[Prognostic importance of early recorded somatosensory evoked potentials in patients not neurologically assessable after craniocerebral trauma]. / Prognostische Bedeutung der früh abgeleiteten somatosensorischen evozierten Potentiale bei neurologisch nicht beurteilbaren Patienten nach Schädel-Hirn-Traumen.

By stimulation of the median nerve at the wrist we recorded the somatosensory evoked potentials (SEP) at several points between the midpoint of the clavicle and the scalp, overlying the area of sensorimotor cortex. The SEP of each side were graded (bilaterally normal SEP's: grade-1/1, pathological SEP's grade-2/1 to grade-4/4). The aim of these recordings is to judge the probability of survival in adult comatous patients in the early phase after a head injury. Our retrospective analysis of these recordings in 108 patients (collective 1988/89) shows a significant correlation of the SEP with the Glasgow Coma Scale score (GCS) (GCS > 8/SEP grade-3 or grade-4: p < 0.005) and the pupillary function (pupillary function disturbed uni- or bilaterally/SEP grade-3 or grade-4: p < 0.0005), being less pronounced with the intracranial pressure (ICP) too. In patients with lack of the component N20 death or vegetative outcome is significantly more frequent than if this component is present (p < 0.005). All the 7 patients without recognisable bilateral component N20 (SEP grade-4/4) died as a consequence of the initial brain injury. 7 out of 9 patients with unilateral lack of the component N20 combined with diminished amplitude ratio and delayed central conduction time (CCT) contralaterally (SEP grade-4/3) died or survived in a vegetative condition; none of them became independent. If the results of the analysis of the patient collective 1988/89 were applied to the patients of 1990 (n = 67) a good correlation between SEP and outcome was confirmed.(ABSTRACT TRUNCATED AT 250 WORDS)

[Who should be hospitalized following mild craniocerebral trauma?]. / Wer soll nach einem leichten Schädel-Trauma hospitalisiert werden?

The frequency of minor closed head injuries is high. These injuries may be complicated by the development of life-threatening intracranial hematomas. A well-defined selection criteria for admission must be proposed to guarantee an efficacious observation. In our series of 489 hospitalized patients with a GCS of 15 when seen in the emergency room: 4 patients required evacuation of an intracranial hematoma, 11 revision of a depressed skull fracture or a compound fracture of base of the anterior fossa. Using the existence of a skull fracture as a selection for admission, a strategy proposed by Jennett and colleagues, it would have been possible to reduce the number of patients hospitalized by 70% without missing a patient who developed an intracranial hematoma. Following these criteria no intracranial hematoma would be missed in our patients with a GCS of 15. We suggest that the use of plain x-rays to identify skull fractures and subsequent hospitalization prevents missing an intracranial hematoma. Those patients with diminished levels of consciousness of focal neurologic deficits require admission irrespective of skull fractures.

[Aseptic cerebral sinus thrombosis. 5 cases and a review]. / Die aseptische zerebrale Sinusthrombose. Fünf Fälle und eine Ubersicht.

From 1988 to 1990, we observed five cases of aseptic dural sinus and cerebral venous thrombosis, all in non-smoking women (age 18 to 47 years) receiving low dose oral contraceptives. Treatment consisted of full anticoagulation over 2 to 6 months, over which time the neurologic symptoms disappeared almost completely. Extensive tests of the blood clotting system in 4 patients after 6 to 19 months revealed a reduction of free protein S in 2 patients with a history of contraceptive use over several years, and normal results in 2 patients in which the sinus thrombosis occurred within the first 6 weeks of use of the oral contraceptive. Whether the protein S deficiency was congenital or caused by the oral contraceptive cannot be decided retrospectively. Even modern oral contraceptives seem to lead to an increased incidence of sinus thrombosis. Initial symptoms of sinus thrombosis include headache and somnolence, followed either by focal neurologic deficits (often associated with focal seizures) or by signs of increased intracranial pressure. CT scans show venous infarcts or general brain edema and may specifically show the "empty triangle sign" and "delta sign". The CT scan may also be normal if focal neurologic deficits are absent. MRI is favoured as it can directly show the thrombosed sinus or veins. Differential diagnosis includes arterial stroke, brain tumor, encephalitis or "benign intracranial hypertension", which should only be diagnosed after sinus venous thrombosis has been appropriately ruled out. Recently, full anticoagulation has been recommended as therapy.

Absence of effects of thymopentin on murine host resistance to Listeria monocytogenes.

The effects of various doses of Thymopentin, the synthetic 5 aminoacid fragment of thymopoietin injected on d -4 and d -1 on murine host resistance to Listeria monocytogenes were tested. The experiments did not reveal any regular dose-effect relationship; i.e. no or only marginal (more often small negative rather than positive) effects were observed on clearance and on resistance neither during the T cell independent first hour or the first 2 days of infection in euthymic or thymus deficient nude mice, nor during the T cell dependent phase after 2 days of infection in euthymic mice. Also survival of mice was not increased in a regular dose-effect relationship with dose ranges of Thymopentin from 0.3 ng-30 mg per 30 g mouse; furthermore, injections of 3 micrograms per 30 g mouse for varying time intervals from -3 days before up to 6 days after infection had no protective effect. Thus Thymopentin apparently does not induce measurable macrophage activation directly or cannot increase macrophage activation mediated by T cells in euthymic mice nor does it induce adequate T cell responses in nude mice to promote improved resistance to Listeria.

Enhanced tumor susceptibility of immunocompetent mice infected with lymphocytic choriomeningitis virus.

Mice infected i.v. with high doses of lymphocytic choriomeningitis virus (LCMV; 10(5)-10(6) plaque-forming units) 8-10 days prior to challenge with the methylcholanthrene-induced fibrosarcoma tumor cell line MC57G or the melanoma cell line B16 tumor cells showed an enhanced tumor susceptibility with respect to both growth kinetics of the tumor and the minimal dose necessary for tumor take. After transient initial growth, MC57G tumor cells were all rejected by uninfected C57BL/6 mice by day 14. Mice preinfected i.v. with LCMV 3 weeks before or at the time of tumor challenge, but not those infected 2 months before or 7 days after, showed increasing tumor growth, the tumor take being 100% for 10(6), 50% for 10(5) and 37% for 10(4) MC57G tumor cells injected into the footpad compared with resistance to 10(6) cells in normal mice. B16 melanoma cells also grew more rapidly in LCMV-preinfected mice and by day 40 tumors were established with about 100 times fewer cells, i.e. about 10(3) compared with 3 x 10(4)-3 x 10(5) for uninfected mice. Analysis of the growth of tumor cells in normal and in LCMV-carrier mice revealed that the latter mice were not more susceptible to LCMV-infected than to uninfected MC57G. Since LCMV-carrier mice fail to mount LCMV-specific T cell responses, these results suggest that anti-LCMV-specific T cells may be responsible for acquired immunodeficiency hampering immune surveillance against the tumors studied.

The significance of the human corpus luteum in pregnancy maintenance. I. Preliminary studies.

PIP: Following the total removal of luteal tissue, circulating plasma progesterone, intrauterine pressure, oxytocin response, and clinical progress in abortion were determined sequentially in 12 first-trimester pregnant patients. 3 patients were ovariectomized for the removal of ovarian cysts and 9 were luteectomized during tubal ligation in an attempt to terminate pregnancy in spontaneous abortion. 7 patients had corpora lutea which averaged 21 plus or minus 1mm in diameter at operation when performed at Day 49 plus or minus 2 (mean S.E.) of pregnancy. These patients responded to ovariectomy or luteectomy by a continuing decrease in progesterone, evolution in intrauterine pressure, oxytocin response, progress in cervical dilitation and, abortion. Abortion occurred with a mean lapse time of 5 plus or minus 1 days after operation. In contrast, 5 patients whose corpora lutea averaged only 11 plus or minus 1mm in diameter when removed at Day 61 plus or minus 4 of pregnancy showed only transient decrease in progesterone after operation. This decrease was followed by an increase in progesterone; no progress in the evolution of intrauterine pressure, oxytocin response, cervical dilatation, and abortion. It appears that so long as the corpus luteum serves as the major source of progesterone, it is indispensable in the maintenance of pregnancy in human subjects as it is in the clinical model animal, the rabbit. However, with the shift of progesterone production from the corpus luteum to the placenta (the luteoplacental shift) the human corpus luteum becomes dispensable. These findings identify the corpus luteum and its secretory product, progesterone, as feasible targets of fertility control strategy.^ieng

Termination of midtrimester pregnancy by transvaginal intra-aminiotic injection of hypertonic solution.

PIP: 18 normal midtrimester patients for whom legal abortion had been granted, and 2 patients with fetal death in utero received amniocentesis, in order to expose the trans-anterio-fornix method to a fair trial. The patient was placed in a supine position and the vagina thoroughly washed. The cervix was disinfected with iodine and an intraamniotic puncture carried out through the anterior fornix. An average volume of 116 ml amniotic fluid was replaced by256 ml 20% sodium chloride. All patients aborted uneventfully and rapidly during a period of only 4 hours after a latency period of 25 hours. In all instances, abortion was completed without pharmacologic or surgical help. The average hospital stay was 3.1 days and the procedure was without complication.^ieng