Biomedical subjects
Publications and source records attributed to C J Lang.
A 26-year old female who had received a cervical cadaveric dural graft 7 years earlier developed psychotic behavior and generalized myoclonic jerks. Following rapid deterioration and appearance of high-charge sharp periodic waves on electroencephalography she died within two months. We believe that this patient is the first German who acquired Creutzfeldt-Jakob disease by dural implant.
We used artificial augmentation of CO2 at a rate of 1 l/min after preoxygenation with 100% O2 to test for apnea in 34 patients with suspected brain death. Observation time was markedly reduced compared with conventional apneic oxygenation, allowing PaCO2 levels > or = 60 mm Hg to be reached within 2 minutes. Properly administered, CO2-supported apnea testing is quick, requires only simple technical equipment, and does not unduly lower PaO2 or pH. It seems to be a useful alternative in cases where reduction of ventilatory volume is not wanted.
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The recognition of handwriting is a specific achievement of the brain which need not be connected to understanding the written text itself. The goal of this study was to determine how this ability is impaired in patients with left- or right-sided lesions. Seventeen aphasic patients with lesions in the left hemisphere, 16 patients with lesions in the right hemisphere, and 15 normal controls (without CNS illness or damage) were investigated. They were asked to recognize the handwriting of a person well-known to them among a sample of ten different handwritten texts. The aphasic patients were able to recognize the handwriting of the familiar person either immediately or after some delay in 96%, the non-aphasic patients in only 44%, and the healthy controls in 100% of the cases. Results indicate that the recognition of handwriting represents a specific achievement which is independent of other verbal and lexical tasks. It is a task which involves the recognition of figural, geometric spatial patterns and, thus, an achievement of the non-dominant hemisphere.
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The differential diagnosis of Alzheimer's and so-called multi-infarct dementia is still a major problem in clinical dementia research. It was Binswanger who in 1894 pointed out that a subtype of vascular dementia exists which is characterized by subcortical arteriosclerotic encephalopathy. It is this type that can most easily be mistaken for Alzheimer's dementia, presented for the first time in 1906, which may be associated with congophilic angiopathy leading to brain infarction. Beyond clinical criteria, which in part are summarized in Hachinski's ischemic score, further advancement of brain imaging techniques, especially those yielding perfusion or metabolic data, has facilitated and substantiated clinical in vivo distinction.
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By means of continuous figure recognition (CFR) using visual pictorial, geometric and nonsense material demented patients could easily be distinguished from vascular controls without dementia and healthy subjects. In cases of infarction in the territory of the middle cerebral artery the hemisphere affected was only a minor determinant of overall scores. Within aphasics there was a tendency for the CFR results to reflect the severity of aphasia being most severely impaired in global aphasics. When aphasics and other cerebrally impaired patients, judged clinically to suffer from memory impairment, were considered as a group, CFR performance was lower than in those without apparent memory problems for the pictures only. It is concluded that CFR is a sensitive indicator of defective memory and/or gross brain lesions and that it is relatively independent of linguistic mediation.
The beneficial effect of elective transfusion on renal allograft survival must be weighed against the risks of sensitisation. We report a randomised controlled trial in which patients in end-stage renal failure who were non-parous and not previously transplanted or transfused, were entered in a transfusion protocol during which one group received no drugs (controls), one received azathioprine, and one received cyclosporin. Each group was given three identical transfusions of leucocyte-enriched fresh blood at 2-3 week intervals. The transfused blood was of known HLA type and donor/recipient pairs were completely mismatched. Sensitisation rates were assessed by T and B cell cross-matches between donor and recipients and by the screening of all sera against lymphocytes from 40 random donors. Fifty-one patients have completed the protocol, 20 in the control group, 12 in the azathioprine group, and 19 in the cyclosporin group. The sensitisation rate in the control group was 30%, occasionally of high titre, and persistent. In the azathioprine group, 25% developed anti-HLA antibodies and reactivity was of high titre and was broadly specific. Sensitisation in the cyclosporin group was 10%, was narrowly specific, reacting with only 10% of a panel, and was transient. There was no difference in graft survival between the groups. We conclude that cyclosporin therapy concurrent with third-party transfusion reduces the incidence, titre, and duration of sensitisation.
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The case of a patient is reported who suffered from disturbed concentration and memory and constructive apraxia. She had only mild neuropsychological deficits at the first examination. T2-weighted MRI presented extensive focal white matter changes. A brain biopsy showed changes typical for Alzheimer's disease (AD). The extent of the white matter lesions was surprising compared to the mild clinical signs she had. This case confirms that AD may result in prominent white matter disease caused by incomplete infarction or demyelination.