A new trigemino-nociceptive stimulation model for event-related fMRI.

Functional imaging of human trigemino-nociceptive processing provides meaningful insights into altered pain processing in head and face pain diseases. Although functional magnetic resonance imaging (fMRI) offers high temporal and spatial resolution, most studies available were done with radioligand-positron emission tomography, as fMRI requires non-magnetic stimulus equipment and fast on-off conditions. We developed a new approach for painful stimulation of the trigeminal nerve that can be implemented within an event-related design using fMRI and aimed to detect increased blood-oxygen-level-dependent (BOLD) signals as surrogate markers of trigeminal pain processing. Using an olfactometer, 20 healthy volunteers received intranasally standardized trigeminal nociceptive stimuli (ammonia gas) as well as olfactory (rose odour) and odorless control stimuli (air puffs). Imaging revealed robust BOLD responses to the trigeminal nociceptive stimulation in cortical and subcortical brain areas known to be involved in pain processing. Focusing on the trigeminal pain pathway, significant activations were observed bilaterally in brainstem areas at the trigeminal nerve entry zone, which are agreeable with the principal trigeminal nuclei. Furthermore, increased signal changes could be detected ipsilaterally at anatomical localization of the trigeminal ganglion and bilaterally in the rostral medulla, which probably represents the spinal trigeminal nuclei. However, brainstem areas involved in the endogenous pain control system that are close to this anatomical localization, such as raphe nuclei, have to be discussed. Our findings suggest that mapping trigeminal pain processing using fMRI with this non-invasive experimental design is feasible and capable of evoking specific activations in the trigeminal nociceptive system. This method will provide an ideal opportunity to study the trigeminal pain system in both health and pathological conditions such as idiopathic headache disorders.

[Dual-source CT: in vitro characterization of gallstones using dual energy analysis]. / Dual-Source-CT: In-vitro-Charakterisierung von Gallensteinen mittels Dual-Energy-Analyse.

PURPOSE: Despite clinically available high-resolution CT, the detection and classification of gallstones remains a challenge in some cases. This pilot study examines whether noninvasive characterization of gallstones in vitro is possible using dual-energy analysis (DECT) of dual source CT datasets. MATERIALS AND METHODS: A total of 43 gallstones (0.4 - 1.5 cm) were examined at 80 kV, 140 kV and in the dual-energy mode. The monoenergetic datasets were examined by two independent examiners and classified as calcium, cholesterol or pigment stones. The results were compared with the pathological classification as the clinical gold standard. After creating reference images for each group via dual-energy analysis, the classification was repeated and compared with the gold standard again. RESULTS: Using the monoenergetic analysis at 80 kV, the sensitivity and specificity were 100 / 84 % and 100 / 88 % for calcium stones. For cholesterol stones the values were 54 / 89 % and 54 / 85 % and for pigment stones 70 / 80 % for both examiners. At 140 kV, the sensitivity and specificity for calcium stones were 100 / 84 % for both examiners, 46 / 92 % for cholesterol stones for both examiners and the sensitivity and specificity were 80 / 75 % and 80 / 80 % for pigment stones. Using the reference images established by DECT, both examiners were able to correctly classify all gallstones. CONCLUSION: The present data indicates that DECT is able to correctly classify Gallstones according to the clinical gold standard in vitro. Clinical studies have to demonstrate whether these results lead to optimized clinical decision making.

Operations on patients deemed "unfit for operation and anaesthesia": what are the consequences?

BACKGROUND: The decision "patient unfit for anaesthesia and operation" is likely to cause a delay of the scheduled operation. This retrospective evaluation was done: 1) to determine the correctness of preoperative tentative diagnoses of coexisting diseases making anaesthesia and operation excessively risky in relation to the physician's training status; 2) to examine the question of whether preoperative medical management modified according to the anaesthesiologist's suggestions had a positive impact on the perioperative course. METHODS: The medical records of patients scheduled for elective non-cardiac surgery who were rated "unfit for operation and anaesthesia" were evaluated. The accuracy of the tentative diagnoses was examined for relation to the training status of the anaesthesiologists. The preoperative management was tested for its impact on postoperative outcome. RESULTS: During the observation period 16,122 patients underwent preoperative anaesthesiological assessment; 1021 (6.3%) were initially considered to be unfit for operation and anaesthesia. The records of 807 patients were available for review. The accuracy of the tentative diagnoses was 70%, and was not significantly affected by the training status of the physicians (P = 0.022). Four hundred and seventeen patients were excluded from the second part of the investigation (discharged without operation, underwent operation using local anaesthesia or tentative diagnosis not confirmed). Three hundred and ninety patients were operated under general anaesthesia. Group I (n = 216) was managed according to the anaesthesiologist's suggestions and was found to have a significantly lower complication rate (18.1%) than group II (n = 174) in which the suggestions from the preoperative assessment were ignored (32.2%; P < 0.05). The perioperative mortality rate in group I was 2.3% compared with 5.2% in group II (n.s.; P > 0.05). CONCLUSIONS: We conclude that the anaesthesiology decision "patient unfit for operation and anaesthesia" has a high accuracy, independent of the anaesthesiologist's training status, and that preoperative medical management significantly reduces complications.

[Population development, 1997]. / Bevolkerungsentwicklung 1997.

PIP: Demographic trends for 1997 in Germany are presented, with an emphasis on international migration. The authors first discuss the rate of natural increase; then they examine internal and international migration. Finally, they calculate net population change for Germany as a whole and for the states, and briefly consider changes in the population's age structure.^ieng

[Population development, 1995]. / Bevolkerungsentwicklung 1995.

PIP: Population trends in Germany for 1995 are outlined and contrasted with the data for 1994. Data are included on natural increase, marriages, live births, deaths, internal and international migration (both of Germans and of foreigners), and population distribution by sex and region.^ieng

Prehospital point of care testing of blood gases and electrolytes - an evaluation of IRMA.

BACKGROUND: This study evaluated the feasibility of blood gas analysis and electrolyte measurements during emergency transport prior to hospital admission. RESULTS: A portable, battery-powered blood analyzer was used on patients in life threatening conditions to determine pH, pCO2, pO2, sodium, potassium and ionized calcium. Arterial blood was used for blood gas analysis and electrolyte measurements. Venous blood was used for electrolyte measurement alone. During the observation period of 4 months, 32 analyses were attempted on 25 patients. Eleven measurements (34%) could not be performed due to technical failure. Overall, 25 samples taken from 21 patients were evaluated. The emergency physicians (all anesthesiologists) considered the knowledge of blood gases and/or electrolytes to be helpful in 72% of cases. This knowledge led to immediate therapeutic consequences in 52% of all cases. After a short training and familiarization session the handling of the device was found to be problem free. CONCLUSIONS: We concluded that knowledge of the patients' pH, pCO2 and pO2 in life threatening situations yields more objective information about oxygenation, carbon dioxide and acid-base regulation than pulse oximetry and/or capnometry alone. Additionally, it enables physicians to correct severe hypokalemia or hypocalcemia in cases of cardiac failure or malignant arrhythmia.

[1996 population trends]. / Bevolkerungsentwicklung 1996.

PIP: 1996 population trends for Germany are summarized. Total population growth was 0.2%, slightly lower than the previous year. Mortality continues to outweigh fertility, and fewer people migrated to Germany than in 1995. The focus of the article is on migration as the largest component of population growth in Germany. The total population of Germany at the end of 1996 was 82,012,000.^ieng

[Trends in private households up to 2015]. / Entwicklung der Privathaushalte bis 2015.

PIP: Projections of the number and size of private households in Germany are presented up to the year 2015. Methodological aspects are also reviewed, and results are analyzed separately for the former East and West Germany. Two alternative projections are discussed.^ieng

[Ways of life of the population, 1993]. / Lebensformen der Bevolkerung 1993.

PIP: Data from the April 1993 microcensus are used to analyze living arrangements in Germany. Information is included on private households by household size and type; the population aged 18 and over by age group and living arrangements; married and unmarried couples; one-parent families; and the presence of children.^ieng

[Households and families: results of the April 1991 microcensus]. / Haushalte und Familien: Ergebnisse des Mikrozensus, April 1991.

PIP: Household and family data from the April 1991 microcensus of Germany are presented. Since this was the first microcensus to include the former East Germany, the emphasis is on comparisons between eastern and western parts of the country. Topics covered include one-person households, two-generation households, nonmarital cohabitation, one-parent families, age of parents, family size, and labor force participation of married couples.^ieng

[Household and family types in 1972 and 1990: results of the microcensus]. / Haushalts- und Familientypen 1972 und 1990: Ergebnisse des Mikrozensus.

PIP: Changes in household and family types in West Germany are analyzed using data from the 1972 and 1990 microcensuses. Trends discussed include the shifts toward fewer multi-generation households, more elderly persons living alone, fewer families with children, more single-parent families, and smaller families.^ieng