The diagnostic accuracy of the Revised Westmead PTA Scale as an adjunct to the Glasgow Coma Scale in the early identification of cognitive impairment in patients with mild traumatic brain injury.

BACKGROUND: Assessment of patients with mild traumatic brain injury (mTBI) is predominantly done using the Glasgow Coma Scale (GCS). While the GCS is universally accepted for assessment of severity of traumatic brain injury, it may not be appropriate to rely on the GCS alone when assessing patients with mTBI in prehospital settings and emergency departments. OBJECTIVE: To determine whether administering the Revised Westmead Post-traumatic Amnesia (PTA) Scale (R-WPTAS) in addition to the GCS would increase diagnostic accuracy in the early identification of cognitive impairment in patients with mTBI. METHODS: Data were collected from 82 consecutive participants with mTBI who presented to the emergency department of a level 1 trauma centre in Australia. A matched sample of 88 control participants who attended the emergency department for reasons other than head trauma was also assessed. All patients were assessed using the GCS, R-WPTAS and a battery of neuropsychological tests. RESULTS: Patients with mTBI scored poorly compared with control patients on all measures. The R-WPTAS showed greater concurrent validity with the neuropsychological measures than the GCS and significantly increased prediction of group membership of patients with mTBI with cognitive impairment. CONCLUSIONS: The R-WPTAS significantly improves diagnostic accuracy in identifying patients with mTBI who may be in PTA. Administration takes less than 1 min, and since early identification of a patient's cognitive status facilitates management decisions, it is recommended for routine use whenever the GCS is used.

Discriminative value of serum phosphatases in patients with prostatic carcinoma.

In a comparative study, we determined the mean serum concentrations of immunoassayable prostatic acid phosphatase (PAP), tartrate-inhibited phosphatase (TP), total acid phosphatase (AcP), and alkaline phosphatase (AP) in different clinical subgroups of patients with histologically proved prostatic carcinoma (PCA). The subgroups were compared with each other and with a reference group of males apparently free of any prostatic disorder. In addition, clinical sensitivities, specificities, and predictive values were calculated to assess the diagnostic value of the different assays. The main results were: (1) Serum PAP concentration measured by immunologic methods best reflected the tumor mass, the presence or absence of metastases, the histologic grade, and the therapeutic efficiency (response) in the patients. (2) The differences in biochemically determined serum TP concentrations were less clear-cut. (3) The serum concentrations of the nonspecific phosphatases AcP and AP were highly elevated in patients with progressed PCA; AP was the highest in patients with palpable tumors and metastases. (4) The sensitivities of each phosphatase were too low for detection of early PCA stages. In conclusion, immunoassayable PAP appears to be the best parameter to monitor advanced PCA disease, and AP may be a useful auxiliary parameter in metastatic PCA.

[Determination of steroid receptors in prostate cancer: possibilities and limits]. / Bestimmung von Steroidrezeptoren im Prostatakarzinom: Möglichkeiten und Grenzen.

In most cases, the prostatic carcinoma (PCA) is a hormone-dependent malignant tumor. Since sexual steroids seem to act upon their target organs by means of specific steroid receptors the determination of receptor concentration in PCA is of great theoretical and practical interest. The state of art of receptor research in PCA can be summarized as follows: 1. The prognostic relevance of receptor determinations in PCA is controversial. The contradictory assessments of the value of receptor measurements may be mainly caused by methodical problems. 2. A possible heterogeneity of the receptor distribution in PCA tissue can not be detected by biochemical receptor determinations. 3. This heterogeneity could be one reason for a lack of response to endocrine therapy in cases which are biochemically receptor-rich (selection of receptor-poor cell clones). 4. The available (immuno)histochemical fluorescence techniques, which have been developed for direct detection of heterogeneous receptor distribution in the tissue, are neither sufficiently sensitive nor specific. 5. It is an open question whether the development of an appropriate (immuno)histochemical method will succeed.

Effect of denervation or castration on steroid receptors in rat bulbocavernosus/levator ani muscles.

Alterations in cytosolic glucocorticoid (GR) and androgen receptors (AR) in atrophic rat bulbocavernosus/levator ani muscles (BCLA) were investigated. The BCLA was removed 15 days after denervation (DEN) of the right part of BCLA or castration (CAS) and compared with the innervated left part of BCLA (INN) or the BCLA from sham-operated rats (SHAM). Receptor analyses were performed using charcoal adsorption or agar-gel electrophoresis. The main results were: (1) no alterations in KD were observed; (2) GR were increased in DEN compared to INN when expressed per mg cytosolic protein (P less than 0.0001) or g tissue (P less than 0.0002) as well as in DEN compared to SHAM when expressed per mg protein (P less than 0.0002) or g tissue (P less than 0.0003); (3) GR were increased in CAS compared to SHAM when calculated per mg protein (P less than 0.05) or g tissue (P less than 0.04); (4) no differences between DEN and INN or SHAM were noted when results were expressed per mg DNA; (5) AR were increased in CAS compared to SHAM only when expressed per mg protein (P less than 0.003); (6) GR/AR was increased in DEN compared to INN (P less than 0.0001) or SHAM (P less than 0.0006), but unaltered in CAS compared to SHAM. The data reflect differences in the behaviour of GR and AR in the atrophic BCLA and suggest a relative increase in sensitivity to glucocorticoids compared to androgens in the DEN muscle.

Are fluorescein-conjugated androgens appropriate for a histochemical detection of prostatic androgen receptors?

Histochemical fluorescence techniques could be of great value in order to assay androgen receptors (AR), particularly in punch biopsies from human prostatic carcinoma (PCA). Therefore, prostatic tissue was examined for specific binding of fluorescein-labeled 5 alpha-dihydrotestosterone derivatives (FDHT) to AR. Using a 17 beta-fluoresceinated DHT derivative (17-FDHT), variable fluorescence was found in human and rat prostates at high 17-FDHT concentrations. This fluorescence could be blocked by unlabeled DHT in 11 and 73% of human and rat prostatic tissue, respectively. Control studies of receptor and organ specificity were conducted and showed that preheated slices from rat prostates displayed no decrease of fluorescent staining. No difference in fluorescence intensity could be seen between prostates from castrated and uncastrated rats. Unstained tissue slices frequently showed a considerable intensity of autofluorescence. An appreciable amount of fluorescence in both rat liver and spleen was found. From these results and various general methodical problems inherent in fluorescent receptor assays, we conclude that the fluorescence techniques described are inappropriate for demonstration of AR.

[Flow cytometric determination of DNA distribution patterns of malignant and benign tumors of the prostate (author's transl)]. / Flusszytometrische Bestimmung von DNA-Verteilungsmustern in malignen und benignen Prostatatumoren.

56 samples of prostates, clinical suspected of being carcinomas, were examined by flow cytometry concerning their DNA distribution patterns. Carcinoma was diagnosed in 25 cases. All histologically benign samples showed a G1-fraction higher than 95%. Accordingly all cases with a G1-fraction lower than or equal to 95% were interpreted to be flow cytometrically positive (= malignant). The results of flow cytometric measurements essentially depend on the relation of the compounds of the sample--carcinomatous and normal tissue. Concerning the DNA distribution pattern, highly differentiated carcinomas do obviously not always differ from normal tissue. Hence they can escape from flow cytometric proof. An improvement of the flow cytometric distinction between histologically malignant and benign samples is achieved by the introduction of correction procedures for background and cell aggregations.