[Chili for therapy of trigeminus neuralgia: a case report]. / Chili zur Therapie der Trigeminusneuralgie : Ein Fallbericht.

We report the case of a 39-year-old female patient who suffered from trigeminal neuralgia of the left lingual nerve for 6 years. The previous therapy according to the guidelines including a Jannetta operation was unsuccessful. Only after beginning with daily mastication and consumption of very hot chilli peppers has the patient become reliably pain-free.

["Relaxant" awake but still relaxed]. / Relaxiert wach und trotzdem "relaxed"

We report on a 23-year-old female patient who underwent removal of the implants after maxillary surgery. At the end of surgery the administration of anaesthetic agents was discontinued. During the following 30 min several attempts were made to wake the patient, but she did not respond to verbal or pain stimuli. No changes in heart rate, blood pressure vegetative reactions such as sweating, lacrimation, or mydriasis were noted. Protective reflexes like coughing could not be elicited. After 30 min neuromuscular monitoring was applied and indicated residual muscle paralysis after the use of mivacurium. The patient was again sedated and transferred to the ICU, where she was mechanically ventilated for an additional 9 h. An atypical cholinesterase was determined as the underlying reason for the prolonged action of mivacurium. Retrospectively, the patient remembered the attempted wake-up period in detail. However, she reported no feelings of fear or helplessness because she had faith in the anaesthesiologist, a close friend of the patient's family for many years, who kept her calm and comfortable by talking to her during the entire period. Several months after the incident, the patient reported having neither increased fear of surgery nor any negative psychological effects on her life following this incident of awareness.

Erythropoietic reconstitution, macrophages and reticulin fibrosis in bone marrow specimens of CML patients following allogeneic transplantation.

A clinicopathological study was conducted on 351 bone marrow trephine biopsies derived from 124 patients with chronic myeloid leukemia (CML) at standardized endpoints before and after allogeneic bone marrow transplantation (BMT). The purpose was to investigate quantitative changes of the nucleated erythroid precursor cell population and other associated features such as resident bone marrow macrophages and myelofibrosis and to elucidate their relevance on engraftment parameters. Monoclonal antibodies were applied for the identification of erythroid precursors and the labeling of mature macrophages; argyrophilic (reticulin-collagen) fibers were demonstrated by a silver impregnation technique. Following morphometric analysis of the pregraft bone marrow specimens statistical evaluation was in line with an adverse correlation between early to moderate reticulin fibrosis and amount of erythropoiesis. Moreover, a significant relationship was calculable between numbers of erythroid precursors and CD68+ macrophages. After myelo-ablative therapy and BMT a pronounced decrease in cellularity and in the quantity of erythropoiesis was found. Comparable with the pregraft samples, a significant association between erythroid precursors and macrophages could be determined in the regenerating donor bone marrow. A pretransplant relevant reduction of the red cell lineage and a manifest (reticulin) myelofibrosis indicating an advanced stage of disease were accompanied by a significant delay to reach transfusion independence. This result was further supported by comparable findings in trephine biopsies performed in the early post-transplant period (second month after BMT). Corresponding examinations revealed an enhancement of fiber density and a decrease in erythropoiesis in those patients who did not conform with the usually accepted criteria for successful engraftment. In conclusion, compelling evidence has been produced that a significantly reduced amount of erythroid precursors, which is usually associated with myelofibrosis in the pretransplant bone marrow, exerts an impairment to undisturbed hematopoietic reconstitution. Moreover, a close spatial and numerical relationship between the erythroid lineage and resident (mature) macrophages is observable, in particular in the state of regeneration after BMT.

Nonstationarity and 1/f noise characteristics in heart rate.

The power spectrum of human heart rate (HR) measured over 24 h exhibits "power-law" 1/f alpha-type spectral behavior with alpha approximately 1. We investigate possible nonstationarity in time of the exponent alpha using maximum likelihood estimation, which allows relatively short data segments to be used. Examination of 24-h HR records from ambulatory normal and congestive heart failure (CHF) subjects indicates that the power-law structure of HR is nonstationary. In addition, alpha varies with time scale and is different for normal (alpha approximately 1) and CHF (alpha approximately 1.5) subjects. Simulations suggest that a possible mechanism underlying the observed power-law spectrum may be a switching between values of alpha near zero (white noise) and near two (Brownian motion). This mechanism generates power-law forms quantitatively similar to CHF subjects when the switching occurs very rapidly and similar to normal subjects when the switching is less rapid.

Characteristics of depressive symptoms in elderly urban and rural African Americans.

BACKGROUND: Despite considerable progress in the epidemiology of late life depression, little data have been documented in the scientific literature on depressive symptoms among elderly African Americans. The present investigation identifies characteristic symptoms of depression in African American community-resident elders. METHOD: Ninety-six African American men and women aged 60 years and older, with equal representation from urban and rural counties in west Tennessee, composed the sample. The sample was stratified in each of the two counties into three age categories; 60-69, 70-79, and 80 and older. Data from the Center for Epidemiological Studies-Depression scale were compared with the association of medical illness, medication use, social network, level of physical function in activities of daily living, and demographic characteristics. RESULTS: Residents screening positive for the presence of depressive symptoms showed an increased report of hypertension (p < .036), arteriosclerosis (p < .035), and circulatory problems (p < .008). There was an increased report of symptoms of depression among those who had six or more different chronic illnesses (p < .001) and among those who reported using four or more different prescription medications in the past month for chronic illnesses (p < .015). Regression analyses of data indicated that medical illness (p < .001) and social network (p < .041) were the most important predictors of depressive symptoms among residents. CONCLUSIONS: Considering the projected increase of African Americans reaching age 60, and because depressive illness is an important public heath concern, early identification of salient risk factors for depression is critical in instituting early intervention programs for the ethnic minority elderly population.

Dynamic detection of rhythmic oscillations in heart-rate tracings: a state-space approach based on fourth-order cumulants.

This paper presents a new procedure specifically aimed at providing a dynamical detection of the oscillations occurring in long-term heart-rate (HR) tracings. The procedure is based on a time-variant state-space modelling of the fourth-order cumulants of the HR signal. The state-space estimator was selected because of its demonstrated capability to distinguish between deterministic and stochastic components of the signal, while the fourth-order cumulants of the signal were used as input of the model to further reduce adverse effects of coloured, white and l/f Gaussian noise possibly present in the input data. The procedure was tested by the analysis of simulated signals and its performance was compared with the results obtained by state-space modelling applied directly on the test signals (instead of on the fourth-order cumulants of the signals) and by the more traditional auto-regressive modelling. The comparison has shown a clear superiority of the proposed procedure over the other techniques in discriminating deterministic oscillations from coloured noise. Finally, the applicability of the procedure to biological data was verified by analysing five experimental HR tracings recorded in normal subjects during laboratory and daily life conditions.

Application of the correlation integral to respiratory data of infants during REM sleep.

Non-linear time sequence analysis has been performed on infant sleep measurement data in order to obtain more information about the respiratory processes. As a first step, respiration data during REM sleep were analysed with methods from non-linear dynamics, especially, the correlation integral and the slope of its log-log plot, representing the correlation dimension. Before calculation of the correlation integral, a special kind of filtering has to be applied to the data. This filtering algorithm is a state space and singular value decomposition-based noise reduction method, and it is used to separate the noise and signal subspaces. The dynamics of a signal (in our case data from the respiratory process) and its degrees of freedom can be characterised by the correlation integral and by the correlation dimension, respectively. The main result of this study is that the highly irregular-looking breathing patterns during REM sleep could be described by a deterministic system, and finally the physiological significance of this finding is discussed.