BACKGROUND AND PURPOSETo prospectively determine the sensitivity in the detection of multiple sclerosis (MS) lesions by using double inversion recovery (DIR), fluid-attenuated inversion recovery (FLAIR), and T2-weighted turbo spin-echo (T2 TSE) MR imaging at 3T.METHODSSeventeen patients presenting with a clinically isolated syndrome (CIS) suggestive of MS, 9 patients with definite MS, and 6 healthy control subjects were included. Imaging was performed on a 3T MR system using DIR, FLAIR, and T2 TSE sequences. Lesions were counted and classified according to 5 anatomic regions: infratentorial, periventricular, deep white matter, juxtacortical, and mixed white matter-gray matter. The sensitivity at DIR was compared with the corresponding sensitivity at FLAIR and T2 TSE sequence. The contrast between lesions and normal-appearing gray matter, normal-appearing white matter, and CSF was determined for all sequences.RESULTSBecause of higher lesion-white matter contrast, the DIR showed a higher number of lesions compared with the FLAIR (7% gain, P = 0.04) and the T2 TSE (15% gain, P = 0.01). The higher sensitivity was also significant for the infratentorial region compared with the FLAIR (56% gain, P = 0.02) and the T2 TSE (44% gain, P = 0.02). Compared with the FLAIR, no significant changes of the lesion load measurements were observed in the supratentorial brain: slightly higher numbers of periventricular and mixed gray matter-white matter lesions on the DIR were counterbalanced by a slightly reduced sensitivity regarding juxtacortical lesions.CONCLUSIONDIR brain imaging at 3T provides the highest sensitivity in the detection of MS lesions especially in the infratentorial region.

BACKGROUND:A sufficient quality of data transfer from written patient records to electronic data processing is a precondition for a reasonable usage of perinatal data. However the quality of data transfer of the almost 200 characteristics routinely recorded at each delivery is largely unknown.MATERIALS AND METHODS:The quality of data transfer of 33 characteristics in 350 randomly selected singleton deliveries of the women's clinic of the University of Marburg from 2002 and 2003 has been checked by comparing electronically recorded data with the original written documents.RESULTS:The quality of data transfer of the tested characteristics turned out to be heterogeneous. Characteristics necessary to calculate quality indicators show a very high data quality when excluding the characteristic attendance of a paediatrician. The quality of data transfer of characteristics denoting time as well as blood gas analysis are heterogeneous. Characteristics with a low quality of data transfer are associated with ambiguous instructions, the fact that the coding obstetrician is not dealing in the first instance with the item being encoded and the characteristics are of no immediate relevance for delivery, as well as difficult application of the software.CONCLUSION:The quality of data transfer of the characteristics collected in perinatal surveys needs to be validated. The type and amount of data being collected should be reassessed considering improvements of data quality.

BACKGROUND AND PURPOSE: Current MR imaging criteria for multiple sclerosis (MS) do not specify the magnetic field strength. The aim of this study was to investigate whether different MR imaging field strengths, specifically high-field MR imaging, have an impact on the classification of patients with clinically isolated syndromes suggestive of MS, according to MR imaging and diagnostic criteria.METHODS: In a prospective intraindividual comparative study, we examined 40 patients with clinically isolated syndromes (CIS) consecutively with a 1.5T and 3T MR imaging system, including axial sections of T2 turbo spin-echo, fluid-attenuated inversion recovery, and T1 spin-echo, before and after injection of gadolinium-diethylene-triaminepentaacetic acid. Constant resolution parameters were used for both field strengths. High-signal-intensity white matter lesions with a size of > 3 mm were counted and categorized according to their anatomic location in infratentorial, callosal, juxtacortical, periventricular, and other white matter areas. Assessment of the fulfilled Barkhof MR imaging and McDonald diagnostic criteria was made separately for both field strengths in every patient.RESULTS: Eleven patients fulfilled more MR imaging criteria at 3T. Two of these patients fulfilled the criterion of dissemination in space (DIS) according to the first definition of McDonald criteria, which is based on imaging criteria alone. Another patient had DIS only at 3T, according to the second definition of the McDonald criteria including CSF parameters.CONCLUSION: MR field strength, specifically high-field MR imaging, has a substantial influence on the classification of patients with CIS according to imaging and a mild influence on the classification according diagnostic criteria for MS, leading to consequences for prognostic classification, imaging guidelines, and clinical trials.

Vorzeitige Wehentätigkeit und Anämie weisen eine positive Korrelation auf. Berichte über eine direkt nachweisbare tokolytische Wirksamtkeit von Bluttransfusionen bei ausgeprägter Anämie finden sich in der Literatur nicht.

Einführung: Postpartale Blutungen aufgrund eines iatrogenen Aneurysma spurium stellen eine sehr seltene Komplikation einer Sectio caesarea dar. Das klinische Bild, Diagnostik und Behandlung werden anhand eines Fallbeispiels berichtet.

Fragestellung: Ziel der externen bundesweiten Qualitätssicherung ist die Steuerung der Qualitätsentwicklung über einen „strukturierten Dialog“ mit den teilnehmenden Kliniken. Kann dieser Dialog über die gezielte Rückkopplung statistisch auffälliger Ergebnisse die Entwicklung von geburtshilflichen Qualitätsindikatoren positiv beeinflussen?

In den letzten 10 Jahren ist die Inzidenz der Frühgeburtlichkeit trotz aller klinischen Überwachungsmethoden mit 6–10% konstant geblieben. Im Bestreben zusätzliche Marker der Frühgeburtlichkeit zu evaluieren, wurde in der vorliegenden Untersuchungsreihe die Wertigkeit der sonographischen Gewebetypisierung der Zervix uteri zurVorhersage der Frühgeburtlichkeit untersucht.

We report a 49-year-old woman with arterial hypertension, transitory neurologic symptoms, and suspected neurosarcoidosis based on elevated plasma and CSF angiotensin converting enzyme (ACE) levels. Sarcoidosis is a multisystem disease of unknown etiology, histopathologically characterized by the formation of noncaseating granulomas. CNS involvement occurs in about 5% of patients, and neurosarcoidosis can present without systemic manifestation.1,2⇓ The most common clinical manifestations of neurosarcoidosis are cranial nerve palsies and CNS parenchymal disease.1,2⇓ MRI typically reveals diffuse meningeal involvement, mass lesions, or diffuse white matter lesions.1,2⇓ Plasma levels of ACE (enzyme commission 3.4.15.1) are increased in 70 to 80% of patients with systemic sarcoidosis. In patients with neurosarcoidosis, plasma ACE levels are increased in about 24%, and …

BACKGROUND:For several decades Apgar scores and umbilical blood pH sampling have been routinely used in the assessment of newborns. The aim of this study was to examine the prognostic value of neonatal survival using population-based data and to put these analyses into context with international studies.MATERIAL AND METHODS:Data from 513,135 live births from the Perinatal Birth Register of Hesse, 1990 - 1999, were used. Death in the first week of life (early neonatal death) was used as endpoint of analyses. Receiver operator characteristic analyses were employed to compare the prognostic value of Apgar scores and umbilical blood pHs independently of cutoffs used.RESULTS:Scores and umbilical blood pH showed a strong association with early neonatal morality. The relative risk of early neonatal mortality in term infants with scores 0 - 3 yields a relative risk of 1193 (95 % confidence interval = 801 - 1778) compared with babies born with scores 7 - 10. Scores at 1, 5, and 10 minutes were superior in predicting early neonatal mortality compared to umbilical blood pH, independent of cutoffs used.CONCLUSIONS:Scores remain essential in the prediction of early neonatal survival. Umbilical blood pH is also strongly and significantly associated with early neonatal death, even though it is much less pronounced than the score.DISCUSSION:The poor mortality prediction of umbilical blood pH sampling in Hesse compared with umbilical blood pH sampling in a large American delivery unit with a highly standardized measuring routine may be explained by a lower proportion of extremely acidotic infants or may be attributable to a decreased proportion of or to a less unified or less reliable measurement of the umbilical blood pH in Hesse.

In the pathogenesis of multiple sclerosis (MS) genetic factors are known to influence autoreactive T-cell-actions like proliferation and chemotaxis across the blood-brain barrier via chemokine receptors (CCR) and G-protein coupled activating mechanisms. For the first time, we studied the frequencies of a recently described C825T polymorphism in the G-protein encoding gene for the beta3 subunit (GNB3) together with frequencies of a 32-base-pair deletion in the CCR5 gene (delta32 CCR5) in patients with MS (n = 253: relapsing-remitting (RR), n = 124 and chronic progressive course, n = 129). Apart from a trend to a reduced frequency of delta32 CCR5 and increased GNB3 825T polymorphism in primary chronic progressive patients, numbers did not reach statistical significance in any group of MS. These results could not support differences in the genetic background of MS based on that CCR5 mutation or the described GNB3 polymorphism.

Morphological and immunohistochemical studies in diabetic subjects have shown a depletion of the neuropeptide substance P (SP) in the central and peripheral nervous system. This is the first study investigating serum levels of substance P in type 1 diabetes patients (n=50) and controls (n=75) by means of an enzyme immunoassay. The serum level of SP was significantly decreased in the diabetic group compared to the control group (10.12+/-0.29 vs. 12.25+/-0.38 pg/ml; p<0.0001). In diabetic patients, there was no correlation of substance P levels with age, serum creatinine, albuminuria, total cholesterol, HDL- or LDL-cholesterol, triglycerides, HbA1c, type or duration of diabetes and gender. Furthermore, there was no difference in serum levels of SP in patients with or without retinopathy, but SP was significantly decreased in patients with neuropathy (9.59+/-0.48 vs. 10.78+/-0.83 pg/ml; p=0.04). These data show that SP is decreased in serum of type 1 diabetes patients, especially in those with diabetic neuropathy. Subsequent and already ongoing prospective studies in well validated diabetic patients with neuropathy may characterize the impact of this neurogenic marker in the course of diabetic neuropathy.

coronary artery disease in men.This may partly explain differences between individuals in the development of coronary artery disease.Of the three other polymorphisms in this gene, the most extensively studied, intronic PvuII polymorphism, showed no association with coronary artery stenosis as measured by angiography. 5 Although the biochemical evidence is presently lacking, we speculate that carriers of the long repeat variants have lower expression of the oestrogen receptor gene and benefit less from the cardiovascular protective effect of oestrogen receptors.We thank Outi Lumme and Mervi Niittylahti for their skilful technical assistance, Seppo Tyynelä for planimetric measurements, and Markus Perola for DNA isolation.

Multiple sclerosis is an inflammatory demyelinating CNS disease of putatively autoimmune origin. Novel models of experimental autoimmune encephalomyelitis (EAE) have demonstrated that T cells specific for various myelin and even nonmyelin proteins are potentially encephalitogenic. The encephalitogenic T cell response directed against different CNS antigens not only determines the lesional topography of CNS inflammation but also the composition of the inflammatory infiltrates. The heterogeneity of the lesional distribution seen in EAE might therefore be useful for the understanding of the various clinical subtypes seen in MS. In this review the possible candidate autoantigens in MS are discussed with special regard to the human T cell and B cell responses against various myelin and nonmyelin proteins.

A decrease in cerebral blood flow and in cerebral blood flow velocity caused by indometbacin administration is well known (Child Neurol 1987;29: 776-82; Eur J Pediatr 1988;147:315-61. For a deeper view on the cellular base we studied seven premature infants (1080g, 30 + 2 weeks), who received indomethacin for closure of PDA (0.2 mg/kg weight, i. v.) with the near infrared technique. Cerebral blood volume (CBV) decreased in every child exept one just after starting the indomethacin administration and remained on a lower level during the monitoring time (30 min). The balance of the redox state of cytochrome a/a3 shifted to a decrease of the oxidised part of the enzyme. Table 1 shows the relative concentration change of the CBV and the CYT. Indomethacin reduced CBV and has a negative effect on the redox state of cytochrome a/a3 as seen by NIRS. Both effects could damage brain cells.