Quantitative comparison of 2D and 3D late gadolinium enhancement MR imaging in patients with Fabry disease and hypertrophic cardiomyopathy.

BACKGROUND: This study aims to determine whether the quantification of myocardial fibrosis in patients with Fabry disease (FD) and hypertrophic cardiomyopathy (HCM) using a late gadolinium enhancement (LGE) singlebreath-hold three-dimensional (3D) inversion recovery magnetic resonance (MR) imaging sequence is comparable with a clinically established two-dimensional (2D) multi-breath-hold sequence. METHODS: In this retrospective, IRB-approved study, 40 consecutive patients (18 male; mean age 50±17years) with Fabry disease (n=18) and HCM (n=22) underwent MR imaging at 1.5T. Spatial resolution was the same for 3D and 2D images (field-of-view, 350×350mm(2); in-plane-resolution, 1.2×1.2mm(2); section-thickness, 8mm). Datasets were analyzed for subjective image quality; myocardial and fibrotic mass, and total fibrotic tissue percentage were quantified. RESULTS: There was no significant difference in subjective image quality between 3D and 2D acquisitions (P=0.1 and P=0.3) for either disease. In patients with Fabry disease there were no significant differences between 3D and 2D acquisitions for myocardial mass (P=0.55), fibrous tissue mass (P=0.89), and total fibrous percentage (P=0.67), with good agreement between acquisitions according to Bland-Altman analyses. In patients with HCM there were also no significant differences between acquisitions for myocardial mass (P=0.48), fibrous tissue mass (P=0.56), and total fibrous percentage (P=0.67), with good agreement according to Bland-Altman analyses. Acquisition time was significantly shorter for 3D (25±5s) as compared to the 2D sequence (349±62s, P<0.001). CONCLUSIONS: In patients with Fabry disease and HCM, 3D LGE imaging provides equivalent diagnostic information in regard to quantification of myocardial fibrosis as compared with a standard 2D sequence, but at superior acquisition speed.

[Ochratoxin a analyses of blood samples from workers at waste handling facilities]. / Ochratoxin A Analysen im Blut von Arbeitnehmern in der Abfallwirtschaft.

Tasks such as manual sorting of domestic wastes for recyclable goods and the deposition of various materials may result in inhalation of mycotoxin-containing aerosols. Ochratoxin A (OTA) was analyzed in blood samples from workers employed at waste handling facilities in Southern Germany to assess the potential impact of this mycotoxin, and explore its use as a biomarker of exposure to bioaerosols. Results from this analysis are reported: OTA serum levels (median values) in subgroups of workers involved in waste deposition (n=76 'Deponierer') or in waste sorting (n=60 'Wertstoffsortierer') were 0.36 and 0.53 ng/ml, respectively. Both groups are natives of countries within the European Community (EU). In waste sorters who were born in other European (non-EU) countries (n=72) or elsewhere (n=12 from Asia, Africa), the OTA serum levels were 0.50 and 0.37 ng/ml, respectively. In controls (n=84 office clerks at the facilities; EU citizens) the median OTA value was 0.39 ng/ml. Comparing the different groups, and previously published data on median OTA levels in the general population (0.21 ng/ml) which result from dietary (background) exposure to OTA in Germany, our data point to an additional uptake of this mycotoxin by inhalation in workers with exposure to bioaerosols. The results support the view that apart from the pathogenic and allergological relevance of microbial emissions from garbage, secondary fungal metabolites, and thus toxicological aspects, deserve further attention.

One-year mortality among unselected outpatients with heart failure.

OBJECTIVE: To estimate 1-year mortality and prognostic factors in unselected outpatients with heart failure, and to compare the observed mortality with the estimates of the primary care physicians. METHODS AND RESULTS: Four hundred and eleven consecutive patients with heart failure New York Heart Association (NYHA) class II-IV (mean population age 75 years, 56% males) were enrolled in 71 primary care offices throughout Switzerland. During a mean follow-up period of 1.4 years, 68 patients had died. One-year total mortality was 12.6% compared to 4.3% in the underlying Swiss population (standardized mortality ratio 3.0). Among patients with heart failure NYHA II, III and IV, mortality was 7.1%, 15.0% and 28.0%, respectively. In multivariate Cox regression, statistically significant (P<0.05) predictors of mortality were NYHA class (NYHA III: risk ratio [RR]=1.6; NYHA IV: RR=2.2), recent hospital stay for heart disease (RR=2.3), creatinine>120 micromol.l(-1) (RR=1.8) systolic blood pressure<100 mmHg (RR=2.4), heart rate>100 min(-1) (RR=2.7), age (per 10 years, RR=1.6) and female gender (RR=0.49). Among patients with reduced left ventricular ejection fraction, 1-year mortality was 14.3%, and predictors were similar except that female gender was no longer associated with reduced mortality. Primary care physicians significantly overestimated 1-year mortality (estimated mortality 25.9% vs observed mortality 12.6%,P =0.001). CONCLUSIONS: Unselected outpatients with heart failure have a poor prognosis, particularly those with advanced heart failure and a recent hospital stay for heart disease. Primary care physicians are aware of the high mortality of this growing patient population.

[Not Available]. / Ochratoxin A Analysen im Blut von Wertstoffsortierern und Deponie-Beschäftigten: Zwischenauswertung.

The results support the view that apart from the pathogenic and allergological relevance of microbial emissions from garbage, secondary fungal metabolites, and thus toxicological aspects, deserve further attention.

Information-theoretic analysis of neural coding.

We describe an approach to analyzing single- and multiunit (ensemble) discharge patterns based on information-theoretic distance measures and on empirical theories derived from work in universal signal processing. In this approach, we quantify the difference between response patterns, whether time-varying or not, using information-theoretic distance measures. We apply these techniques to single- and multiple-unit processing of sound amplitude and sound location. These examples illustrate that neurons can simultaneously represent at least two kinds of information with different levels of fidelity. The fidelity can persist through a transient and a subsequent steady-state response, indicating that it is possible for an evolving neural code to represent information with constant fidelity.

Intrauterine treatment of fetal goitrous hypothyroidism controlled by determination of thyroid-stimulating hormone in fetal serum. A case report and review of the literature.

We report a rare case of fetal goitrous hypothyroidism complicated by polyhydramnios and preterm labor in a mother without thyroid gland pathology. The diagnosis was made in the 26th week by ultrasound and cordocentesis [TSH 170 microU/ml, free T(4) 0.2 ng/dl]. The therapeutic regime required repeated fetal blood sampling for determination of thyroid hormones. Five intra-amniotic administrations of 250 microg levothyroxine (LT4) weekly were initiated. Because of the persisting goiter and the elevated level of TSH (128 microU/ml in 32 weeks) in the fetal serum the dosage had to be adjusted to 500 microg LT4 in the next five injections. TSH in fetal serum declined to 49.2 microU/ml in 36 weeks. Normal fetal growth and an uncomplicated course of pregnancy between the 27th and 37th week of gestation were observed. Monitoring of intrauterine therapy by determination of TSH in fetal serum may provide more reliable data than measuring TSH in amniotic fluid. A review of 15 cases of fetal goitrous hypothyroidism in the English literature is presented.

Rapid development of hydrops fetalis in the donor twin following death of the recipient twin in twin-twin transfusion syndrome.

Intrauterine death of one fetus in monochorionic twinning is associated with high rates of perinatal morbidity and mortality in the surviving fetus. Subsequent development of hydrops fetalis in the donor twin after fetal demise of the recipient twin has been described in only two case reports and pathophysiology remains unclear. We report on a monochorionic-diamniotic twin pregnancy complicated by severe twin-twin transfusion syndrome. Ultrasound examination at 20 weeks of gestation showed discrepant twins with oligohydramnios in the smaller twins' sac and polyhydramnios in that of the larger twin. Repeated amniocenteses permitted prolongation of the pregnancy. However, the recipient twin developed deteriorating hydrops fetalis and died at 28 weeks of gestation. After this event, subsequent development of hydrops fetalis in the surviving donor twin could be observed, as well as an increase of amniotic fluid. An elective cesarean section was performed at 29 weeks of gestation. Initial hypoxemia could be effectively treated by high frequency oscillatory ventilation, surfactant therapy and inotropic support. The infant was discharged in good condition at the age of 2 months. Although rare, antenatal demise of the recipient twin in a monochorionic pregnancy can be associated with the subsequent development of hydrops fetalis in the surviving donor twin. We speculate that this phenomenon is due to ischemia-reperfusion injury of the previously poorly perfused twin.

[Effect of microbial aerosols on the human]. / Wirkung von mikrobiellen Aerosolen auf den Menschen.

Based on numerous publications dealing with the effects of microbial emissions on workers in waste processing plants and on few papers concerning the assessment of the environmental health relevance of microbial aerosols on people living in the vicinity of composting facilities, the current state of the art in this field is presented. With regard to occupational exposure the possible health effects like infections, toxicity and allergies are specified. Since to date only few studies have been made of populations exposed to microbial aerosols in ambient air, the environmental health aspects are reviewed in the context of a study of three compost plants in Hesse, where ambient air measurements as well as epidemiological investigations were carried out. Final recommendations are given and the research needs regarding the environmental health significance of microbial aerosols are formulated.

[Health risk to workers in recycling plants and on waste disposal sites]. / Untersuchungen zur gesundheitlichen Gefährdung von Arbeitnehmern in Wertstoffsortieranlagen und auf Deponien.

Two groups of workers in garbage sorting plants and waste landfills and a control group of community employees were physically examined. In garbage sorting plants elevated microbial counts were measured in the air of the workplace compared to outdoor air microbial counts (cfu/m3). Workers in garbage treatment plants were higher exposed to airborne microbial agents. In consequence immunological reactions and the occurrence of workplace related symptoms were found more frequently, These symptoms are described in literature as mucous membrane irritation syndrome (MMI). More infectious diseases were seen in workers in garbage treatment plants than in the control group. As significant more health problems were seen in groups exposed to very high concentrations of microbial agents in the air at the workplace (moulds more than 10(5) cfu/m3, bacteria more than 10(4) cfu/m3), this study supports the recommendations in the LASI-guidelines 1, 13 and 15 and the TRGS 540 to reduce the microbial load in the air at the workplace.

[What is the role of Doppler color sonography associated with echo-signal enhancing levovist in complementary breast diagnosis?]. / Welche Rolle spielt die Farbdopplersonographie, unterstützt mit dem Echosignalverstärker Levovist, in der komplementären Mammadiagnostik?

At the women's hospital of the University of Erlangen we performed a prospective clinical study to evaluate the use of color Doppler imaging supported by the new echo contrast agent Levovist in comparison to clinical examination, B-mode sonography, mammography, and MRI. In 40 patients the sensitivity and specificity of each method was estimated in predicting the dignity of palpable or mammographically detectable tumors of the breast. Prior to and after administration of Levovist we recorded the number of vessels, the PI, RI, SD-ratio, and maximum flow velocity after correction of the angle. Color Doppler imaging of the tumor and the surrounding tissue was documented on video tape for five minutes after the administration of Levovist. We measured the time until an increase and decrease in color signal was detectable. The following sensitivities/specificities were found: clinical examination 57.1% (12/21)/73.7% (14/19), B-mode sonography 100% (21/21)/84.2% (16/19), mammography 100% (21/21)/89.5% (17/19) and MRI 92.3% (14/15)/78.6% (15/18). Without the contrast agent color Doppler imaging could not differentiate between malignant and benign lesions. There was no significant difference in the perfusion of benign and malignant tumors. However, after the administration of Levovist, there appeared to be a significant difference for SD-ratio. With a cut-off-level of 3.5 we found a sensitivity/specificity of 85% (17/ 20)/78.6% (11/14) for the Doppler method. There was a weak correlation between the time of appearance of the augmented Signal in color Doppler and the velocity of enhancement of the contrast agent in MRI (n = 24, r = 0.47, p = 0.02). Only with the use of a contrast agent was color Doppler ultrasound able to support the other methods in pre-operative differentiation of benign and malignant lesions in the breast.

[The exencephaly-anencephaly sequence. Ultrasound diagnosis in early pregnancy]. / Die Exenzephalie-Anenzephalie-Sequenz. Ultraschalldiagnostik in der Frühschwangerschaft.

AIM: In animal studies exencephaly is well described as a precursor of anencephaly. We have evidence that also in the human fetus the transition from exencephaly to anencephaly is possible. METHOD: We diagnosed either exencephaly or anencephaly by high-frequency vaginal ultrasound in 14 human fetuses at gestational ages varying between 9 + 4 and 22 + 3 weeks. RESULTS: In the first trimester exencephaly was the predominant finding, while in the second trimester the classic appearance of anencephaly was seen more often. In one fetus with exencephaly diagnosed at a gestational age of 12 + 2 weeks, where the parents decided not to intervene, the transition to anencephaly was documented by serial ultrasound examinations. CONCLUSIONS: Our findings support an exencephaly-anencephaly sequence also in humans. The cephalic changes resulting in the classic anencephalic appearance are of importance for the first trimester diagnosis with high resolution vaginal probe ultrasound.

Another quasi-experimental study of understanding/appreciation of editorial satire.

College students completed a 17-item scale measuring the "propensity to argue controversial topics" and 7 other nominal-scale independent variables. They then read three editorial satires and checked which of five statements was the intended thesis of each satire's author. They also rated each satire on interestingness and funniness. Analysis indicated dependence between understanding of satire and sex and regular readership of "The Far Side."

Common respiratory and gastrointestinal illness in paediatric student nurses and medical technology students.

The aim of this study was to establish the risk of acquiring common respiratory and gastrointestinal illness for paediatric nurses. Using self-administered questionnaires, student nurses at two children's hospitals and students at one school of medical technology reported biweekly the number of minor illnesses, symptoms, and indicators of severity of infection over a 3-year period (1975-8). Although a systematic bias was evident with some symptoms, others appeared to be quite reliable. The following four syndromes were defined to estimate the risk: upper respiratory syndrome (URS), lower respiratory syndrome (LRS), respiratory and gastrointestinal syndrome (RGS), and gastrointestinal syndrome (GS). Surveillance days were allocated to groups with high- or low-intensity contact with children. The incidence of all illnesses was 2.9 per person-year in the low-intensity contact group and 4.4 per person-year in the high-intensity contact group. The reported incidence of LRS and RGS in the high-intensity contact group was 1.55 times higher than in the low-intensity group (P less than 0.001). LRS and RGS incidence was similar in nurses at both schools. During low contact periods it corresponded to that of the medical technologists.

Seroepidemiological studies on the occurrence of common respiratory infections in paediatric student nurses and medical technology students.

The occupational risk of acquiring minor respiratory infections for paediatric student nurses was estimated by performing serological examinations with influenza A, B, C, parainfluenza, mumps, respiratory syncytial virus, adenovirus and Mycoplasma pneumoniae at 6-month intervals over a period of 4 years in paediatric student nurses at two schools of nursing and students at one school of medical technology. Titre increases against all tested agents occurred 1.86 times more often in the student nurses than in the medical technology students, the most frequent agents in both groups being influenza A and B. No difference in the relative distribution of the agents could be verified in the two occupational groups. Data on the protective value of pre-infectious antibody levels for influenza A, B, and coronavirus OC43 and on the importance of the spread of single agents among classmates are presented.