Effect of daytime, weekday and year of admission on outcome in acute ischaemic stroke patients treated with thrombolytic therapy.

BACKGROUND: Since doubts were raised, if a challenging medical procedure such as acute stroke treatment including thrombolysis with recombinant tissue plasminogen activator (rTPA) is available with identical standard and outcome 24 h and 7 days a week our aim was to examine if acute stroke patients defined by onset-admission time (OAT) of

Stroke-like episodes in familial mitochondrial encephalomyopathy: clinical and biochemical aspects.

Acute episodes of focal neurological dysfunction are a well-recognized complication of the mitochondrial encephalomyopathies. Because of rapid remission, biochemical tests and other diagnostic procedures are mostly performed after the acute phase. We report the case of a patient suffering from mitochondrial disease manifesting primarily with seizures, progressive deafness and dementia, who experienced multiple stroke-like episodes. Other members of the family with evidence of mitochondrial dysfunction are presented briefly. EEG and biochemical findings in the acute stage are correlated with clinical symptoms, showing characteristics distinct from the chronic illness. The possible involvement of dietary factors in the provocation of stroke-like episodes is discussed and regulation of glucose intake suggested as a strategy in the prevention of stroke-like episodes.

Continuous production of kyotorphin.

The continuous alpha-chymotrypsin-catalyzed peptide synthesis of kyotorphin, tyrosyl-arginine, via the N(alpha) formyltyrosyl-arginine propyl ester is described. For continuous process development, two reaction systems were studied: immobilized alpha-chymotrypsin covalently bound to Eupergit C packed in a column, and soluble alpha-chymotrypsin utilizing an enzyme membrane reactor. Selectivities and kinetic parameters are discussed. The use of soluble enzyme in an enzyme membrane reactor proved superior to the covalently immobilized enzyme. A significant loss of enzyme activity and a certain decrease of selectivity was observed during immobilization. It was shown that the addition of organic solvent, in this case n-propanol, causes a severe diminuation of the enzyme activity.

Alteration of substrate regulation patterns in glutamate dehydrogenase by enzyme immobilization.

Substrate regulation patterns were changed by covalent binding of bovine liver glutamate dehydrogenase via primary amino groups to CNBr- and CH-activated Sepharose 4B. Lineweaver-Burk plots show that the NAD activation region changed from being abrupt to elongated when the enzyme was immobilized to either support. The elongated region contains two inflection points and resembles substrate activation of several other allosteric oligomers. Glutamate induced varying degrees of abrupt activation in immobilized glutamate dehydrogenase and inhibited the native enzyme. This activation is characterized by an activation threshold, an increase in the apparent dissociation constant, and a correlation between the apparent rate constant and the degree of activation. These three features characterize other glutamate dehydrogenase systems.

[Spinal claudication caused by thoracic intervertebral disk displacement]. / Claudicatio spinalis durch thorakalen Bandscheibenvorfall.

We report a case of a 53 year old man with spinal claudication caused by a medial disc prolapse at the 11/12 thoracic intervertebral space. The disc prolapse was successfully removed via posterolateral approach.

[Clinical aspects and long-term prognosis of spontaneous thalamus hematomas]. / Klinik und Langzeitprognose spontaner Thalamushämatome.

In 47 cases with thalamic hemorrhage the estimated volume and the extension of the hematoma was compared to clinical data. The critical blood volume above which the mortality rate markedly increased was 10 cc. The most unfavourable outcome was found in hematomas extending to the midbrain or causing extensive ventricular hemorrhage. The severity and characteristics of the neurological deficit depended on the extension of the hematoma as well. Aphasia was a common feature when the thalamic hemorrhage occurred in the dominant hemisphere. Thalamic syndrome and ocular abnormalities were rare. The mortality rate was 17% and increased to 32% within the limits of twelve months. After a mean observation period of 31 months over 60% of the survivors had no or minimal disabilities. Only 20% remained seriously handicapped. The degree of the remaining disabilities depended on the original blood-volume. Eighteen of 32 survivors were submitted to neuropsychological tests. Three patients had an amnestic syndrome.

[Use of long spin-echo sequences for imaging demyelinating diseases]. / Einsatz von langen Spinechosequenzen zur Darstellung demyelinisierender Erkrankungen.

A multiple spin-echo-sequence has been evaluated in diagnosis of demyelinating diseases. TE in these MR-experiments was between 14 and 336 msec, TR between 860 and 1660 msec. Three groups of patients were examined, and it could be shown that the probability to detect MS-plaques grows with long TE's up to 300 msec. T2-relaxation-time-values range between 126 and 250 msec. Different MS-plaques in the same patient might show different T2-values.

[Polyneuropathy caused by disulfiram poisoning]. / Polyneuropathie nach Disulfiram-Intoxikation.

Disulfiram is known to produce toxic encephalopathy and peripheral neuropathy. The case of a 37-year-old alcoholic who attempted to commit suicide by taking 22.5 g disulfiram is described. During the first 6 days after the intoxication he was stuporous and had cerebellar ataxia and dysarthric speech. Then he became comatose, and as he recovered from coma, he showed peripheral neuropathy including diplegia faciei and severe tetraparesis. Denervation potentials were detected in both facial muscles and distal muscles of the upper and lower limbs, while conduction velocity was normal. Axonal degeneration was verified by sural nerve biopsy. In addition neurofilamentous axonopathy was documented. The recovery from his paresis lasted 2 years.

[The clinical significance of ventricular enlargement and cortical atrophy in computed tomography of the brain (author's transl)]. / Klinische Bedeutung der Ventrikelerweiterung und Rindenatrophie im Computer Tomogramm.

The diagnosis of atrophy of the brain based on the visual interpretation of CT findings appears questionable. In 56 patients there was no correlation between the CT findings of enlarged ventricles and sulci and clinical findings of psychoorganic syndromes. Only the group of 60 to 80 year old patients showed a statistically significant correlation between psychoorganic findings and the area of the lateral ventricles - measured planimetrically - and the diameter of the cella medica, but not the group of the 40 to 60 year old. There was no relationship between the number of cortical sulci and psychopathology. The morphological findings of ventricular enlargement and cortical atrophy in CT - even with exact measurements - do not allow any conclusions in regard to psychoorganic findings.

Semliki forest virus: cause of a fatal case of human encephalitis.

A fatal case of human encephalitis has been observed for which our results indicate that Semliki Forest virus (SFV) was the etiologic agent. This is surprising in view of the fact that this virus, which has been widely studied, was believed to be one of the arboviruses nonpathogenic for man. Described are the clinical course, the virological examinations performed, and the histopathological findings in the central nervous system.