[Effect of Light Color Temperature on Human Concentration and Creativity]. / Wirkung der Farbtemperatur des Lichts auf Konzentration und Kreativität.

Light has different biological effects depending on the color temperature and intensity. This may be the reason for its differing effects. We investigated the influence of color temperature (3000 K, 4500 K, 6000 K) under constant high intensity (1000 Lux) on concentration and creativity of 50 students and employees of the Cologne University of Applied Sciences, Campus Gummersbach (age: 30.9 +/- 10.8y.). As test method we used d2-bq-test, creativity test (mean of the number of ideas on 5 themes), word test and logic test. In addition, test subjects were asked to evaluate their impression of light by means of a questionnaire. To exclude the circadian influence and learning effects on the result, we performed tests at the same time of the day using a random order of color temperature. We found that creativity was better under warm light (3000 K) than under colder light (4500 K, 6000 K). Concentration was best under cold light (6000 K). Under the same light intensity conditions, subjects judged blue light (6000 K) to be brighter than red light (3000 K).

[Combined idiopathic forearm entrapment syndromes]. / Kombinierte idiopathische Nervenkompressionssyndrome des Unterarms.

OBJECTIVE: The aim of this study was to investigate the frequency of combined entrapment syndromes of the forearm in a clinical collective with regard to the question of whether this is an especially configured subgroup. METHODS: We included 1 051 patients (747 females aged 52.93 +/- 14.08 years, 304 males aged 52.63 +/- 12.49 years) with clinically and electrophysiologically verified entrapment syndromes (carpal tunnel syndrome n = 957, sulcus ulnaris syndrome n = 143, supinator syndrome n = 12). We excluded patients with symptomatic entrapment syndromes, e. g., post-traumatic or patients with polyneuropathy. The clinical symptoms were compared. RESULTS: In 61 (5.8 %) patients we found combined entrapment syndromes (carpal tunnel syndrome/sulcus ulnaris syndrome n = 54, carpal tunnel syndrome/supinator syndrome n = 5, sulcus ulnaris syndrome/supinator syndrome n = 2). 32.9 % of the sulcus ulnaris syndromes and 41.7 % of the supinator syndromes were combined with carpal tunnel syndrome. CONCLUSIONS: In spite of the very different anatomy of the entrapment, combinations are more frequent than was to be expected from knowledge of the epidemiological data of carpal tunnel syndrome. Combined entrapment was more frequent at the handed side than carpal tunnel syndrome. Thus, forced use of the hand may be a cause for the more frequent appearance of combined entrapment syndromes.

[Phantom sensations and peripheral induced neglect following implantation of total hip prosthesis]. / Phantomsensationen und peripher induzierter Neglect nach Hüfttotalendoprothese.

OBJECTIVES: O. Sacks describes in his book "A leg to stand on" the inability to move his leg for along period after rupture of the tendon of m. quadriceps. He refers the history of similar cases, especially of a woman with a hip fracture. He discusses this as a result of disruption of proprioception (peripheral induced neglect). The aim of this investigation is to answer the question how frequently this symptom may be found in patients with hip fracture and/or arthrosis perioperativly after implantation of a total prosthesis. METHODS: we examined 106 patients aged 70.35 +/- 10.01 years (36-male 67.54 +/- 9.74 years and 69 female 71.9 +/- 9.9 years) who underwent an implantation of a hip prosthesis - antero-lateral access Watson-Jones - (right side n = 61, left n = 44) because of arthrosis (n = 81) or a hip fracture (n = 18) on postoperative day 1./2. and 10. - 14. Besides exact neurologic examination, we particularly asked for changed perception of the operated leg. RESULTS: by neurological examination we found only rarely signs of peripheral nerve lesion as a complication of implantation of hip prosthesis (1 femoral nerve lesion, 1 ischiadicus nerve lesion). 14 patients reported a changed perception at the first examination: 5 patients felt their operated leg shorter or longer, 4 patients described their leg changed in a strange manner (like a block of wood or lead), 2 patients felt their leg changed, but could not tell how. At follow-up examination there was no patient with a changed perception of the operated leg. CONCLUSIONS: at first examination only a small number of patients report a changed perception of the operated leg. Early mobilization of the operated leg may be the cause of quick normalization of perception. The peripherally induced neglect, described by O. Sacks, was possibly caused by decrease of cortical representation because of immobilization, but not by disrupted proprioception.

[Influence of the drug package information paper on compliance of neurological and psychiatric outpatients]. / Zum Einfluss der Packungsbeilage von Fertigarzneimitteln auf die Compliance der Patienten einer nervenärztlichen Praxis.

The influence of demographic parameter, the number of different drugs or the frequency of the single doses on the reliability of compliance was subject in different studies. The goal of this investigation was to examine the influence of the drug package information paper on the compliance of neurological-psychiatric patients. 951 patients of one quarter of a neurological-psychiatric practice were given a questionnaire, which examined the income behavior and the estimate of the meaning of the drug package information paper. 352 patients answered the questionnaires. Only 15.6 % refused it to answer the questionnaire. The remaining were not able to answer because of different reasons (dementia, aphasia, acute psychiatric disorders, foreign language origin, immobility, etc.). 98.1 % considered the drug package information paper to be important. Older patients and patients with lower education degree judged the drug package information paper to be too extensive. Only few patients (11.5 %) let the physician explain the drug package information paper. 86.3 % of the patients assumed the medication prescribed by the physician to be correct. 58.1 % of the patients however were not satisfied with the information by the physician. Patients with neuroses were particularly dissatisfied over the clearing-up by the physician (77.3 %). 73.3 % of the patients were deterred from taking in their medicines occasionally or frequently by the side effects described in the drug package information paper. 59.9 % of the patients would take the medicine, if the physician insisted on it. Independently of the influence of the drug package information paper 57.5 % of the patients forgot to take their medicines occasionally or frequently. Patients with epilepsies and M. Parkinson were most compliant. In summary the investigation showed that the clearing-up only by the drug package information paper in contrast to the clearing-up by the physician leads to more non-compliance.

[Agee endoscopic operation of carpal tunnel syndrome in comparison with open surgical technique]. / Endoskopische Operation des Karpaltunnelsyndroms nach Agee im Vergleich mit der offenen Operationstechnik.

In the course of a prospective randomised study, 120 patients underwent a carpal tunnel release procedure. The follow-up documentation included 101 patients. 54 patients had the conventional open procedure, including epineural neurolysis of the median nerve. 47 patients were treated with the Agee endoscopic procedure. The documentation included: patients age, sex, profession, duration of treatments, disablement, return to the activities of daily life (ADL) and pre- and postoperative neurological symptoms and postoperative complications. The electroneurographical measurements were performed preoperatively and nine months after operation by the same neurologist. The open and endoscopic carpal tunnel release procedures are described and the study results are reported. None of the 101 patients had wound-healing impairments. Clinical and neurological follow-up examinations did not reveal any signs of injured nerves or tendons. The study shows that the endoscopic group returned to work significantly earlier compared to the control group. At the same time, the Agee group had reduced postoperative pain symptoms. Regarding the long-term results, no significant difference between both groups was found. Based on the electrophysiological results, the study shows that epineural neurolysis of the median nerve is not necessary.

[Is physiotherapy useful following surgery for carpal tunnel syndrome?]. / Ist Krankengymnastik nach Karpaltunnelsyndromoperation sinnvoll?

A prospective follow-up-study of 97 patients operated because of a carpal tunnel syndrome was carried out to investigate postoperative use of physiotherapy. Postoperative 32 patients were treated at least 12 times and 65 patients were not treated physiotherapeuticly. Physiotherapists postoperatively treated by activating joints of fingers and hand. We examined the patients one day preoperative and on an average of 9 months postoperative. Complaints of the patients, local findings, vigorimetrically measured strength and electromyography were registered. The vigorimetrically measured strength of the operated hand improved significantly less in patients treated physiotherapeutically compared to not treated patients. All other complaints and findings improved equally. We interpreted this difference as a result of spare caused by awareness of a sick hand.

[Long-term prognosis of cerebral infarct in comparison with a normal population]. / Langzeitprognose von Hirninfarkten im Vergleich zur Normalpopulation.

This investigation analyses up to 5.5 years longterm-prognosis of 956 patients with acute ischemic stroke admitted to hospital between 1.1.86-31.12.90. The probability of survival was calculated by Kaplan-Meier-indices and compared with the population of the state of Nordrhein-Westfalen. The longterm prognosis of all patients and age subgroups with ischemic stroke was worse compared to the normal population. Determinants of longterm mortality were age, obesity, cardiac arrhythmias, diabetes mellitus, coronary heart disease and organic brain syndrome at discharge from hospital. Hypercholesterinaemia and smoking did not affect longterm outcome.

[Acute prognosis and differentiation of various cerebral infarct groups in comparison with cerebral hemorrhage]. / Akutprognose und Differenzierung verschiedener Hirninfarktgruppen im Vergleich mit Hirnblutungen.

For clinical trials classification of stroke should be possible at the bedside by simple methods that are available every where. In this study are 1105 patients with every first ischaemic strokes and 130 patients with intracerebral haemorrhages. The differences between severity of clinical symptoms, outcome and risk factors of intracerebral haemorrhages, ischaemic stroke caused by cerebral microangiopathy, ischaemic stroke combined with extracranial carotid stenosis, cardiogenic brain embolism and atherothrombotic stroke, were analysed. Intracerebral haemorrhages show the poorest outcome of all groups (mortality 23.8%), due to increased intracranial pressure. Cardiogenic brain embolism is more frequent in older women (mean age 77.8 y.). Main risk factor is atrial fibrillation with absolute arrhythmia. The outcome of this group is the worst of all subgroups of ischaemic stroke and survivors most often in need of institutionalization. Patients with ischaemic stroke combined with extracranial carotid stenosis are significantly younger (mean age 67.6 y.), predominantly male, and smokers. Their mortality is low (0.63%), but recovery of paresis is slower than in other subgroups. Ischaemic strokes caused by cerebral microangiopathy with hypertension as main risk factor recover most quickly but acute mortality is higher than in ischaemic stroke combined with extracranial carotid stenosis because of higher age (mean age 74.5 y.). Institutionalization is more frequent too because of higher incidence of dementia in this subgroup. The main prognostic factors of all groups are age and severity of clinical symptoms. A special subgroup are infratentorial ischaemic strokes.(ABSTRACT TRUNCATED AT 250 WORDS)

[Cerebral infarcts and length of stay--a multivariate analysis]. / Hirninfarkte und Liegezeit--Eine multivariate Analyse.

This paper investigates by factor analysis the correlation between kind of ischemic stroke, risk factors, complications of the clinical course and duration of hospitalization of 1105 patients admitted to hospital with acute ischemic stroke in the period of 1.1.86-31.12.90. There was no correlation between increasing age and duration of hospitalization. Especially young men with ischemic stroke combined with carotid artery stenosis and cigarette smoking need the longest time of treatment in hospital. Smoking seems to be a predicting factor for worse prognosis of neurological deficits. Acute strokes in patients with cerebral microangiopathia have the best prognosis and the shortest period of hospitalization. In other patients infectious complications of immobilisation as pneumonia or urinary infections and need of care--especially older women--cause longer periods of hospitalization.

[Progressive subcortical gliosis]. / Progressive subkortikale Gliose.

A case of autoptically verified progressive subcortical gliosis (PSG) is reported. The 79 year old woman developed subacutely a right sided hemisyndrome and a cerebellar syndrome. Generalized action myoclonus of the left leg evolved into left sided Epilepsia partialis continua and dementia appeared. After a 6 month course the patient died of aspiration pneumonia. There was no indication of alcoholism or HIV-dementia neither clinically nor at autopsy. Morphologically the brain showed a diffuse proliferation of astrocytes in the subcortical white matter, thalamus, basal ganglia, brain stem and cerebellum. A severe neuronal dropout was found in medial thalamic neurons but Wernickes encephalopathy was ruled out. 21 cases of PSG confirmed by autopsy were found in the literature. Clinics, neuropathology and classification of PSG is discussed.

[Effect of the weather on acute hospital admissions. Observations at a neurologic clinic]. / Einfluss des Wetters auf Akutkrankenhausaufnahmen. Beobachtungen in einer neurologischen Klinik.

In 1,286 acute admissions to a neurological department in 1987/88, the relationship between admission rate and the continuously recorded meteorological parameters air pressure, temperature, and humidity, together with their differences over 24 hours (previous day and next day), as well as subjective weather effects, were submitted to factor analysis. No correlation was found between admission rate and absolute meterological parameters, but there was a relationship between admission rate and 24-hour differences, which was age-dependent and decreased from younger to older patients. This was considered to show that in the elderly, the usual course of their disease is more decisive than any influences of the weather. This contrasts with the results of demoscopic polls that show an increase in weather-dependent complaints with age.

[Effect of meteorologic parameters on acute admission of patients with lumbar intervertebral disk displacement]. / Einfluss von meteorologischen Parametern auf Akutaufnahmen von Patienten mit lumbalen Bandscheibenvorfällen.

The correlation between local meteorological parameters and acute admittance to hospital of patients with lumbar disk prolapses was investigated. The study shows a significant correlation between drop of temperature and increase of humidity for male on the day of admittance and for female on changes from the day before to the day of admittance. This seems to be in contrast with other investigators, who couldn't find a correlation between local meteorological parameters and pain. The reasons for this are discussed.

Cross-sectional epidemiological study on neurotoxicity of solvents in paints and lacquers.

In a multi-disciplinary retrospective study we examined 105 house painters employed for at least ten years (median 27 years, range 10-36 years). Fifty-three workers from various professions (non-painters), who were matched with regard to age, occupational training and socio-economic status served as the control group. In both groups no cases of a clinically manifest polyneuropathy or encephalopathy were found. The neurophysiological examinations (EEG and NCV-measurement) showed no differences in painters and controls that would indicate adverse effects of organic solvents. There were no cases with neuroradiological findings of a diffuse cerebral atrophy. Furthermore the evaluation of certain brain structures (ventricular diameter, cella media index) of the CAT films did not reveal any significant differences. In the neurobehavioral tests significant differences in the results were only found in the subtests "change of personality" and "short term memory capacity" in a subgroup of painters with repeated prenarcotic symptoms at the workplace. Ambient air monitoring measurements at 30 representative workplaces showed that the concentrations of the main components of the solvent-mixtures were well below the MAK-values. The results of the "Erlangen Painter Study" does not confirm former epidemiologic findings from other countries, mainly Denmark. However, there are some aspects, such as minor solvent exposure in German house painters, insufficient diagnostic and etiological procedures as well as misclassifications which may explain the different experiences.

[Progressive lipodystrophy (Barraquer-Simon syndrome): differential diagnosis and clinical aspects]. / "Lipodystrophia progressiva" (Barraquer-Simon-Syndrom): Differentialdiagnose und Klinik.

"Progressive lipodystrophy" or "partial lipodystrophy of the cephalothoracic type" is a rare, acquired condition of unknown aetiology with onset in childhood and a complete loss of subcutaneous fat of face, neck, trunk and upper extremities. The disease is more common in females than males and causes a disfigurement of the face; that it cannot be regarded only as a harmless variation, is above all due to a typical concomitant disease, membranoproliferative glomerulonephritis with hypocomplementaemia. Laboratory investigations nearly always reveal a complement-activation by the "alternative pathway" with consumption and lack of complement-component C3, a finding which allows a clear distinction between partial lipodystrophy and congenital or acquired forms of total lipodystrophy ("Berardinelli-Seip-Syndrom", lipoatrophic diabetes) and other circumscript lipodystrophies.

[Analysis of movement in extrapyramidal motor diseases using a computer]. / Bewegungsanalyse extrapyramidalmotorischer Erkrankungen mit Hilfe eines Prozessrechners.

Normals are able to move their limbs in a continuous spectrum of speeds. In contrast patients with so called extrapyramidal disorders show typical changes of movement. Short ballistic movements of the upper limb were analysed by a joystick connected with a computer in 57 patients with different extrapyramidal disorders (parkinsonsyndrome, essential tremor, torsion dystonia, chorea and intention tremor) and in 22 normals. Patients with parkinsonsyndrome and with torsion dystonia move the upper limb slower than normals and all other patients. Their movements show breaks. All patients execute aimed movements less precisely than normals. Most unprecise are the movements of patients with essential tremor. Oscillation of movements of all patients deminish, but less than in normals. Patients with parkinsonsyndrome show smallest oscillations at the beginning of each movement. Patients with intention tremor differ not from normals at the beginning, but show still the highest oscillations at the end of movement. Holding the target they correct most frequent. We discuss, that striatum generates timing and strength of ballistic movement and cerebellum apeases oscillation of movement and frequency of correcting while holding a target.

[Mononuclear phagocytes in the cerebrospinal fluid. Studies on the clinical significance and factors of activation]. / Mononukleäre Phagozyten im Liquor cerebrospinalis. Untersuchungen zur klinischen Bedeutung und zu Faktoren der Aktivierung.

Examination of 1050 cerebrospinal fluid samples showed, that mononuclear phagocytes contribute only slightly to the explanation of affections of the CNS except they are containing specific particles e.g. iron. Further investigations on patients with concussion, herniation of the intervertebral disk and cerebral infarction turned out, that the relative proportion of mononuclear phagocytes and qualitative cytological changes correlate with the extent of the CNS lesion. Phagocytosis of India ink was studied dependent on milieu and different mediators. Phagocytosis correlates with alpha-1-glycoproteid and the relative part of mononuclear phagocytes in cerebrospinal fluid. It depends on pH, various ions and mediators (adrenalin, histamine, prostaglandines, cAMP, cGMP). DNA-contents of the nucleus was measured by cytophotometria. No signs of proliferation (tetraploidia) were found. The slightly increased contents of nuclear DNA of some phagocytes was interpreted as a metabolically active DNA.