German Environmental Survey (GerES): human biomonitoring as a tool to identify exposure pathways.

The German Environmental Survey (GerES) is a representative population study and has been repeatedly carried out since the mid-1980s. The currently run survey (GerES IV) is the first one solely targeted on children. The GerES IV Pilot Study resulted in first insights into major exposure pathways relevant to children. These insights were made possible by the determination of pollutant concentrations in blood and urine and the additional consideration of their occurrence in the indoor environment and by using questionnaire data. The results of the GerES IV Pilot Study are presented according to major exposure pathways such as house dust, food and environmental tobacco smoke (ETS). An overview on relevant pilot study results is given. The results of GerES IV will permit the verification and substantiation of the pilot study results.

Organochlorine residues in fish and water samples from lake victoria, Uganda.

Nile tilapia and Nile perch samples from Lake Victoria were analyzed for lindane (gamma-1,2,3,4,5,6-hexachlorocyclohexane), aldrin (1,2,3,4,10,10-hexachloro-1,4,4a,5,8,8a-hexahydro-1,4:5,8-dimethanonaphthalene), alpha-endosulfan (6,7,8,9,10,10-hexachloro-1,5,5a,6,9,9a-hexahydro-6,9-methano-2,4,3- benzo(e) dioxathiepin-3-oxide), dieldrin (1,2,3,4,10,10-hexachloro-6,7-epoxy-1,4,4a,5,6,7,8,8a-octahydro-1,4,5,8-dimethanonaphthalene), DDE (p,p'-1,1-dichloro-2,2-bis-(4-chlorophenyl)ethylene), and DDT (p,p'-1,1,1-trichloro-2,2-bis-(4-chlorophenyl)ethane). No significant difference (alpha = 0.05) in the residue levels between fish types for lindane, alpha-endosulfan, p,p'-DDE, p,p'-DDT, and dieldrin was observed. The aldrin levels in Nile perch (Lates niloticus) were significantly higher than the levels in Nile tilapia (Oreochromis niloticus). No difference was observed in the distribution of residues in the different parts of Nile tilapia, although a difference for p,p'-DDE was observed in the Nile perch. No significant difference was observed in the average fat content of the tissue of Nile perch and Nile tilapia; however, the distribution of fat was significantly different in the different parts of the fish, with the abdominal portion having the highest amount of fat. There was no correlation observed in this study between fat content and organochlorine concentration. Lower p,p'-DDT residues levels compared with the p,p'-DDE levels observed in this study indicate that DDT is no longer in use. The levels of organochlorine pesticide residues found in fish samples in this study were below the FAO, U.S. FDA, Australian, and German extraneous residue limits and maximum residue limits. The concentration of organochlorine residues in surface water within the Napoleon Gulf of Lake Victoria was below detection limit (0.1 microg L(-1)).

Towards the development of molecularly imprinted polymer based screen-printed sensors for metabolites of PAHs.

This paper describes the fabrication of a sensor for 1-hydroxypyrene (1-OHP) based on a screen-printed carbon electrode (SPCE) modified with a molecularly imprinted polymer (MIP); 1-OHP was chosen as a model metabolite of polyaromatic hydrocarbons (PAHs). It was shown that 1-OHP could be readily oxidised at a plain SPCE and the electrochemical mechanism was found to involve an ECE (electron transfer-chemical reaction-electron transfer) process. The MIP for 1-OHP was prepared using only divinylbenzene (DVB) and styrene as monomers and the binding was only based on hydrophobic interactions. Batch binding studies revealed that optimum uptake of 1-OHP by the MIP occurred from solutions containing 35% water in methanol. Selectivity of the binding sites in the MIP was examined by performing uptake studies in the same solution containing either phenol or 1-naphthol; the specific binding of 1-OHP was twenty times greater than the former and five times greater than the latter. Preliminary calibration studies were performed with the MIP-SPCE using a two-step approach; accumulation was carried out in 35% water in methanol followed by measurement in 50% methanol-0.025 mol dm(-3) phosphate buffer pH 12. This two-step non-competitive affinity assay gave encouraging results and indicated potential for use in pollution studies.

Effect of lateralized kinetic visual cues on visual search in patients with unilateral spatial neglect.

Patients with left neglect following right cerebral infarcts and normal control subjects searched for a single target letter among distractor letters presented on a display screen while kinetic visual cues were continuously presented on the left side or the center of the display screen. Kinetic visual cues presented on the left side enhanced patients' detection of left-sided targets but did not reduce the time that they required to search for left-sided targets. In contrast, the same cues did not alter the patients' detection or rate of search for left-sided targets when they were presented in the center of the display screen. Analysis of these and previous results suggest that kinetic visual cues may be more suitable than other forms of cueing for rehabilitation of neglect and may be particularly effective with neglect patients whose attention is strongly biased to the unneglected side.

Coping with the late effects: differences between depressed and nondepressed polio survivors.

This study examined differences between depressed and nondepressed individuals with a history of paralytic poliomyelitis in terms of demographics, health status and coping strategies. The prevalence of distress and depression in this group of 116 polio survivors was determined. Subjects completed the Brief Symptom Inventory, the Coping with Disability Inventory and a questionnaire concerning their polio histories and self-perceptions of health. Medical assessments were performed by physicians. Only 15.8% of the sample had scores indicating depression and elevated distress. Depressed/distressed polio survivors were more likely to: be living alone, be experiencing further health status deterioration, seek professional help, view their health as poor, report greater pain, be less satisfied with their occupational status and their lives in general and exhibit poorer coping outcome behaviors in relation to their disability. Three factors in coping with the late effects of polio were identified through a factor analysis of the Coping with Disability Inventory: positive self-acceptance, information seeking/sharing about the disability and social activism. Differences between depressed/distressed and other polio survivors were found across these three factors, with depressed/distressed subjects having significantly lower coping scores. These and other results are discussed.

Prevalence and associated features of depression and psychological distress in polio survivors.

This cross-sectional study examines the prevalence of psychological distress and depression among 116 polio survivors. It investigates demographic, medical, and coping differences between subjects with (n = 17) and without (n = 99) these symptoms. Subjects were administered the Brief Symptom Inventory (BSI), the Coping with Disability Inventory (CDI), and a questionnaire about their polio histories. The BSI provided measures of psychological distress and depression that defined the subgroups. The CDI assessed coping behaviors. BSI scores for the overall sample were within the normal range indicating no major distress, depression, nor elevated somatic complaints. Several significant differences were found between the two subgroups. On average, depressed/distressed subjects reported an increase in pain (p < .01) and further deterioration of their medical status since the time of their physical best subsequent to the onset of polio (p < .01). They consistently rated their health as poorer than did nondepressed/nondistressed subjects (p < .001). They also reported less satisfaction with life and their occupational status (p < .001) and displayed poorer coping behaviors combined (p < .001). Selected variables such as life satisfaction, pain, decrease in activity, and current living situation accounted for 51% of the variance when predicting distress and depression among this group of polio survivors.

Combined and separate effects of eye patching and visual stimulation on unilateral neglect following stroke.

In Experiment 1, 11 of 13 stroke patients with left-sided neglect benefitted from monocular patching in at least one (of five) tests of neglect. This beneficial effect in most cases was limited to the period when the patch was worn. In Experiment 2, another group of stroke patients (n = 18) with left-sided neglect were tested in a line-bisection task with monocular patching and/or lateralized visual stimulation--a procedure previously shown to reduce neglect. Each procedure resulted in substantial benefits; the two procedures combined resulted in significantly larger benefits than either alone. As in Experiment 1, the degree of benefit of patching (alone or in combination with stimulation) was not related to several demographic factors. These findings suggest that monocular patching, together with lateralized visual stimulation, may significantly reduce neglect in daily activities and may be more beneficial than procedures requiring patients to be aware of their disorder and to use strategies for scanning the neglected side.

The effect of lateralized dynamic stimuli on unilateral spatial neglect following right hemisphere lesions.

Patients with unilateral (left-sided) spatial neglect following right-hemisphere stroke were tested for the effects of visual stimulation on performance of a line-bisection task. As predicted from research on brain mechanisms of spatial orientation and attention, dynamic visual stimuli presented on the left side substantially reduced neglect in the task. In contrast, left sided static stimuli reduced neglect significantly less and dynamic stimuli presented in the center had no effect on neglect. Neglect patients with hemianopia did not show significantly less benefit of left-sided dynamic stimuli compared to neglect patients without hemianopia, suggesting that the effect of these stimuli was unconscious and automatic. The potential advantages of lateralized dynamic stimuli in the rehabilitation of neglect are discussed.

Altitudinal neglect following traumatic brain injury: a case report.

We present an analysis of altitudinal neglect in a patient who following traumatic brain injury showed extinction to a visual stimulus presented in the lower field when another stimulus was simultaneously presented in the upper field. When estimating the midpoint of vertically-oriented rods presented below eye level using visual cues, tactile/kinesthetic cues or a combination of these cues, she consistently pointed higher than control subjects did. She showed less severe impairments when the rods were presented at or above eye level. When estimating the midpoint between two clicks presented above and below her head, she pointed higher than did control subjects. These deficits cannot be accounted for by sensory or motor disorders and appear to be due to a disorder in attending to stimuli in the lower half to space.

[Erectile dysfunction following pelvic fracture and pelvic trauma]. / Erektile Dysfunktion nach Beckenfrakturen und Beckentraumen.

In the course of this research a questionnaire was submitted to 209 male patients who had been treated in the surgical university clinic of Erlangen between 1976 and 1985, in order to get knowledge about possible complications in the form of erectile non-functioning. 29 of these patients had died in the meanwhile, 32 had moved to an unknown address. Among the other 148, 86 were willing to give some information. 44% of these people turned out to be suffering from an impotentia coeundi. Furthermore, we were able to prove that 40% of those patients for whom a large haematoma of the pelvis had been diagnosed were impotent. Finally, 73% of the patients who had additionally suffered an injury of the urogenital canal turned out to be impotent. On closer examination of the urogenital side-effect case of rupture of the bladder and as much as 87.5% in the case of lesions of the urethra. In connection with the urethra lesions reference is made to the controversial discussion about their therapy, with dichronous recanalling clearly being given preference as it involves considerably fewer complications compared to primary recanalling.

Assessment of distractibility in auditory comprehension after traumatic brain injury.

In a simulated functional task involving comprehension of a spoken passage, the performance of 20 traumatically brain-injured and 14 non-brain-injured control patients was compared under conditions which included the presence and absence of competing vocal stimuli. The subjects heard 10 target paragraphs which were approximately 1 minute in length. Five of these paragraphs were transmitted without any interference, while the other five were presented with distraction caused by a second voice reading a different paragraph with equal volume and intensity. Based on the answers to subsequent multiple-choice questions, the traumatically brain-injured subjects had significantly more difficulty comprehending the target passages in the presence of the interfering or competing passages compared to control subjects. The results of this study suggest the need for specific rehabilitation programmes to aid brain-injured persons in improving their auditory comprehension in everyday situations where distracting or competing auditory stimuli are present.

Engineering therapy: an approach to treatment of a patient with severe cognitive and physical handicaps.

"Engineering therapy" may be defined as therapeutic intervention based on technologic aids. The concept is illustrated by the case of a 63-year-old woman who sustained a traumatic brain injury that resulted in severely limited functional capabilities and inability to communicate or interact with her environment in any meaningful way. Although she participated in an intensive rehabilitation program, no significant improvement occurred and she was transferred to a nursing home. Two years postinjury a microcomputer and other technical aids were used to facilitate communication and interaction with her environment. During the course of the engineering therapy, voluntary motor skills and endurance significantly improved and communication skills markedly increased. Many secondary benefits were also noted such as increased participation by the nursing home staff in her therapy. It is concluded that engineering therapy can benefit severely handicapped patients even after many years of disability.

Atypical fibroxanthomas of the skin: multiple primaries.

An 83-year-old man experienced, within a four-year span, two separate atypical fibroxanthomas occurring on the right ear and right forehead without any satellite lesions or obvious lymph node metastases. Such an occurrence has not been reported before.

Low-sulfur hair syndrome associated with UVB photosensitivity and testicular failure.

A 16-year-old male patient had a syndrome that included growth retardation, mental retardation, hair shaft abnormalities, neurosensory hearing loss, contractures of the fifth fingers, ultraviolet B (UVB) photosensitivity, small testicular size, and elevated levels of follicle-stimulating hormone. Reduced hair sulfur content and a characteristic pattern of light and dark birefringent bands, seen when hairs were viewed with polarization microscopy, were typical of the low-sulfur hair syndrome. UVB photosensitivity and testicular failure have not previously been identified as components of this syndrome.

Elastosis perforans serpiginosa induced by penicillamine.

A patient with Wilson disease, under prolonged treatment with penicillamine, developed lesions of elastosis perforans serpiginosa (EPS). Examination of biopsy specimens by light microscopy revealed the characteristic changes of EPS. Examination by transmission electron microscopy revealed structural changes in the elastic fibers not previously described. The appearance of the lesions by scanning electron microscopy is described for the first time. It is suggested that penicillamine induced EPS may be morphologically distinct from the idiopathic form.

Dapsone-induced motor polyneuropathy. A complication of prolonged treatment of subcorneal pustular dermatosis.

A motor polyneuropathy developed in a woman with subcorneal pustular dermatosis of 16 years' duration, who had received at least 300 gm of dapsone over a five-year period and 80 gm during the four-month period of progression of her neurologic symptoms. Although the patient believed her muscle power had returned to normal four months after the drug was stopped, a slight peripheral neuropathy remained. Electrodiagnostic and clinical features during the period of greatest weakness and the subsequent 16 months were consistent with a polyneuropathy of the axonal type. The neurotoxicity of dapsone appears to be dose-dependent, but the mechanism by which it occurs is unknown.