[The early recognition of infected fluid collections in acute pancreatitis in computed tomography]. / Zur Früherkennung infizierter Flüssigkeitsansammlungen bei akuter Pankreatitis in der Computertomographie.

UNLABELLED: Infected accumulations of abdominal fluid are a severe complication and the major cause of death (mortality rate between 20 and 60%) in patients suffering from acute pancreatitis. In 93 patients with confirmed acute pancreatitis including 28 with surgically confirmed pancreatic abscess CT findings (volume of pancreatic and extrapancreatic necrosis, capsular enhancement, gas bubble formation and contact between fluid collection and intestinum) were retrospectively correlated with clinical and operative data to assess abscess formation. This revealed a sensitivity of 0.57 in respect of pancreatic necrosis; for extrapancreatic necrosis the sensitivity was 0.39, for capsular enhancement 0.5, for gas bubble formation 0.46 and for intestinal contact 0.93. The specificity was high for gas bubbles (1.0) and intestinal contact (0.91) and low for the other criteria. IN CONCLUSION: There is a strong relationship between fluid accumulations in direct contact with intestinal structures and the occurrence of abscess. This parameter enhances the reliability of CT in the early detection of extrapancreatic infection.

[Sonographic aspects of clinically suspected acute appendicitis]. / Sonographische Aspekte bei klinischem Verdacht auf akute Appendizitis.

Revealing a sensitivity of 97.5% and a specificity of 95.12% this study emphasizes the excellent diagnostic value of sonography in the elucidation of patients with clinical signs of "acute appendicitis". Evaluation of morphology on the one hand and maximal diameter of the organ and the organ wall on the other, in conjunction with the clinical presentation, allows a restrictive management of the surgical treatment and thus decreases the rate of negative laparotomy.

[The place of portangiography in the follow-up control of locoregional chemotherapy]. / Stellenwert der Portangiographie bei der Verlaufskontrolle der lokoregionären Chemotherapie.

101 portangiographies in patients with liver metastases from colorectal primaries who underwent hepatic intraarterial or intraperitoneal chemotherapy were performed and studied between January 1991 and February 1992. 81% of the examinations did not involve complications. In 19% of the angiographies abnormalities of the arterial perfusion of the liver, like occlusion, dissection or narrowing of hepatic arteries, were found. We conclude that portangiography is a very important investigation before regional chemotherapy.

Spectral analysis of EEG during self-paced movements: differences between untreated schizophrenics and normal controls.

Thirteen untreated schizophrenic patients, among them nine who had never been treated, were compared with a corresponding number of matched normal controls with regard to changes of the spectral composition of the electroencephalogram (EEG) accompanying voluntary movements. Triggered by self-paced movements of the right fingers (fast fist closure), the spectral composition of three epochs was analyzed: (1) rest (2,5-1,5 sec before movement), (2) movement preparation (last sec before movement onset), and (3) movement execution (1st sec following movement onset). For frequencies above 6 Hz, marked differences between schizophrenics and controls were evident, in particular over the parietal electrodes. Whereas patients exhibited a clear decrease of power density during movement as compared to rest, controls showed only a small decrease (left and mid parietal) or virtually none (only right parietal). Consequently there were significant differences over the right parietal area (P4) between patients and controls in the theta, alpha- and beta-bands with regard to the mean power density and center frequencies of these bands. Also at parietal positions, schizophrenics lacked the enhancement of theta-power during the preparatory epoch that was characteristic for normal controls at all parietal positions. The results are discussed with regard to the well-known disturbances of voluntary motor behavior in schizophrenia.

Anticholinergic influences of biperidene on the EEG effects of haloperidol.

15 normal volunteers demonstrated after 14 days of haloperidol (HA) medication (3 mg/day) a higher mean power density (mpd) in all frequency bands of the EEG power spectra combined with a higher theta and a lower alpha center frequency (cf). After further 7 days of HA medication together with the additionally applied anticholinergic biperidene (BI) (6 mg/day) the HA effects were antagonized especially in the theta cf and the alpha mpd. The higher delta and theta mpd were not antagonized. The EEG spectra of the pre- and posttreatment condition did not differ. There was a significant effect of HA on the "Adjective Mood Scale" and on the "Complaint List", which disappeared during the additional BI medication. The reaction times were prolonged with HA and decreased with BI. Blocked dopaminergic impulses on the cholinergic EEG mechanisms possibly produce higher amplitudes during HA medication. Schizophrenic patients treated with neuroleptic drugs showed similar EEG spectra in previous studies during rest but not during motor activation.

Slower theta activity over the midfrontal cortex in schizophrenic patients.

Disturbances of the topographical distribution of theta activity in the EEG spectra before and during voluntary movements were investigated in 31 neuroleptic-treated and in 13 untreated schizophrenics and matched controls as well as in 15 normals medicated with haloperidol. All 4 groups demonstrated similar topographical distribution of theta mean power density, with highest values over the midfrontal region. In the center frequency of the theta band, however, treated and untreated schizophrenics had lower values over the midfrontal region than at parietal electrodes. In controls and normals medicated with haloperidol, this frontoparietal "gradient" demonstrated the inverse picture, with highest values at the frontal midline electrode. Patients and controls differed significantly in this gradient. The slower theta activity over the midfrontal cortex in the schizophrenic patients is related to the hypofrontality hypothesis.