Dynamic changes in DNA methylation of stress-associated genes (OXTR, BDNF ) after acute psychosocial stress.

Environmentally induced epigenetic alterations are related to mental health. We investigated quantitative DNA methylation status before and after an acute psychosocial stressor in two stress-related genes: oxytocin receptor (OXTR) and brain-derived neurotrophic factor (BDNF ). The cross sectional study took place at the Division of Theoretical and Clinical Psychobiology, University of Trier, Germany and was conducted from February to August 2009. We included 83 participants aged 61-67 years. Thereof, 76 participants completed the full study procedure consisting of blood sampling before (pre-stress), 10 min after (post-stress) and 90 min after (follow-up) the Trier social stress test. We assessed quantitative DNA methylation of whole-blood cells using Sequenom EpiTYPER. Methylation status differed between sampling times in one target sequence of OXTR (P<0.001): methylation increased from pre- to post-stress (P=0.009) and decreased from post-stress to follow-up (P<0.001). This decrease was also found in a second target sequence of OXTR (P=0.034), where it lost statistical significance when blood cell count was statistically controlled. We did not detect any time-associated differences in methylation status of the examined BDNF region. The results suggest a dynamic regulation of DNA methylation in OXTR-which may in part reflect changes in blood cell composition-but not BDNF after acute psychosocial stress. This may enhance the understanding of how psychosocial events alter DNA methylation and could provide new insights into the etiology of mental disorders.

Lumbosacral spine imaging: physioanatomic method.

Noninvasive evaluation of low back and leg pain has progressed rapidly over the past decade. The development of computed tomography, single-photon emission-computed tomographic bone scan, and magnetic resonance imaging has markedly increased diagnostic accuracy in detecting pathologic conditions. With this increased accuracy has come recognition of a 50% prevalence of underlying abnormalities in patients between 20 and 60 years old who have no symptoms. When such patients have a back injury, subsequent imaging will show in half of the population studied abnormalities that are not related to an acute injury. Degeneration of the spine progresses in all patients throughout their lifetime, and nearly all of the population will have back discomfort at some time. Political- and judicial-based compensation for back injuries related to accidents and on-the-job injuries provides an incentive for patients not to improve on therapy and to exaggerate symptoms, further complicating the clinical evaluation of their condition. The goal of physioanatomic noninvasive and invasive imaging evaluation presented in the following chapters is to increase specificity by differentiating pain generators from asymptomatic underlying pathologic conditions. When used with intensive conservative management and psychologic testing, this physioanatomic approach has resulted in much better treatment outcomes in our experience. The physioanatomic approach is quite simple, consisting of rigorous correlation of pathologic changes demonstrated by noninvasive imaging modalities (computed tomography, single-photon emission-computed tomographic bone scan, and magnetic resonance), or invasive modalities (diskography-enhanced computed tomography, nerve root block and facet block) with the patient's symptoms to evaluate whether the symptoms and the pathologic lesion are concordant or discordant. Patient symptoms and history are evaluated by use of a pain drawing and information sheet. The patient's pain pattern is categorized into a nonspecific pattern or into one of four recognizable pathway patterns (radicular, dorsal ramus, polyneuropathy, and sympathetic). Because each spinal lesion is typically manifested primarily via one of the four symptom pathways, the distribution of expected symptoms from each pathologic feature can be compared with the patient's pain drawing, and an assessment of the significance of imaged lesions can be made. The patient's presenting symptoms are also used to determine the most cost-effective and efficacious use of initial diagnostic imaging evaluation. In a minority of patients the findings on noninvasive imaging either will not correlate with the patient's symptoms or will demonstrate multiple abnormalities that could account for the patient's symptoms. In these patients, invasive techniques are extremely helpful in defining a pain generator or pain generators.(ABSTRACT TRUNCATED AT 400 WORDS)

Unanswered questions concerning the indication for cochlear implant.

In a discussion of the function of cochlear implant (CI), the following criteria should be mentioned: (1) If possible, all deaf persons (including the prelingually deaf and children) should benefit from CI. (2) Since the number of patients with late deafness is doubtlessly decreasing with better prevention and medical care (elimination of ototoxic damage, decrease of iatrogenic deafness), the percentage distribution of the deaf will be displaced in favor of the prelingually deaf. At present, the ratio of cases of late deafness to those of prelingual deafness among our CI candidates is 1:3. (3) The objective of CI must be to provide the advantage of the procedure to children as early as possible. This means that under certain circumstances a technique that is as low in risks as possible and with a handy implement should already have been used in patients at the age of 3 to 4 years.

Extracochlear sixteen-channel electrode system.

This article summarizes 10 years of work by the Cologne-Düren Research Group. The purpose of our research was to develop a noninvasive operation technique and to avoid opening the inner ear cavities (extracochlear technique). On the basis of empiric experience, a 16-channel electrode system was developed. The electrodes were fixed on a "hedgehog" contact plate with an arrangement corresponding to the projection of the cochlea. A microprocessor, which enables individual programmability in the different groups of deaf persons (prelingual, postlingual deafness), was integrated into the speech processor. Experience to date was summarized in statistical data. Not only the results of the psychoacoustic tests, but also the applicability of the cochlear implant as seen by the patients were considered. We next plan to miniaturize the system.

Massive arterial hemorrhage in patients with pancreatitis. Complementary roles of surgery and transcatheter occlusive techniques.

Massive arterial hemorrhage from multiple sites caused by tissue injury and infection following severe pancreatitis occurred in 12 patients, who were treated with the combination of angiographic embolization techniques and surgery; five survived. Complete hemostasis was obtained in eight of 12 patients who underwent primary angiographic therapy. Bleeding was temporarily controlled in two patients, who then underwent directed surgical ligation of the bleeding vessel under more favorable conditions. In two patients, bleeding was not controlled. The use of permanent occluding materials, particularly bucrylate, resulted in the highest success rate. When the bleeding artery could not be individually catheterized for safe occlusion, balloon occlusion or vasopressin infusion stabilized the patient's condition, with a decrease in the rate of bleeding prior to subsequent surgical therapy. Inadequate control of further tissue necrosis and sepsis was the cause of death in five of the seven patients who died. The other two patients died of recurrent hemorrhage despite attempts at both arteriographic occlusion and surgical ligation.

Radiographic and clinical findings in unusual abdominal aortic aneurysms.

Atherosclerotic abdominal aortic aneurysms typically present either asymptomatically or with abdominal or back pain. Inflammatory, mycotic, and traumatic aortic aneurysms and aneurysms complicated by venous fistula are less common. The different clinical presentations of these latter aneurysms should raise a suspicion to their diagnosis and appropriate preoperative evaluation. The radiographic and clinical features of inflammatory, mycotic, traumatic, and complicated atherosclerotic aneurysms are presented and discussed.

Extracochlear eight-channel electrode system.

The Cologne-Düren research group has developed a new extracochlear eight-channel electrode system. The first observations on six cases have shown encouraging psychoacoustic results.

Improved detection of upper abdominal abscesses by combination of 99mTc sulfur colloid and 111In leukocyte scanning.

Indium-111-labeled leukocyte scanning is an excellent technique for detecting abdominal abscesses. However, since labeled leukocytes are normally taken up by the liver and spleen, diagnosing upper abdominal abscesses can be difficult. A prospective study was undertaken to see if having a technetium-99m sulfur colloid liver-spleen scan to compare with the 111In leukocyte scan would improve the reader's ability to diagnose or exclude upper abdominal abscesses. Ninety patients with suspected upper abdominal abscesses were examined with 111In leukocyte scans followed immediately by conventional 99mTc sulfur colloid liver-spleen scans in the same projections. In 57% of patients with upper abdominal abscesses and 26% of all patients studied, the 99mTc sulfur colloid scan was essential to diagnose or exclude an upper abdominal abscess. The liver-spleen scan was considered helpful in another 13%. The addition of a 99mTc sulfur colloid liver-spleen scan to the 111In leukocyte study is useful when evaluating patients with suspected upper abdominal abscesses.

Cochlear implants. Selection of patients.

Apart from detailed clinical ENT investigations on the indication for cochlear implant, we considered the following conditions and corresponding preliminary investigations to be indispensable: (1) confirmation of diagnosis of complete deafness, (2) the detection of sufficiently functional auditory nerve fibers, (3) clarification of the sociocultural conditions of the patient, (3.1) family conditions; possibility of auditory training at home, (3.2) psychological state, motivation for auditory training, and (3.3) degree of intelligence. Individual points are explained in accordance with our statistical data.

Cochlear implants. Clinical results: the rehabilitation.

In principle, an acoustic contact with the environment can be achieved in all cochlear implant patients. However, the results vary greatly in our 37 surgically treated cases. On average, our patients can (1) perceive background noises, (2) recognize different human voices, (3) differentiate differences in pitch, (4) improve lip reading and (5) improve pronunciation appreciably. (6) In addition, closed speech is largely understood. Apart from these average values, we were able to observe a beginning of open speech in 20% of the cases (simple sentences from everyday speech). A precise statistical documentation is presented with an evaluation table we have elaborated. The results of comparison between the pre-lingual and post-lingual patients are analyzed statistically. The special significance of subjective evaluation of the advantages of cochlear implant on the part of the patients is pointed out. The lower age limit in our patient material is 10 years.

Neodymium yttrium aluminum garnet laser treatment of hemobilia via a percutaneous biliary catheter track.

The authors describe the use of neodymium yttrium aluminum garnet laser introduced via a percutaneous catheter track for photocoagulation of a bleeding bile duct tumor.

Clinical intra-arterial digital subtraction imaging. Use of small volumes of iodinated contrast material or carbon dioxide.

Forty patients were examined with intra-arterial digital subtraction angiography (DSA) using meglumine iothalamate (202 mg iodine/ml) or CO2 as a contrast medium. Diagnostic studies were obtained in all patients. The use of CO2 resulted in diagnostic examinations of the common femoral artery to the level of the trifurcation. The use of CO2 and low-iodine-content contrast material reduced the iodine dosage, and temporal bandpass filtration DSA permitted a lower entrance exposure than pulsed systems. It is concluded that intra-arterial DSA, using the techniques described in this paper, will become a more important and widely used procedure than it currently is.

Transcatheter vessel occlusion: angiographic results versus clinical success.

A review was made of 219 transcatheter vessel occlusion procedures performed over a ten-year period for control of hemorrhage, tumor palliation, or blood supply redistribution prior to intra-arterial chemotherapy. Complete angiographic success was obtained in 85% of the procedures, with partial success in 8%; complete clinical success was achieved in 53% of patients, with partial success in 23%. The most satisfactory clinical results were obtained with hemorrhagic gastritis and pelvic trauma. Embolizations for duodenal ulcer hemorrhage and transhepatic variceal occlusion were the least clinically successful, although isobutyl-cyanoacrylate appeared to be a significant improvement in angiographic therapy for duodenal ulcer. The overall complication rate was 13%, with one third of the complications clinically silent. These results indicate that transcatheter vessel occlusion is a relatively safe and effective method for control of hemorrhage or tumor infarction.

[Contribution with regard to the standardization of the terminology, the data and the rehabilitation program in cochlear implant research]. / Beitrag zur Vereinheitlichung der Definition, der Masseinheiten und des Rehabilitationsprogramms im Bereich der Cochlear-Implant-Forschung.

In the Field of Cochlear Implant Research the new terms are presented in a number of different ways. Further the achieved results have been based on varying data, making a comparison extremely difficult when not impossible. The contributors to this publication attempt to standardize the terminology, electrical data, and the evaluation of the hearing result, in order to achieve an objective comparison.

CT demonstration of cortical nephrocalcinosis in congenital oxalosis.

The clinical, pathologic and roentgenographic features of a case of congenital oxalosis are discussed and contrasted to the more common forms of primary oxalosis. The ease of demonstration of the cortical deposition of calcium oxalate crystals on the CT scanner is reported.