[Risk factors for sporadic Creutzfeldt-Jakob disease]. / Risikofaktoren der sporadischen Creutzfeldt-Jakob-Krankheit.

Sporadic Creutzfeldt-Jakob disease (sCJD) is the most common form of human transmissible spongiform encephalopathies (prion disease), but its cause has not been fully elucidated. According to its biochemical properties prion protein is resistant to routine sterilisation methods. Thus, invasive medical procedures could be involved in the genesis of the disease. Present knowledge about iatrogenic routes of transmission, oral infection and transmission via blood products in variant CJD (vCJD) underlines the importance of careful surveillance and analysis of potential routes of transmission. Several studies of risk factors for sCJD published in the past have given contrary results, which may be largely explained by different control groups. This article reviews epidemiology and classification of CJD and discusses possible risk factors and summarizes previous case-control studies.

CABG and bone marrow stem cell transplantation after myocardial infarction.

OBJECTIVE: Bone marrow-derived adult stem cells may be able to regenerate infarcted myocardium. We initiated a phase-I study of autologous stem cell transplantation in patients undergoing coronary artery bypass grafting. METHODS: Inclusion criteria were: acute myocardial infarction > 10 days ago; presence of a distinct area of infarcted and akinetic myocardium; CABG indicated to treat ischemia of other LV wall areas. Stem cells were isolated from bone marrow using a ferrite-conjugated AC133 antibody, and were injected in the infarct border zone during the CABG operation. RESULTS: To date, 12 patients were treated without major complications. There is no evidence of new ventricular arrhythmia or neoplasia. Scintigraphic imaging demonstrated significantly improved local perfusion in the stem cell-treated infarct area. LV dimensions (LVEDV 140 +/- 38 ml vs. 124 +/- 30 ml, p = 0.004, paired t-test) and LV ejection fraction (39.7 +/- 9 % vs. 48.7 +/- 6 %, p = 0.007) have improved. CONCLUSIONS: Bone marrow stem cell transplantation for myocardial regeneration can be safely performed in humans. There is evidence of improved revascularization and contractility of infarct areas, but controlled studies are needed to clearly determine the clinical benefit.

Penile perfusion and functional scintigraphy: preliminary clinical results before and after microsurgical revascularization.

OBJECTIVE: To determine the effect on penile haemodynamics of vascularization using the Hauri method for the treatment of erectile dysfunction of vascular aetiology, as assessed by penile perfusion and functional scintigraphy. PATIENTS AND METHODS: Penile perfusion and functional scintigraphy were performed before and after penile revascularization by the Hauri method in 13 patients. The established method of scintigraphy was carried out using 10 MBq/kg body weight of 99m technetium pertechnetate for in vivo labelling of erythrocytes, modified by including an estimate of mean virtual blood inflow rate. RESULTS: In 10 of the 13 patients there was a significant increase in the mean virtual blood inflow rate after surgery (P < 0.01, Wilcoxon test). In three patients, the inflow rate was lower after surgery than before; Doppler ultrasonography showed an occluded anastomosis in these patients. CONCLUSIONS: Penile vascularization using the Hauri method provides an objectively demonstrable improvement in penile haemodynamics in man. It is thus a sufficiently therapeutic procedure for treating erectile dysfunction of vascular aetiology and its effect greatly exceeds any 'psychological influence'.

Protein A immunoadsorption (i.a.) in renal transplantation patients with vascular rejection.

Vascular rejection after renal transplantation is connected with a higher frequency of allograft dysfunction or graft loss. Plasmapheresis as an adjunctive therapy in the treatment of humoral mediated acute graft rejection was compared with protein A immunoadsorption. Eleven patients with acute graft rejection and high titers of cytotoxic HLA-Ab and/or signs of vascular rejection at graft biopsy (performed in 9 patients) have been treated. Six of them have a stable graft function, the longest graft survival until now is 41 months, four are back on haemodialysis and one patient died from CMV-pneumonia with a stable graft function 9 months after transplantation. We conclude that IA is a useful adjunctive therapy in the treatment of vascular rejection after renal transplantation. Further investigations are necessary to optimize criteria for inclusion.

[Lymphatic outflow scintigraphy in a case of artificial edema of the lower limb]. / Lymphabstromszintigraphie bei einem artefiziellen Odem des Unterschenkels.

The case of a young woman is reported who after injury to the left leg was three times hospitalized for diagnosing the cause of her lower limb edema. It took two months to verify its artificial origin. Scintigraphy showed an intensive acceleration of the lymphatic outflow from the left leg.

[The trend distribution quotient, a new tool for evaluating renal perfusion scintigraphy using 99mTc-DTPA following renal transplantation]. / Der Trendverteilungsquotient, ein neues Werkzeug zur Auswertung der Nierenperfusionsszintigraphie mit 99mTc-DTPA nach Nierentransplantation.

We developed a new quantitative concept in dynamic renal transplant imaging, the Trend Distribution Ratio, and tested its diagnostic usefulness in 137 examinations. This ratio is an expression of the distribution of blood flow velocity in different areas of the kidney. With regard to the differential diagnosis between acute tubular necrosis and the various forms of rejection we arrived at a sensitivity of 0.83 and a specificity of 0.54. A differentiation between the various histological types of rejection has not yet been possible.