Expert consensus on acute management of ventricular arrhythmias - VT network Austria.

The Arrhythmia Working Group of the Austrian Society of Cardiology (ÖKG) has set the goal of systematically structuring and organizing the acute care of patients with ventricular arrhythmias (VA), i.e. ventricular tachycardia (VT) or ventricular fibrillation (VF) in Austria. Within a consensus paper, national recommendations on the basic diagnostic work-up of VA (12-lead ECG, medical history, family history, laboratory analyses, echocardiography, search for reversible causes, ICD interrogation), as well as further medical treatment and therapeutic measures (indication of coronary angiography, ablation therapy) are established. Since acute ablation of VT is indicated in the current ESC guidelines as a class IB indication for scar-associated incessant VT or electrical storm (ES; ≥ 3 ICD therapies in 24 h) as well as for ischemic cardiomyopathy (iCMP) with recurrent ICD shocks, organizational measures must be taken to ensure that these guidelines can be implemented. Therefore, a VT network will be established covering all areas in Austria, consisting of primary and secondary VT centers. Organizational aspects of an acute VT network are defined and should subsequently be implemented by the participating hospitals. All electrophysiologic centers in Austria that deal with VT ablation are to be integrated into the network in the medium-term. Centers that co-operate in the network are divided into primary and secondary VT centers according to predefined criteria.

Reproducibility of quantitative sensory testing applied to musculoskeletal orofacial region: Site and sex differences.

BACKGROUND: This study estimated the inter-rater reliability and agreement of the somatosensory assessment performed at masseter and temporomandibular joint (TMJ) region in a group of healthy female and male participants. METHODS: Forty healthy participants (20 men and 20 women) were evaluated in two sessions by two different examiners. Cold detection threshold (CDT), warm detection threshold (WDT), thermal sensory limen (TSL), cold pain threshold (CPT), heat pain threshold (HPT), mechanical detection threshold (MDT), mechanical pain threshold (MPT), wind-up ratio (WUR) and pressure pain threshold (PPT) were assessed on the skin overlying TMJ and masseter body. Mixed ANOVA, intraclass correlation coefficients (ICC) and standard error of measurement (SEM) were applied to the data (α = 5%). Nonoverlapping 95% confidence intervals (95% CI) of ICCs were considered significantly different. RESULTS: The ICCs of 77% of all quantitative sensory testing (QST) measurements were considered fair to excellent (ICCs: 0.47-0.97), and WUR presented the lowest values. The reliability of WDT, TSL and HPT of masseter was significantly higher than TMJ, whereas the MDT reliability of TMJ was higher than masseter. In addition, the following combination of test/sites presented significantly lower ICCs for women: HPT, MDT of TMJ and MPT of both TMJ and masseter. Finally, the highest SEM values were presented for CPT and MPT. CONCLUSION: The overall somatosensory assessment of the masticatory structures performed by two examiners can be considered sufficiently reliable to discriminate participants, except WUR. Possible site and sex influences on the reproducibility parameters should be taken into account for an appropriate interpretation and clinical application of QST. SIGNIFICANCE: The test site and participant's sex can significantly influence the relative reliability and agreement of quantitative sensory testing applied to musculoskeletal orofacial region, which affect the capacity to discriminate participants and to evaluate changes over time.

Evaluation of 177Lu[Lu]-CHX-A″-DTPA-6A10 Fab as a radioimmunotherapy agent targeting carbonic anhydrase XII.

INTRODUCTION: Due to their infiltrative growth behavior, gliomas have, even after surgical resection, a high recurrence tendency. The approach of intracavitary radioimmunotherapy (RIT) is aimed at inhibiting tumor re-growth by directly administering drugs into the resection cavity (RC). Direct application of the radioconjugate into the RC has the advantage of bypassing the blood-brain barrier, which allows the administration of higher radiation doses than systemic application. Carbonic anhydrase XII (CA XII) is highly expressed on glioma cells while being absent from normal brain and thus an attractive target molecule for RIT. We evaluated a CA XII-specific 6A10 Fab (fragment antigen binding) labelled with 177Lu as an agent for RIT. METHODS: 6A10 Fab fragment was modified and radiolabelled with 177Lu and characterized by MALDI-TOF, flow cytometry and radio-TLC. In vitro stability was determined under physiological conditions. Biodistribution studies, autoradiography tumor examinations and planar scintigraphy imaging were performed on SCID-mice bearing human glioma xenografts. RESULTS: The in vitro CA XII binding capacity of the modified Fab was confirmed. Radiochemical purity was determined to be >90% after 72 h of incubation under physiological conditions. Autoradiography experiments proved the specific binding of the Fab to CA XII on tumor cells. Biodistribution studies revealed a tumor uptake of 3.0%ID/g after 6 h and no detectable brain uptake. The tumor-to-contralateral ratio of 10/1 was confirmed by quantitative planar scintigraphy. CONCLUSION: The radiochemical stability in combination with a successful in vivo tumor uptake shows the potential suitability for future RIT applications with the 6A10 Fab.

Ear-EEG allows extraction of neural responses in challenging listening scenarios - A future technology for hearing aids?

Advances in brain-computer interface research have recently empowered the development of wearable sensors to record mobile electroencephalography (EEG) as an unobtrusive and easy-to-use alternative to conventional scalp EEG. One such mobile solution is to record EEG from the ear canal, which has been validated for auditory steady state responses and discrete event related potentials (ERPs). However, it is still under discussion where to place recording and reference electrodes to capture best responses to auditory stimuli. Furthermore, the technology has not yet been tested and validated for ecologically relevant auditory stimuli such as speech. In this study, Ear-EEG and conventional scalp EEG were recorded simultaneously in a discrete-tone as well as a continuous-speech design. The discrete stimuli were applied in a dichotic oddball paradigm, while continuous stimuli were presented diotically as two simultaneous talkers. Cross-correlation of stimulus envelope and Ear-EEG was assessed as a measure of ongoing neural tracking. The extracted ERPs from Ear-EEG revealed typical auditory components yet depended critically on the reference electrode chosen. Reliable neural-tracking responses were extracted from the Ear-EEG for both paradigms, albeit weaker in amplitude than from scalp EEG. In conclusion, this study shows the feasibility of extracting relevant neural features from ear-canal-recorded "Ear-EEG", which might augment future hearing technology.

Treatment responses in collagenous colitis.

OBJECTIVE: In the nearly 20 yr since collagenous colitis was first recognized, the results of therapies have not been systematically described in substantial numbers of patients. We have therefore conducted a retrospective analysis of 26 patients treated in this institution during the years 1991-1994. METHODS: Twenty-nine cases of collagenous colitis were obtained by review of biopsy specimens collected between 1991 and 1994 at The Mount Sinai Hospital. Each chart was reviewed for patient demographics, symptoms, coexisting conditions, specific therapies, and therapeutic outcomes. Additional data were obtained from telephone calls to patients when deemed necessary. Three patients were exeluded from the study because of lack of follow-up. Therapeutic outcomes were defined as follows: Complete Remission (CR): normalization of bowel function; Partial Remission (PR): 50% reduction in frequency of bowel movements; Failure: <50% reduction in frequency of bowel movements; or Relapse: return of symptoms after cessation of treatment. Median follow-up was 58 wk from time of diagnosis, with a range of 22-376 wk. RESULTS: The 26 patients (25 women, one man) had a mean age of 62 yr (range, 22-85 yr) at diagnosis. Of 26 patients, 22 responded to some form of therapy and one had spontaneous remission. Six of the responders ultimately remained in CR with no therapy. Twelve are maintained on 5-aminosalicylic acid (5-ASA) and or antidiarrheals to control symptoms. An additional six required prednisone throughout the follow-up period to remain in CR or PR. Two patients failed all therapy. CONCLUSION: Collagenous colitis is a treatable condition in most patients. We recommend initial therapy with antidiarrheals, followed by a trial of 5-ASA agent. A trial of 5-ASA in combination with prednisone should be attempted in patients refractory to 5-ASA alone, with subsequent attempts in the responders to taper prednisone and maintain remission with no therapy, if possible, or with 5-ASA and/or antidiarrheal agents if necessary.

[Sonographic representation of the normal and acute inflamed appendix--in patients wi right-sided abdominal pain]. / Sonographische Darstellbarkeit der normalen und der entzündeten Appendix--bei Patienten mit rechtsseitigen Unterbauchschmerzen.

The detectability, vascularization and size of the normal and inflamed appendix were investigated in the study. 148 patients under suspicion of appendicitis or with lower right abdominal pain were studied over a period of five months beginning in January 1998. An ultrasound-transducer was employed at a wave length of 3.5 MHz to 10 MHz. Vascularization was measured using 'Duplex' and 'Color Angio'. The results were compared with operative evidence, histology and patient history. The appendix was detected in about 30% of the cases (47/148). But of the presumably normal appendices only 12% (13/109) were detected. 27 appendices sonographically diagnosed as acutely inflamed were confirmed by operation and phlegmonic. The acute appendicitis was sonographically diagnosed with a sensitivity of 82% and a specificity of 95%. The diameter of the normal appendices was an average of 5.5 mm, that of the acute was 12.2 mm whereby 21 of 25 organs were at least 9 mm. The measurement of the organ size seems to be more helpful than the detection of vascularization. Both methods alone cannot detect the acute phlegmonic appendicitis. The normal appendix was less frequently detected than described in current literature. Patients with pain present difficulties in ultra-sound examination because both the cooperation and the time for the correct diagnosis are limited.

A gastroenterological list for the millennium.

To determine the 10 most significant advances in gastroenterology during this century as we approach the millennium, the authors polled 50 distinguished active clinicians and leading researchers in the field, including workers in liver disease and the pathology of the gut and its associated glands. Forty-five persons (90%) responded and listed 58 different items. These were then organized into four groups: group A, with 10 categories that received between 42 and 11 votes; group B, with 10 categories that received between 10 and 3 votes; group C, with 3 items receiving 2 votes each; and group D, with the remaining 14 items receiving 1 vote each. The respondents did not indicate their choices in rank order. The top 10 leading choices (group A, containing between 42 and 11 votes) included Helicobacter pylori, fiberoptic endoscopy, gastrointestinal imaging by radiograph and computed tomographic scan, Australia antigen including vaccines for hepatitis A and B, the molecular basis of colon cancer, liver transplantation, laparoscopic-assisted surgery, therapy for peptic ulcer disease including H2-receptor antagonists and proton pump inhibitors, the discovery of gastrointestinal hormones beginning with secretin, and lastly the discovery of the role for gluten in celiac disease.

[Ultrasound diagnosis of acute appendicitis--possibilities and limits of the method--results of prospective and retrospective clinical studies]. / Die sonographische Diagnostik der akuten Appendizitis--Möglichkeiten und Grenzen einer Methode--Ergebnisse prospektiver und retrospektiver klinischer Studien.

AIM: In the diagnosis of appendicitis high-resolution ultrasound has become "gold standard" among the imaging methods. The ranking of the method and its dependence on the experience of the examiner, the quality of different ultrasound machines and the time of the examination, were examined in a trial during a 7-year period. METHOD: In 905 patients examination by the surgeon was followed by ultrasound. The results were compared with clinical or histological diagnosis. RESULTS: In a prospective study we examined sonographical 367 patients with the diagnosis of "appendicitis" at admission. The sensitivity was 75.3%, the specificity 96.2%. In a retrospective analysis of 538 patients with appendectomy, the sensitivity was 50.5% and the specificity 95.4% in pre-operative diagnosis. If the examination was done by a less experienced examiner (less than 500 ultrasound examinations/year) the sensitivity was 45.1% and specificity 93.6%; an experienced doctor (500-1000 ultrasound examinations/year) achieved 57.9 and 92.9% and a highly qualified investigator (more than 1000 ultrasound examinations/year) a sensitivity of 73.9% and a specificity of 97%. If the examination was realised with high frequency ultrasonic scanning (10 MHz), sensitivity (73.9%) and specificity (96.3%) could be increased. Essential for an exact diagnosis was a short-term period between ultrasound examination and intra-abdominal diagnosis. CONCLUSION: Optimal sonographical appendicitis diagnosis must be based on a combination of a qualified examiner, high-resolution ultrasound and short-term follow-up.

[The layers of the gallbladder wall: an ultrasound-anatomic comparative study]. / Die Schichten der Gallenblasenwand: Eine sonographisch-anatomische Vergleichsuntersuchung.

In a sonographic-histological comparative test, operatively withdrawn gallbladders in native and formol-fixed states were examined. The thickness of the gallbladder wall and of its layers was measured sonographically. Afterwards the gallbladders were reexamined microscopically in the sonographic sectional plane and the measurement was repeated. By removal of the single layers of the wall and by repeated sonographic measuring, sonographic and microscopic measurements of the parietal layers could be correlated. Both gallbladder wall thickness and thickness of the single anatomic layers can be evaluated sonographically. The correlation between sonographic and histological measurements is fairly to highly significant. The sonographically measurable layers can be related to the following anatomical layers (when measuring from outwards to inwards): 1. echogenic layer = initial echo and subserosa; 2. echo-poor layer = muscularis; 3. echogenic layer = lamina propria; 4. echo-poor layer = mucosal epithelium; 5. echogenic layer = exit echo.

The revised Generalized Expectancy for Success Scale: a validity and reliability study.

The Generalized Expectancy for Success Scale (GESS; Fibel & Hale, 1978) was revised and assessed for reliability and validity. The revised version was administered to 199 college students along with other conceptually related measures, including the Rosenberg Self-Esteem Scale, the Life Orientation Test, and Rotter's Internal-External Locus of Control Scale. One subsample of students also completed the Eysenck Personality Inventory, while another subsample performed a criterion-related task that involved risk taking. Item analysis yielded 25 items with correlations of .45 or higher with the total score. Results indicated high internal consistency and test-retest reliability.

[Comparison of results of daily blood pressure self-monitoring and general practice monitoring within the scope of a study assessing treatment of hypertension with quinapril]. / Vergleich der Ergebnisse von täglichen Blutdruckselbstmessungen und Praxismessungen im Rahmen einer Studie zur Behandlung der Hypertonie mit Quinapril (Accupro).

24 hour blood pressure monitoring is a well established method in the field of antihypertensive research. Patients self recorded blood pressure values are an additional option to overcome the disadvantages of casual office readings--however they are not frequently used within intervention trials. To prove the usefulness of selfrecordings in clinical trials we investigated both selfrecordings taken twice a day and casual readings within intervals of 1 to 3 weeks, in this study on the efficacy and tolerability of the ACE-inhibitor Accupro. 108 hypertensive patients (grade WHO I to II) were included in this trial for ten weeks. Although blood pressures were measured by the patients using sphygmomanometers of the same type and the physicians, decisions to treat or to increase dosage were based on the patients' recordings only. Accupro was dispensed according to the package leaflet at a daily dosage of 5 mg up to 40 mg. In case of failing response to monotherapy, Accupro was combined with Diltiazem or with a diuretic. 7 patients discontinued the treatment due to mild adverse events, one did not cooperate. 82 of the remaining patients were treated effectively with Accupro monotherapy--60 (73%) got one dose daily, 22 (27%) 2 doses per day,--and in 18 patients a drug combination was required. Therapeutic response (RRd < or = 90 mm Hg) was gained within 86 of the 100 evaluable patients according to the doctors' and 83 according to the patients' records. In this respect the two methods used gave comparable overall results. This somewhat surprising fact is due to the design of the study, because treatment decisions were based on the selfrecordings only. Clinical trials based on selfrecordings are in some points preferable to casual office readings: As patients being normotensive at home should not be included into an interventional study, a change of dosage within this group is avoided. Additionally the compliance of a cooperative patient taking his blood pressure twice daily is at a high level. Measurements of each single patient may be evaluated statistically by time series-analysis regarding longterm distribution of blood pressure-values. Taking the means of selfrecordings over adequate time-intervals eliminates the influence of "outliers" (occasionally extremely high or low values) and also reduces the standard deviation compared to that of the casual readings. Research work based on self recordings provides more information and therefore more security for treatment decisions.

Isolated chronic mitral regurgitation with preserved systolic left ventricular function and severe pulmonary hypertension.

Pulmonary hypertension in chronic mitral valve disease has been related most commonly to left ventricular dysfunction or mitral stenosis; its association with chronic, isolated mitral regurgitation and preserved left ventricular systolic function is unclear. In 41 catheterized patients with chronic mitral regurgitation (known history of mitral regurgitation for greater than 18 months) and preserved left ventricular systolic function (ejection fraction greater than 0.55), historic, electrocardiographic, echocardiographic and hemodynamic variables were analyzed. Ten patients (Group I) had normal pulmonary artery systolic pressure (less than 30 mm Hg), whereas 31 patients had pulmonary hypertension. Pulmonary artery systolic pressure was mildly increased (30 to 49 mm Hg) in 13 patients (Group II) and was greater than or equal to 50 mm Hg in 18 patients (Group III). Univariate analysis showed the more frequent occurrence of male gender and ruptured chordae tendineae in the groups with pulmonary hypertension. Mean pulmonary capillary wedge pressure, size of the V wave in pulmonary capillary wedge pressure and pulmonary arteriole resistance were higher, whereas cardiac index was lower in the hypertension groups. Multivariate stepwise analysis revealed higher mean pulmonary capillary wedge pressure and pulmonary arteriole resistance as the only variables independently differing among groups. In conclusion, pulmonary hypertension occurs frequently (76% of cases) in patients with chronic, isolated mitral regurgitation with preserved left ventricular systolic function. In these patients, a severe increase in pulmonary capillary wedge pressure is associated with elevation in pulmonary artery resistance, a finding similar to that in mitral stenosis.

[Posthepatic jaundice caused by abnormalities of the pancreaticobile duct system in early childhood]. / Posthepatischer Ikterus durch Fehlbildungen des pancreatiko-biliären Gangsystems im Kleinkindesalter.

Anomalies of the pancreatico-biliary tract present the most frequent cause of posthepatic cholestasis in the young child, whereas calculous disease or infections or compression by vascular abnormalities or neoplasms are less frequent. Generally, abdominal pain and jaundice begin acutely and increase following progressive biliary congestion. The preoperative diagnosis by ERCP or PTC or the intraoperative diagnosis of a relevant pancreaticobiliary anomaly stress the necessity of an operative management performing a bypass of the Sphincter Oddi and of the site of the anomaly. Local operative revision alone seems to be associated with a frequent relapse of cholestasis.

Effects of thyroidectomy, parathyroidectomy and lithium on circadian wheelrunning in rats.

Circadian rhythms and levels of wheelrunning were studied in thyroidectomized, parathyroidectomized, thyro-parathyroidectomized, and sham-operated male rats. Animals were entrained to a 12:12 light:dark schedule, then exposed to constant dim red illumination, and then given a diet containing lithium. Under constant conditions, free-running circadian activity rhythms were shorter, and levels of activity were greater, in thyroidectomized and thyroparathyroidectomized animals. Lithium reversed these effects, lengthening free-running circadian periods in all groups, with a greater reduction of activity observed in animals with thyroids removed. Parathyroidectomy had no clear effects. Since lithium slowed circadian rhythms and reduced activity even in the absence of intact thyroid or parathyroid glands, these effects may have been due to the action of lithium at some other site. The same may be true of other thyroid suppressors reported to affect circadian rhythms. These findings may be relevant to the biological substrates of major affective disorders in humans, which have been associated with abnormalities of thyroid function, abnormally short circadian rhythms, abnormal activity levels, and responsiveness to lithium therapy.

[Cancer of the middle third of the rectum]. / Rektumkarzinom im mittleren Drittel.

Anterior resection and abdominoperineal resection are standard procedures to treat cancer in the upper and the lower third of the rectum, respectively. The area of interest today is the middle third of the rectum, i.e. the part 7.5-12 cm above the anal verge. Surgical therapy is mainly based on prognostic tumor factors and preoperative staging. The degree of tumor infiltration of the rectal wall and the number of positive lymph nodes are of paramount importance. For preoperative staging the results of digital examination are improved by new imaging techniques. Endorectal ultrasound is able to oklineate tumor infiltration of the rectal wall, whereas computed tomography is better suited to identify tumor infiltration outside the rectum. Preoperative lymph node staging is still not reliable. The surgeon, therefore, has to decide on the surgical therapy intraoperatively. Local tumor excision is possible only if the tumor can be reached by the finger of the surgeon, i.e. if located not more than 10 cm above the anal verge. Local excision is an acceptable procedure in high grade cancers of less than 3 cm diameter and infiltration of the muscularis propria, preferably submucosa only. Further studies are needed to evaluate the long term results. Adjuvant preoperative radiation therapy is applied increasingly in tumors infiltrating beyond the rectal wall. There is at present no apparent benefit from chemotherapy for carcinoma of the rectum.