[Pain management of cognitively impaired patients]. / Schmerzmedizinische Versorgung von Patienten mit kognitiven Beeinträchtigungen.

Pain is a significant problem in clinical practice and its control is one of the most important challenging aspects as pain has a major impact on patients' quality of life and health care costs. Particularly vulnerable persons, like cognitively impaired patients are challenging for pain management and underline its increasing relevance.National and international studies showed significant differences concerning pain therapy between cognitively impaired and cognitively intact patients. A possible cause of this may be that patients who are cognitively impaired are only in a restricted way able to express their pain. Furthermore, knowledge gaps and reservations concerning the effect and dosage of analgesics among cognitively impaired patients could be identified on the involved professions.Further investigations in Germany are needed as deficient treatment remains a persistent problem and evidence-based data are missing. These investigations should describe the status quo of pain management for cognitively impaired patients and provide information which processes have to be adapted to the needs of these vulnerable patients.

SPECT perfusion patterns distinguish psychogenic from essential tremor.

BACKGROUND: Psychogenic movement disorders pose formidable challenges to diagnosis and treatment reflecting our limited understanding of the basic brain mechanisms that cause them. Recently, functional brain imaging has been utilized to study psychogenic movement disorders. OBJECTIVES: To identify characteristic patterns of cerebral perfusion distinguishing psychogenic tremor (PT) from essential tremor (ET). METHODS: We studied five patients each with PT, ET and normal controls. SPECT imaging was performed at rest and during a tremor-inducing motor task. RESULTS: In ET, rest imaging revealed increased rCBF (relative cerebral blood flow) in cerebellar hemispheres and left inferior frontal gyrus. During the motor task, ET patients demonstrated increased rCBF in the supplementary motor area (SMA) and contralateral motor cortex and reduced rCBF in the cerebellum and visual cortex. In contrast, PT images at rest revealed increased rCBF in left inferior frontal gyrus and left insula. Motor task imaging revealed increased rCBF in the cerebellum and reduced rCBF in anterior regions of the default mode network. CONCLUSIONS: Our study revealed distinct patterns of cerebral perfusion during rest and motor task that distinguish PT from ET. Deactivation of the default mode network may serve as a marker for psychogenic movement disorders.

Parkinsonism and tardive antecollis in frontotemporal dementia--increased sensitivity to newer antipsychotics?

Frontotemporal dementia (FTD) often presents with behavioural changes warranting treatment with antipsychotic medications. It is known that patients with Lewy body dementia are sensitive to developing extrapyramidal symptoms (EPS) from these medications. This has not been emphasized in FTD. We report three patients with FTD that developed parkinsonism and prominent antecollis after treatment with newer antipsychotics, including olanzapine, risperidone and quetiapine. Patients with FTD might have increased sensitivity to antipsychotic medications as with Lewy body dementia. Although newer antipsychotics have favourable side effect profiles, there is increasing evidence that EPS develop more frequently than previously thought.

Sequence-selectivity of 5,11-dimethyl-5H-indolo[2,3-b]quinoline binding to DNA. Footprinting and molecular modeling studies.

Indolo[2,3-b]quinolines are a new family of the DNA intercalators showing significant cytotoxic activity. The mechanism of their action is based on the inhibition of DNA topoisomerase II activity. It depends on their ability to induce and stabilize drug-topII-DNA cleavable complexes. Site-specific intercalation of 5,11-dimethyl-5H-indolo[2,3-b]quinoline (DiMIQ) was analyzed in vitro by DNaseI footprinting and by molecular modeling. To model the DNA-intercalator complex, use was made of the CVFF and ESFF force fields implemented in Insight 97.0 software. Experimental results were verified using a simple statistical model. The DiMIQ molecule was found to bind preferentially to the pBR322 DNA plasmid in the 5'-TGCTAACGC-3' region between adjacent adenine bases.

Relationship between altered structure and photochemistry in mutant reaction centers in which bacteriochlorophyll replaces the photoactive bacteriopheophytin.

Qy-excitation resonance Raman (RR) spectra are reported for two mutant reaction centers (RCs) from Rhodobacter capsulatus in which the photoactive bacteriopheophytin (BPhL) is replaced by a bacteriochlorophyll (BChl) molecule, designated beta. The pigment change in both mutants is induced via introduction of a histidine residue near the photoactive cofactor. In one mutant, L(M212)H, the histidine is positioned over the core of the cofactor and serves as an axial ligand to the Mg+2 ion. In the other mutant, F(L121)H/F(L97)V, the histidine is positioned over ring V of the cofactor, which is nominally too distant to permit bonding to the Mg+2 ion. The salient observations are as follows: (1) The beta cofactor in F(L121)H/F(L97)V RCs is a five-coordinate BChl molecule. However, there is no evidence for the formation of a Mg-His bond. This bond is either much weaker than in the L(M212)H RCs or completely absent, the latter implying coordination by an alternative ligand. The different axial ligation for beta in the F(L121)H/F(L97)V versus L(M212)H RCs in turn leads to different conformations of the BChl macrocycles. (2) The C9-keto group of beta in F(L121)H/F(L97)V RCs is free of hydrogen bonding interactions, unlike the L(M212)H RCs in which the C9-keto of beta is hydrogen bonded to Glu L104. The interactions between other peripheral substituents of beta and the protein are also different in the F(L121)H/F(L97)V RCs versus L(M212)H RCs. Accordingly, the position and orientation of beta in the protein is different in the two beta-containing RCs. Nonetheless, previous studies have shown that the primary electron transfer reactions are very similar in the two mutants but differ in significant respects compared to wild-type RCs. Collectively, these observations indicate that changes in the conformation of a photoactive tetrapyrrole macrocycle or its interactions with the protein do not necessarily lead to significantly perturbed photochemistry and do not underlie the altered primary events in beta-type RCs.

Resonance Raman characterization of reaction centers in which bacteriochlorophyll replaces the photoactive bacteriopheophytin.

Qy-excitation resonance Raman (RR) spectra are reported for two mutant reactions centers (RCs) from Rhodobacter sphaeroides in which the photoactive bacteriopheophytin (BPhL) is replaced by a bacteriochlorophyll (BChl) molecule, designated by beta L. One mutation, (M)L214H, yields the pigment change via introduction of a histidine residue at position M214. The other mutation, (M)L214H/(L)-E104V, removes the putative hydrogen bond between beta L and the native glutamic acid residue at position L104. The vibrational signatures of the beta L cofactors of the mutants are compared with one another and with those of the accessory BChls (BChlL,M) in both beta-mutant and wild-type RCs. The spectroscopic data reveal the following: (1) The beta L cofactor is a five-coordinate BChl molecule with a histidine axial ligand. The conformation of beta L and the strength of the Mg-histidine bond are very similar to that of BChlL,M. (2) The beta L cofactor is oriented in the protein pocket in a manner similar to that of BPhL of wild-type. (3) The beta L cofactor of the (M)L214H mutant forms a hydrogen bond with glutamic acid L104 via the C9-keto group of the macrocycle. The strength of this hydrogen bond is identical to that formed between this protein residue and the C9-keto group of BPhL in wild-type. (4) The hydrogen bonding interaction at the C9-keto site induces secondary cofactor-protein interactions which involve the C2a-acetyl and Cb-alkyl substituent groups. Collectively, the vibrational signatures of beta L indicate that its intrinsic physicochemical properties are very similar to those of BChlL. Consequently, the initial charge-separated intermediate in beta-type RCs is best characterized as a thermal/quantum mechanical admixture of P+ beta L- and P+ BChlL-(P is the primary electron donor), as originally proposed by Kirmaier et al. [(1995) J. Phys. Chem. 99, 8903-8909].

Resonance Raman spectra of native and mesoheme-reconstituted horseradish peroxidase and their catalytic intermediates.

Resonance Raman studies of native and mesoheme-reconstituted horseradish peroxidase and their catalytic intermediates, known as Compounds I and II, have been conducted using both near UV ( approximately 350 nm) and visible (406.7 nm) excitation. Careful power studies indicate that the authentic Compound I spectra are obtainable using near UV excitation, but that use of visible excitation results in contamination of the Compound I spectrum with the spectrum of a Compound II-like photoproduct. Using H218O2, the nu(Fe=O) stretching modes for both systems are unambiguously identified, for the first time, at approximately 790 cm-1. The authentic Compound I spectra are indicative of an 2A1u-like ground state for both the native and the mesoheme-reconstituted proteins. Finally, the possible biological implications of such information are briefly discussed.

[Primary aorto-intestinal fistula as a diagnostically difficult complication of ruptured abdominal aortic aneurysm]. / Pierwotna przetoka aortalno-jelitowa jako trudne diagnostycznie powiklanie peknietego tetniaka aorty brzusznej.

Three cases are presented of a rare complication of abdominal aorta aneurysm, that is its rupture into the gastrointestinal tract. In two cases the aneurysm ruptured into the duodenum, and in one case into small intestine. The authors call attention to the variety of symptomatology and diagnostic difficulties with the primary aorto-intestinal fistula. This is true especially of cases in which the rupture is the first and not infrequently the only symptom of the aneurysm. The rupture of the abdominal aorta aneurysm into the gastrointestinal tract is still fraught with a very high mortality; out of three patients with primary aorto-intestinal fistula only one was saved.

[Early results of acute non-traumatic ischemia of the limbs]. / Wczesne wyniki leczenia ostrego nieurazowego niedokrwienia konczyn.

The results of therapy of 726 patients with the acute non-traumatic ischemia of the limbs are discussed. These patients were treated in the 11 centres of vascular surgery in Poland between 1986 and 1988. Out of causes of the acute non-traumatic ischemia of the limbs arterial embolism was diagnosed in 450 patients, thrombosis in 229 cases, and dissecting aneurysm in 8 patients as well as phlegmasia coerulea dolens in 1 patient Surgical treatment included 665 patients, and the remaining 383 patients were treated conservatively. The results of the conservative and surgical treatment were scored with a 5-point scale. Excellent results with the return of complete functioning of the affected limb and presence of peripheral pulse were achieved in 291 patients, positive result, i.e. lack of the peripheral pulse, in 197 cases, moderate result in 80 patients in whom complete functioning of the limb has not been restored. In case of 64 patients an amputaion proved necessary. Nine four patients died.