Krankenhaus Lübbecke-Rahden, Universitätsklinik für Psychiatrie und Psychotherapie

OBJECTIVES: The intestinal flora of breast-fed infants is generally dominated by Bifidobacteria. We aimed to investigate whether an infant formula supplemented with galacto-oligosaccharides and fructo-oligosaccharides (GOS/FOS) is able to establish a bifido-dominant microflora, not only in numbers but also with respect to the metabolic activity in the colon. METHODS: Two groups of infants fed infant formula with 0.8 g/100 ml GOS/FOS in a ratio of 9:1 (OSF group), or control formula (SF group) were evaluated in a randomised, double blind, placebo controlled intervention study. A breast-fed group was studied in parallel. At study onset and after 4 and 6 weeks, faecal samples were examined for the number of bifidobacteria, pH, short chain fatty acids and lactate. RESULTS: After 6 weeks, the mean proportion of bifidobacteria was significantly higher in the OSF group (59.6% versus 49.5% in the SF group; P < 0.05). Compared with controls, infants in the OSF group had a lower stool mean pH and an increased proportion of acetate and a decreased proportion of propionate. The mean pH in the OSF and SF groups were 5.7 and 6.3, respectively (P < 0.001). CONCLUSIONS: The addition of the prebiotic GOS/FOS mixture to an infant formula has a stimulating effect on the growth of bifidobacteria and on the metabolic activity of the total intestinal flora. The changes in short chain fatty acids, lactate and pH in the prebiotic group represent a fermentation profile that is closer to that observed in breast-fed infants compared to infants fed control formula.

So far, sigma-ligands have been investigated for several indications in human studies in functional diarrhea as a model of somatoform disorder (igmesine), depression (igmesine, opipramol), anxiety (opipramol and--in animal models--siramisine), schizophrenia (panamasine, SL 82.0715, rimcazole, DuP 734, BMY 14 802), and somatoform disorders (opipramol). Results for schizophrenia failed to be clear cut and so investigations have apparently stopped for the time being. The Sigma-1-selective igmesine (200 mg) showed good results in a phase-1-model of functional diarrhea and some promising results in depressed patients. However, further development has been stopped due to marketing reasons, which is also true for siramasine, a selective sigma-2-ligand with anxiolytic properties. Opipramol, which, apart from a sigma-1- and 2-receptor liability, also possesses histamine-H(1)-antagonistic properties in connection with lower affinities for D(2) and 5-HT(2A) showed broad efficacy in generalized anxiety disorder and somatoform disorders. The receptor profile of opipramol and the results of studies of the selective sigma site ligands siramisine and igmesine suggest that opipramol acts pharmacologically and clinically via sigma receptors.

Extended microbiological studies were performed on 49 patients with acute or chronic epididymitis, including bacteriology of epididymal specimens in cases of scrotal surgery. In no patient had instrumentation or catheterization resulted in epididymitis. The microbiological data showed a prevalence of Chlamydia trachomatis epididymal infections in men less than 40 years old, whereas common urinary tract pathogens prevailed in older patients. Cultures of urethral swabs and midstream urine provided reliable information on the type of microorganism that caused epididymitis. Ofloxacin, an antibiotic of the new quinolone group, was proved to be highly effective in the treatment of acute and chronic bacterial as well as chlamydial epididymitis.

BACKGROUND: Schizophrenia is the collective term for an exclusively clinically diagnosed, heterogeneous group of mental disorders with still obscure biological roots. Based on the assumption that valuable information about relevant genetic and environmental disease mechanisms can be obtained by association studies on patient cohorts of ≥ 1000 patients, if performed on detailed clinical datasets and quantifiable biological readouts, we generated a new schizophrenia data base, the GRAS (Göttingen Research Association for Schizophrenia) data collection. GRAS is the necessary ground to study genetic causes of the schizophrenic phenotype in a 'phenotype-based genetic association study' (PGAS). This approach is different from and complementary to the genome-wide association studies (GWAS) on schizophrenia. METHODS: For this purpose, 1085 patients were recruited between 2005 and 2010 by an invariable team of traveling investigators in a cross-sectional field study that comprised 23 German psychiatric hospitals. Additionally, chart records and discharge letters of all patients were collected. RESULTS: The corresponding dataset extracted and presented in form of an overview here, comprises biographic information, disease history, medication including side effects, and results of comprehensive cross-sectional psychopathological, neuropsychological, and neurological examinations. With >3000 data points per schizophrenic subject, this data base of living patients, who are also accessible for follow-up studies, provides a wide-ranging and standardized phenotype characterization of as yet unprecedented detail. CONCLUSIONS: The GRAS data base will serve as prerequisite for PGAS, a novel approach to better understanding 'the schizophrenias' through exploring the contribution of genetic variation to the schizophrenic phenotypes.

BACKGROUND: Borderline personality disorder (BPD) is a severe and highly prevalent mental disorder. Schema therapy (ST) has been found effective in the treatment of BPD and is commonly delivered through an individual format. A group format (group schema therapy, GST) has also been developed. GST has been found to speed up and amplify the treatment effects found for individual ST. Delivery in a group format may lead to improved cost-effectiveness. An important question is how GST compares to treatment as usual (TAU) and what format for delivery of schema therapy (format A; intensive group therapy only, or format B; a combination of group and individual therapy) produces the best outcomes. METHODS/DESIGN: An international, multicentre randomized controlled trial (RCT) will be conducted with a minimum of fourteen participating centres. Each centre will recruit multiple cohorts of at least sixteen patients. GST formats as well as the orders in which they are delivered to successive cohorts will be balanced. Within countries that contribute an uneven number of sites, the orders of GST formats will be balanced within a difference of one. The RCT is designed to include a minimum of 448 patients with BPD. The primary clinical outcome measure will be BPD severity. Secondary clinical outcome measures will include measures of BPD and general psychiatric symptoms, schemas and schema modes, social functioning and quality of life. Furthermore, an economic evaluation that consists of cost-effectiveness and cost-utility analyses will be performed using a societal perspective. Lastly, additional investigations will be carried out that include an assessment of the integrity of GST, a qualitative study on patients' and therapists' experiences with GST, and studies on variables that might influence the effectiveness of GST. DISCUSSION: This trial will compare GST to TAU for patients with BPD as well as two different formats for the delivery of GST. By combining an evaluation of clinical effectiveness, an economic evaluation and additional investigations, it will contribute to an evidence-based understanding of which treatment should be offered to patients with BPD from clinical, economic, and stakeholders' perspectives. TRIAL REGISTRATION: Netherlands Trial Register NTR2392. Registered 25 June 2010.

There is a general agreement that blood alcohol concentrations (BACs) of about 0.05% result in impairment of the ability to drive. This fact has been supported by means of experiments. In addition, there are only a few studies to date investigating low BACs. The present study aims to investigate the extent and quality of cognitive changes in low BACs of around 0.03%. Sixteen healthy male subjects were examined in a double-blind, placebo-controlled study. During the trials the BAC was regulated to about 0.03%. As part of the study a record was made of the general level of intelligence, subjective impairments, possible depressive symptoms, general ability to perform, vigilance, divided attention, response times and performance of memory. Statistical analysis took place using the two-period crossover design. Verbal intelligence, general performance, vigilance (optical stimuli), divided attention, vigilance towards acoustic stimuli and the general response time to acoustic and visual-acoustic sequential stimuli, and memory were not impaired significantly by a BAC of around 0.03%. The total response and motor response time to optical stimuli as well as decision time about sequential optical stimuli were, however, significantly changed for BACs of around 0.03%. In conclusion, the present results show that already in BACs of around 0.03%, particular cognitive functions which rely on perception and processing of visual information, are significantly impaired. This was evident in the more complex and urgent tasks.

ABSTRACT Objectives: The intestinal flora of breast‐fed infants is generally dominated by Bifidobacteria. We aimed to investigate whether an infant formula supplemented with galacto‐oligosaccharides and fructo‐oligosaccharides (GOS/FOS) is able to establish a bifido‐dominant microflora, not only in numbers but also with respect to the metabolic activity in the colon. Methods: Two groups of infants fed infant formula with 0.8 g/100 ml GOS/FOS in a ratio of 9:1 (OSF group), or control formula (SF group) were evaluated in a randomised, double blind, placebo controlled intervention study. A breast‐fed group was studied in parallel. At study onset and after 4 and 6 weeks, faecal samples were examined for the number of bifidobacteria, pH, short chain fatty acids and lactate. Results: After 6 weeks, the mean proportion of bifidobacteria was significantly higher in the OSF group (59.6% versus 49.5% in the SF group; P &lt; 0.05). Compared with controls, infants in the OSF group had a lower stool mean pH and an increased proportion of acetate and a decreased proportion of propionate. The mean pH in the OSF and SF groups were 5.7 and 6.3, respectively ( P &lt; 0.001). Conclusions: The addition of the prebiotic GOS/FOS mixture to an infant formula has a stimulating effect on the growth of bifidobacteria and on the metabolic activity of the total intestinal flora. The changes in short chain fatty acids, lactate and pH in the prebiotic group represent a fermentation profile that is closer to that observed in breast‐fed infants compared to infants fed control formula.

Autoimmune encephalitis (AE) can rarely manifest as a predominantly psychiatric syndrome without overt neurological symptoms. This study's aim was to characterize psychiatric patients with AE; therefore, anonymized data on patients with suspected AE with predominantly or isolated psychiatric syndromes were retrospectively collected. Patients with readily detectable neurological symptoms suggestive of AE (e.g., epileptic seizures) were excluded. Patients were classified as "probable psychiatric AE (pAE)," if well-characterized neuronal IgG autoantibodies were detected or "possible pAE" (e.g., with detection of nonclassical neuronal autoantibodies or compatible cerebrospinal fluid (CSF) changes). Of the 91 patients included, 21 (23%) fulfilled our criteria for probable (autoantibody-defined) pAE and 70 (77%) those for possible pAE. Among patients with probable pAE, 90% had anti-NMDA receptor (NMDA-R) autoantibodies. Overall, most patients suffered from paranoid-hallucinatory syndromes (53%). Patients with probable pAE suffered more often from disorientation (p < 0.001) and impaired memory (p = 0.001) than patients with possible pAE. Immunotherapies were performed in 69% of all cases, mostly with high-dose corticosteroids. Altogether, 93% of the patients with probable pAE and 80% of patients with possible pAE reportedly benefited from immunotherapies (p = 0.251). In summary, this explorative, cross-sectional evaluation confirms that autoantibody-associated AE syndromes can predominantly manifest as psychiatric syndromes, especially in anti-NMDA-R encephalitis. However, in three out of four patients, diagnosis of possible pAE was based on nonspecific findings (e.g., slight CSF pleocytosis), and well-characterized neuronal autoantibodies were absent. As such, the spectrum of psychiatric syndromes potentially responding to immunotherapies seems not to be limited to currently known autoantibody-associated AE. Further trials are needed.

Past reviews on Cimicifuga racemosa (CR) without differentiation between extracts, quality, and indication altogether led to inconsistent data. Therefore, for the first time, we meet the requirements of the system's logic of evidence-based phytotherapy by taking into consideration extracts, pharmaceutical quality (reflected in a regulatory status as medicinal product), and indication. A literature search for clinical studies examining CR's efficacy and safety for menopausal complaints was conducted. The results were sorted by type of extract, regulatory status, and indication. Accordingly, Oxford Levels of Evidence (LOE) and Grades of Recommendation (GR) were determined. CR extracts demonstrated a good to very good safety in general, on estrogen-sensitive organs and the liver. However, only registered CR medicinal products were able to prove their efficacy. Best evidence was provided by the isopropanolic CR extract (iCR): the multitude of studies including more than 11,000 patients demonstrated consistent confirmatory evidence of LOE 1b (LOE 1a for safety) leading to GR A. The studies on the ethanolic extract BNO 1055 including more than 500 patients showed exploratory evidence of LOE 2b resulting in GR B. A positive benefit-risk profile is stated and limited to Cimicifuga racemosa products holding a marketing authorisation for treating climacteric complaints.

, Serovar Typhi), we observed relapse of typhoid fever following delayed response to treatment with meropenem, suggestive for limited clinical efficacy of the drug. Three previously published cases supported our suspicion. Within this context, we discuss the case details with a focus on potential explanations for insufficient clinical response to meropenem (e.g. limited intracellular penetration, phenomena of tolerance and persistence). Meropenem is a last-resort antimicrobial agent for the treatment of multi-drug resistant Gram-negative infections. Reliable clinical data evaluating the efficacy of meropenem for the treatment of typhoid fever are urgently needed. Future clinical studies evaluating typhoid fever outcome should also investigate the impact of (i) intracellular penetration of antibiotics, and (ii) tolerance and persistence on outcome.

BACKGROUND: Hypertrophic cardiomyopathy (HCM) is a genetic cardiomyopathy with a prevalence of about 1:200. It is characterized by left ventricular hypertrophy, diastolic dysfunction and interstitial fibrosis; HCM might lead to sudden cardiac death (SCD) especially in the young. Due to low autopsy frequencies of sudden unexplained deaths (SUD) the true prevalence of SCD and especially of HCM among SUD remains unclear. Even in cases of proven SCD genetic testing is not a routine procedure precluding appropriate risk stratification and counseling of relatives. METHODS: Here we report a case of SCD in a 19-year-old investigated by combined forensic and molecular autopsy. RESULTS: During autopsy of the index-patient HCM was detected. As no other possible cause of death could be uncovered by forensic autopsy the event was classified as SCD. Molecular autopsy identified two (probably) pathogenic genetic variants in FHL1 and MYBPC3. The MYBPC3 variant had an incomplete penetrance. The FHL1 variant was a de novo mutation. We detected reduced FHL1 mRNA levels and no FHL1 protein in muscle samples suggesting nonsense-mediated mRNA decay and/or degradation of the truncated protein in the SCD victim revealing a plausible disease mechanism. CONCLUSION: The identification of the genetic cause of the SCD contributed to the rational counseling of the relatives and risk assessment within the family. Furthermore our study revealed evidences for the pathomechanism of FHL1 mutations.

Aims Mechanical unloading by ventricular assist devices (VADs) has become increasingly important for the therapy of end‐stage heart failure during the last decade. However, VAD support was claimed to be associated with partial reverse remodelling. Unfortunately, the literature describes the contradictory effects of VAD systems on cardiac fibrosis, a hallmark of cardiac remodelling. To clarify these inconsistent results, the effects on cardiac fibrosis before and after mechanical unloading in 125 patients were examined. Methods and results Left ventricular myocardial tissue from ischaemic or non‐ischaemic cardiomyopathy patients undergoing VAD implantation and subsequent cardiac transplantation and non‐failing hearts of the control group were analysed for 4‐hydroxyproline (4OH‐P) content as a marker for collagen protein. In addition, collagen cross‐linking and mRNAs of collagens I and III and transforming growth factor beta‐1 were measured. 4OH‐P content was significantly increased in failing hearts compared with the control group and increased ( P &lt; 0.05) after mechanical unloading (nmol/mg tissue, mean ± standard deviation: 16.74 ± 9.68 vs. 7.75 ± 2.39 and 18.57 ± 9.19). However, plotting of the 4OH‐P ratios (post/pre‐VAD) against the collagen content pre‐VAD could be fitted by non‐linear regression. Collagen cross‐linking correlated strongly with the total collagen content in pre‐ and post‐VAD myocardium (r 2 = 0.73 and 0.71, respectively). In contrast to the total collagen content, all three mRNAs of fibrotic genes were significantly down‐regulated during VAD support when compared to pre‐VAD. Conclusions This investigation of a comparably large patient cohort revealed that cardiac fibrosis was strongly increased in heart failure and increased even after mechanical unloading. The mRNAs of collagens I and III are independently regulated from the collagen protein.

Abstract Bei der Umsetzung zwischen N 2 O 5 und H 2 O 2 (100proz.) erfolgt schon bei−80° eine sehr lebhafte Reaktion, die auf die Entstehung einer Peroxysalpetersäure zurückgeführt wird. Die gebildete Verbindung ist sehr instabil und zerfällt bereits bei −30° explosionsartig. Ihre Isolierung in reinem Zustande gelang nicht. In verdünnenden Medien wie Eiscssig oder Wasser ist es möglich, bei bestimmten Konzentrationen beständige Lösungen der Peroxysäure herzustellen. Ein äquimolekulares Gemisch der 70proz. Lösungen von HNO 3 und H 2 O 2 bildet die obere Grenze für eine bei 20° gefahrlos zu handhabende und längere Zeit beständige Peroxysalpetersäurelösung, deren Formel sehr wahrscheinlich HNO 4 ist. Konzentriertere Lösungen verpuffen infolge autokatalytischer Zersetzung unter spontaner Temperaturerhöhung. Die untere Grenze liegt bei einer etwa 20proz. Lösung, in der die Hydrolyse quantitativ wird.

BACKGROUND: The potential cardiotoxicity of antipsychotic drugs is well known. The N-terminal fragment of B-type natriuretic peptide (NT-proBNP) is considered to be a possible biomarker in clinical practice for the diagnosis and prognosis in patients with suspected heart failure. This pilot evaluation tests the influence of antipsychotic drugs on NT-proBNP concentration in view of the hypothesis that NT-proBNP could be used as marker for the tolerability and safety of antipsychotic medications. METHODS: On a routine basis, patient's blood samples were examined for NT-proBNP on days 0, 7 and 21 after initiation of a new antipsychotic monotherapy. All plasma samples were analysed for NT-proBNP using an electrochemiluminiscence immunoassay "ECLIA" (proBNP kit, Roche Diagnostics, Mannheim, Germany) on an Elecsys 2010 analyser. RESULTS: A difference was found in NT-proBNP values at day 0 between patients younger versus older than 40 years. Also women had comparatively lower NTproBNP on days 7 and 21. Smokers' levels of NT-proBNP values decreased more from day 0 to day 7. CONCLUSION: Our results suggest that antipsychotic medication influences the plasma concentration of NT-proBNP, suggesting a possible method to identify high-risk-patients for cardiovascular adverse effects due to antipsychotic medication. Larger studies should further test this hypothesis.

Die distale Radiusfraktur ist mit einer Inzidenz von 2 - 3 pro 1000 Einwohner und Jahr die häufigste Fraktur des menschlichen Skelettes und damit von hoher sozioökonomischer Relevanz. Im Rahmen einer prospektiven Studie werden mittlerweile die Behandlungsergebnisse von 64 Patienten beurteilt, die mit einer neuen winkelstabilen Osteosynthese versorgt wurden. Implantat, Nachbehandlungskonzept und Frühergebnisse werden präsentiert. Die neue volare winkelstabile Plattenosteosynthese am distalen Radius ermöglicht eine sichere, dauerhafte Retention des Repositionsergebnisses sowie eine frühfunktionelle Nachbehandlung. Hauptindikation sind komplexe artikuläre Frakturen mit einfach frakturierter Gelenkfläche, Typ C1 und C2 nach der AO-Klassifikation. In verschiedenen Scoringsystemen zeigten die Frühergebnisse nach 6 Monaten bereits in über 75 % gute bis sehr gute Ergebnisse. Auch im Literaturvergleich mit der herkömmlichen Plattenosteosynthese bzw. der Anwendung des Fixateur externe zeigt das neue Implantat deutliche Vorteile in Versorgung, Nachbehandlung und funktionellem Resultat. Die klinischen Erfahrungen mit dem winkelstabilen Implantat ermöglichen eine breite Indikation und sichere operative Versorgung. Eine frühfunktionelle Nachbehandlung ist auch bei Problemfrakturen am distalen Radius möglich und vielleicht der Schlüssel zu einem besseren Langzeitergebnis.

Präklinische Kindernotfälle stellen für Notärzte besonders fordernde Einsatzsituationen dar. Untersucht wurden Notfallspektrum und Häufigkeit invasiver Maßnahmen bei pädiatrischen Notfällen; auch im Kontext der individuellen Aus- und Weiterbildung nichtpädiatrischer Notärzte. Retrospektive Auswertung der Notarzteinsatzprotokolle (2009 – 2014) bei Patienten bis zum vollendeten 14. Lebensjahr am Notarztstandort Bad Oeynhausen (Kreis Minden-Lübbecke). Der Anteil von Kindernotfällen an den Gesamteinsätzen betrug 3,4 % (n = 321). Von diesen waren in 22,7 % der Fälle Säuglinge (0 – 1 Jahre), in 36,6 % Kleinkinder (2 – 6 Jahre) und in 40,8 % Schulkinder (7 – 14 Jahre) betroffen. Das Spektrum umfasste mehrheitlich respiratorische Störungen (20,9 %), neurologische Erkrankungen (30,8 %) und Traumata (28,3 %). Bis zum 6. Lebensjahr dominierten akute Erkrankungen, bei älteren Kindern standen Traumata im Vordergrund. 64,4 % der Patienten erhielten eine Medikamentenapplikation, bei 5,9 % wurde eine Reposition durchgeführt; Raritäten waren die Intubation (1,2 %) und die Reanimation (0,9 %). Ein intravenöser Zugang wurde in 34,4 % gelegt. Im Notarztdienst sind präklinische Kindernotfälle und die damit notwendigen Maßnahmen zwar relativ selten, sollten aber den Notarzt nicht unvorbereitet treffen. Ohne eine klinische Schwerpunkttätigkeit oder eine langjährige Erfahrung mit entsprechender Aus- und Weiterbildung ist der Erwerb individueller Fertigkeiten, insbesondere beim Atemwegs- und Traumamanagement oder der Medikamentenapplikation, nicht möglich. Gerade weil zeitkritische bzw. unmittelbar lebensbedrohliche Einsatzsituationen selten sind, erscheint ein ergänzendes und möglichst realitätsnahes Training zu ihrer Beherrschung unverzichtbar.

Zusammenfassung Fragestellung Je nach untersuchter Region beträgt der Anteil von Patienten mit einer palliativen Grunderkrankung 3 – 10% (ca. 1% in einer Terminalphase) der Gesamteinsätze im Rettungsdienst. Dabei ist ein breites Spektrum zu bewältigen. Es reicht von Symptomkrisen und psychosozialen Belastungen des Umfelds, über erkrankungsunabhängige Notfälle bis hin zur Frage der Durchführung einer Reanimation. Hierbei besteht ein Spannungsfeld zwischen dem kurativen Ansatz der Notfallrettung und dem Ansatz einer palliativen, symptomkontrollierenden Therapie vor Ort. Unter Zeitdruck müssen die Gesamtsituation erfasst und medizinische, juristische und ethische Aspekte im Sinne des Patienten gewürdigt werden. Es wurde der Frage nachgegangen, welche Strukturen und Hilfsmittel dem Notarzt für ein palliativmedizinisches Vorgehen und Denken im Einsatz zur Verfügung stehen. Material und Methoden Datenerhebung zur Strukturqualität bei der Versorgung von Palliativpatienten mittels Fragebogen bei den Ärztlichen Leitern Rettungsdienst der Region Ostwestfalen-Lippe und der Stadt Münster. Ergebnisse Rücklaufquote 8/8. Gesamtzahl der regelmäßig aktiven Notärzte pro Gebietskörperschaft 71 – 80; hiervon mit Zusatzweiterbildung Palliativmedizin 0 – 10. Fragenauswahl (in Klammern Anzahl der Nennungen), Strukturdaten Leitstelle: Kontaktdaten des ambulanten Palliativmediziners (z. B. Mobilfunknummer) für Disponenten zur Verfügung: ja (7), nein (1). Spezielle Schulungen der Disponenten: ja (1), nein (7). Strukturdaten zum Advance-Care Planning: Qualitätszirkel/Treffen Rettungsdienst/Palliativnetzwerk: ja (2), nein (6), geplant (1). Regional standardisierte Notfallausweise o. Ä.: ja (4), nein (4), geplant (1). Entscheidungshilfen im Einsatz: Standard operating Procedure (SOP) als Entscheidungspfad vorhanden: ja (3), nein (5), geplant (1). Ausstattung der Rettungsmittel: Port-Nadeln: ja (7), nein (1); MAD-Systeme (Intranasal Mucosal Atomization Device): ja (8), Gesamtmenge Morphinsulfat vor Ort ≥ 40 mg: ja (7), nein (1). Diskussion und Schlussfolgerung Optionen, die ein palliativmedizinisches Vorgehen für die Notfallmedizin bieten können, wurden bislang uneinheitlich implementiert. Dies gilt für die Weiterbildung in medizinischen, rechtlichen und ethischen Fragen, die Ausstattung und Hilfsmittel auf den Rettungsmitteln sowie für die Kooperation mit den ambulanten Partnern. Mögliche Konflikt- und Schnittmengen sollten lokal und überregional erkannt und besprochen werden. Ziel ist ein souveränes und differenziertes Vorgehen zwischen kurativer Behandlungsoption und palliativer Symptomkontrolle, um im Sinne des Patienten handeln zu können.

BACKGROUND: Polymorphonuclear, neutrophil granulocytes (PMN) play a major role in the control of infections, and people who abuse alcohol are susceptible to infections. Resistance against infections ensues intracellularly following initial phagocytosis of microorganisms with the oxygen-dependent respiratory burst, the key enzyme of which is the respiratory burst oxidase, whereby oxygen radicals are produced for microbial destruction. To date there is insufficient information available in connection with the process of impaired defence against infection in patients suffering from alcohol dependence. Therefore, our investigation was carried out to determine the influence of alcohol exposition on the formation of oxygen radicals and the respiratory burst. METHODS: 4.5 ml of whole blood was taken from 10 healthy adults and 10 patients suffering from alcohol dependence. An additional 3.5 ml of whole blood was taken from the alcoholic patients for determination of the blood alcohol concentration. The respiratory burst of PMN was tested using the Four-Colour-Continuous Flow Cytometer. Each experimental procedure consisted of 4 test samples [negative controls, Escherichia coli, FMLP-supplement (N-formyl-l-methionyl-l-leucyl-l-phenylalanin), PMA-supplement (phorbol-12-myristate-13-acetate)]. Differing concentrations of ethanol were also introduced to each of the tests performed (0.20 to 4.00 g/l). RESULTS: Ethanol revealed a marked decrease of burst activity in those patients suffering from alcoholism with increased alcohol concentration. A dependence between the burst activity and the ethanol concentration was seen to be statistically significant. This effect was only evident after stimulation with E. coli and FMLP in those patients with alcohol dependence. CONCLUSION: The results presented in this study show an impairment in the function of PMN in those patients addicted to alcohol due to the decrease in burst activity. In view of the results of the different stimuli, the second-messenger effects were not evident. A clarification of this phenomenon could well be assumed as an allosteric receptor effect on the burst oxidase, namely, a direct effect on the phagocytosis interaction between circulating granulocytes and causative organisms.

We report the rare case of a 19-year old man, first diagnosed with schizophrenia but finally shown to have subacute sclerosing panencephalitis (SSPE). Initial symptoms were hallucinations and negative symptoms until the onset of a seizure. Changes in the CSF, MRI, EEG and increasing neurological symptoms led to the correct diagnosis of subacute sclerosing panencephalitis. The EEG results were of particular importance as they already showed the characteristic changes, even while the patient still only presented with psychotic symptoms. This case report demonstrates the importance of ongoing neurological examinations in patients with psychiatric disorders. In the literature, there are only three case reports about children (8, 9 and 10 year old) as well as one of a 21-year old women with subacute sclerosing panencephalitis presenting with psychosis.

Abstract Catatonia is a widespread problem in psychiatric hospitals as approximately 10% of patients present with catatonic symptoms upon admission. Catatonia carries the risk of severe, even fatal complications. The first line treatment is usually electroconvulsive therapy (ECT) or benzodiazepines, but ECT may not be readily available and benzodiazepines may not always be effective. We describe the case of a patient presenting with severe symptoms of catatonic depression who completed a 3-day course of 25 mg aripiprazole that rapidly resolved his catatonic symptoms. Several cases have already been reported where administration of aripiprazole successfully resolved catatonic symptoms after other treatment options had failed. Aripiprazole’s efficacy and advantages may lie in its unique receptor profile. It acts as a dopamine D2 receptor (D2 R) antagonist and partial D2 R agonist depending on the precise cellular milieu, which may explain its efficacy and favourable side effect profile compared to other antipsychotics used to treat catatonia. Aripiprazole also partially agonises D3 receptors and serotonin 2 C receptors (5-HT2 C), which may contribute to its antidepressant properties. Aripiprazole enhances gamma-aminobutyric acid (GABA) transmission in certain brain areas, and it is widely agreed that low GABA activity may contribute to catatonic symptoms. Pharmacokinetics studies show that peak plasma levels are reached rapidly, within 2–3 hours of intramuscular administration and 4–6 hours of oral administration. Administration of high-dose aripiprazole (&gt;25 mg/day) should be considered as a viable alternative to ECT and benzodiazepines in patients presenting with catatonic symptoms. Aripiprazole also carries a much lower risk of complications compared to other antipsychotics.