Investigation of the refractive index repeatability for tantalum pentoxide coatings, prepared by physical vapor film deposition techniques.

Random effects in the repeatability of refractive index and absorption edge position of tantalum pentoxide layers prepared by plasma-ion-assisted electron-beam evaporation, ion beam sputtering, and magnetron sputtering are investigated and quantified. Standard deviations in refractive index between 4*10-4 and 4*10-3 have been obtained. Here, lowest standard deviations in refractive index close to our detection threshold could be achieved by both ion beam sputtering and plasma-ion-assisted deposition. In relation to the corresponding mean values, the standard deviations in band-edge position and refractive index are of similar order.

CSF levels of growth factors and plasminogen activators in leptomeningeal metastases.

OBJECTIVE: To investigate the diagnostic value of transforming growth factor beta(1) (TGFbeta(1)), vascular endothelial growth factor (VEGF), urokinase-type plasminogen activator (uPA), and tissue-type plasminogen activator (tPA) in CSF for leptomeningeal metastasis (LM). METHODS: The authors measured concentrations of biomarkers by ELISA in matched samples of CSF and serum, collected from 132 patients with a solid malignancy with LM (n = 19) and without LM (n = 54) and patients with viral (n = 16) and bacterial (n = 16) meningitis and a variety of nonmalignant, noninfectious neurologic disorders (n = 27). Indexes of the biomarkers (CSF/serum value relative to CSF/serum albumin ratios) were calculated to correct for the serum contribution to the CSF marker concentration. RESULTS: CSF VEGF concentration was significantly higher in LM than in all other groups. VEGF indexes were also higher, although not significant. In contrast, the tPA index was significantly decreased in LM compared with all other groups. The combination of the VEGF and tPA indexes resulted in a sensitivity of 100% for LM and a specificity of 73% for the patient group with a primary tumor but without LM. CONCLUSION: Patients with leptomeningeal metastasis have high vascular endothelial growth factor (VEGF) indexes and low tissue-type plasminogen activator (tPA) indexes. As cytologic examination of CSF lacks 100% sensitivity for the diagnosis of leptomeningeal metastasis (LM), the combination VEGF and tPA index analysis may be of additional value in the diagnostic workup of patients suspected of having LM.

Glial and neuronal proteins in serum predict outcome after severe traumatic brain injury.

OBJECTIVE: To study the ability of glial (glial fibrillary acidic protein [GFAP] and S100b) and neuronal (neuron specific enolase [NSE]) protein levels in peripheral blood to predict outcome after severe traumatic brain injury. METHODS: Eighty-five patients with severe traumatic brain injury (admission Glasgow Coma Score [GCS] < or = 8) were included. Blood samples taken at the time of hospital admission were analyzed for S100b, GFAP, and NSE. Data collected included demographic and clinical variables. Outcome was assessed using the Glasgow Outcome Scale (GOS) at 6 months post injury. RESULTS: The median serum levels of S100b, GFAP, and NSE were raised 18.3 fold (S100b), 4.6 fold (GFAP), and twofold (NSE) compared to normal reference values. S100b, GFAP, and NSE serum levels correlated significantly with the injury severity score and CT findings but not with age, sex, or GCS. S100b, GFAP, and NSE levels were significantly higher in patients who died or had a poor outcome 6 months post injury than in those who were alive or had good outcome. S100b level >1.13 microg/L was the strongest predictor of death with 100% discrimination, but GFAP (>1.5 microg/L) and NSE (>21.7 microg/L) levels also strongly predicted death (adjusted odds ratios 5.82 [for GFAP] and 3.91 [for NSE]). S100b, GFAP, and NSE all strongly predicted poor outcome (adjusted odds ratios 5.12 [S100b], 8.82 [GFAP], and 3.95 [NSE]). CONCLUSIONS: These results suggest that determination of serum levels of glial and neuronal proteins may add to the clinical assessment of the primary damage and prediction of outcome after severe traumatic brain injury.

[The use of disinfectants in veterinary practice]. / Het gebruik van desinfectiemiddelen in de dierenartspraktijk.

The use of chemical disinfectants within the veterinary practice is only permitted when the disinfectants are legally registered. A distinction has to be made between disinfectants to be used on the skin of men or animals and disinfectants to be used on surfaces like floors, walls, cages, stables and for veterinary instruments. For the first group, to be considered as (veterinary) medicines, the Act on (Veterinary) Medicines applies. For the second group, to be considered as veterinary biocides, the Pesticide Act applies. A small survey carried out by the Keuringsdienst van Waren shows that in veterinary practice disinfectants are applied in an inappropriate way. A lack of knowledge and the lack of hygienic protocols could be reasons for these misuses. In this article the Keuringsdienst van Waren gives information about the legal aspects of disinfectants that fall within the scope of the Pesticide Act.

Peri-operative levels of s-100 protein in serum: marker for surgical manipulation and postoperative complications.

Although minimally invasive neurosurgical techniques are highly sophisticated nowadays, almost any operative procedure causes an inevitable surgical trauma to the brain. As a consequence unfavorable functional outcomes are not rare. Intraoperative biochemical monitoring can be helpful first to detect but also to prevent brain damage. We investigated if serum S-100 protein (S-100) levels are a reliable marker for the extent of acute cerebral damage caused by surgical trauma or postoperative complication. S-100 is present in the cytosol of glial cells. This protein leaks into the extracellular space after cell damage and can be detected both in the cerebrospinal fluid (CSF) and serum. To determine S-100 protein levels, serum samples from 20 patients with various intracranial tumors were collected before surgery, and at one day, as well as at seven days after surgery. It was hypothesised that the size of the tumor-brain contact surface (TBCS) was closely related to the dimension of the surgical trauma. TBCS was measured from radiological imaging. The pre- and postoperative (day 1 and day 7) clinical condition of each patient was assessed. The S-100 levels were correlated with the TBCS and the clinical condition. Levels of S-100 on day 1 and day 7 were significantly higher as compared with levels on day 0 ( p = 0.02, respectively p = 0.01). There was a significant relationship between rise of S-100 level and worsening of clinical condition between day 0 and day 1 ( p = 0.001). Also a significant positive relationship between TBCS and the level of S-100 could be found on day 1 and on day 7 ( R = 0.71, p = 0.0009, respectively R = 0.73, p = 0.004). Furthermore, a significant relationship between the rise of S-100 level between day 0 and day 1, as well as between day 0 and day 7, and TBCS could be documented ( R = 0.61, p = 0.01, respectively R = 0.64, p = 0.005). In conclusion, serum S-100 levels are a reliable marker for acute or recent CNS damage caused by neurosurgical manipulation or as a result of secondary postoperative complications. Therefore, intraoperative monitoring of serum S-100 levels seems very promising. In such a setting the negative effects of surgical manipulation can be measured instantaneously, which should bring the neurosurgeon to change his strategy. As a consequence the surgical trauma can be minimized and functional outcome can be optimized.

Serum- and CSF-concentrations of brain specific proteins in hydrocephalus.

OBJECT: Hydrocephalus is characterised by elevated intracranial pressure (ICP) and gives rise to brain damage. The aim of this study was to investigate the significance of brain specific proteins as markers in the evaluation of brain damage in hydrocephalus. Therefore we determined the levels of four brain specific proteins in cerebrospinal fluid (CSF) and serum of symptomatic hydrocephalic patients. METHODS: During 41 CSF shunt-operations (both primarily placed shunts and shunt-revisions) CSF and blood samples were obtained and analysed for neuron-specific enolase (NSE), S-100b, glial fibrillary acidic protein (GFAP) and myelin basic protein (MBP). The results were compared with an age-matched control group. Patients with varying clinical symptoms, denoting different levels of increased intracranial pressure prior to surgery, were included in this study. RESULTS: We observed significantly increased CSF-levels of S-100b and GFAP in the hydrocephalic patients, whereas NSE and MBP were markedly increased only in patients with very severe symptoms. Serum levels of all proteins were only minimally increased and did not correlate with CSF-levels. The slightly elevated levels of CSF-NSE in most of the patients suggest only subtle neuronal damage, which is not related to permanent neurological symptoms. The elevated levels of S-100b and GFAP are indicative of a reactive astrogliosis, which has also been demonstrated in histopathological studies. No demyelination seems to occur, according to the normal levels of MBP observed in this study. CONCLUSIONS: Although CSF levels of brain specific proteins are elevated in hydrocephalic patients, indicating brain damage due to hydrocephalus, neither CSF- nor serum-concentrations of brain specific proteins seem to be valuable tools in the clinical evaluation of the severity of hydrocephalus.

Myelin basic protein in CSF as indicator of disease activity in multiple sclerosis.

There is an evident need for a quantitative laboratory marker for ascertaining disease activity and treatment effects in multiple sclerosis (MS) patients. Activity of the disease process in MS is accompanied by myelin breakdown and appearance of myelin basic protein (MBP) in cerebrospinal fluid (CSF). In this paper MBP in CSF of relapsing-remitting (RR) MS patients is reviewed. MBP in CSF is a fragment containing an epitope corresponding to amino acid residues 45-89 of the native molecule. From several relevant studies about CSF MBP in RR MS the following relations can be concluded: CSF MBP levels in active MS patients are frequently increased (45-100%), remain increased until 5 to 6 weeks after onset symptoms and are higher in polysymptomatic exacerbations and correlate with number of gadolinium-enhanced (Gd) lesions on MRI, severity of relapses, EDSS score and CSF intrathecal IgM synthesis. After an intravenous methylprednisolone treatment the increased CSF MBP levels return to normal values and reduction in CSF MBP is related to reduction in EDSS score, number of Gd lesions and CSF intrathecal IgM synthesis.

Dry bed training by parents: results of a group instruction program.

PURPOSE: We assessed results of intensive dry bed training for groups of parents outside the hospital setting. MATERIALS AND METHODS: During 5 consecutive meetings 2 appointed coaches were responsible for providing 5 to 10 parents with detailed instructions outlining the dry bed training program for their child. The 91 participating children (mean age 9.3 years) were selected from various primary schools by school physicians from the youth health care sections of 2 community health services in The Netherlands from April 1991 to May 1994. RESULTS: All 91 parents completed the initial questionnaire and 86 (95%) completed the second questionnaire 6 months after dry bed training. Before starting the dry bed training program the children were wetting the bed an average of 5.4 times weekly. A total of 69 children (80%) successfully achieved the continence criterion of 14 consecutive dry nights. Mean time plus or minus standard deviation needed to achieve dryness was 6.9 +/- 3.7 weeks, including the continence criterion. Girls responded significantly faster than boys to dry bed training (5.1 versus 7.4 weeks, t[67] = 2.16, p < 0.05). A total of 16 children (23%) had relapse of whom 7 regained dryness 6 months after training. There were no statistical differences between the successful and unsuccessful groups for the variables of patient age, sex, bed-wetting frequency, secondary enuresis, family history and therapies followed. However, there was a difference in the use of drugs and number of specialist visits before dry bed training. The majority of parents (84%) was satisfied with the program but the opinions of the children were divided. CONCLUSIONS: Group dry bed training has proved to be effective therapy. It may rapidly result in improvement through intensive training in a relatively short period. Group dry bed training is a suitable method to control nocturnal enuresis in children 6 years old or older.

[Good long-term results of dry bed training in children with nocturnal enuresis]. / Goede lange-termijnresultaten van droog-bedtraining bij kinderen met enuresis nocturna.

OBJECTIVE: To determine the long-term effect of dry bed training in a youth health care setting. SETTING: Haarlemmermeer, the Netherlands. DESIGN: Descriptive. METHOD: Parents of 36 children (mean age 9 year) subjected to dry bed training in 1987-1989, were asked in 1993 if their child had wet his or her bed in the past 4 weeks. The parents were instructed in the training in group sessions in the youth health care setting. RESULTS: In 1993, that is 4-6 years after the training, 83% slept dry. In the other 17% the number of wet nights dropped from 6 times to twice a week. CONCLUSION: We can conclude that the long-term success rate of dry bed training is high. Group dry bed training is a suitable method for children with nocturnal enuresis from age 8 when other methods are unsuccessful. The training is feasible outside the hospital.

[Dry bed training in nocturnal enuresis]. / Droog-bedtraining bij enuresis nocturna.

In order to determine the prevalence of bedwetting, in the period September 1987-June 1989 an investigation was conducted among 1882 pupils of 15 primary schools in a rural area of the Netherlands. The investigation coincided with the periodical medical examination for which all pupils of these groups were invited and for which over 99% reported. In addition to this epidemiological study, a study was made of the effect of dry bed training, as a part of youth health care, in 36 children with nocturnal enuresis. Of the children examined, 8% wet their beds at least once a week, boys twice as often as girls. The secondary form of nocturnal enuresis occurred mostly in those aged 7-8 (44%) and mostly after certain events such as start of the school year, family problems or hospitalization. The proportion of bedwetting children with a parent with a history of nocturnal enuresis in youth was large: 56%. Of the girls with nocturnal enuresis, 25% had had a urinary tract infection as against 0.4% of the control group. Nocturnal enuresis often caused emotional stress in child and parents. The success rate of the dry bed training was 86%. Most children were dry within two months; 32% had a--frequently transient--relapse. After six months, 75% of the children who had had dry bed training remained dry at night. Group dry bed training appears a suitable method for children with nocturnal enuresis from age 8 when other methods (including the pad and buzzer) are unsuccessful. The training is feasible outside hospital and is an appropriate part of the tasks of youth health care.

[Pulse oximetry monitoring of single lung anesthesia in non-cardiac thoracic surgery]. / Pulsoximetrische Uberwachung der Eine-Lunge-Anästhesie bei nichtkardialen thoraxchirurgischen Eingriffen.

The pulse oximeter provides continuous and non-invasive measurement of the arterial oxygen saturation. Pulse oximetry contributes to safer patient management because of the immediate availability of oxygen saturation values. This is particularly important in high-risk anaesthesia such as one-lung anaesthesia. Pulse oximetry is as important as ECG monitoring and invasive blood pressure monitoring and should therefore be a standard monitoring technique in thoracic surgery. With a pulse oximeter it is possible to efficiently monitor anaesthesia during one lung ventilation thereby avoid hypoxia with its life-threatening complications.

[Tomography in excretory urography (author's transl)]. / Tomographie bei intravenöser Urographie

Urographic diagnosis has been significantly improved by the routine addition of tomography. This simple, effortless and time saving technique has resulted in the salvage of urographic studies that would otherwise have been considered indeterminate. Repeated-examinations are avoided. Tomography has also demonstrated lesions where conventional urograms have been considered normal. Finally renal lesions already demonstrable by conventional urography, can be better interpreted and analyzed.

[Theoretical considerations for improving oral cholegraphy (author's transl)]. / Verbesserung der oralen Cholegraphie, theoretische Grundlagen

Oral cholegraphy is one of the most accurate procedures in diagnostic radiology. Nevertheless it is not without shortcomings. To achieve an enhancement of its reliability the biochemical and physiological processes involved in an ultimately sufficient biliary-tract opacification are analysed. From these theoretical considerations some conclusions are drawn which could be important for the improvement of oral cholegraphy and which appeared to be worth testing in practice.