investigation with TRUS and cystography. RESULTS: In the majority of patients (79%) the vesicourethral anastomosis was watertight on postoperative day 6 (POD) or showed minimal leakage (8%) so that the urinary catheter was removed. Different degrees of paravasates were detected in 21 patients. Because of small, moderate, or marked paravasations the indwelling catheter was removed on POD 9, 14, and 21 in 5, 3, and 5 patients, respectively. Every paravasate documented by cystography had been detected by TRUS before. Therefore, TRUS showed no false-negative result in detecting insufficient anastomosis. In two patients paraurethral fluid was detected by TRUS mimicking anastomotic paravasation, without confirmation by cystography. CONCLUSIONS: TRUS can safely replace cystography to detect anastomotic leakage after radical prostatectomy.

Quantitative sensory testing in cluster headache: increased sensory thresholds.

To determine if recently reported changes in sensory thresholds during migraine attacks can also be seen in cluster headache (CH), we performed quantitative sensory testing (QST) in 10 healthy subjects and in 16 patients with CH. Eight of the patients had an episodic CH and the other eight a chronic CH. The tests were performed on the right and left cheeks and on the right and left side of the back of the hands to determine the subjects' perception and pain thresholds for thermal (use of a thermode) and mechanical (vibration, pressure pain thresholds, pin prick, von Frey hairs) stimuli. Six patients were examined in the attack-free period. Three were also willing to repeat the tests a second time during an acute headache attack, which was elicited with nitroglycerin. The healthy subjects performed the experiments in the morning and evening of the same day to determine if sensory thresholds are independent of the time of day. If they were, this would allow estimation of the influence of the endogenous cortisone concentration on these thresholds. The control group showed no influence of the time of day on the thresholds. There was a significant difference in pain sensitivity between the back of the hands and the cheeks (P<0.05): higher thresholds were found on the back of the hands. The thresholds generally exhibited little intersubject variability, indicating that QST is a reliable method. There was also a significant difference between the test areas in the patient group (P<0.001): the cheeks were also more sensitive than the back of the hands. In comparison with reference data of healthy volunteers, the detection thresholds were increased in the patients on both test areas. These were statistically significant for warmth, thermal sensory limen (TSL), heat and pressure on the back of the hands (P<0.04) and for the warmth and TSL thresholds on the cheeks (P<0.05). There were no differences in the thresholds regardless of whether the patients were examined in or outside of a cluster bout. Furthermore, we found no cutaneous allodynia in the three patients tested during an attack. The increased sensory thresholds on the cheeks as well as on the back of the hands are in agreement with an increased activation of the patients' antinociceptive system. The seasonal variation and the temporal regularity of single attacks as well as the findings in imaging studies indicate that the hypothalamus is involved in the pathophysiology of CH. In view of the strong connectivity between the hypothalamus and areas involved in the antinociceptive system in the brainstem, we hypothesize that this connection is the reason for the increased sensory thresholds in CH patients found in our study.

Initial characterization of a blue-light sensing, phototropin-related protein from Pseudomonas putida: a paradigm for an extended LOV construct.

The open reading frame PP2739 from Pseudomonas putida KT2440 encodes a 151 amino acid protein with sequence similarity to the LOV domains of the blue-light sensitive protein YtvA from Bacillus subtilis and to the phototropins (phot) from plants. This sensory box LOV protein, PpSB2-LOV, comprises a LOV core, followed by a C-terminal segment predicted to form an alpha-helix, thus constituting a naturally occurring paradigm for an extended LOV construct. The recombinant PpSB2-LOV shows a photochemistry very similar to that of YtvA and phot-LOV domains, yet the lifetime for the recovery dark reaction, taurec=114 s at 20 degrees C, resembles that of phot-LOV domains (5-300 s) and is much faster than that of YtvA or YtvA-LOV (>3000 s). Time-resolved optoacoustics reveals phot-like, light-driven reactions on the ns-micros time window with the sub-nanosecond formation of a flavin triplet state (PhiT=0.46) that decays into the flavin-cysteine photoadduct with 2 micros lifetime (Phi390=0.42). The fluorescence spectrum and lifetime of the conserved W97 resembles the corresponding W103 in full-length YtvA, although the quantum yield, PhiF, is smaller (about 55% of YtvA) due to an enhanced static quenching efficiency. The anisotropy of W97 is the same as for W103 in YtvA (0.1), and considerably larger than the value of 0.06, found for W103 in YtvA-LOV. Different to YtvA and YtvA-LOV, the fluorescence for W97 becomes larger upon photoproduct formation. These data indicate that W97 is located in a similar environment as W103 in full-length YtvA, but undergoes larger light-driven changes. It is concluded that the protein segment located C-terminally to the LOV core (analogous to an interdomain linker) is enough to confer to the conserved tryptophan the fluorescence characteristics typical of full-length YtvA. The larger changes experienced by W97 upon light activation may reflect a larger conformational freedom of this protein segment in the absence of a second domain.

Saccades to moving targets.

The metrics and dynamics of saccades to stationary and moving targets were observed in monkeys (Macaca mulatta). To isolate the effects of target speed on the saccade from contributions of smooth pursuit, saccade velocity was corrected for intrasaccadic pursuit velocity on a trial-by-trial basis prior to analysis. The effects of presaccadic retinal error and target speed on the saccadic velocity profile were determined by analyzing the partial correlations computed as a function of time after saccade onset. The main results are: (1) Saccade amplitude is determined not only by the retinal error sampled before the saccade, but also by the speed of the target during the latency period. (2) The dynamics of saccades, even if compensated for smooth-pursuit components, differ between forward- and backward-moving targets. (3) Whereas the presaccadic retinal error affects the eye velocity throughout the saccade, target speed has no effect before peak velocity. These results are discussed in the context of current models of saccade generation and their physiological substrates, in particular the role of the cerebellum in the local feedback loop.

[Transrectal ultrasound-guided punch biopsies of the prostate. Indication, technique, results, and complications]. / Ultraschallgesteuerte transrektale Prostatastanzbiopsien. Indikation, Technik, Ergebnisse und Komplikationen.

The golden standard for diagnosis of prostate cancer is transrectal ultrasound-guided systematic biopsy (TRUS-Bx). The optimal number of cylinders, sampling design, and indications for repeat biopsy are still in a state of flux. At the beginning of the 1980s, considerable doubts persisted regarding the benefit of ultrasound-guided punch biopsy for the diagnosis of prostate cancer. The examination on a chair with a fixed ultrasound head caused the patient substantial discomfort. Besides, in the pre-PSA era, most prostate carcinomas were detected by palpation and digitally guided biopsies were easily obtained. Indeed, the DRU procedure alone exhibited low sensitivity. Keetch et al. found that in only 25% of patients with abnormal palpatory findings and PSA between 4 and 20 ng/ml was a carcinoma revealed upon biopsy. On the other hand, patients with suspicious palpatory findings and proven malignancy suffered more frequently from locally advanced and systemic metastasizing tumors. As a result of restaging based on PSA, in most series more than half of the detected carcinomas presented normal palpatory findings. Ultrasound examination made precise imaging of zonal structures possible and thus offered the advantage of precision guidance for tissue biopsy despite lower sensitivity and specificity for diagnosis of suspicious lesions. Furthermore, calculation of prostate volume was possible. At the end of the 1980s, Hodge defined the systematic sextant biopsy as the first golden standard for early detection of prostate cancer. This meant the systematic removal of three punch cylinders from both lateral lobes of the prostate in the parasagittal midline at various levels (apex, middle, and base).

[Functional results of various surgical techniques for radical prostatectomy]. / Funktionelle Ergebnisse unterschiedlicher Operationstechniken der radikalen Prostatektomie.

Radical prostatectomy for the treatment of prostate cancer can be performed by various techniques using a retropubic, perineal, or laparoscopic approach. Besides tumor control, the postoperative urinary continence rates and potency rates impact patients' quality of life after radical prostatectomy. This paper shows the results of our own center and compares the data in the literature regarding functional results of radical prostatectomy with respect to various operative techniques.

Anterior canal failure: ocular torsion without perceptual tilt due to preserved otolith function.

A patient with anterior semicircular canal dehiscence syndrome underwent surgical patching that caused an isolated dysfunction of the left anterior semicircular canal postoperatively. He exhibited significant ocular torsion toward the side of the affected labyrinth (17 degrees excyclotropia of the ipsilateral eye), but no displacement of the subjective visual vertical. This dissociation suggests that an isolated ocular torsion may occur after an anterior semicircular canal lesion. A combined ocular torsion and subjective visual vertical tilt, which is usually seen with vestibular lesions, requires an associated otolith dysfunction.