A possible impact of the neuroD2 transcription factor on the development of drug abusing behavior.
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Adult↗
Biomedical subjects
A Büttner
Publications and source records attributed to A Büttner.
Death due to neurogenic shock following gastric rupture in an anorexia nervosa patient.
We report a case of fatal gastric rupture discovered after death, which developed due to a bulimic attack of a 19-year-old woman suffering from anorexia nervosa. An autopsy revealed an acute gastric dilatation and rupture without commonly observed ischemic damage of gastric wall structures. However, it may be difficult to determine the cause of death despite the marked findings. The death as a consequence of neurogenic shock accounts for all the results of gross examination and histologic analysis. This case is the first reported case of fatal gastric rupture of an anorectic patient discovered after death.
Adult↗
[Quality of life before and during nCPAP].
The obstructive sleep apnea syndrome is accompanied by an impairment of patients' condition during the day. The latter, in turn, is a decisive criterion quality of life. The instruments employed for data gathering, objectification and observation of the course of therapy are questionnaires. Questionnaires like Satisfaction With Life Scale SWLS: for global quality of life; Münchner Lebensqualitäts-Dimensionen-Liste MLDL and Short Form-36 of the Health Survey SF-36: for specific areas of life quality are often used. The purpose of this study is to clarify, to what extent and in which areas quality of life of OSAS patients improves both after initiation of therapy and under long-term therapy. By comparing effect size the value for effectiveness of therapy can be estimated. Thus, 41 OSAS patients and 40 controls were given an extensive set of tests addressing parameters of both sleep and quality of life. Testing of global quality of life with the Satisfaction With Life Scale (SWLS) did not reveal any significant difference between the controls and the OSAS patients. In specific araeas of life quality, 2 (of 4) subscales (Physical satisfaction: p = 0.003; Psychological satisfaction: p = 0.001) of the Münchner Lebensqualitäts-Dimensionen-Liste (MLDL) showed differences between the controls and the OSAS patients. For the Short Form-36 of the Health Survey (SF-36), 7 (of 8) subscales indicated significant differences between this groups (except for Emotional Role Function). The comparison of the effect size revealed the strongest effect in the subscale vitality of the SF-36 after more than 6 months (0.93). Good effect sizes were found in the domains Physical satisfaction (0.70) and Psychological satisfaction of the MLDL (0.56). In conclusion the MLDL is in consideration of its simple performance and evaluation compared with the SF-36 the better instrument in the clinical routine for the coverage of improved Quality of Life through a nCPAP therapy.
Female↗
Adipose tissue at entheses: the rheumatological implications of its distribution. A potential site of pain and stress dissipation?
OBJECTIVES: To describe the distribution of adipose tissue within and adjacent to entheses in order to assess its functional significance at attachment sites. METHODS: Entheses were removed from 29 different sites in the limbs of formalin fixed, elderly, dissecting room cadavers and the samples prepared for paraffin and/or methylmethacrylate histology. Entheses from four young volunteers with no history of significant musculoskeletal injury were examined by magnetic resonance imaging using T(1) weighted sequences. RESULTS: Adipose tissue was present at several different sites at numerous entheses. Many tendons/ligaments lay on a bed of well vascularised, highly innervated, "insertional angle fat". Endotenon fat was striking between fascicles, where entheses flared out at their attachments. It was also characteristic of the epitenon, where it occurred in conjunction with lamellated and Pacinian corpuscles. Fat filled, meniscoid folds often protruded into joint cavities, immediately adjacent to attachment sites. CONCLUSION: Adipose tissue is a common feature of normal entheses and should not be regarded as a sign of degeneration. It contributes to the increase in surface area of attachment sites, promotes movement between tendon/ligament and bone, and forms part of an enthesis organ that dissipates stress. The presence of numerous nerve endings in fat at attachment sites suggests that it has a mechanosensory role and this could account for the rich innervation of many entheses. Because damage to fat is known to lead to considerable joint pain, our findings may be important for understanding the site of pain in enthesopathies.
Adipose Tissue↗
[3H]-nociceptin ligand-binding and nociceptin opioid receptor mrna expression in the human brain.
Following the cloning of the novel nociceptin opioid receptor (NOP(1)) and the identification of its endogenous ligand orphanin FQ/nociceptin the distribution and functional role of the NOP(1) receptor system have been studied mainly in the rodent CNS. In the present study the regional distribution and splice variant expression of the NOP(1) receptor was investigated in the adult human brain using [(3)H]-nociceptin autoradiography, NOP(1) reverse transcriptase PCR and mRNA in situ hybridization. Ligand binding revealed strong expression of functional NOP(1) receptors in the cerebral cortex and moderate signals in hippocampus and cerebellum. Interestingly, the NOP(1) receptor specific ligand was also strongly bound in the human striatum. A matching pattern of mRNA expression was observed with high amounts of NOP(1) mRNA in the prefrontal and cingulate cortex as well as in the dentate gyrus of the hippocampus. mRNA levels in the Ammon's horn and cerebellar cortex were moderate and low in the striatum. A considerable expression of N-terminal NOP(1) splice variant mRNAs was not detectable in the human brain by means of in situ hybridization. This suggests that functional NOP(1) receptors in the human brain are encoded by N-terminal full length NOP(1) transcripts. The present data on the anatomical distribution of nociceptin binding sites and NOP(1) receptor mRNA contribute to the knowledge about opioid receptor systems in the human brain and may promote the understanding of function and pharmacology of the orphanin FQ/nociceptin receptor system in the human CNS.
Aged↗
[Two simulation programs to measure continuous attention in obstructive sleep apnea syndrome].
Patients with obstructive sleep apnea syndrome suffer from reduced continuous attention due to neuropsychological deficits. Among other means, driving simulator programs are employed for registration and objectification as well as observation of the course of therapy. While Steer Clear by Findley et al. and the driving simulator Carda (Randerath et al.) represent pure continuous attention tests, the new driving simulator test Carsim, measures attention interactively and continuously. This way, more complex functions are recorded. We therefore investigated Carda and the program Carsim to study the various features of both methods. For this purpose, 105 OSAS patients were tested on both driving simulators concerning the mistake rate in Carda and the time of tracking deviations in Carsim. We defined the normal range by using the mean value +/- 2 standard deviations from our earlier publications in healthy persons without sleep disorders. With Carda the mistake rate exceeded in 10 of 105 patients (9.5%) the normal range and with Carsim the frequency of tracking deviations exceeded in 49 of 105 patients (46.7%) the normal range. The incidence of deviation from normal was significantly higher with Carsim testing. By additionally testing the number of pathological cases is with Carda increased from 46.7% to 51.4%. The tests characterize different components of neuropsychological deficits. Driving simulators with tracking tasks describe neuropsychological deficits in comparison with those measuring only components of reaction in a higher percentage.
Automobile Driving↗
An immunohistochemical study of the dorsal capsule of the lumbar and thoracic facet joints.
STUDY DESIGN: The molecular composition of the extracellular matrix in the dorsal capsules of lumbar and thoracic facet joints was analyzed immunohistochemically. OBJECTIVES: To determine whether the immunohistochemical profile of the lumbar joint capsule suggests a role of the capsule in limiting axial rotation of the lumbar motion segment. SUMMARY OF BACKGROUND DATA: During axial rotation of the lumbar vertebrae, the axis of rotation shifts toward the facet joints in the direction of rotation. Thus, the capsule of the opposing joint should become tensed and wrap around the inferior articular process. Previous studies suggest that wrap-around ligaments are fibrocartilaginous. However, thoracic joint capsules are largely shielded from such loading and should be purely fibrous. METHODS: Dorsal capsules were removed from lumbar and thoracic facet joints of six adult cadavers. Specimens were immunolabeled with monoclonal antibodies for collagens, chondroitin, dermatan and keratan sulfates, versican, tenascin, aggrecan and link protein. Antibody binding was detected using the Vectastain ABC 'Elite' peroxidase kit (Vector Laboratories, Inc., Burlingame, CA). RESULTS: Both lumbar and thoracic joint capsules immunolabelled for most glycosaminoglycans and for Type I, III and VI collagens. However, labeling for Type II collagen, chondroitin-6-sulfate, aggrecan, and link protein was restricted to lumbar capsules. Such labeling was constantly seen at entheses and occasionally in the midsubstance. CONCLUSIONS: The molecular composition of the lumbar joint capsule suggests that it acts as a fibrocartilaginous, 'wrap-around' ligament that withstands compression in addition to tension during torsional movements of the lumbar spine. It wraps around the inferior articular process as rotation occurs and limits further movement.
Adult↗
Sex determination and estimation of stature from the long bones of the arm.
The determination of sex and the estimation of stature from bones play an important role in identifying unknown bodies, parts of bodies or skeletal remains. In medico-legal practice statements on the probable sex of a decomposed body or part of a body are often expected even during autopsy. The present study was, therefore, restricted to few easily accessible dimensions from bones which were prepared only by mechanically removing soft tissues, tendons and ligaments. The specimens came from the Anatomical Institutes in Munich and Cologne from the years 1994-1998 including a total of 143 individuals (64 males and 79 females). The mean age was 79 years (46-108), the mean body height 161cm (134-189). The following measurements were taken: maximum humeral length (mean: 33.4cm in males; 30.7cm in females), vertical humeral head diameter (mean: 5.0cm in males, 4.4cm in females), humeral epicondylar width (mean: 6.6cm in males; 5.8cm in females), maximum ulnar length (mean: 26.5cm in males, 23.8cm in females), proximal ulnar width (mean: 3.4cm in males, 2.9cm in females), distal ulnar width (mean: 2.2cm in males; 1.8cm in females), maximum radial length (mean: 24.6cm in males; 22.0cm in females), radial head diameter (mean: 2.6cm in males, 2.2cm in females) and distal radial width (mean: 3.6cm in males; 3.2cm in females). The differences between the means in males and females were significant (P<0.0005). A discriminant analysis was carried out with good results. A percentage of 94.93% of cases were correctly classified when all measures of the radius were applied jointly, followed by humerus (93.15%) and ulna (90.58%). Applied singly, the humeral head diameter allowed the best distinction (90.41% correctly grouped cases), followed by the radial length (89.13%), the radial head diameter (88.57%) and the humeral epicondylar width (88.49%). The linear regression analysis for quantifying the correlation between the bone lengths and the stature led to unsatifactory results with large 95%-confidence intervals for the coefficients and high standard errors of estimate.
Adult↗
Resistance of the lumbar spine against axial compression forces after implantation of three different posterior lumbar interbody cages.
BACKGROUND: The aim of using interbody fusion cages is to distract the degeneratively decreased disc height to decompress the neural structures in the intervertebral foramina and allow bony fusion. Prerequisite for a successful fusion therapy is a high resistance against subsidence and breakage. METHOD: Three types of implants, a cylindrical threaded titanium cage (Ray) (1c), a bullet shaped PEEK cage (Stryker) (1a) and a rectangular titanium cage with an endplate anchorage device (Marquardt) (1b) were implanted in eight monosegmental lumbar spine specimens (L 2/3 and L 4/5). Each specimen underwent a cyclic loading test with 40000 cycles at a rate of 5 Hz. A cyclic axial compression force ranging from 200 Newton [N] to 1000 N was applied and the axial translation recorded simultaneously to determine the subsidence tendency. After this procedure the specimens were tested with a progressive axial force until breakage. FINDINGS: There were only small differences in the subsidence tendency for the three cage designs. The height reduction due to cyclic loading ranged between 0.9 mm (Marquardt), 1.2 mm (Stryker) and 1.4 mm (Ray). The median break force ranged from 5486 N (Marquardt), 8359 N (Stryker) to 8413 N (Ray). No correlation between bone mineral density and failure load could be detected. INTERPRETATION: Endplate preparation and cage design of the tested implants do not seem to influence the resistance of the segment against cyclic axial compression. The compression with a continuously increasing load revealed that an implant-bone failure is not to be expected in physiological limits for all three cage types.
Biomechanical Phenomena↗
Progressive idiopathic bilateral striato-pallido-dentate calcinosis (Fahr's disease) in a person with anabolic steroid abuse.
A 33-year-old male black student suddenly died during a basketball game. His previous medical history, including his neurological status, was unremarkable, but he was known to take anabolic steroids for several years. At autopsy, the cause of death was due to a fresh myocardial infarction. On neuropathological examination, there was extensive bilateral symmetrical calcification involving the basal ganglia as well as the dentate nuclei and the white matter of the cerebellum (Fahr's disease). A possible correlation between anabolic steroid-induced hypercalcemia and brain calcification is discussed.
Journal Article↗
The diagnostic relevance of cerebral amyloid angiopathy in the setting of forensic pathology - a report of two cases and review of the literature.
The neuropathological features seen in two cases with cerebral amyloid angiopathy (CAA) are presented. An 85-year-old woman was found comatose at home and died on the way to the hospital. The cause of death was an intracerebral hemorrhage (ICH) in the right parietal lobe. A 93-year-old woman with a history of traumatic subarachnoid hemorrhage was operated on for a chronic subdural hematoma. Intraoperatively, she developed severe ICH and died. The cause of death was an ICH in the parieto-occipital lobe. The morphology of the vessels was studied on differently stained sections and the neuropathological findings of the surrounding brain tissue were investigated. The affected vessels showed the characteristic alterations seen in CAA and included vascular amyloid deposition, fibrinoid necrosis, double-barrel lumen, splitting of the internal elastic lamina, defects of the vessel wall, and microaneurysms. Visualization of beta-amyloid protein was performed by histological and immunohistochemical methods. The immunohistochemistry for beta-amyloid was more sensitive and yielded better results compared with Congo red. In cases of ICH, CAA has to be considered in the differential diagnosis. Besides the use of Congo red stain, the application of beta-amyloid immunohistochemistry is requested to reliably make the diagnosis of CAA. Additional staining with a modified silver impregnation technique (AgNOR) is useful to detect associated neurodegenerative changes.
Journal Article↗
Primary meningeal sarcomas in two children.
Primary meningeal sarcomas are rare but highly aggressive tumors predominantly affecting children. The clinical course, imaging characteristics and histopathological features of meningeal sarcomas in two pediatric patients are presented. Furthermore, we critically discuss the new WHO classification of these entities comparing them to older descriptions. In a 6-year-old girl, a cranial computed tomography (CT) scan was performed, after a mild head trauma, showing a parieto-occipital hemorrhage. One month later, a circumscribed mass adhering to the meninges and with central areas of hemorrhage was evident on magnetic resonance imaging (MRI) scans. Brain biopsy revealed a polymorphocellular sarcoma originating from the leptomeninges and infiltrating the brain. In an 8-year-old girl, who presented with headaches and vomiting, several MRI-examinations were inconspicuous for nearly one year until the latest MR-scan revealed a diffuse contrast enhancement of the leptomeninges of the whole brain and spinal canal. After open biopsy, primary leptomeningeal sarcomatosis was diagnosed. Although CT and MRI did not allow a specific diagnosis in both cases the exact visualization of the extent of the tumor and/or meningeal involvement was possible. Since there are no specific imaging criteria to differentiate meningeal sarcoma from other solid brain tumors or from other tumoral or inflammatory meningioses brain biopsy is indispensable. In order to avoid misinterpretations and delays of therapy, early open brain biopsy or surgical resection of the lesion is necessary in cases of unclear brain masses, especially of unclear meningeal processes. Due to the low number of cases published so far, the biological behavior and clinical management of this tumor entity still awaits further investigation.
Child↗
Fibrocartilage in the transverse ligament of the human acetabulum.
Biomechanical experiments on isolated hip joints have suggested that the transverse ligament acts as a bridle for the lunate articular surface of the acetabulum during load bearing, but there are inherent limitations in such studies because the specimens are fixed artificially to testing devices and there are no modifying influences of muscle pull. Further evidence is thus needed to substantiate the theory. Here we argue that if the horns of the lunate surface are forced apart under load, the ligament would straighten and become compressed against the femoral head. It would thus be expected to share some of the features of tendons and ligaments that wrap around bony pulleys and yet previous work has suggested that the transverse ligament is purely fibrous. Transverse ligaments were removed from 8 cadavers (aged 17-39 y) and fixed in 90% methanol. Cryosections were immunolabelled with antibodies against collagens (types I, II, III, VI), glycosaminoglycans (chondroitins 4 and 6 sulphate, dermatan sulphate, keratan sulphate) and proteoglycans (aggrecan, link protein, versican, tenascin). A small sesamoid fibrocartilage was consistently present in the centre of each transverse ligament, near its inner surface at the site where it faced the femoral head. Additionally, a more prominent enthesis fibrocartilage was found at both bony attachments. All fibrocartilage regions, in at least some specimens, labelled for type II collagen, chondroitin 6 sulphate, aggrecan and link protein, molecules more typically associated with articular cartilage. The results suggest that the ligament should be classed as containing a 'moderately cartilaginous' sesamoid fibrocartilage, adapted to withstanding compression. This supports the inferences that can be drawn from previous biomechanical studies. We cannot give any quantitative estimate of the levels of compression experienced. All that can be said is that the ligament occupies an intermediate position in the spectrum of fibrocartilaginous tissues. It is more cartilaginous than some wrap-around tendons at the wrist, but less cartilaginous than certain other wrap-around ligaments, e.g. the transverse ligament of the atlas.
Acetabulum↗
Fibrocartilage at the entheses of the suprascapular (superior transverse scapular) ligament of man--a ligament spanning two regions of a single bone.
The suprascapular ligament converts the suprascapular notch into a foramen separating the vessels and nerve of the same name. It connects 2 regions of the same bone and does not cross any joint, and no mechanical function has yet been attributed to it. Nevertheless, variations in its thickness and length, and its tendency to ossify, suggest that the ligament responds to changes in mechanical load. This should be reflected in the composition of the extracellular matrix. The primary purpose of the present study is to demonstrate that the suprascapular ligament has fibrocartilaginous entheses (i.e. insertion sites), even though there is no obvious change in insertional angle that directly results from joint movement. Such a change is more typical of tendons or ligaments that cross highly mobile joints. The complete ligament (including both entheses) was removed from 7 cadavers shortly after death and fixed in 90% methanol. Cryosections were immunolabelled with a panel of monoclonal antibodies against collagens (types I, II, III, VI), glycosaminoglycans (chondroitin 4 sulphate, chondroitin 6 sulphate, dermatan sulphate and keratan sulphates), proteoglycans (aggrecan and versican) and link protein. Both entheses were strongly fibrocartilaginous, and a moderately fibrocartilaginous matrix was also detected throughout the remainder of the ligament. The extracellular matrix of both entheses labelled strongly for type II collagen, aggrecan and link protein. The fibrocartilaginous character of the entheses suggests that the insertion sites of the ligament are subject to both compressive and tensile loading and are regions of stress concentration. This in turn probably reflects the complex shape of the scapula and the presence of a conspicuous indentation (the suprascapular notch) near the ligament. The loading patterns may reflect either the attachment of muscles and/or the forces transmitted to the suprascapular ligament from the neighbouring coracoclavicular ligament.
Adult↗
The neuropathology of heroin abuse.
A broad spectrum of neuropathologic changes are encountered in the brains of heroin abusers. The main findings are due to infections, either due to bacterial spread from bacterial endocarditis, mycoses, or from HIV-1 infection. Other complications include hypoxic-ischemic changes with cerebral edema, ischemic neuronal damage and neuronal loss, which are assumed to occur under conditions of prolonged heroin-induced respiratory depression, stroke due to, for example, thromboembolism, vasculitis, septic emboli, hypotension, and positional vascular compression. Myelopathy is believed to be the result of an isolated vascular accident within the spinal cord due to an as yet unknown mechanism. A distinct entity, spongiform leukoencephalopathy, has been described mainly after inhalation of pre-heated heroin. A lipophilic toxin-induced process was considered to be due to contaminants and to be induced or enhanced by cerebral hypoxia, but a definite toxin could not be identified. At the cellular level, abnormalities in signal transduction systems and changes of various receptor densities have been reported. The exact etiology of the different neuropathological alterations associated with heroin abuse is still unclear, but may also be related to additional substances used as adulterants.
Autopsy↗
Determination of time-dependent skin temperature decrease rates in the case of abrupt changes of environmental temperature.
The present study deals with the development of a method for determining time-dependent temperature decrease rates and its application to postmortem surface cooling. The study concentrates on evaluating skin cooling behavior since data on skin cooling in the forensic literature are scarce. Furthermore, all heat transfer mechanisms strongly depend on the temperature gradient between body surface and environment. One of the main problems in modelling postmortem cooling processes is the dependence on the environmental temperature. All models for postmortem rectal cooling essentially presuppose a constant environmental temperature. In medico-legal practice, the temperature of the surrounding of a corpse mostly varies; therefore, an approach for extending the models to variable environmental temperatures is desirable. It consists in 'localizing' them to infinitesimal small intervals of time. An extended model differential equation is obtained and solved explicitly. The approach developed is applied to the single-exponential Newtonian model of surface cooling producing the following differential equation:T(S)'(t)=-lambda(t)(T(S)(t)-T(E)(t))(with T(S)(t) the surface/skin temperature, T(E)(t) the environmental temperature, lambda(t) the temperature decrease rate and T(S)'(t) the actual change of skin temperature or first-order derivative of T(S)). The differential equation directly provides an estimator:lambda(t)=-T(S)'(t)T(S)(t)-T(E)(t)for the time-dependent temperature decrease rate. The estimator is applied to two skin cooling experiments with different types of abrupt changes of environmental temperature, peak-like and step-like; the values of the time-dependent temperature decrease rate function were calculated. By reinserting them, the measured surface temperature curve could be accurately reconstructed, indicating that the extended model is well suited for describing surface cooling in the case of abrupt changes of environmental temperature.
Autopsy↗
Histologically repeatedly confirmed gliosarcoma with long survival: review of the literature and report of a case.
OBJECTIVE AND IMPORTANCE: A rare case of gliosarcoma in a 61-year-old woman is presented with a stable situation over 22 years with an excellent quality of life. CLINICAL PRESENTATION: The patient was initially symptomatic and was operated on in 1975 for a deep-seated left parietal gliosarcoma. During the following 20 years, she was clinically asymptomatic until she complained of increasing headache in 1995. Neuroradiological imaging showed a sharply demarcated lesion on MRI at the former operative site, which was operated on again. Four months later, the residual tumour did grow again. INTERVENTION: As radiation therapy could not stop tumour progression and the neurological status worsened, the patient was operated on again for a massive tumour mass in the left parieto-occipital region, filling out nearly all of the previous resection cavity. Despite radio-immunotherapy, the patient finally died 22 years after the first discovery of the tumour. CONCLUSION: The present case shows that, in rare instances, gliosarcomas may show prolonged survival, although the underlying pathogenetic mechanisms for this clinical behaviour are not understood.
Brain Neoplasms↗
Lisch corneal dystrophy is genetically distinct from Meesmann corneal dystrophy and maps to xp22.3.
PURPOSE: There is an ongoing discussion whether Lisch corneal dystrophy (band-shaped and whorled microcystic dystrophy of the corneal epithelium) represents a disorder that is different from Meesmann corneal dystrophy. The purpose of this study was to evaluate at the molecular level if Lisch and Meesmann corneal dystrophies are genetically distinct. METHODS: We examined at the slit lamp a total of 48 members of a family with an aggregation of Lisch corneal dystrophy. Genomic DNA was extracted from leukocytes of the peripheral blood of seven affected and six unaffected members of this family. Mutational hotspots in the cornea-specific keratin genes K3 and K12 were scanned for mutations by single-strand conformation analysis. To test for linkage to the keratin K3 or K12 loci or for X-chromosomal inheritance, six (K3) and four (K12) microsatellite markers each flanking the keratin loci as well as 22 microsatellite markers covering the X-chromosome were typed. Linkage was analyzed using the MLINK and FASTMAP procedures. RESULTS: A total of 19 trait carriers were identified in six generations of the family. No hereditary transmission from father to son was observed. Linkage was excluded for the keratin K3 and K12 genes. Furthermore, single-strand conformation analysis detected no mutations in these genes. Multipoint linkage analysis revealed linkage with a maximum likelihood of the odds (LOD) score of 2.93 at Xp22.3. Linkage was excluded for Xp22.2 to Xqter. CONCLUSIONS: Lisch corneal dystrophy is genetically different from Meesmann corneal dystrophy. Evidence was found for linkage of the gene for Lisch corneal dystrophy to Xp22.3.
Adolescent↗