A new electromechanical trainer for sensorimotor rehabilitation of paralysed fingers: a case series in chronic and acute stroke patients.

BACKGROUND: The functional outcome after stroke is improved by more intensive or sustained therapy. When the affected hand has no functional movement, therapy is mainly passive movements. A novel device for repeating controlled passive movements of paralysed fingers has been developed, which will allow therapists to concentrate on more complicated tasks. A powered cam shaft moves the four fingers in a physiological range of movement. METHODS: After refining the training protocol in 2 chronic patients, 8 sub-acute stroke patients were randomised to receive additional therapy with the Finger Trainer for 20 min every work day for four weeks, or the same duration of bimanual group therapy, in addition to their usual rehabilitation. RESULTS: In the chronic patients, there was a sustained reduction in finger and wrist spasticity, but there was no improvement in active movements. In the subacute patients, mean distal Fugl-Meyer score (0-30) increased in the control group from 1.25 to 2.75 (ns) and 0.75 to 6.75 in the treatment group (p < .05). Median Modified Ashworth score increased 0/5 to 2/5 in the control group, but not in the treatment group, 0 to 0. Only one patient, in the treatment group, regained function of the affected hand. No side effects occurred. CONCLUSION: Treatment with the Finger Trainer was well tolerated in sub-acute & chronic stroke patients, whose abnormal muscle tone improved. In sub-acute stroke patients, the Finger Trainer group showed small improvements in active movement and avoided the increase in tone seen in the control group. This series was too small to demonstrate any effect on functional outcome however.

Three-dimensional flow instabilities in a thermocapillary-driven cavity.

A linear stability analysis of the buoyant-thermocapillary flow in open rectangular cavities with aspect ratios in the range Gamma=1.2 to 8 is carried out for Prandtl number Pr=10 and conditions of previous experiments. The results are in very good agreement with most available experimental data. The energy transfer between the basic and the perturbation flow reveals that buoyancy is not directly instrumental in the instabilities. For aspect ratios less than about three a stationary three-dimensional cellular flow arises. The instability relies on the lift-up mechanism operating in the shear layer below the free surface and it is aided by weak Marangoni forces. For larger aspect ratios Marangoni effects play a more significant role. While plane hydrothermal waves may appear a certain distance away from the hot wall for sufficiently large aspect ratios, the instability at intermediate aspect ratios is strongly influenced by the local nonparallel basic-flow structure.

[Laparoscopic hernioplasty by total extraperitoneal approach]. / Die laparoskopische Hernioplastik nach dem TEP-Verfahren -- Eine Analyse und Nachbeobachtung von 195 Fällen.

INTRODUCTION: Despite the increasing acceptance of the TEP-procedure by patients and general practitioners this method has to be further examined. In addition to the classic surgical criteria of examination, subjective aspects of patient comfort must be taken into consideration as they are getting more and more significant for the evaluation of different methods. METHODS: According to this targets patients were clinically examined and questioned about specific topics regarding their quality of life after TEP-surgery and evaluated prospectively. RESULTS: Between 1995 and 2000 endoscopic total extraperitoneal hernioplasty (TEP) was used for 200 inguinal hernia repairs in 195 patients. 195 patients could be interviewed about the operation's outcome and examined physically and sonographically after 3 months, 188 patients after 6 months and 184 patients after 12 months post-op. The recurrence rate was 1.7 %, the rate of major complications was < 1 %. Sensitivity disorders were found in 7.3 % of all cases at the final examination prior to discharging but none at the 3 months check-up. The median postoperative period until the resumption of sexual intimacy was approximately two weeks, but one male patient reported about long-lasting pain in copulation (0.51 %). DISCUSSION: With regard to the aspects mentioned above, the TEP-procedure provided excellent results in the examined patient cohort and therefore turned out to be at least comparable with competitive endoscopic methods. A remarkable new finding was that patients could go back to work on average 2 weeks earlier than regaining their everyday fitness.

[German-speaking memory clinics: state of the art and practical recommendations]. / Erkennung und Behandlung der Demenz in den deutschsprachigen Memory-Kliniken: Empfehlungen für die Praxis.

The 7th annual meeting of the memory clinics of Germany, Switzerland and Austria in March 2002 in Göttingen, Germany was an optimal opportunity to make an inventory about the state of the art in diagnostic and therapy of dementia and mild cognitive impairment in German-speaking memory clinics. Several problems were discussed including difficulties in 1) diagnosis of patients with aphasia or foreign patients, 2) handling of demented patients without a caregiver, 3) psychological support for patients, who have been diagnosed in a very early stage, 4) misunderstandings between general practitioners, neurologists and psychiatrists in private practice on the one hand and the memory clinics on the other hand, 5) recommendations for prevention of dementia, 6) recommendations concerning dementia and car driving and 7) questions of genetic counselling. The following paper is a summary of the results of a workshop in Göttingen and gives practical recommendations based on the experiences of the memory clinics.

Association between polymorphisms in candidate genes and morbid obesity.

Polymorphisms in a number of candidate genes have been reported to be associated with obesity. We have determined the incidence of the following polymorphisms in the following candidate genes in a group of 388 morbid obese patients (mean body mass index (BMI) 52+/-8.01) who underwent gastric banding surgery: lipoprotein lipase (LpL) t-93 g and N291S; peroxisome proliferator receptor gamma (PPARgamma), P12A, P115Q and c1431t; peroxisome proliferator receptor alpha (PPARalpha) L162V; beta-adrenergic receptor 2 (beta-AR 2), Q27E; beta-adrenergic receptor 3 (beta-AR 3) W64R; uncoupling protein 1 (ucp-1), a-3826g, ucp-2, 45 bp insertion. Only for the ucp2 polymorphism did we find a statistically significant association with obesity. The beta-AR 3 W64R and ucp-1 a-3826g polymorphisms influenced the rate of the development of obesity and may act synergistically.

Results of bariatric surgery.

OBJECTIVE: To present the results of bariatric surgery performed in our hospital over the last ten years. DESIGN: Longitudinal, clinical intervention with obesity surgery. SUBJECTS: To date in our hospital we have performed bariatric surgery on 496 patients. Ninety-seven percent of them received a restrictive method and 3% a combined procedure. The mean age of our patients was 39+/-9 y. The mean weight was 144+/-28 kg which corresponds to a mean BMI of 51+/-8 kg/m(2). The gender distribution is 18% male and 82% female patients. MEASUREMENTS: Success of surgery with early and late complications, no laboratory measurements. RESULTS: The early postoperative complications were the following: wound infection 3%, lethality 1.2%, pleural infusion 0.7% and evisceration 0.5%. The important late complications were pouch dilatation and stomastenosis in 18% and staple line disruption in 11%. Slippage of the adjustable silicone gastric banding (ASGB) amounted to 5% and hernias emerged in 7% of patients. A migration and band infection occurred in 0.7%. Reoperations were necessary in 10% of the silastic ring vertical gastroplasty (SRVG) and in 39% of the ASGB patients. Patients were followed up every two months in the first year and later, annually. Blood samples were taken after 25%, 50%, 75% and 100% loss of excess weight. To date, 91% of our patients have reached an excess weight loss of 25%. 71% lost half of their overweight and one third (32%) were able to reduce it by 75%. 8% of our patients attained normal weight. CONCLUSIONS: For long term compliance and to avoid regain of weight, a close follow-up is necessary. We therefore offer special care which, in addition to the postoperative surgical care, includes visits by dieticians, internists, psychologists as well as exercise therapy. Knowledge of morbid obesity and skill in bariatric surgery are prior conditions to avoid complications and for success in bariatric surgery.

Phototaxis in the ciliated protozoan Ophryoglena flava: dose-effect curves and action spectrum determination.

The sensitivity of positive phototactic orientation of cells of the ciliated protozoan Ophryoglena flava has been measured for white light, broad-band blue and red light, and narrow-band monochromatic light, using a laboratory-developed computer aided system. The white-light fluence rate-response curve shows that there is no negative phototaxis in the fluence rate range investigated (0-15 W/m2) and no adaptation phenomena; it is very well fitted by a hyperbolic function; the fluence rate curves under broad band blue and red light (full width at half maximum, FWHM= 100 nm) can be fitted by the same model. The saturation level is, within experimental errors, the same for the three curves, indicating that there are no chromaticity effects and that if there is more than one photoreceptor pigment, they act independently of each other. The fluence rate-response curves determined under narrow band monochromatic light (FWHM = 10 nm) can also be fitted by the same model and show, within experimental errors, the same saturation level. An action spectrum for positive phototaxis at 10-nm intervals has been calculated from fluence rate-response curves: it shows three maxima, at 420, 540 and 590 nm. This action spectrum is significantly different from the ones for photomotile responses in Blepharisma japonicum, Stentor coeruleus and Chlamydodon mnemosyne, whereas it resembles the ones of Paramecium bursaria and Fabrea salina.

BAROS: an effective system to evaluate the results of patients after bariatric surgery.

BACKGROUND: Success in bariatric surgery is most often evaluated by a sufficient loss of excess weight and an improvement in the medical conditions. The expected increase in quality of life (QoL) after weight loss, however, has not often been systematically analyzed. BAROS (Bariatric Analysis and Reporting Outcome System) is a scoring system which, along with easy handling, allows comparisons to be made internationally. METHODS: 386 morbidly obese patients who had undergone bariatric surgery in our hospital were evaluated with BAROS. Five categories- failure, fair, good, very good, excellent- were taken from the scoring system that BAROS offers. This system has three major points: excess weight loss, medical co-morbidities and QoL. Points are subtracted for reoperations and defined complications. The operations performed were silastic ring vertical gastroplasty (72%), adjustable gastric banding (23%), biliopancreatic diversion (3%), vertical banded gastroplasty (1%) and gastric banding of Molina (1%). RESULTS: In 1991 and 1993, we had a fair result in 3% and 10% of the patients. A good score with a mean of 3.6 to 4.1 was reached in 1992, 1994 and 1995. In the last 3 years, 1996 to 1998, the mean score was 5.0 to 5.7, which is a very good result when compared with the scoring key. CONCLUSION: BAROS is a valuable tool to access the QoL of patients who have undergone bariatric surgery.

Cost-effective bariatric surgery in Germany today.

BACKGROUND: The reason for this inquiry was to assess the actual state of Bariatric Surgery in Germany, especially relating to the much discussed economic aspect. METHOD: A questionnaire was sent to those hospitals in Germany in which we knew that obesity surgery was performed, concerning the year 1997. RESULTS: To our regret, the feedback was only 37%, although this must be considered an adequate response for Germany. Nevertheless, some interesting trends are easily seen. CONCLUSION: Bariatric Surgery in Germany could pay for itself by saving the costs associated with conservative therapy and preventing co-morbidities in patients with morbid obesity.

Intra- and intercellular communication systems in ciliates.

Intracellular signaling and cell-cell interactions are basic features of living organisms. Ciliated protozoa show complex mechanisms of intracellular signaling, as is demonstrated for the phagosomal pathway. Although unicellular, ciliates also communicate with other cells, for example, with invading or symbiotic micro-organisms, some of which are dwelling in the nuclei. In predator-prey interactions chemical signals (kairomones) released by certain predators induce defensive morphological or behavioral changes in the prey ciliates. In intercellular communication sensu strictu ciliate cells communicate with each other, for example, in sexual propagation. A variety of sexual signals have been found to function in preconjugant interaction. Many phenomena of cellular communication in ciliates appear to be similar to those found in multicellular organisms.

Does gastric restriction surgery reduce the risks of metabolic diseases?

BACKGROUND: Certain risk factors for arteriosclerosis are associated with obesity, e.g. hypertension, insulin resistance, the high triglyceride - low HDL pattern. One aim in treating morbid obesity is to reduce these risk factors. This study was designed to follow metabolic risk factors after weight loss in 165 morbidly obese patients who underwent a gastric restriction operation. METHODS AND PATIENTS: Lipid and hormone levels were analyzed before surgery and after 25, 50, 75 and 100% loss of excess weight. Mean cholesterol and triglyceride levels were normal or slightly elevated. HDL cholesterol was also normal (41 mg/dl). Thirty eight percent of the patients had elevated cholesterol and triglyceride levels. Insulin levels were measured as an indicator of potential insulin resistance, and with a mean of 21 microU/ml it was at the upper normal level. RESULTS: After reaching 75% reduction of overweight in a mean time of 10 months, serum cholesterol levels were unchanged. Serum triglycerides, however, decreased by 35% (P<0.0001) and HDL cholesterol increased by 24% (P<0.0001). Insulin levels decreased to 8 microU/ml (P<0.0001). CONCLUSION: We found an amelioration in the metabolic parameters in 75% of the patients. Nevertheless morbidly obese patients were found to have fewer abnormalities in lipid and glucose metabolism than expected from data of overweight patients with metabolic syndrome. Further long-term studies with careful evaluation of the metabolic parameters as risk factors in patients with morbid obesity need to be performed.

Low-dose iloprost infusions compared to the standard dose in patients with peripheral arterial occlusive disease Fontaine stage IV. DAWID Study Group.

BACKGROUND: Intravenous iloprost, titrated from 0.5 up to 2.0 ng/kg/min has been shown in patients with PAOD III/IV to significantly improve healing of trophic lesions, relief of rest pain, and reduce the rate of major amputation or death at 6 months as compared to placebo. The effect is considered related to improvement of the microcirculation. The aim of the present trial was to identify an optimum dose regarding treatment response and tolerability, by studying 4 doses of 25, 50, 75 and 100 micrograms iloprost daily. PATIENTS AND METHODS: 302 patients with PAOD IV were randomised via a double-blind fashion to one of the 4 doses. The primary endpoint was the responder rate at end of treatment. Responders were defined as patients with very good or good global efficacy, as judged by lesion healing and pain relief. Side effects were documented and a pre-defined benefit/risk index was calculated. RESULTS: No dose-dependency of iloprost regarding primary or secondary endpoints was observed. The rate of responders ranged between 48.7-53.5%. Side effects, mainly related to vasodilation, increased dose-dependently (p < 0.001, chi 2-test), with a significant decrease of the benefit/risk index from 2.19 +/- 1.19 to 1.64 +/- 0.97 (p = 0.012, ANOVA). Responders had a better outcome at 6 months than non-responders (2.6 fold higher rate of major amputation or death; life table analysis). CONCLUSIONS: It is concluded that iloprost should be titrated to the optimum rather than maximum tolerated dose, since a higher incidence of side effects not associated with an increased treatment response was observed at higher doses.

[Surgery for obesity: a current trend or a specialty to be taken seriously?]. / Adipositaschirurgie: Modeerscheinung oder ernst zu nehmendes Spezialgebiet?

We performed gastric restriction operations in our hospital on 320 patients. 55% of them lost 50% of their excess weight within 7 months. The success of this kind of operation depends on a comprehensive therapeutic concept in addition to the surgical treatment.

Pheromones of the ciliate Euplotes octocarinatus not only induce conjugation but also function as chemoattractants.

Cells of the ten mating types of the ciliate Euplotes octocarinatus communicate by pheromones before they enter conjugation. The pheromones induce homotypic pairing when applied to mating types that do not secrete the same pheromone(s). Heterotypic pairs (i.e., those between cells of different mating types) are formed only when both mating types in a mixture secrete a pheromone that the other does not. The genetics of mating types is based on four codominant mating type alleles, each allele determining production of a different pheromone. Here we report that the pheromones not only induce pair formation but also attract cells. This was shown by placing cells of various mating types in neighboring agar wells so that the pheromones could diffuse from one well to the next. We found that the cells accumulated on the side of the well where a pheromone entered by diffusion. This response was observed only if the pheromone had the capacity to induce the cells to conjugate. That the pheromones and not some other substances attract the cells was shown by placing pheromone 3, expressed in Escherichia coli, in wells next to tester strains. Mating types known to respond to pheromone 3 by pair formation also showed accumulation on the side of the well at which the pheromone entered by diffusion. Since the pattern of cell attraction corresponds with the pattern of conjugation induction, we suggest that not only conjugation induction but also cell attraction is governed by pheromone-specific receptors. In addition, we describe a succession of changes in the behavior of cells affected by the pheromones.

Electrophysiological motor testing, MRI findings and clinical course in AIDS patients with dementia.

Thirty-three HIV-positive patients with clinical signs of dementia according to the 1991 AAN criteria underwent psychometric, electrophysiological and radiological examination and were compared with a group of normal healthy subjects and a cohort of clinically asymptomatic HIV-1-positive individuals of comparable education and social environment. Compared with the other groups, test performance was severely impaired in the demented patients. Results of motor testing and MRI revealed that subcortical structures were not exclusively affected, but most severely and early, thus characterizing the clinical feature in HIV-1-associated dementia. In demented patients a rapid deterioration was observed, leading to death within about 12 months on average, which is a markedly shorter survival time than described in the literature for non-demented HIV-1-positive individuals.

Interspecific mating reactions between Euplotes octocarinatus and Euplotes patella syngen 2.

Euplotes octocarinatus and E. patella syngen 2 were tested for their capacity to undergo interspecific mating reactions. Pheromones which the cells of both species secrete to induce cells of other mating types of the same species to prepare for conjugation by changing their cell surface properties were found to act only species-specific. Cells which have changed their surface properties under the influence of their species-specific pheromones, however, are able to form interspecific conjugant pairs. Our cytological investigations show that the micronuclear processes of about 75% of interspecific conjugant pairs become arrested in the course of the premeiotic division. In these cases the co-conjugants separate from each other and return to the vegetative cell cycle. About 25 % of the interspecific pairs enter meiosis, but the nuclear processes in the co-conjugants are not well synchronized and finally become blocked at metaphase of the first meiotic division. The fate of such co-conjugants is always cell death. The results show that sexual incompatibility between the two species is not only due to different pheromones; in addition, it appears to be necessary that the progress of the nuclear events in a cell is stimulated repeatedly by species-specific signals provided by the co-conjugant.

Life cycle dependent phototactic orientation in Ophryoglena catenula.

The histophagous ciliate Ophryoglena catenula, which is characterized by a conspicuous "watchglass organelle", shows a pronounced orientation with respect to the direction of light. The five stages of the common reproduction cycle are all light sensitive: Positive phototaxis was regularly found in "theronts" exposed to unilateral white light at intermediate fluence rates (e.g. 10 klx), and also in "trophonts" and "protomonts" within 2.5 hours after feeding. Negative phototaxis was observed under identical experimental conditions in "protomonts" about 5 h after feeding as well as in "tomonts" and "tomites" which had settled down and were mechanically irritated. In contrast to these stages individuals of a rarely occurring "migratory stage" are insensitive to light. Theronts which were exposed to an attractive chemical stimulus immediately interrupted their oriented movement towards the direction of the light, showing near random orientation or following the chemical gradient. Phototaxis in Ophryoglena is discussed in terms of its significance for orientation in the natural environment of these ciliates.

Nuclear processes in Euplotes octocarinatus during conjugation.

The pregamic and metagamic nuclear divisions during conjugation of Euplotes octocarinatus and the development of new micro- and macronuclei were investigated with the help of phase contrast microscopy and a staining of the cells by aceto carmine. The most important stages are illustrated with microphotographs and a time table of the events based on experiments carried out at 26°C is presented. It is shown that E. octocarinatus has n = 35 chromosomes and that all of them enter the macronuclear anlage and undergo polytenisation before they break down into the short DNA-pieces typical of the adult macronucleus of hypotrich ciliates. The nuclear events suggest that, similar to what has been reported for E. patella, frequently sister nuclei become the pronuclei which should result in the formation of a high proportion of isogenic co-conjugant lines. A comparison of the nuclear events in heterotypic pairs (co-conjugants of different mating types) with those in homotypic pairs (co-conjugants of the same mating type) revealed no differences apart from a tendency of homotypic pairs to become arrested at the premeiotic division and then to separate. Although hundreds of cells were investigated, regeneration of pieces of the old macronucleus or fusion of fragments with a newly formed anlage, as is reported for certain other Euplotes species, has not been observed.