Validity of carbohydrate-deficient transferrin (%CDT), gamma-glutamyltransferase (gamma-GT) and mean corpuscular erythrocyte volume (MCV) as biomarkers for chronic alcohol abuse: a study in patients with alcohol dependence and liver disorders of non-alcoholic and alcoholic origin.

AIM: To test the clinical performance of carbohydrate-deficient transferrin (%CDT), gamma-glutamyltransferase (gamma-GT) and mean corpuscular erythrocyte volume (MCV) as biomarkers for alcoholism with a special focus on patients suffering from liver diseases. DESIGN: Well-characterized collectives of alcohol-dependent patients with current consumption (ALC patients, n = 101), and relevant control groups (115 social drinkers, 46 patients with unspecifically increased gamma-GT, 51 hepatitis patients and 20/31 patients with non-alcohol/alcohol-dependent liver cirrhosis) were included into the study. The Positive Alcohol Use Disorders Test (AUDIT) score, International Classification of Diseases version 10 (ICD-10)/Diagnostic and Statistical Manual version IV (DSM-IV) criteria and blood drawn within 4 days of last drinking were inclusion criteria for subjects with regular heavy drinking. %CDT was determined using an automated assay which recently had been completely modified. FINDINGS: Median AUDIT scores of patients without/with regular heavy drinking were 1-3/27. The following medians/95th percentiles were obtained for %CDT: social drinkers 2.2/3.0, patients with unspecifically increased gamma-GT 2.1/3.0, hepatitis 2.0/4.4, non-alcohol-dependent liver cirrhosis 2.4/4.8, alcohol-dependent liver cirrhosis 3.0/5.9, ALC patients 3.9/14.9. Differences between patients without and with alcohol abuse were highly significant (P < 0.001). No differences in CDT values were found between males and females. There was no correlation between %CDT values, gamma-GT, MCV and the amount of alcohol consumed in ALC patients; 3.0%CDT (95th percentile social drinkers) is proposed as cut-off for the test used (Tina-quant %CDT 2nd-generation). At this cut-off, the sensitivity for ALC patients was 73.3%, whereas gamma-GT/MCV had a sensitivity of 71.3%/64.4%. Multivariate analysis performed at 95% specificity resulted in an improvement of the sensitivity by combining %CDT with gamma-GT (83.2%). A further enhancement of the sensitivity to 88.1% was obtained by combination of %CDT, gamma-GT and MCV. The diagnostic specificity of %CDT calculated at the cut-off of 3% was 93.5% in patients with unspecifically increased gamma-GT, 88.2% in hepatitis patients and 70.0% in patients with non-alcohol-dependent liver cirrhosis. %CDT was more specific in these patient collectives than MCV, and especially more than gamma-GT (specificity in hepatitis 52.9%, and 35.0% in non-alcohol-dependent liver cirrhosis). CONCLUSION: %CDT is of high diagnostic value to support diagnosis of alcohol-use disorders. The specificity of this marker in patient groups with liver disorders is superior to the biomarkers gamma-GT and MCV.

Is obesity a risk factor for childhood asthma?

BACKGROUND: In adolescents and adults, an association between obesity and asthma was found in females. Does this sex-specific association already exist in young children? METHODS: Questionnaire data on 9357 5- and 6-year-old German children were collected in 1997 in two rural regions in Bavaria. The diagnosis of asthma, hay fever, and eczema was ascertained with the ISAAC core and other validated questions. Overweight was defined by a BMI of >90th and < or =97th percentile and obesity by a BMI of >97th percentile. RESULTS: The lifetime prevalence of doctor's diagnosed asthma in girls was 3.5% (95%, CI 2.9-4.1%) for normal weight, 5.8% (95% CI 3.2-8.4%) for overweight, and 10.3% (95% CI 5.3-15.2%) for obesity, whereas no relation to weight was found in boys. Hay fever and eczema were unrelated to weight in girls and boys. The adjusted odds ratio for asthma in girls was 2.12 (95% CI 1.22-3.68) for overweight and 2.33 (95% CI 1.13-4.82) for obesity. CONCLUSIONS: A sex-specific association with doctor's diagnosed asthma was also observed in girls at school entry. Since this association was confined to doctor's diagnosed asthma in the absence of other atopic conditions, and no association with other atopic manifestations was found, we hypothesize that this association is related to factors other than atopic sensitization.

Prevention of childhood leukemia by BCG vaccination in newborns? A population-based case-control study in Lower Saxony, Germany.

Data from a case-control study in Lower Saxony, Germany, were used to assess whether the risk for childhood cancer may be reduced by bacille Calmette-Guérin (BCG) vaccination in the neonatal period. There were 420 newly diagnosed childhood cancer cases from the German cancer registry and 613 controls eligible for this study. A mailed questionnaire was completed during a telephone interview with parents. Details on the perinatal history were abstracted from the birth charts by nurses blinded to the children's case-control status. Complete information was available for 259 cases and for 323 controls. A total of 85% of the controls had been BCG vaccinated in the newborn period. The adjusted odds ratios for BCG vaccination were 0.90 (95% confidence interval; 0.51-1.61) for leukemia and 0.61 (95% confidence interval; 0.25-1.50) for other cancers. Based on these data the probability of a 50% or more reduction of more reduction of the cancer risk by BCG vaccination in the newborn period is small. The statistical power of this study, however, was not high enough to rule out a smaller, still relevant reduction in cancer risk.

Breast feeding and obesity: cross sectional study.

OBJECTIVE: To assess the impact of breast feeding on the risk of obesity and risk of being overweight in children at the time of entry to school. DESIGN: Cross sectional survey SETTING: Bavaria, southern Germany. METHODS: Routine data were collected on the height and weight of 134 577 children participating in the obligatory health examination at the time of school entry in Bavaria. In a subsample of 13 345 children, early feeding, diet, and lifestyle factors were assessed using responses to a questionnaire completed by parents. SUBJECTS: 9357 children aged 5 and 6 who had German nationality. MAIN OUTCOME MEASURES: Being overweight was defined as having a body mass index above the 90th centile and obesity was defined as body mass index above the 97th centile of all enrolled German children. Exclusive breast feeding was defined as the child being fed no food other than breast milk. RESULTS: The prevalence of obesity in children who had never been breast fed was 4.5% as compared with 2.8% in breastfed children. A clear dose-response effect was identified for the duration of breast feeding on the prevalence of obesity: the prevalence was 3.8% for 2 months of exclusive breast feeding, 2.3% for 3-5 months, 1.7% for 6-12 months, and 0.8% for more than 12 months. Similar relations were found with the prevalence of being overweight. The protective effect of breast feeding was not attributable to differences in social class or lifestyle. After adjusting for potential confounding factors, breast feeding remained a significant protective factor against the development of obesity (odds ratio 0.75, 95% CI 0.57 to 0.98) and being overweight (0.79, 0.68 to 0.93). CONCLUSIONS: In industrialised countries promoting prolonged breast feeding may help decrease the prevalence of obesity in childhood. Since obese children have a high risk of becoming obese adults, such preventive measures may eventually result in a reduction in the prevalence of cardiovascular diseases and other diseases related to obesity.

[Clinical and therapeutic aspects of essential blepharospasm]. / Klinische und therapeutische Aspekte des essentiellen Blepharospasmus.

The rare disease of blepharospasm which is nowadays believed to be an extrapyramidal dystonic movement disorder is discussed in clinical, differential diagnostic and therapeutic viewpoints. The abundant number of treatment methods proposed in the literature are critically reviewed. 13 cases are described, which were treated by our own surgical procedure - a modified neurotomy of branches of the parotid plexus. The importance of botulinum-toxin treatment in mild and moderate cases of blepharospasm, as well as the success and low rate of complications in neurotomy-treated patients with severe eyelid spasms, is stressed.

Rupture of a giant aneurysm of the inferior wall of the internal carotid artery after saphenous vein interposition graft to the middle cerebral artery.

A patient with a giant aneurysm of the inferior wall of internal carotid artery presented with progressive vision failure with optic nerve atrophy on the left eye. She underwent exploration of the aneurysm, which was found impossible to clip. Clamping of the common carotid artery was not tolerated there being inadequate collateral circulation. A saphenous vein graft was interposed between the occipital artery and a branch of the middle cerebral artery. The previously unruptured aneurysm bled fatally 4 hours after surgery, just before intended clipping of the aneurysm or ligation of the internal carotid artery.

The calcium entry blocker nimodipine improves the quality of life of patients operated on for cerebral aneurysms. A 5-year follow-up analysis.

Between 1981 and 1985 at our clinic 204 consecutive patients underwent surgical repair of cerebral aneurysms after spontaneous subarachnoid hemorrhage. Of these 113 were treated with Nimodipine, a predominantly cerebrovaskular-active substance. The preoperative condition according to Hunt and Hess (9), the locations of the aneurysms, and the ages of the two groups of patients were directly comparable. The incidence of postoperative cerebral vasospasm was however higher in the Nimodipine group (49%) than in the control group (33%). Retrospectively we analyzed the progress of the patients as to their neurological, intellectual, and social function for up to five years after the operation. Mortality and morbidity in the Nimodipine group amounted to 10% and 7% respectively, in the group without Nimodipine 20% and 17% respectively (p less than 0.001). Of the Nimodipine patients, 72% showed excellent neurological outcome, with 73% intellectually, and 72% completely resocialized, as compared to 53% in the control group with an excellent neurological outcome, 39% intellectually intact (p less than 0.0001, and 52% completely resocialized (p less than 0.01). These results suggest that Nimodipine not only increases cerebral blood flow, but also protects brain tissue from ischemic damage.

Photodynamic therapy of malignant brain tumours: a phase I/II trial.

Twenty patients bearing malignant brain tumours (18 glioblastoma multiforme, one malignant meningioma, one melanoma metastasis) were treated 25 times with photodynamic therapy (PDT)--the combination of Hematoporophyrin derivative and light at 630 nm (40-120 J/cm2). Sixteen times the PDT was followed immediately by a single dose radiation of 4 Gy of fast electrons. Conventional radiotherapy following PDT was performed in eight patients. The median survival of three patients with multiple recurrences of glioblastoma grade IV and various chemo- and radiotherapy was 5 months. Four out of 10 patients with one recurrence and prior treatment died with a median survival of 5 months, six are still living up to 12 months. Six patients with a primary glioblastoma are surviving now up to 22 months. Phototoxicity to the skin, the only side effect of PDT, was noted in five cases, but did not pose any threat to the patients. The treatment did not affect the quality of life of the patients. Our preliminary results with the photodynamic treatment of malignant gliomas indicate that PDT might be a valuable addition to our armament in the treatment of such tumours.

A thrombosed giant MCA aneurysm in a ten-week-old infant.

A 10-week-old child was operated upon for a left temporal intracerebral haematoma resulting from a ruptured giant MCA aneurysm. The aneurysm was found accidentally during the operation because there was no filling on angiography. The aneurysm was clipped successfully and the child's postoperative course was uneventful. Similar cases in the literature as well as possible aetiological circumstances in childhood aneurysms are discussed.

Macroprolactinomas and functionless pituitary tumours. Immunostaining and effect of dopamine agonist therapy.

In 32 patients with macroprolactinomas or functionless pituitary macroadenomas biochemical and clinical data were correlated with PRL immunocytochemistry. Serum PRL levels revealed a positive correlation with tumour PRL content. Hyperprolactinaemia of 3000 mU/l or more was found only in patients with PRL-positive tumours. In 15 patients with borderline hyperprolactinaemia (below 3000 mU/l), 7 PRL-positive and 8 PRL-negative macroadenomas were found, and in 9 normoprolactinaemic patients 4 PRL-positive and 5 PRL-negative macroadenomas. Patients with PRL-immunostainable tumours had significantly higher median basal serum PRL (P less than or equal to 0.05) than patients with PRL-negative tumours. PRL stimulation after TRH, basal and GnRH-stimulated FSH and LH did not show significant differences between the two groups. A discriminant analysis using 6 biochemical variables was attempted to differentiate between PRL-negative and -positive tumours, which would be helpful in patients with borderline hyperprolactinaemia. Dopamine agonist therapy led to suppression of serum PRL with few exceptions in patients with PRL-positive and -negative tumours, whereas shrinkage was only observed in PRL-immunostainable tumours with high serum PRL levels (over 18,000 mU/l). All patients with PRL-negative tumours showed no change or even growth of the tumour despite dopamine agonist therapy. Our observations indicate that a pituitary macroadenoma associated with serum PRL of more than 3000 mU/l is most probably a prolactinoma (tumour immunostainable for PRL). Dopamine agonist therapy is effective in PRL suppression and tumour shrinkage in most of these patients. Macroadenomas without hormone hypersecretion or with borderline hyperprolactinaemia below 3000 mU/l may or may not contain PRL-immunostainable cells.(ABSTRACT TRUNCATED AT 250 WORDS)

[Hydrocephalus following spontaneous subarachnoid hemorrhage]. / Hydrozephalus nach spontaner Subarachnoidalblutung.

In the period 1980-1985 221 patients presenting with subarachnoid haemorrhage were operated on at the Department of Neurosurgery of the University of Innsbruck. 26 patients (11.7%) of them required a ventriculoatrial or ventriculoperitoneal shunt. The relationship between the incidence of this complication and the various clinical features of subarachnoid haemorrhage is discussed. Computed tomography is the most important investigative tool for diagnosis and follow-up of hydrocephalus. The results after shunt operation are correlated with the site of the aneurysm and the pre-operative grade of the patient.

[Intracranial manifestation of so-called "melanotic neuroectodermal tumor of infancy"--a choristoma with neural crest potentials]. / Intrakranielle Manifestation eines sogenannten "melanotischen neuroektodermalen Tumors des Säuglingsalters"--Ein Choristom mit Neuralleistenpotenzen.

A case is reported of so-called "melanotic neuroectodermal tumour of infancy" (= MNTI) in a female newborn. The tumour, whose localization was intracranial, but extracerebral, could be removed subtotally. A further 22 cases of the MNTI with neurocranial manifestations reported in the literature, but differing from our case in their extracranial growth, are listed for comparison. We believe that the neural crest is the histogenic origin of the MNTI and, therefore, our proposed definition is: "Christoma with neural crest potencies."

[Photodynamic therapy of malignant brain tumors]. / Photodynamische Therapie von malignen Hirntumoren.

The combination of haematoporphyrin derivative (HPD) and visible light at 630 nm, termed as photodynamic treatment (PDT), provides a new tool in tumour therapy, causing selective tumour destruction initiated by photochemical reactions. Up to now 13 patients with malignant brain tumours (12 glioblastoma multiforme, 1 leiomyosarcoma) were treated with 40-80 J/cm2 light following parenteral or direct injection of HPD (5 mg/i.a. or 1 mg/ccm tumour volume). In 5 patients the PDT was followed by subsequent radiotherapy with 4 Gy. The patients with recurrent tumour showed a median survival time of 5 months, whereas the 6 patients with primary manifestations have survived so far for periods of up to 9 months. However, the follow up period is too short to allow final conclusions to be reached on the effect of PDT in the treatment of malignant brain tumours.

[Simultaneous occurrence of brain tumors and aneurysms]. / Gleichzeitiges Vorkommen von Hirntumoren und Aneurysmen.

Three patients with different types of intracranial tumour--glioma, meningioma and pituitary adenoma--and associated aneurysms are described. The aetiology of aneurysm formation in the presence of tumours is discussed and a review of the literature given.

Tractotomy and partial vertical nucleotomy--for treatment of special forms of trigeminal neuralgia and cancer pain of face and neck.

The therapy of face and neck pain has often been elusive. We attempted to improve the condition of these patients and tried to influence 1. pain of trigeminal neuralgia, where other forms of therapy had failed, 2. pain due to tumours in the distribution of the Vth, IXth and Xth nerve, when all other methods had proved to be unsuccessful, 3. pain due to a traumatic lesion of the Vth nerve after severe injury of the face and 4. pain in the first division of the Vth nerve after herpes zoster infection, when other forms of therapy had failed. After tractotomy the subnucleus caudalis n.V. is partially destroyed. Aim of the partial vertical nucleotomy is the interruption between the first and second neuron of the Vth nerve conveying pain and thermal sensibility, but also of the IXth and Xth nerve, which end in the subnucleus caudalis n.V. as well. Tactile and some thermal sensibility in the face is so retained, and anesthesia dolorosa or keratitis neuroparalytica avoided. Medially of and vertically to the tractotomy a 4-6 mm long incision both cranially and caudally of the tractotomy was made. For the first division of the Vth nerve the nucleotomy is performed on the lateral end of the tractotomy incision. In the patients with cancer of the face and neck a rhizotomy C 1/2 was added. 7 of the 12 patients with trigeminal neuralgia and 3 of the 6 patients with tumors of the face and neck were pain-free. The rest also showed a marked improvement.(ABSTRACT TRUNCATED AT 250 WORDS)

[Epidermoid in the 4th ventricle]. / Uber ein Epidermoid im IV. Ventrikel.

A case of pearly tumor (cholesteatoma or epidermoid cyst) of the IV. ventricle in a patient aged 64 years is reported. The patient had been treated one year earlier for lumbar herniated nucleus pulposus. The symptoms, pathogenesis, CT-appearance and operative therapy of the cyst are discussed.

[Partial vertical nucleotomy as a modification of tractotomy of the trigeminal nerve]. / Partielle vertikale Nukleotomie als Modifikation der Traktotomie des Nervus trigeminus.

The authors report on partial vertical nucleotomy, a modification of tractotomy of the quintothalamic tract. In 1979 eight patients underwent this procedure. Three of them showed a recurrence of pain from genuine trigeminal neuralgia. Three patients had symptomatic trigeminal neuralgia, one patient atypical neuralgia of the face without organic cause, whereas in one case the neuralgia occurred subsequent to a herpes zoster. At the time of examination all patients were free from pain.

[Intraneural ganglion of the ulnar nerve. Case description]. / Intraneurales Ganglion des N. ulnaris. Fallbeschreibung.

The authors report on an intraneural ganglion of the ulnar nerve. Intraneural ganglia are rare lesions. Diagnosis, clinical appearance, operating technique and etiology are discussed and the literature reviewed.