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Background The regular arrangement of collecting venules (RAC) and the Kimura-Takemoto classification of atrophic change (KTC) are simple and easy-to-use criteria which have been shown to reliably predict or rule out a Helicobacter pylori infection of the stomach. Although these features have been investigated extensively in Asia, their significance in the West has not been evaluated. Methods In a series of 200 consecutive gastroscopic examinations (single examiner, single center), the presence or absence of RAC and the KTC grade (open type vs closed type) were recorded prospectively. Helicobacter pylori infection was defined as a positive histology or a positive rapid urease test. Furthermore, multivariate analysis of endoscopic predictors of H. pylori infection based on the Kyoto classification of gastritis was performed. Results Two hundred patients were examined of which 57 had a H. pylori infection (28%). Both RAC and KTC had excellent negative predictive values of about 90% and sensitivity values of up to 85%. In multivariate analysis, atrophic change and diffuse redness without RAC were significantly associated with H. pylori infection. Conclusion Regular arrangement of collecting venules and KTC are simple endoscopic features which should be given attention by Western endoscopists and can be easily used to rule out a H. pylori infection of the stomach.

Standard first-line treatment of aggressive B cell lymphoma comprises six or eight cycles of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) plus eight doses of rituximab (R). Whether adding two doses of rituximab to six cycles of R-CHOP is of therapeutic benefit has not been systematically investigated. The Positron Emission Tomography-Guided Therapy of Aggressive Non-Hodgkin Lymphomas (PETAL) trial investigated the ability of [18F]-fluorodesoxyglucose PET scanning to guide treatment in aggressive non-Hodgkin lymphomas. Patients with B cell lymphomas and a negative interim scan received six cycles of R-CHOP with or without two extra doses of rituximab. For reasons related to trial design, only about a third underwent randomization between the two options. Combining randomized and non-randomized patients enabled subgroup analyses for diffuse large B cell lymphoma (DLBCL; n = 544), primary mediastinal B cell lymphoma (PMBCL; n = 37), and follicular lymphoma (FL) grade 3 (n = 35). With a median follow-up of 52 months, increasing the number of rituximab administrations failed to improve outcome. A non-significant trend for improved event-free survival was seen in DLBCL high-risk patients, as defined by the International Prognostic Index, while inferior survival was observed in female patients below the age of 60 years. Long-term outcome in PMBCL was excellent. Differences between FL grade 3a and FL grade 3b were not apparent. The results were confirmed in a Cox proportional hazard regression model and a propensity score matching analysis. In conclusion, adding two doses of rituximab to six cycles of R-CHOP did not improve outcome in patients with aggressive B cell lymphomas and a fast metabolic treatment response.

ZusammenfassungUmsetzung der Vorgaben des Nationalen Kompetenzbasierten Lernzielkatalogs Medizin (NKLM, 2015) für ein Curriculum Nuklearmedizin im Auftrag des Ausschusses Fort- und Weiterbildung der Deutschen Gesellschaft für Nuklearmedizin (DGN). Methoden 100 Lernziele (LZ) in 7 Domänen wurden in einem Delphi-Verfahren unter Einbeziehung aller habilitierten Mitglieder der DGN als Experten durch einen Fragebogen einer Priorisierung in 3 Kategorien (A, B und C) unterzogen. Kategorie A definierte für die jeden Arzt unerlässlichen LZ. Die Priorisierung erfolgte durch Rangbildung nach dem Anteil der A-Klassifikationen. Eine LZ-Liste mit den Rangplätzen 1 – 5 in jeder Domäne wurde in der 2. Stufe des Delphi-Verfahrens den Experten der ersten Runde als Kern-Curriculum mit der Frage nach Akzeptanz bzw. Modifikationen vorgelegt. Ergebnisse Die Ergebnisse der 1. Stufe des Delphi-Verfahrens zeigte einen Rücklauf der Fragebögen von 29 % (55 von 184). Die 2. Runde erbrachte einen Rücklauf von 30,9 % (57 von 184) und eine uneingeschränkte Akzeptanz der vorgeschlagenen LZ in allen LZ-Domänen bei im Median 72 % der befragten Experten (61 %–81 %). Die vorliegende Endfassung enthält 37 kompetenzbasierte LZ in den LZ-Domänen „Gesetzliche Grundlagen und Strahlenschutz“, „naturwissenschaftliche Grundlagen“, Indikationen und Kontraindikationen zu „PET/CT“, „Szintigraphie und SPECT“, „Patientenvorbereitung“, „Befundanalyse und -interpretation“ sowie „Therapie“. Ausblick Der kompetenzbasierte LZ-Katalog Nuklearmedizin beschreibt die Kenntnisse und Kompetenzen, über die jeder Arzt am Ende seines Studiums verfügen sollte. Der LZ-Katalog ist ein lebendes Dokument, das fortlaufend an den Fortschritt der medizinischen und technologischen Entwicklung angepasst werden muss.

Summary It was of interest to determine the impact of FDG-PET/CT on general therapy management and radiotherapy (RT) planning in patients with stage IV head and neck tumours. The study was conducted prospectively between March 2006 and March 2007 in 35 patients with histologically confirmed, locally advanced squamous cell carcinomas of the head and neck. Prior to primary radiochemotherapy, whole-body and head/neck FDG-PET/CT was performed. The FDG-PET information was integrated into RT planning. By comparison with anatomical imaging, the FDG-PET/CT yielded the following additional information: distant metastases in 17.1% (6/35), second primary tumours in 11.4% (4/35), and changes in nodal status based on metabolic activity, i.e. upstaging in 34.3% (12/35) or downstaging in 22.9% (8/35). As a result, treatment strategy was changed from curative to palliative in six patients, and additional curative therapy was implemented following exclusion of distant metastases in two patients with a simultaneous local second primary tumour. The discordant nodal status found with head/neck FDG-PET/CT compared with anatomical imaging led to modification of radiotherapy volume and dose in 20 patients (57.1%). From the radiotherapist’s perspective FDG-PET/CT is therefore useful and justifiable in the management of stage IV head and neck tumours.

Therapeutic options to cure advanced, recurrent, and unresectable thymomas are limited. The most important factor for long-term survival of thymoma patients is complete resection (R0) of the tumor. We therefore evaluated the response to and the induction of resectability of primarily or locally recurrent unresectable thymomas and thymic carcinomas by octreotide Long-Acting Release (LAR) plus prednisone therapy in patients with positive octreotide scans. In this open label, single-arm phase II study, 17 patients with thymomas considered unresectable or locally recurrent thymoma (n = 15) and thymic carcinoma (n = 2) at Masaoka stage III were enrolled. Octreotide LAR (30 mg once every 2 weeks) was administered in combination with prednisone (0.6 mg/kg per day) for a maximum of 24 weeks (study design according to Fleming´s one sample multiple testing procedure for phase II clinical trials). Tumor size was evaluated by volumetric CT measurements, and a decrease in tumor volume of at least 20% at week 12 compared to baseline was considered as a response. We found that octreotide LAR plus prednisone elicited response in 15 of 17 patients (88%). Median reduction of tumor volume after 12 weeks of treatment was 51% (range 20%-86%). Subsequently, complete surgical resection was achieved in five (29%) and four patients (23%) after 12 and 24 weeks, respectively. Octreotide LAR plus prednisone treatment was discontinued in two patients before week 12 due to unsatisfactory therapeutic effects or adverse events. The most frequent adverse events were gastrointestinal (71%), infectious (65%), and hematological (41%) complications. In conclusion, octreotide LAR plus prednisone is efficacious in patients with primary or recurrent unresectable thymoma with respect to tumor regression. Octreotide LAR plus prednisone was well tolerated and adverse events were in line with the known safety profile of both agents. peerReviewed

Untersuchung folgender Fragen: Welche Faktoren beeinflussten die Haufigkeit hamatogener Fernmetastasen bei Patienten mit lokal fortgeschrittenen Kopf-Hals-Tumoren (HNO-Tumoren), wie war die topographische Verteilung der Fernmetastasen, und welche Konsequenzen resultierten daraus fur die pratherapeutische Diagnostik? Retrospektiv wurden 600 Patienten (524 Manner, 76 Frauen, medianes Alter 56 Jahre, Behandlungszeitraum 03/1993–07/2005, Stichtag 01.12.2005, mediane Nachbeobachtungsdauer 25,7 Monate) mit HNO-Tumoren (Plattenepithelkarzinome) untersucht. Die Verteilung der Primartumoren und Stadien stellte sich folgendermasen dar: Oropharynx: n = 161 (26,8%), Hypopharynx: n = 187 (31,2%), Mundhohle: n = 89 (14,8%), Larynx: n = 118 (19,7%), Lymphknoten bei unbekanntem Primartumor: n = 13 (2,2%), sonstige: n = 32 (5,3%). Stadium I: n = 24 (4%), II: n = 49 (8,2%), III: n = 89 (14,8%), IV: n = 438 (73%). 270 Patienten (45%) wurden primar radiochemotherapiert, 330 (55%) operiert und nachbestrahlt. Fur die Analyse der Haufigkeitsverteilung von Fernmetastasen wurden folgende Merkmale untersucht: Primartumorlokalisation, Stadium (AJCC), Tund N-Kategorie, Primartherapie, lokale Tumorkontrolle nach abgeschlossener Primartherapie sowie ein bekannter Zweittumor. 114/600 Patienten (19%) manifestierten Fernmetastasen, 29/600 (4,9%) zum Zeitpunkt der Primartherapie, 50% innerhalb von 9,3 Monaten nach Erstdiagnose. Metastasen waren am haufigsten im Stadium IV (24,2%), bei Hypopharynxkarzinom (25,7%), bekanntem Lokalrezidiv (24,3%) bzw. Zweittumor (31,7%) mit folgender Verteilung: pulmonal 61/114 (53,5%), pleural 15/114 (13,1%), davon 8/114 pleuropulmonal, ossar 45/114 (39,5%), hepatisch 14/114 (12,3%), zerebral 8/114 (7%), kutan 14/114 (12,3%). Bei 34/114 Patienten (29,8%) lag eine monotope, bei 80/114 (70,2%) eine polytope Metastasierung vor. 82 Patienten hatten Zweittumoren, davon 20 synchrone oder metachrone Bronchialkarzinome. Bei lokal fortgeschrittenem HNO-Tumor im Stadium IVa/b, Hypopharynxkarzinom, bekanntem Lokalrezidiv bzw. Zweittumor sollte pratherapeutisch zumindest eine CT des Thorax erfolgen, da jeder siebte Patient (88/600) im Verlauf seiner Erkrankung ein primares oder sekundares Malignom im Thoraxraum manifestierte. In Anbetracht der Nebenwirkungen und Kosten kurativer Therapien bei lokal fortgeschrittenen HNO-Tumoren ware die Definition allgemein akzeptierter Richtlinien zum Ausschluss von Fernmetastasen sinnvoll.

We report the clinical, structural, functional and genetic characterization of a 37-year-old Caucasian female, presenting as a sporadic case of complicated spastic paraplegia with thin corpus callosum (CC), cognitive impairment, amyotrophy of the hand muscles and a sensorimotor neuropathy and review the literature for spastic paraplegia with thin CC. Magnetic resonance imaging (MRI) examination revealed a thin CC with fronto-parietal cortical atrophy. 18Fluordesoxyglucose positron emission tomography (FDG–PET) showed reduced cortical and thalamic metabolism. By transcranial magnetic stimulation, we delineated a severe impairment of transcallosal inhibition. Sequence analysis did not reveal disease causing mutations in the genes SLC12A6 (Andermann), Spastin (SPG 4), BSCL2 (SPG 17) and Spartin (SPG 20). We reviewed the literature for HSP with thin CC and found 113 HSP patients with thin CC previously described (35 with linkage to chromosome 15q13–15). Thin CC and peripheral neuropathy often appear together in spastic paraplegia and might be indicative for combined degeneration mechanism of central and peripheral axons.

In the diagnosis of coronary artery disease (CAD) with Dobutamine Stress Echocardiography (DSE), regional wall motion abnormalities (RWMA) are assumed to indicate a perfusion deficit.For a more particular examination of RWMAs, we compared simultaneous echo-contrast (Optisone)-enhanced DSE (0-40 microg/kg Dobutamine, 16-segment- model) and MiBi-SPECT in a prospective double-blinded study design in 69 non-selected consecutive patients (44 male, 25 female, age 64+/-12 years). Additionally, all patients were examined by coronary-angiography. The prevalence of significant CAD (stenosis50% lumen diameter) was 52%. DSE had a sensitivity of 78% and a specificity of 66% for the detection of significant CAD with a positive and negative predictive value of 72 and 73%, respectively. Among 28 patients with significant CAD and positive DSE study (true positive), 78% displayed a corresponding perfusion deficit in MiBi-SPECT. Among 11 patients with a positive DSE study but no current significant coronary stenosis (false positive), 82% showed stress-induced RWMAs in the inferior/posterior region, 73% displayed left ventricular hypertrophy, 54% resting-ECG abnormalities and 45% resting-RWMA (3 previous MI, 2 previous CABG surgery). Among 8 patients with negative DSE study but significant coronary stenosis (false negative), 75% had a stenosis of the LCX, 63% displayed resting- WMA, 63% displayed left bundle branch block or ST-segment depression, 50% displayed only peripheral coronary stenosis, and DSE visualization was suboptimal in 38%.This prospective study in non-selected patients shows that the majority of RWMAs in DSE are matched to a perfusion deficit detectable by nuclear imaging. Nevertheless, pre-existing cardiac abnormalities may also lead to stress-induced RWMA not associated with a perfusion deficit or mask a perfusion deficit upon DSE. Particularly in patients with LV hypertrophy, resting-RWMA, bundle branch block or ST segment depression, the predictive value of DSE may, therefore, be limited.

Histologisch entspricht die Sekundarkatarakt („posterior capsule opacification“ [PCO]) regenerativem Gewebe aus transformierten Linsenepithelzellen („lens epithelial cells“ [LEC]) und Extrazellularmatrix. In dieser Studie wurde der Einfluss ionisierender Strahlen auf proliferierende LEC in vitro untersucht. Jeweils vier bzw. 14 Linsen aus Schweinebulbi wurden mit Elektronen der Energie 6 MeV mit je 8, 10, 12 und 20 Gy bestrahlt. 1–2 h nach Radiatio wurde der Linsenkern durch Kapsulorrhexis und Hydrodissektion aus der Linsenkapsel extrahiert. Nach Fixation der Linsenkapsel in einer speziellen Halterung wurde taglich die Proliferation residueller LEC bei zwolffacher Vergroserung untersucht und photographisch dokumentiert. Der Versuch galt als beendet, wenn die Linsenkapsel durch konfluierende Zellproliferate vollstandig getrubt war. Eine Radiatio mit Elektronen verzogert signifikant die Entwicklung einer PCO im Dosisbereich von 8–12 Gy in vitro. Ab 20 Gy induziert sie eine vollstandige Inhibition der PCO. Zur Inhibition einer PCO in vitro ist eine Einzeldosis von mindestens 20 Gy erforderlich. Das hier angewandte Modell erlaubt eine optimale Untersuchung der PCO-Genese unter verschiedenen auseren Einflussen und eignet sich gut fur radiobiologische Fragestellungen.

BACKGROUND Doxorubicin exhibits high efficacy in malignant glioma cell cultures. Nonetheless, as a standard formulation, doxorubicin has not been used clinically, due to poor penetration of the blood-brain barrier. Furthermore, doxorubicin is known to induce tumor resistance genes. To address both of these issues, the authors investigated the use of pegylated liposomal doxorubicin (Caelyx™; Essex Pharma, Munich, Germany) alone (Trial 1) and in combination with tamoxifen (Trial 2) in two sequentially performed nonrandomized prospective Phase II trials involving patients with recurrent high-grade glioma. METHODS Twenty patients were included in each trial. Progression-free survival at 6 months (PFS-6) and toxicity were the primary endpoints. Expression of the tumor resistance proteins multidrug resistance protein 1 (MDR-1) and multiple resistance protein (MRP) was evaluated by immunohistochemical methods and by sestamibi–single-photon emission computed tomography (SPECT). RESULTS The overall response rate (including cases of disease stabilization) was 40% in both Trial 1 and Trial 2. PFS-6 was 15%, and the median time to disease progression was 17 weeks. It is noteworthy that 40% of patients with Grade III tumors had long-term responses, which lasted for up to 3 years. There was no significant difference between Trial 1 and Trial 2 in terms of efficacy. Both regimens were well tolerated, with the main side effect being palmoplantar erythrodysesthesia. The authors found no correlation between clinical response and expression of tumor resistance genes or between clinical response and SPECT data. CONCLUSIONS Pegylated liposomal doxorubicin administered alone or in combination with tamoxifen is safe and moderately effective in patients with recurrent high-grade glioma. None of the putative predictors for response that were evaluated proved to be significant in this setting. Cancer 2004. © 2004 American Cancer Society.

OBJECTIVE To report a case of acute central nervous system (CNS) toxicity with multiple hemorrhages restricted to the corpus callosum associated with combination therapy of cisplatin, ifosfamide, and etoposide. CASE SUMMARY A 38-year-old white man with a testicular germ cell tumor received a cisplatin-based chemotherapy consisting of cisplatin 45 mg (20 mg/m 2 ), etoposide 570 mg (250 mg/m 2 ), and ifosfamide 4600 mg (2000 mg/m 2 ) given on 5 consecutive days during each course. After the first course of chemotherapy, the patient appeared to be neuropsychologically impaired with episodes of decreased alertness and features of a depressive syndrome. He became severely diminished in mental function, orientation, and psychomotor activity after a second course of treatment. In addition, he showed transient urinary incontinence. Motor and sensory deficits could not be detected. Magnetic resonance imaging demonstrated multiple hemorrhages restricted to the corpus callosum. An objective causality assessment revealed that an adverse drug reaction was probable. DISCUSSION Neurotoxicity has been associated with the administration of various antineoplastic agents. In particular, cisplatin and ifosfamide can cause both acute and delayed CNS toxicity. While ifosfamide neurotoxicity has been predominantly associated with neuropsychological impairment without evidence of structural abnormalities in neuroimaging studies, cisplatin has been shown to cause cerebrovascular complications. Various pathophysiologic conditions may contribute to these complications including thrombosis secondary to vascular endothelial injury or thromboembolic events. To our knowledge, as of December 2, 2003, vascular lesions restricted to the corpus callosum have not been reported as a complication of cisplatin- or ifosfamide-based chemotherapy. CONCLUSIONS Clinicians should be aware of the potential neurovascular adverse effects of cisplatin-based protocols. This is especially true in patients with subtle neurologic or neuropsychological symptoms. Chemotherapy-induced neurotoxicity should be considered in the differential diagnosis.

Purpose Heat shock protein 70 (Hsp70) was detected on the cell membrane of human tumor cell lines, but not on normal cells. Here we studied Hsp70 membrane expression as a target for natural killer (NK) cells on tumor material and control tissues of head-and-neck cancer patients. Methods and materials Membrane-bound Hsp70 was determined by flow cytometry on single-cell suspensions of tumors and the corresponding normal tissues of head-and-neck cancer patients. The cytolytic activity of NK cells against Hsp70-positive tumor cells was measured in a standard cytotoxicity assay. Results In total, 54 of 74 primary tumors were found to be Hsp70 membrane-positive (73%); tongue/mouth, 21 of 24 (88%); oropharynx, 13 of 20 (65%); hypopharynx, 3 of 6 (50%); larynx, 8 of 11 (73%); trachea 1 of 2 (50%); esophagus, 4 of 5 (80%); lymph node metastases, 4 of 6 (67%). The corresponding control tissue was negative for membrane-bound Hsp70. Biopsies (6 of 6) of patients after in vivo γ-irradiation (fractionated 5 × 2 Gy) were strongly Hsp70 membrane-positive. Irradiated, Hsp70-positive tumor cells are targets for Hsp70-peptide stimulated NK cells. Conclusion An irradiation-inducible, tumor-selective Hsp70 membrane localization provides a target structure for Hsp70-peptide stimulated human NK cells.

As a result of increased interest and public demand, providing patients with adequate information about radiooncology has become more and more difficult for the doctor. Insufficient patient information can not only cause anxiety for the patient, but can also lead to legal action against the physician. In order to gain a deepter insight into our clinical practice of providing patient information, we developed a special questionnaire. We describe our first experiences in using this questionnaire at our institute. Patients and Methods: We examined the amount of information and level of satisfaction, as well as the agreement of assessment between patient and physician after the provision of standard patient information before and at the end of radiotherapy. 51 consecutive patients were interviewed with a newly designed questionnaire. The first questioning with 13 items was carried out before radiotherapy and the second with ten items was done at the end of treatment. Sum scores for information and satisfaction were defined and agreement was measured by the weighted κ coefficient. Results: Global level of information and satisfaction was good, and a significant increase in information level and a significant decline in satisfaction were seen between questionnaire 1 and 2. Agreement between patient and physician was fair, for example intent of treatment resulted in a κ coefficient of 0.34, and poor for the doctor's role with a κ coefficient of −0.002. Only 52% of the patients who received palliative radiotherapy rated correctly the non-curative intent of treatment, whereas 86% of the patients who received curative radiotherapy made a currect statement. Before radiotherapy, emotional state was often both negatively and positively assessed by the patients. Conclusion: Our short questionnaire is simple and easy to understand. It provides insights into patient information with respect to assessment of the information, satisfaction level, and agreement between doctor and patient. Therefore, it is suitable for use in the clinical routine. We found a high information and satisfaction score, but limited agreement between physician and patient. In the future, the questionnaire can be used as an aid to evaluate patient information in everyday practice and to train the communication skills of the physician. Further evaluation of the questionnaire is needed and, in particular, the aspect of patient information with palliative radiotherapy has to be improved.

OBJECTIVE To describe differences in cerebral glucose metabolism between frontotemporal lobar degeneration (FTLD) and Alzheimer's disease (AD). METHODS 14 patients with FTLD (7 f/7 m, mean age 60.1 years) and 14 patients with AD (7 f/7 m, mean age 59.5 years) were examined. [18F]FDG positron emission tomography (PET) scans were analysed with statistical nonparametric mapping (SnPM) and statistical parametric mapping (SPM99). RESULTS Significant decreases in glucose metabolism in FTLD compared to AD were detected in the left insula/left inferior frontal gyrus (Brodman area [BA]13, 45 and 47) and in the medial frontal gyrus bilaterally (BA10). A significant decrease in AD compared to FTLD was identified in the right middle temporal gyrus (BA39). CONCLUSION Cerebral PET could be a promising tool to discriminate FTLD from AD.

Objective Clinical, neurophysiological and neuroimaging data suggest that chronic tinnitus resembles neuropsychiatric syndromes characterised by focal brain activation. Low frequency repetitive transcranial magnetic stimulation (rTMS) has been proposed as an efficient method in treating brain hyperexcitability disorders. Methods Patients suffering from chronic tinnitus underwent a [ (18)F]deoxyglucose-PET (positron emission tomography). Fusioning of the individual PET scan with the structural MRI-scan (magnetic resonance imaging, T1, MPRAGE) revealed an increased metabolic activation in the primary auditory cortex as target point for rTMS. A neuronavigational system enabled the positioning of the figure of eight coil in relation to the target area. rTMS (110 % motor threshold; 1 Hz; 2000 stimuli/day over 5 days) was performed using a placebo controlled cross-over design. Results Following active rTMS there was a moderate improvement of tinnitus perception. Treatment effects lasted up to six months in some patients. Conclusions Neuronavigated rTMS offers new possibilities in the understanding and treatment of chronic tinnitus.

Idiopathic hypertrophic chronic pachymeningitis (IHCP) is characterised by inflammatory fibrotic thickening of the dura mater. Long term management is controversial. A 28 year old man with craniospinal IHCP and prominent lymphocytic meningitis is reported. Cerebrospinal fluid and histological examination suggested a CD4+ T cell driven process and B cell stimulation. After surgical, tuberculostatic, and immunosuppressive treatment failed to control the progressive meningeal hypertrophy, causing severe headache and neurological disability, the disease process eventually abated with intraventricular cytarabine treatment.

Background Patients with encephalitis associated with antibodies against N-methyl-D-aspartate-receptor antibody (NMDAR-ab) encephalitis frequently show psychotic symptoms, amnesia, seizures and movement disorders. While brain MRI in NMDAR-ab encephalitis is often normal, abnormalities of cerebral glucose metabolism have been demonstrated by positron emission tomography (PET) with 18F-fluorodeoxyglucose(FDG) in a few usually isolated case reports. However, a common pattern of FDG-PET abnormalities has not been reported. Methods The authors retrospectively identified six patients with NMDAR-ab encephalitis in two large German centres who underwent at least one whole-body FDG-PET for tumour screening between January 2007 and July 2010. They analysed the pattern of cerebral uptake derived from whole-body PET data for characteristic changes of glucose metabolism compared with controls, and the changes of this pattern during the course of the disease. Results Groupwise analysis revealed that patients with NMDAR-ab encephalitis showed relative frontal and temporal glucose hypermetabolism associated with occipital hypometabolism. Cross-sectional analysis of the group demonstrated that the extent of these changes is positively associated with clinical disease severity. Longitudinal analysis of two cases showed normalisation of the pattern of cerebral glucose metabolism with recovery. Conclusions A characteristic change in cerebral glucose metabolism during NMDAR-ab encephalitis is an increased frontotemporal-to-occipital gradient. This pattern correlates with disease severity. Similar changes have been observed in psychosis induced by NMDAR antagonists. Thus, this pattern might be a consequence of impaired NMDAR function.

On the assumption that maximum R peak time prolongation in the left-sided leads I, V5, or V6 and its time relationship to the S peak time of the maximum S amplitude in leads V1, V2, or V3 (representing dorsally directed forces of ventricular depolarization) could indicate the extent of left ventricular volume overloading and possibly left ventricular systolic function, these variables and the preoperative findings of angiocardiography were compared between patients with chronic mitral incompetence who, late after corrective valve surgery, had either well-preserved radionuclide left ventricular ejection fraction (group 1, n = 36) or radionuclide left ventricular ejection fraction below 50% (group 2, n = 30). Before surgery, group 2 patients had a highly significant lower mean left ventricular ejection fraction, a highly significant greater mean end-systolic volume index, a significantly greater mean end-diastolic volume index, a significantly greater mean maximum R peak time in leads I, V5, or V6, and a significantly greater prolongation of the maximum R peak time above the S peak time in the right precordial leads, as compared with group 1. R peak times greater than 50 ms or the presence of R peak delay (maximum R peak time greater than the S peak time of the maximum right precordial S amplitude) yields less sensitive but highly reliable results in predicting radionuclide left ventricular ejection fraction below 50% with both specificity and positive predictive values of 100%. Thus, in chronic mitral regurgitation surgery should not be delayed if patients present these signs because they are specific markers of irreversibly impaired chamber function.

Chairpersons of medical conferences usually allow a central place in the program for poster exhibitions. Moderated poster presentations often take place during lunch breaks on the main conference days. These presentations compete only with the satellite symposia organized by the pharmaceutical industry. In contrast to the prominent positioning of poster exhibitions in conference programs, conference delegates’ interest in and attendance at poster presentations at national (and sometimes international) specialist medical conferences is occasionally rather modest. Who benefits from poster exhibitions? To whom are they useful? How might they be made more attractive? Should they even be organized at all? There are some studies relating to partial aspects of poster exhibitions at non-German specialist conferences, e.g., about the process of abstract selection for diverse conferences (1–11), electronic posters (12, 13), and the publication rate of conference contributions (14–20). Further studies have shed light on the motivation of authors to design a poster (21), redundant poster contributions (22, 23), or the time spent by conference delegates in studying a poster (24). This study aims to present systematically and prospectively the poster exhibition of a German specialist medical conference as a platform for presenting current research findings in terms of its acceptance and perceived value. The selection process for contributions and the poster awards, the scientific and personal benefits of the poster exhibition for its authors, chairpersons, and visitors were studied systematically. The number of participants at the individual poster presentations was documented and compared with the number of poster contributions on offer.

Cardiovascular morbidity and mortality is high in patients following renal transplantation. The present analysis assessed major cardiovascular risk factors and estimated the risk of coronary artery disease in the largest present-day comparative trial of tacrolimus vs. microemulsified cyclosporine A. In this 6-month study, 557 patients were randomly allocated to therapy with tacrolimus (n = 286) or cyclosporine A (n = 271) concomitantly with azathioprine and corticosteroids. The primary endpoint was the incidence of and time to acute rejection. Blood pressure, serum cholesterol, HDL cholesterol, triglycerides, and blood glucose were measured at baseline, and at months 1, 3, and 6. Ten-year risk of coronary heart disease was estimated according to the Framingham risk algorithm. Tacrolimus resulted in significantly lower summary measures (time-weighted average) of serum cholesterol (p = 0.0004) and mean arterial blood pressure (p = 0.0156), but in a higher summary measure of blood glucose (p = 0.0028) than cyclosporine. The summary measure of serum triglycerides was not different between treatment groups (p = 0.368). The mean 10-year coronary artery disease risk estimate was significantly lowered in men (p = 0.0032) treated with tacrolimus, but was unchanged in women. Tacrolimus and cyclosporine A microemulsion exert a compound-specific impact on cardiovascular risk factors and appear to affect the predicted rate of cardiovascular morbidity in different manners.

To investigate new methods of diagnostic transcranial sonography for brain parenchymal, vascular and perfusion imaging, we performed 3-D native tissue harmonic transcranial sonography (3D-nthTCS), 3-D transcranial color-coded duplex sonography (3D-TCCS), and "loss-of-correlation" imaging (LOC-TCCS) in four patients following early hemicraniectomy due to space-occupying "malignant" middle cerebral artery infarction (MMCAI). Three-dimensional datasets, utilizing 3D-nthTCS and 3D-TCCS, were created and up to 10 axial 2-D B-mode image planes, similar to CCT, reconstructed in each patient. Three-dimensional reconstructions of the circle of Willis documented one persistent carotid-T occlusion and three recanalizations of the MCA. LOC-TCCS, based on stimulated acoustic emission from an ultrasound (US) contrast agent, demonstrated a perfusion deficit in 2 of 3 patients, with regard to their infarcts. Concluding, 3D-nthTCS, 3D-TCCS and LOC-TCCS are promising tools for bedside monitoring, early prognosis and treatment evaluation for MMCAI in the postoperative period. Further studies should be performed to standardize these new methods and evaluate their applications through the intact calvarina.