EEG findings in dementia with Lewy bodies and Alzheimer's disease.

OBJECTIVES: To evaluate the role of the EEG in the diagnosis of dementia with Lewy bodies (DLB). METHODS: Standard EEG recordings from 14 patients with DLB confirmed at postmortem were examined and were compared with the records from 11 patients with Alzheimer's disease confirmed at postmortem RESULTS: Seventeen of the total of 19 records from the patients with DLB were abnormal. Thirteen showed loss of alpha activity as the dominant rhythm and half had slow wave transient activity in the temporal lobe areas. This slow wave transient activity correlated with a clinical history of loss of consciousness. The patients with Alzheimer's disease were less likely to show transient slow waves and tended to have less marked slowing of dominant rhythm. CONCLUSIONS: The greater slowing of the EEG in DLB than in Alzheimer's disease may be related to a greater loss of choline acetyltransferase found in DLB. Temporal slow wave transients may be a useful diagnostic feature in DLB and may help to explain the transient disturbance of consciousness which is characteristic of the disorder.

[Effectiveness of intravesical administration of lidocaine gel in females with urge and urge incontinence]. / Untersuchungen zur Effektivität eines intravesikal applizierten Lidocain-Gels bei Frauen mit Urge und Urge-Inkontinenz.

In a prospective study, 31 unselected patients with urge or urge incontinence, where previous treatment had been unsuccessful, were given repeated instillations of Lidocain gel for 11 days. Detailed histories were obtained by questionnaire both before instituting and after termination of the therapy. A cystourethrotonometric examination was also performed by the microtransducer method. The urge symptoms improved in almost all the patients. There was also a distinct improvement in subjective feelings of incontinence. There was a statistically significant reduction in mean micturition frequency. In 50% of the patients it was no longer possible to detect hypertonic bladder tone and pathologic detrusor contractions by cystourethrotonometry. Patients who had had lower bladder capacity prior to therapy showed a tendency to increased capacity after treatment. While there was no change in functional urethral length, there was a significant increase in maximum urethral closing pressure. Tonometrically detectable stress incontinence disappeared in one-fourth of the patients. No side effects were observed. In view of the high rate of success and the acceptance of intravesicular Lidocain therapy, it can also be recommended for cases resistant to therapy and, if necessary, can be included in an all-embracing therapeutic concept for urge incontinence.

[Prevention of thromboembolism in hysterectomies with low molecular weight heparin Fragmin]. / Thromboembolie-Prophylaxe bei Hysterektomien mit dem niedermolekularen Heparin Fragmin.

In comparison to standard heparins, the low-molecular types are said to have equal or better antithrombotic action and--since they affect coagulation less--to induce fewer hemorrhage complications. As they have a longer biologic half-life, a single subcutaneous injection per day is sufficient. In a prospective randomized study patients who had undergone vaginal and abdominal hysterectomy were given either the low-molecular heparin Fragmin (n = 95) or a combination of heparin-dihydergot (n = 98) as prophylaxis against thrombosis. Dosages of Fragmin were 2 X 2500 anti-Xa units on the day of surgery (Day 1) and 1 X 5000 anti-Xa units from Days 2 to 8; the dosage of heparin-dihydergot (HDHE) was 2 X 5000 IU heparin with 0.5 mg DHE from Days 1 to 8. There was no difference between the two groups with regard to the tendency to intraoperative bleeding, the incidence of severe wound hematomas and the postoperative hemoglobin course. Blood quantities in the drains were somewhat higher in the Fragmin group. Hemostasis studies showed that, also in patients on Fragmin, the activated partial thromboblastin time, thrombin time and reaction and clot formation time in the thromboelastogram are significantly prolonged three to four hours after injection. The heparin activity measured as the anti-Xa factor was higher by a factor of ten in patients on Fragmin than in those on HDHE. The thromboserate, recorded thermographically with the DeVeTherm unit, was the same in the two groups. Subjective acceptance of Fragmin prophylaxis was distinctly higher. Further studies to establish the required dose and show the effectiveness of low-molecule heparins seem necessary.

[Risk of thrombosis in irradiation of uterine cancer. A review with new results of studies]. / Das Thromboserisiko bei Radiumbestrahlung von Uteruskarzinomen. Eine Ubersicht mit neuen Untersuchungsergebnissen.

Malignomas of the uterus predispose to thromboembolism. Local application of radium increases the activation of hemostasis. In newer examinations there are hints, that impairment to thrombocyte function and prostacyclin metabolism may have a pathogenetic meaning. Thrombocyte aggregation and prostacyclin sensitivity of thrombocytes have been examined in two groups of patients: 21 patients following hysterectomy because of endometrium cancer stage I, treated with one vaginal application for the vaginal cuff and 10 patients with cervical carcinoma Stage IIa-IIIb treated combined intrauterine-intravaginally. The first group was prophylactically treated with low-dose-heparin, the second one with acenocoumarol (Sintrom). A slight, but significant increase of thrombocyte aggregation by 4.8 per cent respectively 5.0 per cent could be observed in both groups. Prostacyclin sensitivity of thrombocytes (PST) was significantly reduced by 20 per cent before irradiation in all patients compared with patients without carcinomas. In cases of intravaginal radium application we saw immediately after removal of the radioactive source a further reduction of PST by 12.5 per cent. 24 hours later a significant decrease of PST by 18.5 per cent could be observed. Contrary to this no significant changes were induced by combined intrauterine and intravaginal radium insertion. Therefore reduction of PST may be interpreted as a possible change of thrombocyte function in vivo caused by irradiation. It may be likely that these disturbances of thrombocyte function combined with radiogenic vessel wall damages and plasmatic hypercoagulability are responsible for the high thromboembolic risk of radium therapy. These patients should be treated prophylactically. Probably the efficiency of this prophylaxis can be improved by additional application of selective inhibitors of thrombocyte aggregation or inductors of prostacyclin synthesis.

[Prevention and therapy of deep venous thromboses in pregnancy]. / Prophylaxe und Therapie tiefer Venenthrombosen in der Schwangerschaft.

This paper presents a review of the current status of prevention and treatment of thromboses in pregnancy and reports the author's own results. Thromboembolism prophylaxis during pregnancy is accomplished with low-dose heparin, and is recommended for patients with a history of thrombosis and/or embolism. Heparin does not permeate the placenta; therefore, long-term use of it in low doses does not involve a risk. Complication-free courses in 18 pregnancies during which low-dose heparin was administered by the author are described. In cases of manifest deep thrombosis in the iliofemoral vein during pregnancy it is advisable today to perform thrombectomy as an alternative to fibrinolysis. This is followed by continuous administration of heparin in a therapeutic doses. Primary heparin treatment is given for thromboses of the knee and lower leg. The individual therapeutic methods are compared on the basis of information in the literature and the author's personal experience with 34 cases. Coumarins should no longer be used during pregnancy. In view of the risk of osteoporosis under high-dose long-term heparinization, one should switch to coumarins as soon as possible post partum; the coumarins are only detectable in traces in the mother's milk. Deep thromboses during pregnancy can only be treated with some promise of success if there is optimal cooperation between gynecologist, hemostasiologist and, if necessary, a vascular surgeon.

[Changes in blood coagulation, thrombocyte function and vascular prostacyclin synthesis caused by magnesium sulfate]. / Veränderungen von Blutgerinnung, Thrombozytenfunktion und vaskulärer Prostazyklinsynthese durch Magnesiumsulfat.

Magnesium deficiency, prostacyclin deficiency and reduced prostacyclin sensibility of the thrombocytes may possibly play an important pathophysiological role in gestosis/pre-eclampsia. For this reason, we studied the influence of magnesium sulphate (in vitro 2-16 mVal/l) on thromboelastogram, spontaneous and ADP-induced thrombocyte aggregation, prostacyclin sensitivity of the thrombocytes and prostacyclin liberation from umbilical cord vessel preparations. The thromboelastogram showed an inhibitory influence of magnesium sulphate on all measurement parameters. Spontaneous and ADP-induced thrombocyte aggregation were inhibited to a statistically significant extent. The prostacyclin sensibility of the thrombocytes was increased by magnesium-sulphate. Magnesium sulphate enhanced prostacyclin liberation from the vascular wall significantly by 20-36%. It is possible that in gestosis magnesium sulphate may exercise a favourable influence on the disturbed balance between prostacyclin production and prostacyclin sensibility of the thrombocytes by exercising an influence on coagulation, thrombocyte function and prostacyclin liberation, and that it can thus contribute towards stabilising coagulation disturbances.

Follow-up of a new modification of the Marshall-Marchetti-Krantz (MMK) procedure.

Clinical and urodynamic effects of a new modification of the Marshall-Marchetti-Krantz procedure for correction of urinary stress incontinence were studied 3-6 years after surgery. A clinical follow-up was made in 239 patients, and 39 had a urodynamic assessment. The subjective cure rate for incontinence was 69% while in another 20% there was improvement. Symptoms caused by the prolapse were relieved in 83%. The incidence of late complications was below 1%. Urodynamic measurements indicated a cure rate of 66%. Pressure transmission to the urethra was significantly improved. At follow-up, the functional length of the urethra and urethral closure pressure values were significantly higher than before operation. The incidence of urge (incontinence) and voiding difficulties was unchanged.

[Prostacyclin sensitivity of thrombocytes and prostacyclin-like activity in the umbilical cord]. / Prostazyklinsensitivität der Thrombozyten (PST) und prostazyklinähnliche Aktivität in der Nabelschnur.

The present paper reports on determination of prostacyclin sensitivity of thrombocytes in the umbilical vein and prostacylin-like activity in the umbilical artery and vein in 16 umbilical cords. Prostacyclin sensitivity of the thrombocytes in the umbilical vein is significantly higher than in the venous blood of nonpregnant women and third-trimester gravidae. The higher the prostacyclin sensitivity of the thrombocytes, the lower the prostacyclin-like activity in the umbilical cord vessels. Prostacyclin-like activity in the umbilical vein is 1.3 times higher than in the umbilical artery. There is a positive correlation between the activity in the umbilical artery and that in the umbilical vein. No significant relations were found between the prostacyclin-like activity of the thrombocytes or respectively the prostacyclin-like activity, and the blood gas and multiple serum analysis values and birth parameters. The significance of the findings with regard to hemodynamics in the umbilical cord is discussed.

[Heparin level and coagulation potential after subcutaneous injection of 7500 international units of heparin calcium]. / Heparinspiegel und Gerinnungspotential nach subkutaner Injektion von 7500 IE Heparin-Calcium.

A dosage of 7500 IU heparin calcium (Calciparin) was administered subcutaneously twice daily in 15 probands. Prior to and after the 1st and 7th injection heparin levels were determined in plasma and coagulation studies were done. The highest heparin levels were found around 4 hours after the injection. They were significantly higher after the 7th injection than after the 1st. Values decreased markedly after 8 hours. After 10-12 hours they approached the initial values, however remained significantly increased. The appropriate changes were seen in activated partial thromboplastin time, thrombin time and reaction- and clotting time in the thrombelastogram. Activity and concentration of antithrombin III decreased by about 10%. Fibrinogen and platelets remained largely unaffected. The results show that twice daily subcutaneous injections of 7500 IU heparin calcium are able to close the anticoagulation gap in plasma which occurs with administration of twice 5000 IU between two injections.

Platelet sensitivity to a prostacyclin analogue in normal and pathological pregnancy.

Platelet sensitivity to a prostacyclin analogue (PSP) was investigated at different stages of normal and pathological pregnancies. During uncomplicated pregnancy PSP decreased progressively by about 30% and returned to almost normal values in the puerperium. In pre-eclamptic women PSP was reduced by 49% and in pregnant diabetics by 50% compared with normal pregnant individuals of corresponding gestational age. Reduced PSP in normal and pathological pregnancy seems to be another aspect of increased coagulability and platelet aggregation found in these patients.

[ADP and collagen-induced thrombocyte aggregation in umbilical cord vein blood]. / Die ADP- und kollageninduzierte Thrombozytenaggregation im Nabelvenenblut.

ADP and collagen induced platelet aggregation were determined in 34 newborns immediately after birth. Blood was drawn from the pulsating not clamped umbilical vein. Parameters of aggregation were correlated to pH values of umbilical artery and vein, Apgar score and to the duration of the first and second stage of labor. No significant correlations were found between parameters of labor and platelet aggregation. It is demonstrated, however, that a decrease of the pH values in the umbilical artery and vein is well correlated with an increase of the main parameters of platelet aggregation. Changes of disaggregation of platelets were only moderate, they showed a tendency to decrease with falling pH values. Altogether there is an increase of platelet aggregability if pH values go down. The results emphasize that the changes of platelet function described should be regarded in the concept of therapy of newborns with severe acidosis or shock as they may accentuate preexisting hypercoagulability.

Low-dose heparin prophylaxis and postoperative wound hematoma.

In a randomized study, 124 patients, undergoing abdominal hysterectomy, were examined for postoperative wound hematoma after receiving low-dose heparin or heparin-dihydroergotamin (DHE) prophylaxis. Different sites of injection were chosen, with or without subcutaneous administration of thrombin at the end of surgery. The postoperative incidence of wound hematoma was not improved by subcutaneous thrombin administration. There was no difference between the two types of prophylaxis. When heparin or heparin/DHE was injected in the upper arm, however, fewer hematomas were found than after injection in the abdominal region. Investigations of the coagulation and fibrinolytic systems showed no difference between the two types of prophylaxis and injection site. The administration of thrombin did not cause intravascular activation of the coagulation system.

[Postoperative changes in hemostasis by heparin/dihydroergotamine prevention]. / Postoperative Hämostaseveränderungen unter Heparin/Dihydroergotamin- Prophylaxe.

Coagulation studies and the J-125-fibrinogen-uptake-test for diagnosis of deep vein thrombosis were carried out in 244 and 288 patients resp. undergoing vaginal or abdominal hysterectomy. They were given a prophylaxis with 2 X 5000 IU calcium heparin (Calciparin) or 2 X 5000 IU sodium heparin with 0.5 mg dihydroergotamine (Heparin-Dihydergot). Control patients received acenocoumarol (Sintrom). The incidence of deep vein thrombosis was lowest in the heparin/dihydroergotamine group and was 5.9%. With calcium heparin prophylaxis it was 15.5%, and with acenocoumarol 12.2%. Plasma heparin levels and parameters of coagulation, fibrinolysis and platelet function showed that after 8 days of heparin prophylaxis with or without dihydroergotamine there is no change in hemostasis towards an increasing hypo- or hypercoagulability. Coagulation changes and the incidence of postoperative wound hematoma were identical using heparin alone or in combination with dihydroergotamine. Thus the improved effectiveness of heparin/dihydroergotamine in prevention of deep vein thrombosis which has been shown in the fibrinogen test cannot be explained by an effect onto the coagulation parameters studied. It is pointed out that a peridural anesthesia can be carried out in low-dose heparin and heparin/dihydroergotamine prophylaxis without the risk of bleeding and that the incidence of wound hematoma can be reduced by correct choice of the site of injection.

[A new disposable, self-retaining, single-bladed vaginal speculum (author's transl)]. / Ein neues selbsthaltendes Einblatt-Vaginalspekulum zum Eimmalgebrauch.

A new, disposable vaginal speculum has been tested clinically. It consists of a thin, elastic plastic sheet which, rolled into the shape of a narrow tube, can be introduced into the vagina. Due to its inherent elasticity, it unfolds and allows examination of the cervix uteri. Of 507 patients investigated using this disposable speculum, cervical examination could be performed in 96%. In a comparative group of 138 patients using the usual metal speculum of Cusco, cervical examination was possible in 100%. The plastic speculum, developed for use in cancer screening tests, is suitable for routine vaginal examination after a little practice in the introduction technique.

Platelet sensitivity to prostacyclin in pregnancy and uterine cancer.

Platelet sensitivity to prostacyclin was investigated in platelet-rich plasma obtained from 12 pregnant women, 5 patients with cancer of the uterine cervix and 5 normal female controls. ADP-, collagen- and arachidonic acid-induced aggregation, as well as spontaneous platelet aggregation, were estimated. It was shown that platelets from pregnant women and, above all, from women with uterine cancer, are less sensitive to the inhibiting effect of prostacyclin on platelet aggregation. Thus, decreased sensitivity to prostacyclin seems to be another aspect of altered platelet function found in pregnancy and malignancy.

Biological action and half life in plasma or intramuscular sulprostone for termination of second trimester pregnancy.

Sulprostone levels in plasma, platelet function and clinical effects were examined in four patients after intramuscular injection of 500 microgram sulprostone for induction of missed and therapeutic abortion in the second trimester of pregnancy. The half life of sulprostone in plasma was 34 (30-45) minutes. The highest sulprostone levels were found 10 to 20 minutes after injection (0.25-0.77 ng/ml) and after 120-240 minutes the values in plasma were no longer distinguishable from zero. Platelet count remained constant. 20 minutes after the injection platelet aggregation was slightly decreased, but not to a significant level. There was no correlation between sulprostone levels in plasma and pain of labour or induction abortion times. Side effects were minimal.

PIP: Plasma levels of sulprostone, a synthetic prostaglandin E2 derivative, were measured along with assessment of platelet function and clinical effects of intramuscular injection in 4 patients. The 4 patients were given 500 mcgm, intramuscularly, of sulprostone to induce missed and therapeutic abortion in the second trimester of pregnancy. Half-life of sulprostone in plasma was 34 minutes (range 30-45), and the highest drug levels were found 10-20 minutes after injection (levels ranged from .25-.77 ngm/ml). Plasma levels diminished to zero after 120-240 minutes. Platelet count was unaltered throughout, although platelet aggregation did decrease slightly, but not significantly, about 20 minutes after injection. Side effects were gastrointestinal and adjudged minimal. An attempt to correlate plasma levels of sulprostone and labor pain or abortion-induction time was fruitless.