Secondary corpus callosum abnormalities associated with antiepileptic drugs in temporal lobe epilepsy. A diffusion tensor imaging study.

Epilepsy is more than a grey-matter disorder affecting large white matter connections of the brain with seizure generation and propagation. The mechanism for such changes remains unclear. The purpose of this study was to investigate the microstructural changes in the corpus callosum in temporal lobe epilepsy (TLE) patients and whether these abnormalities are related to antiepileptic drug (AED) therapy. Ten TLE patients receiving AED therapy, ten TLE patients with no therapy and ten controls were included in the study. The regions of interest in the corpus callosum were outlined to each Witelson region (WR). Fractional anisotrophy (FA), apparent diffusion coefficient (ADC), three main diffusivity values (λ1, λ2, λ3) and tractography were acquired from each WR. DTI indices of these tracts and each WR were compared between the three subject groups and correlates examined with clinical variables that included duration of epilepsy, gender, AED type and AED therapy exposure. In TLE subjects with receiving AED therapy significantly (p<0.05) decreased FA and increased ADC values of corpus callosum were obtained when compared to the other groups. There was no significant relationship between AED type and DTI indices. Analysis of eigen values in the splenium of corpus callosum (WR7) showed λ1 values were significantly decreased in relation to AED medication duration (p<0.05). FA values of rostrum and corpus showed a reduction with duration of epilepsy. TLE is associated with abnormal integrity of corpus callosum white matter tracts. AED therapy may cause additional damage on secondary degeneration and medication time effects especially on the splenium of corpus callosum.

[Surgical therapy of pronounced gout tophi in both hands. Case report]. / Chirurgische Therapie ausgeprägter Gichttophi an beiden Händen. Fallbericht.

We report an 80-year-old male patient who had been suffering from gouty arthritis for the last seven years, both hands being deformed by multiple tophaceous deposits within soft tissue and bone. Immediate surgical therapy became inevitable when a ruptured tophus led to a severe infection of the right index finger. We describe the surgical procedure as well as the pathological findings and the clinical course.

[Can muscle transposition of an antagonist modify regeneration of the peroneal nerve?]. / Kann die Muskelverlagerung eines Antagonisten die Regeneration des N. peronaeus beeinflussen?

The prognosis after injury and microsurgical repair of the peroneal nerve is poor. However, clinical experience seems to indicate better results if nerve repair or neurolysis is combined with transposition of the tibialis posterior muscle. This hypothesis was tested in 20 rabbits by severing the peroneal nerve of one lower extremity. Nerve repair with muscle transposition was performed in ten rabbits and nerve repair without muscle transposition in the remaining ten animals. Six to twelve months later, histological and histochemical studies of nerve and muscle tissue were performed. No significant differences between the two groups could be determined.

Maintenance of stump length of both upper extremities after severe electrical burn injury.

A patient with electrical injury to both upper extremities which necessitated amputation above the elbow on both sides is presented. Further débridement on the stumps resulted in extensive exposure of bone with little coverage by skin and granulation tissue. Adequate coverage and maintenance of the length of both stumps was possible with bilateral myocutaneous latissimus dorsi flaps. This enabled the patient to carry out various activities and to wear a prosthesis.