Extensive fibrofatty infiltration of the left ventricle in two cases of sudden cardiac death.

Replacement of the myocardium by fibrous and adipose tissue is well documented in the right ventricle, but has been rarely described in the left ventricle. We present two cases of extensive fibrofatty infiltration of the left ventricle without significant right ventricular involvement in young men whose presenting symptom was sudden death.

[Situational anxiety in myasthenia gravis]. / Situationsbezogene Angste bei Myasthenia gravis.

Neuromuscular block can cause anxiety. These known experimental results lead to the expectation of conditioned phobic reactions in myasthenia gravis. A sample of 240 patients with the disease do not show the theoretically expected results in the Fear-Survey-Schedule. But interindividual variation of anxiety corresponds to some clinical parameters, relevant for the disease. Patients with facial muscular symptoms have higher values on social phobia but no higher scores on a depression-scale. Opposite to the facial-feedback theory, this result supports the hypothesis, that intersubjective feedback is more significant to the development of the emotional reaction than proprioceptive (facial) feedback. Social anxiety also covariates with defensive coping-strategies. Implications for supportive psycho(behaviour)therapy are discussed.

[Myasthenia gravis in the frontier of psychiatric diagnosis]. / Myasthenia gravis im Grenzgebiet psychiatrischer Diagnostik.

Retrospectively 20% of more than 200 patients with myasthenia gravis reported being initially diagnosed as having a psychiatric disorder. Younger women are significantly most at risk of a psychiatric misdiagnosis whereas men are more often subject to somatic misdiagnoses. The sample's mean duration of the disease was 10 years. Nevertheless misdiagnoses still coincide with higher depression scores. Depression is also related to the dosage of anticholinesteratic medication as well as to the self-reported muscular weakness. Personality assessment through an inventory reveals only slight emotional instabilities and no illness specific profiles.

[Obsessive behavior and thoughts in patients with myasthenia gravis]. / Handlungs- und Gedankenzwänge bei Patienten mit Myasthenia gravis.

230 patients with myasthenia gravis were investigated by a german questionnaire, the HAMBURGER-ZWANGS-INVENTAR, in order to quantify their obsessive and compulsive behaviour. Compared to normals, myasthenic patients show higher scores on the compulsion-subscales of the inventory. The most significant differences appeared on the orderliness-subscale. On the other hand ratings of obsessive behaviour are significantly lower than in the normal population. Especially (auto)aggressive ruminations do hardly occur in myasthenia, which is a remarkable fact in this autoaggressive immunological disease. Compulsive behaviour cannot be interpretated as clinical compulsive disorder, caused by myasthenia. Questionnaire replies rather indicate one aspect of the way of coping with the disease and its treatment.

[Bilateral traumatic eye avulsion]. / Beidseitige traumatische Avulsio bulbi.

A 26 year old patient with a LeFort III fracture after an automobile accident exhibited bilateral luxation of the globes. An avulsio imcompleta with an evulsion of the optic nerve posteriorly was noted on his right eye and an avulsio incompleta with evulsion of the optic nerve anteriorly was seen on his left eye as a cause for the luxation. The said locations may represent predilection sites for an evulsion of the optic nerve.

[Behavior analysis in myasthenia gravis]. / Verhaltensanalyse bei Myasthenia gravis.

A first step in approaching the autoimmune-disease myasthenia gravis from behavior therapy is reported. 23 patients were investigated by a two to four hours lasting structured behavior analytic interview (SBAI) and a set of standardized questionnaires, used routinely for neurotic reactions. A marked disability was found in occupation. Significant social phobic and depressive reactions became obvious in the interview but not in the questionnaire data. Half of the subjects reported interactions between emotions, cognitions and motoric behavior. Onset of sufficient treatment was preceded by a diagnostic Odyssey, lasting up to 9 years. Our results correspond to the sparse literature. Further basic research on the subject has to be done that may lead to first experimental behavior therapeutic trials.

Improved assessment of lower extremity alignment using new roentgenographic techniques.

Accurate assessment of total hip and knee alignment requires a single-exposure weight-bearing roentgenogram of the involved limb. The problem with single-exposure technique is that a good exposure of the hip overexposes the lower leg. This problem is solved by using leaded acrylic wedges, which, when placed in front of the X-ray tube (collimator), block excessive radiation to the lower limb and create an evenly exposed film of the entire lower extremity. The development of these collimator wedge filters and the advent of newer fast-speed film and screens have reduced the amount of radiation absorbed by the patient by eight times or more. Guided by a chart to interchange and choose between film/screen combinations, the method and technique provides the surgeon with an exact alignment of the limb and joints for all kinds of operations.

[Continuous frequency analysis (spectral trend analysis) in the evaluation of long-term EEG recordings]. / Die kontinuierliche Frequenzanalyse (spektrale Trendanalyse) in der Auswertung von EEG-Langzeitableitungen.

This study demonstrates the possibilities of continuous frequency analysis supporting the evaluation of long lasting EEG recordings which present problems in analysing large amount of data. Avoiding some disadvantages of the usual presentation of power spectra by compressed spectral array compression of the spectral data will be obtained in a more suitable way by sequential plots of the data on the abscissa as time axis. The spectra will be separated in only a few number of frequency bands. A special conversion procedure (linear multiplication of the data within each frequency band by logarithmic calculated factors) provides for the essential enhancement of low spectral power in the upper EEG frequency domain preserving the full dynamic of spectral variations. The efficiency of this spectral trend analysis is shown by two examples: (1) In the study of the variations of cerebral excitability in a patient with epileptic seizures depending on the waking-sleeping-cycle (Fig. 3), and (2) in the documentation of the EEG dynamics in the course of intensive care monitoring. Fig. 5 shows the development of a cerebral autorhythmicity representing reintegration of cerebral function in a patient with severe head injury.

Comprehensive monitoring and computerized tomographic follow up in patients with acute severe head injury: coma-outcome correlations.

In 88 patients with acute severe head injury the Glasgow coma scale (GCS), computerized tomography and autonomic monitoring during the first 24 hours were used to characterize different types of post-traumatic brain dysfunction. A subgroup is defined--GCS 8.1--with signs of diffuse brain swelling and autonomic instability which included two cases with dorsal midbrain lesions. These preliminary results suggest that autonomic instability is a valid criterion for identifying patients suffering from diffuse axonal injury.

Effect of postural changes on certain circulatory and respiratory values in the horse.

Certain circulatory and respiratory values were measured in horses in the standing, lateral, and supine positions. Twelve adult horses were kept in the standing position under the influence of glycerol guiacolate. Alterations in position to lateral and dorsal recumbencies were achieved without any further drug administration. The changes from the standing to the lateral position decreased the arterial oxygen tension, but left the arterial carbon dioxide tension unchanged. There was no statistically significant effect of body position on respiratory flow rates or volumes. The shift from the lateral position to the supine position had no statistically significant effect on any of the measured values. It is assumed that the change from the standing to the lateral position results in an increase in ventilation of the uppermost parts of the lung. The perfusion inequalities are due mainly to the effect of gravity of the pulmonary circulation which may result in a decrease in arterial oxygen tension.

Contrast bolus technique with rapid CT scanning. A reliable diagnostic tool for the determination of brain death.

Twenty-three patients complying with the clinical criteria for brain death were studied by contrast-enhanced CT. In all but one, the great intracranial vessels escaped visualization; accordingly, angiography demonstrated cerebral circulatory arrest. In the remaining case, faint enhancement of the circle of Willis corresponded to angiographic demonstration of the proximal segments of cerebral arteries. Neither in normal brain nor in dead brain did slow CT scanning disclose any postcontrast increase in parenchymal attenuation. An improved technique is proposed to demonstrate the transit of the contrast bolus by rapid CT with image splitting. If cerebral blood flow is preserved, the grey and white matter will enhance significantly following administration of contrast medium. Vice versa, the absence of enhancement confirms brain death, even in instances in which the great cerebral vessels are obscured by hemorrhage or other extensive lesions. Two additional cases of brain death were evaluated by rapid CT scanning. As to brain death, the technique obviates the need for angiography or radionuclide angiography, usually applied in prospective organ donors, because its informative content is superior to that of either method. The CT technique described affords a reliable and safe diagnosis of brain death, and can be interpreted easily.