Flashback phenomenon and residual neurological deficits after the use of "bath salt" 3, 4- methylenedioxypyrovalerone / 世界急诊医学杂志（英文）

BACKGROUND:The use and abuse of designer drugs has been recognized for decades;however there are many derivatives of compounds that make their way into the community. Abuse of compound(s) known on the street as "bath salt" is on the rise. METHODS:We report the case of a 33-year-old man who complained of "flashbacks"and right arm shaking that followed a night of "bath salt" snorting. The active compound methylenedioxypyrovalerone methamphetamine (MDPV) was confirmed; however, analysis of three different "bath salt" products showed difference in their active components. RESULTS:The patient's symptoms remained stable and he was discharged home after observation in the emergency department with instructions to return for any symptom progression. CONCLUSION:Practitioners should be aware of the abuse of the compounds and that not all"bath salt" products contain MDPV.

[Paraganglioma of the head and neck--tumor control, functional results and quality of life]. / Paragangliome des Kopf-Hals-Bereiches--Tumorkontrolle, funktionelle Ergebnisse und Lebensqualität nach Operation.

BACKGROUND: Surgical therapy for paragangliomas (PG) of the head and neck is, due to the alternatives of radiation therapy and wait-and-scan strategy and because of postoperative morbidity, under ongoing discussion. MATERIAL AND METHODS: Between 1981 and 2004, 79 patients with 94 PG of the head and neck were treated at our department. These patients had follow-up examination within a clinical trial considering tumor control, functional results and for the first time neuropsychologically evaluated postoperative quality of life. Mean follow-up time was 65 months (1 to 228 months). RESULTS: Among the 94 PG there were 19 carotid body (GCP), 12 vagal nerve (GVP) and 63 jugular-tympanal paragangliomas (JTP). Of these, 87 tumors underwent surgery. In 68 patients (78.1 %), the tumor could be removed completely. In particular, complete resection of GCP was achieved in 100 %, of GVP in 90.9 %, of JTP type A in 100 %, of JTP type B in 83.3 %, of JTP type C in 66.6 % and of JTP type D in 61.5 %. During the follow-up period, residual or recurrent tumors were diagnosed in 17 patients (19.5 %). Six of the seven residual PG were observed by magnetic resonance tomography and did not show growth. One residual PG and 6 recurrencies were resected completely. One recurrent tumor was radiated and 3 others are under observation without showing growth tendencies. Two patients died postoperatively due to borderline operations of extended tumors. The quality of life after PG surgery showed a SIP of 4.8, which is comparably much better than after acoustic neuroma surgery (SIP 10.3). CONCLUSION: Whereas complete tumor resection of GCP and JTP types A and B is almost ever possible without cranial nerve palsies, surgery of GVP and advanced JTP causes often severe functional deficits. However, postoperative quality of life is mostly good. Nevertheless, advanced PG require an individualized therapeutic regime also including radiation and observation of tumor growth.

[Functional results, cognitive and effective quality of life disturbances after trans-temporal resection of acoustic neuroma]. / Funktionelle Ergebnisse, Lebensqualität, kognitive und affektive Konsequenzen nach transtemporaler Exstirpation von Akustikusneurinomen.

BACKGROUND: The aim of the study was to evaluate postoperative hearing, facial nerve function, quality of life (QOL), affective status and neuropsychological performance after trans-temporal removal of acoustic neuromas (AN). PATIENTS AND METHODS: A retrospective analysis was carried out in 89 patients with AN who were operated at the ENT-Department of the Hospital Fulda between 1988 and 2004. Median follow up was 57 months. Of these 41 patients were additionally examined by a psychologist for evaluation of QOL, neuropsychological functions and affective disorders using several questionnaires. RESULTS: The AN were classified as follows: Type A = 53 %, type B = 35 % and type C = 12 %. One year postoperatively facial nerve function was excellent in 93.3 % of the patients (grade I and II). In 53 % of cases hearing could be preserved. The subjective QOL was expressed through depression and social withdrawal associated with deafness. However, facial nerve dysfunction did not lead to QOL effect. Objective QOL (functional level) was reduced because of verbal memory disturbances and symptoms like dizziness. In 47.5 % of the patients affective and/or neuropsychological dysfunctions were diagnosed. Subsequent MRI evaluation showed lesions of the temporal lobe in 40.5 % of the cases. Of these 80 % suffered from cognitive and/or affective disturbances. CONCLUSIONS: The cognitive and affective disturbances after trans-temporal removal of AN could be to a certain degree due to the elevation of the temporal lobe during surgery. Further research, especially pre- and postoperative examination of QOL and psychological state as well as the comparison between different approaches, particularly trans-temporal vs suboccipital have to clear up specific morbidity of the different approaches.

[Stress-induced changes of attention during choking in judo]. / Stressinduzierte Aufmerksamkeitsänderungen beim Würgen im Judo.

The aim of the investigation is the registration and analysis of cognitive parameters in the alarm phase of the stress reaction during a conventional judo cross choking technique. 57 judoka (41 males, 16 females; mean age 23.1 +/- 6.7 years) underwent a standardized cross-choking maneuvre (juji-jime), which lasted for 6 - 8 s until giving up, carried out by a black belt physician. The Stroop inference test was performed before and twice after the intervention. The reading velocity of the interference task was reduced by an average of 77.4 s to a mean of 74.4 s (p < 0.01), and the number of reading errors decreased by a mean from 2.9 to 2.1 (p < 0.01), finally increasing to 2.4 s. The data show the most important improvement in performance in 25 s after choking in the male judoka. In the female judoka increasing performance started already 25 s before choking and continued 25 s after the intervention. The alarm reaction following the potential life threatening stressor with an attack upon the throat improves selective attention before (female subjects) and after choking (female and male subjects) depending on gender.

[ENZIAN-score, a classification of deep infiltrating endometriosis]. / ENZIAN-Score, eine Klassifikation der tief infiltrierenden Endometriose.

The ENZIAN-Score is presented as a new instrument to classify the deep infiltrating endometriosis. Especially the retroperitoneal part of the severe endometriosis is focussed on. In analogy to an oncological staging four different stages are pronounced. The localisation and the expansion of the endometriosis nodule was indicated to different subgroups. The still used rAFS-score is of no clinical evidence, as we pointed out in a retrospective study of our patients with severe intestinal endometriosis.

[Computer support of workflow in the hospital: concepts, technology and application]. / Computerbasierte Unterstützung von Arbeitsabläufen im Krankenhaus--Konzepte, Technologien und deren Anwendung.

For a variety of reasons, hospitals are developing a growing interest in changing their information systems to support patient processes in a more direct way. This means to actively deliver the tasks to be performed to the right persons at the right point in time with the necessary information and the application functions needed for performing these tasks. Process-oriented workflow technology is a very interesting candidate to achieve this goal. It offers components for the computer-based analysis, modeling, animation, coordination and monitoring of (hospital) processes. In this paper we discuss the perspectives offered by workflow-based, clinical information systems. We survey key features of today's business process modeling tools and of workflow management systems, and we show how they can be applied in the clinical domain. To illustrate the huge potential offered by workflow technology, we present results from the project "Using Workflow Management Systems for Clinical Applications". Within this project we thoroughly analyzed and redesigned core processes from the University's Women hospital and we proto-typically implemented a workflow-based application system for the support of processes from the division day clinic. Although our work shows that current workflow technology is still lacking some important features, in the long run, it may strongly influence information processing within hospitals.

Fibromyalgia in men: comparison of clinical features with women.

OBJECTIVE: To describe possible differences between male and female patients with fibromyalgia syndrome (FM) in their clinical manifestations. METHODS: Five hundred thirty-six consecutive patients with FM (469 women, 67 men) seen in a university rheumatology clinic and 36 healthy men without significant pain seen in the same clinic were included in the study. Data on demographic and clinical features were gathered by a standard protocol. Tender point examination was performed by the same physician. Level of significance was set at p < or = 0.01. RESULTS: Several features were significantly (p < or = 0.01) milder or less common among men than women, including number of tender points (TP), TP score, "hurt all over," fatigue, morning fatigue, and irritable bowel syndrome (IBS). The total number of symptoms was also fewer among men and approached significance (p = 0.02) by parametric test, but reached significance (p = 0.001) by nonparametric analysis. All clinical and psychological symptoms as well as TP were significantly (p < 0.01) more common or greater in male patients with FM than healthy male controls, with the exception of IBS (p = 0.03). Patient assessed global severity of illness, Health Assessment Questionnaire disability score, and pain severity were similar in both sexes. CONCLUSION: Male patients with FM had fever symptoms and fewer TP, and less common "hurt all over," fatigue, morning fatigue, and IBS, compared with female patients. Stepwise logistic regression showed significant differences between men and women in number of TP (p < 0.001).

Emotionally evoked changes in cerebral hemodynamics measured by transcranial Doppler sonography.

The cerebral representation of emotions has previously been investigated by the study of patients with local brain damage, experiments with selective stimulation of only one hemisphere, and more recently by imaging techniques such as positron-emission tomography or magnetic resonance imaging measuring local cerebral blood flow. We investigated the mean flow velocity (FVmean) in the middle cerebral artery (MCA) by transcranial Doppler sonography during emotional stimulation with video scenes in 24 healthy test persons. The videos consisted of an erotic scene and a violent scene shown in contrast to a calming scene. Blood pressure, heart rate, and breathing frequency were monitored continuously by noninvasive measurement. FVmean increased during the erotic scene to 108.5+/-11.9% (P < 0.05) of the baseline value in the right MCA and to 109.0+/-10.6% (n.s.) in the left MCA. During the violent scene FVmean reached 109.0+/-8.7% (P < 0.05) on the right side and 108.1+/-13.0% (n.s.) on the left side. The FVmean time course showed a close relationship to the video sequence. During scenes involving great tension FVmean showed a plateaulike state and peaked during sudden actions. Blood pressure, heart rate, and respiratory rate showed no significant changes. However, we observed a tendency towards lower heart rates (lowest value 94.5+/-13.6%) during the erotic scene and two peaks (103.2+/-13.3%, 104.8+/-16.8%) coinciding with sudden violent actions. The significant increase in FVmean in the right MCA supports the theory of a right hemisphere dominance for the processing of emotions.

[Iatrogenic androgenization]. / Iatrogene Androgenisierung.

Virilization in postmenopausal women is suspicious for androgen-secreting adrenal or ovarian tumors; however, iatrogenic androgenization needs to be additionally considered. Here we report on a 64-year-old patient who presented clinically with progressive signs of virilization. An adrenal source of androgen excess was excluded, and the patient strictly denied the use of any androgenic medication. Thus, elevated serum levels of testosterone were suspicious of ovarian hyperandrogenism. Shortly before planned surgical exploration, the clinical finding of an extensive vulvar lichen sclerosus pointed towards a possible long-term use of testosterone-containing cremes for symptomatic relief of this disease. Apparently, the patient did not consider the mere topical application of potent agents to be a medication. This case demonstrates that besides adrenal or ovarian sources of hyperandrogenism, iatrogenic androgenization has to be considered.

Laparoscopic extirpation of an aplastic ectopic uterus in a patient with Mayer-Rokitansky-Küster-Hauser syndrome.

The Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome comprises the combined hypoplasia of the vagina and the uterus. In recent years, variable anomalies of the development of the Mullerian duct [as classified by the American Fertility Society (AFS)] have been operated on by the laparoscopic approach. We describe here a laparoscopic extirpation of an aplastic ectopic uterus in a patient found to have a hypoplastic vagina and ectopic uterus attached to the right pelvic wall. The uterus was linked to a normotopic right Fallopian tube and right ovary which were covered with endometriosis and adhesions. While the uterine vessels and the round ligament could be demonstrated on the right side, these structures were missing on the contralateral left side of the uterus. However, a normal tube and ovary were present on the left pelvic wall. Although not explicitly described in the AFS classification, this constellation most likely corresponds to the AFS classification stage Ie.

Undernutrition and recovery from brain damage: a preliminary investigation.

Rats undernourished early in life did not differ from control animals in acquiring a light-dark discrimination. Posterior cortical lesions impaired retention in both nutritional groups, but the relearning scores of the undernourished animals with lesions were significantly worse than those of the lesion group that had been well fed. Amphetamine was found to enhance recovery, especially in the undernourished group. These data thus show that early nutritional history can be an important factor in accounting for differences in performance following later, focal brain damage, but that pharmacological intervention still can be of great value in these cases.

Effects of one- and two-stage lesions of the posterior hypothalamus on temperature regulation in the rat.

Rats received 1-stage bilateral and sequential unilateral (serial) lesions of the posterior hypothalamus and were tested for the ability to regulate body temperature after a lengthy recovery period. The groups with lesion differed from the sham-operated groups in the cold, although not under ambient or warm conditions. The fact that the serial lesion group performed the same as the 1-stage lesion groups in the cold is significant because earlier tests on these same animals revealed much better recovery after serial lesions in swimming, and a partial serial lesion effect in open field performance.

[On the cytostatic mechanism of action of N-methyl-N-beta-chloroethylhydrazine and its benzaldehydhydrazone (author's transl)]. / Zum cytostatischen Wirkmechanismus von N-Methyl-N-beta-chloräthylhydrazin und seinem Benzaldehydhydrazon

N-Methyl-N-beta-chloroethyl-hydrazine and its bezaldehydhydrazone inhibit the synthesis of DNA and RNA in ascites cells in vitro faster and stronger than N,N-Dimethylhydrazine and procarbazina does. The benzaldehydhydrzone essentially inhibits influx and phosphorylation of nucleosides whereas N-Methyl-N-beta-chloroethylhydrazine acts directly on DNA synthesis.

[Effect of N-methyl-N-beta-chloroethylhydrazine and its benzaldehydhydrazone on RNA-and protein synthesis as well as metabolism of synchronously growing yeast cells (Saccharomyces cerevisiae) (author's transl)]. / Zur Wirkung von N-Methyl-N-beta-chloräthylhydrazin und seinem Benzaldehydhydrazon auf die RNA- und Proteinsynthese sowie Stoffwechsel von synchronisierten Hefezellen (Saccharomyces cerevisiae)

N-methyl-N-beta-chloroethylhydrazine and its benzaldehydhydrazone inhibit the influx of [6-3H]-uracil and L-[U-14C]leucin in yeast cells as well as the incorporation in RNA and protein. Experiments with synchronously and asynchronously growing cells showed the N-methyl-N-beta-chloroethylhydrazine essentially influences the dividing phase while the benzaldehydhydrazone is more effective in the growth phase. The effect of these two substances on respiration, glycolysis and the concentration of fructose-1,6-diphosphate, triose phosphate, and adenosine triphosphate is small.