An Acute Ocfentanil Fatality: A Case Report with Postmortem Concentrations.

A 24-year-old man known to consume illegal drugs was found dead in his apartment. A reclosable plastic zipper bag containing several hundred milligrams of a brown powder was found close to the dead body and the first assumption of the investigators was death due to heroin intoxication. Therefore, a legal autopsy was ordered. The following toxicological analysis revealed ocfentanil in urine and in the brown powder. Four different approaches for the determination of the ocfentanil concentrations in peripheral whole blood are described. Enrichment of ocfentanil from the powder was realized. With this reference, it was possible to determine the ocfentanil concentration in the seized powder to be 0.91%. Concentrations of ocfentanil were also determined in the sampled body fluids using the standard addition procedure. In peripheral blood 9.1 µg/L, in heart blood 27.9 µg/L and in urine 480 µg/L were measured. In addition, the antidepressant citalopram, the neuroleptic quetiapine and cannabinoids were found in urine and subsequently quantified in peripheral blood.

Lateralisation in agonistic encounters: do mirror tests reflect aggressive behaviour? A study on a West African cichlid.

In this study, population level lateralisation and the suitability of mirror tests as a test of natural aggressive behaviour in male rainbow kribs Pelvicachromis pulcher was investigated. Aggressive behaviour in live agonistic trials correlated positively with behaviours towards a mirror image and no visual lateralisation was detected.

Emissions of heavy metals into river basins of Germany.

The input of seven heavy metals (Cd, Cr, Cu, Hg, Ni, Pb and Zn) into the large river basins of Germany via various point and diffuse pathways were estimated for the period of 1985 through 2000. To quantify the emissions via point sources a nationwide survey on heavy metal data of municipal wastewater treatment plants and industrial direct discharges was carried out. The input via diffuse pathways was calculated using an adapted version of the model MONERIS. This model accounts for the significant transport processes, and it includes a Geographical Information System (GIS) that provides digital maps as well as extensive statistical information. For a comparison of the calculated heavy metal emission with the measured heavy metal load at monitoring stations the losses of heavy metals due to retention processes within the river systems have to be considered. Therefore heavy metal retention was calculated according to the retention functions given by Vink and Behrendt. For the large river basins a good correspondence could be found between estimated and measured heavy metal loads in rivers. The total emission into the North Sea decreased for each metal during the period of 1986 to 2000. The reduction varies between 87% for Hg and 41% for Ni mainly caused by the decline via point sources. Today's emissions of heavy metals into river basins of Germany are dominated by the input via diffuse pathways. The most important diffuse emission pathways are "paved urban areas" and "erosion".

Gated metabolic positron emission tomography (GAPET) of the myocardium: 18F-FDG-PET to optimize recognition of myocardial hibernation.

The aim of this study was to test the feasibility of the direct measurement of global and regional metabolic wall thickening with 18F-FDG-gated positron emission tomography (PET) in patients with coronary artery disease (CAD). Based on non-invasive (ECG, echocardiography) and invasive [cineventriculography (CVG), coronary angiography] investigations, 12 patients with CAD underwent gated metabolic PET studies with 18F-FDG. Myocardial wall thickening and wall motion analysis from short-axis horizontal and vertical long-axis slices were studied. PET-derived global ejection fraction correlated with CVG-derived global ejection fraction (r = 0.75). Forty-eight of 72 segments investigated were normal (66.7%); 24 of 72 segments were abnormal (33.3%), of which 10 (41.7%) were considered to be hibernating. Four segments were classified as partially fibrotic (16.7%) and 10 (41.7%) as entirely scar-like. Gated PET (8 gates, tail drop corrected) allows quantification of global and regional ejection fraction to detect metabolic wall thickening in left ventricular segments with dyskinesia on CVG due to critical CAD stenoses. By improving data analysis methods, our approach may enhance the detection of viable, hibernating myocardium before revascularization.

Coping strategies, personality, and voice quality in patients with vocal fold nodules and polyps.

Emotional state affects the physiological mechanism involved in phonation. Differences in acoustical parameters of the voice under stress have been attributed to the coping mechanism used, which is based on the individual's perception of the situation. This study examines the relationship between coping strategies, personality, and voice in female subjects, ranging in age from 19.3-55.7 years, diagnosed with vocal nodules or polyps. The differences between coping strategies and personality are examined and compared with another group with no history of voice pathology. The relationship of personality and coping strategies to voice quality variables is reported. Results show that patients use emotional coping strategies more and cognitive coping strategies less than the comparison group. Type of voice pathology was found to be related to dominance, and a number of coping and personality variables were found to correlate significantly with voice quality.

A new implant site in iliac crest bone graft for retention of orbital epistheses: a preliminary report.

Osseointegrated percutaneous implants were placed at different sites of the facial skeleton to improve the retention of facial prostheses. Based on four cases a new implant position in autogenous bone grafts for retention of orbital restorations is described. As a first step an autogenous iliac bone graft was transplanted into the orbit. After a minimum interval of 3 months endosseous implants were placed into the grafted bone in axial direction in the middle of the orbit. A third operation several months later uncovered the implants. Using single free-standing rare earth magnetic attachments the orbital episthesis or the eye prosthesis was reliably stabilized. In all cases the bone grafts were integrated at the host site. Nine implants with a follow-up period of 4-66 months have been placed of which one was lost. The patients experienced subjective and objective improvement. Indications and advantages of the method are discussed.

[Bone transplantation in the orbits as a prerequisite for prosthetic management]. / Die Knochentransplantation in die Orbita als Voraussetzung zur prothetischen Versorgung.

We report on a method of fixing orbital prostheses and artificial eyes: First the orbit is filled by cortico-spongious bone graft. Afterwards two implants are centrally located in the graft, so that the prosthesis can be kept in place by magnetic retention. The advantage of this procedure is that the implants are more stable than those located in the orbital rim.

[Dance training and eating disorders]. / Apprentissage de la danse et troubles alimentaires.

Medical history, eating habits, weight, current symptomatology and EDI (Eating Disorders Inventory)-scores of 41 bulimic female patients with and without past training in dancing, who came for treatment to an outpatient clinic, were compared. It was found that both groups of patients were not different for age, age at beginning of bulimia, actual as well as minimal and maximal BMI (Body mass index), length and severity of symptomatology, frequency of bulimic behaviors, and scores on the subscales of the EDI, but it should be noted that these similarities might be in relationship with some methodological shortcomings. Considering the prevalence of bulimia nervosa in women and the high frequency of ballet and sports training in teenagers, some hypotheses about the possible influence of strenuous physical exercise in childhood on the symptomatology and some psychological traits in adults with anorexia nervosa, bulimia nervosa, or binge-eating disorder are presented. Further studies, including standardized scales and larger samples, are necessary.

[Status of obstetrical anesthesia in Germany]. / Zum Stand der geburtshilflichen Anästhesie in Deutschland.

A study on actual trends in obstetric analgesia and anaesthesia was conducted on data received from 385 German departments of obstetrics with a total of 267441 deliveries. On the basis of these extensive data quantitative results could be obtained about analgesic procedures for spontaneous deliveries, operative-vaginal deliveries, Caesarean sections and in cases of foetal or maternal risks. The type of analgesics and local anaesthetics used, their side effects and complications were recorded. In addition the cooperation and interaction between obstetricians and anesthesiologists in practising and monitoring obstetrical analgesia and anaesthesia are described.

[Echographic findings in cyclitis annularis pseudotumorosa and ring melanoma of the ciliary body]. / Echographische Befunde bei Cyclitis annularis pseudotumorosa und Ringmelanom des Ziliarkörpers.

Ring melanomas can closely simulate annular choroidal detachments ophthalmoscopically. In A-scan sonography the malignant melanoma of the ciliary body is characterized by low to medium reflectivity, whereas annular choroidal detachment manifests no internal reflectivity.

[Echographic diagnosis of orbital floor fractures]. / Echographische Diagnostik bei Orbitabodenfrakturen.

In this study symptoms of fractures of the orbital floor are described. The problems of diagnosis by x-ray are demonstrated. There is no evidence of bony fractures in many cases in standard x-ray pictures. Diagnosis of fractures of the orbital floor is established in most patients by polytomography. This method, however, implicates the disadvantage of high radiation exposure. Experimental studies have shown that fractures of a width of at least 1 mm. and bony fragments greater than 1 X 1 mm. can be visualized in the B-scan. All 62 cases of fractures of the orbital floor found intraoperatively had been diagnosed by ultrasound before surgery.

[Computer tomographic diagnosis of liver diseases]. / Computertomographische Diagnostik bei Lebererkrankungen.

Computed tomography is one out of several imaging procedures used in the detection of liver disease (radionuclide imaging, ultrasound). It is a noninvasive technique convenient for the patient and generally an outpatient procedure. Many focal lesions and some diffuse liver disease are characterized by a specific pattern. For space-occupying lesions, the diagnostic accuracy ranges between 86 and 95 percent.

[Artifacts in A and B-scan echograms following the implantation of artificial lenses]. / Artefakte im A- und B-Bild-Echogramm nach Implantation von Kunstlinsen.

In the A scan and B scan echogram of the eye and orbit artifacts may arise following implantation of an intraocular lens. Their origin, form, and localization can be explained by means of physics. Reverberation, foreign body, refraction, and absorption artifacts can be distinguished; familiarity with their appearance will avoid erroneous interpretation and results.

[Intracranial manifestations of lymphogranulomatosis]. / Intrakranieller Befall bei Lymphogranulomatose.

Intracerebral manifestations of Hodgkin's disease are rare. They may occur as a primary or secondary manifestation and cause a variety of neurological symptoms. Frequently other organs as lungs, liver, bones and gastrointestinal tract are involved. Computer tomography and scintigraphy of the brain are valuable tools to help establish the diagnosis. Most patients have a poor prognosis. The treatment of choice is radiation of the brain. The literature of 34 reported cases is reviewed and two own cases are reported.

Computed tomography for localizing enlarged parathyroid glands in primary hyperparathyroidism.

Computed tomography (CT) has been performed in 21 patients with primary hyperparathyroidism (HPT) in an attempt to localize preoperatively the parathyroid tumors. Eighteen of these patients also had ultrasound examinations. The CT examinations included the neck and mediastinum and were performed before and after contrast medium administration. At subsequent surgery, 24 enlarged glands were found, 20 in the neck and 4 in the mediastinum. In the neck, two were locally recurrent carcinomas. The true positive diagnostic rate for ultrasound was 60% with a false positive rate of 15% and a false negative rate of 25%. The CT examinations resulted in 70.9% true positive, 8.3% false positive, and 20.8% false negative diagnoses. The combination of both methods in the 18 patients so studied resulted in 80% true positive, 10% false positive, and 10% false negative findings. The CT examination procedure and its interpretation and limitations in primary HPT are described.

[Clinical value of bronchoalveolar lavage in progressive systemic scleroderma (author's transl)]. / Klinische Bedeutung der bronchoalveolären Lavage bei progressiver systemischer Sklerodermie.

As an enlargement of conventional diagnostic methods the cell spectrum of bronchoscopically obtained bronchoalveolar lavage was investigated in 10 patients with progressive systemic scleroderma. Two cases showed marked lymphocytosis, one increased numbers of granulocytes, two patients had marginally increased percentages of inflammatory cells. Four of these patients were in a progressive active phase of scleroderma with humoral inflammation signs and round cell infiltrates of the skin. In contrast, the lavage cell picture of the other five patients was unremarkable. One of these had advanced pulmonary fibrosis, however without signs of progression. The results show that the lavage cell pattern reflects the acute phase with cellular inflammation of lung parenchyma disease such as occurs in progressive systemic scleroderma. Staging of pulmonary organ manifestation in progressive systemic scleroderma can be markedly improved by low-risk bronchoalveolar lavage.