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Fluorescence lifetime sensing enables researchers to probe the physicochemical environment of a fluorophore providing a window through which we can observe the complex molecular make-up of the cell. Fluorescence lifetime imaging microscopy (FLIM) quantifies and maps cell biochemistry, a complex ensemble of dynamic processes. Unfortunately, typical high-resolution FLIM systems exhibit rather limited acquisition speeds, often insufficient to capture the time evolution of biochemical processes in living cells. Here, we describe the theoretical background that justifies the developments of high-speed single photon counting systems. We show that systems with low dead-times not only result in faster acquisition throughputs but also improved dynamic range and spatial resolution. We also share the implementation of hardware and software as an open platform, show applications of fast FLIM biochemical imaging on living cells and discuss strategies to balance precision and accuracy in FLIM. The recent innovations and commercialisation of fast time-domain FLIM systems are likely to popularise FLIM within the biomedical community, to impact biomedical research positively and to foster the adoption of other FLIM techniques as well. While supporting and indeed pursuing these developments, with this work we also aim to warn the community about the possible shortcomings of fast single photon counting techniques and to highlight strategies to acquire data of high quality.

International audience; The healing of the intestine is becoming an important objective in the management of inflammatory bowel diseases. It is associated with improved disease outcome. Therefore the assessment of this healing both in clinical studies and routine practice is a key issue. Endoscopy for the colon and terminal ileum and computerized tomography or magnetic resonance imaging for the small bowel are the most direct ways to evaluate intestinal healing. However, there are many unsolved questions about the definition and the precise assessment of intestinal healing using these endoscopic and imaging techniques. Furthermore, these are relatively invasive and expensive procedures that may be inadequate for regular patients' monitoring. Therefore, biomarkers such as C-reactive protein and fecal calprotectin have been proposed as surrogate markers for intestinal healing. Nevertheless, the sensitivity and specificity of these markers for the prediction of healing may be insufficient for routine practice. New stool, blood or intestinal biomarkers are currently studied and may improve our ability to monitor intestinal healing in the future.

Objective: Impaired quality of life (QOL) in patients with ulcerative colitis (UC) may be a prominent feature of the disease, and in some cases, may become an indication for surgical treatment. The objective of this study was to assess QOL in patients who underwent proctocolectomy with ileo-anal anastomosis with a J pouch for severe UC and to compare it with patients with UC of different severity who were under medical treatment. Methods: We used a validated, disease-specific research instrument (a 29 item, self-administered questionnaire) that examines the following four functions: intestinal (score 0–24) and systemic symptoms (0–21), and emotional (0–27) and Social Function (0–15). High scores indicate an impairment of the function examined and the sum of the four scores (maximal total score = 87) reflects the patient's QOL. We studied 29 operated patients (22 men, mean age 35 yr, mean time after intervention 3.8 yr) and compared their scores with those of 57 UC patients (39 men, mean age 36 yr) with different degrees of disease activity, and with those of 72 healthy controls (38 men, mean age 31 yr). Results: In UC, scores were significantly higher than in controls, increasing with the severity of the disease. Even patients in remission had higher scores than controls in the “systemic” (4.6 vs. 2.0) and emotional (5.6 vs. 2.5) functions. Patients who underwent surgical treatment had much better scores than patients with severe disease (total score 20.1 vs. 38.2), with values comparable to those of patients in remission or with mild disease activity. There was no significant gender difference, either for UC and ileo-anal anastomosis patients, or in healthy controls. Conclusion: In patients with UC, even in remission, there is a measurable impairment of QOL, which increases with the severity of disease. Operated patients have a QOL that is comparable to that of patients in remission or with mild disease, and proctocolectomy with ileo-anal anastomosis may restore an acceptable QOL in patients with moderate/severe UC.

Personal contextual factors play an essential part in the model of the International Classification of Functioning, Disability and Health (ICF). The WHO has not yet classified personal factors for global use although they impact on the functioning of persons positively or negatively. In 2010, the ICF working group of the German Society of Social Medicine and Prevention (DGSMP) presented a proposal for the classification of personal factors into 72 categories previously arranged in 6 chapters. Now a positioning paper has been added in order to stimulate a discussion about the fourth component of the ICF, to contribute towards a broader and common understanding about the nature of personal factors and to incite a dialogue among all those involved in health care as well as those people with or with-out health problems in order to gain a comprehensive perspective about a person's condition.

To date there is a lack of tools to measure participation and the already existing measures are not properly used as yet. In 2005 the IMET (Index zur Messung von Einschränkungen der Teilhabe) was developed and is able to measure the ICF associated construct participation as a generic instrument in chronic diseases. IMET and numerous instruments were applied in our own study and results were compared with results of an unpublished study. In addition, to test IMET for its use in neurorehabilitation the effects of outpatient neurorehabilitation were investigated and compared with results obtained in an inpatient setting.In a multicentric observational study, consecutively treated patients of 6 outpatient neurorehabilitation centres were asked to fill in a questionnaire at three time points (admission and discharge in the course of rehabilitation and at 4 months follow-up). Additionally, clinical experts were asked to rate the patients' status at admission and discharge. The data were compared with results of a sample of inpatients of an unpublished study.The IMET seems to be the to date best instrument to measure participation in a global, ICF-defined and economic way. Especially participation, general health status and capacity in leisure time and daily routine show the biggest improvements. In comparison, the outpatients show improvements in their participation status. Participation-oriented outpatient neurorehabilitation seems to have a considerable impact on participation status in neurological patients through the course of rehabilitation.

In 2005, the "Deutsche Gesellschaft für Neurowissenschaftliche Begutachtung" (German Society for Neuroscientific Legal Evaluation) together with other Societies published a guideline for the legal evaluation of patients with closed head injuries. Meanwhile, not only scientific progress in imaging techniques but also in other fields such as neuropsychology has necessitated a revision, which is presented here. In the mean time, the handling of guidelines has been systematised in Germany so that a registration with the Cooperation of German Medical Learned Societies is applied for and publication in the German Guideline Registry is expected.

Highly selective vagotomy (HSV) or sham operation was performed in male rats. Fifteen weeks later bone mineralization, fractional intestinal absorption and balance, urinary excretion, and serum levels of calcium, magnesium and phosphorus, together with serum gastrin, parathyroid hormone, calcitonin, vitamin D metabolites, osteocalcin, isoenzymes of alkaline phosphatase, and the urinary excretion of cyclic AMP and hydroxyproline were assessed. HSV induced chronic hypergastrinemia and enhanced the weight of the fundus, antrum, and pancreas. Body weight, food intake, intestinal absorption, mineral balance, and bone mineralization were unaffected by HSV, whereas serum parathyroid hormone levels and urinary hydroxyproline excretion were increased. It is concluded that in the rat 1) HSV has a trophic effect on gastric and extragastric tissues; 2) gastric acid production is not a major determinant of intestinal calcium absorption; and 3) normal bone mass in the presence of signs of hyperparathyroidism indicates an intrinsic capacity of HSV to interfere with calcium metabolism, probably via hypergastrinemia, gastrin being an element of the gastro-parathyroid axis. Our present findings underscore the fact that osteopenia after HSV in man may be a rare finding, but it cannot be ruled out that bone disease found after partial or total gastrectomy may be due in part to concomitant vagotomy.

Inflammatory bowel diseases are chronic diseases that affect the gastrointestinal tract. Mesalamine, corticosteroids, immunosuppressants and biological agents are currently used to treat these diseases. Due to inadequacies of the currently available delivery systems, a large number of patients do not respond to treatment, especially when they are affected by distal colonic disease. Multimatrix (MMX) technology comprises hydrophilic and lipophilic excipients, enclosed within a gastro-resistant, pH-dependent coating. This new delivery technology has been used to modify some commonly used drugs, including mesalamine and budesonide, as well as heparin, which are now being investigated for their utility in the management of IBD.The aim of this review is to explore the MMX delivery technology and its efficacy for the treatment of IBD.The results of various studies involving MMX drugs have been published. Mesalamine MMX induces clinical and endoscopic remission in patients with mild to moderate ulcerative colitis (UC) compared with placebo. Positive results have also been observed with MMX budesonide in two phase I studies. In a pilot study involving ten patients with UC, efficacy of heparin-MMX as an IBD therapy was observed.MMX is a promising new delivery system that can improve efficacy of current and new drugs, augmenting targeting to the affected tract, thereby increasing response and remission rates for those drugs in patients with IBD.

The SGB IX, book 9 of the German social code (Sozialgesetzbuch, SGB), which is the legal basis of rehabilitation in Germany, states "participation and self-determined conduct of life" as the ultimate ambition of rehabilitation. This concept of participation and disability is based on the WHO model expressed in the International Classification of Functioning, Disability and Health (ICF). In this model, participation after the onset of a health problem may not only be infringed by disturbances in body functions and structures and the resulting activity limitations but also by contextual factors such as environmental and personal factors. In an outpatient neurological rehabilitation centre we prospectively rated for 49 patients the influence of these contextual factors as well as of objectively assessed functional/activity limitations on the overall disability. On average, functional/activity limitations were rated as contributing 58.4% (SD=17.2%), personal factors 26.4% (SD=12.7%) and environmental factors 15.1% (SD=11.2%) to the overall disability. The functional/activity limitations closely matched the expected limitations based on the underlying brain lesions. The degree of disability based on contextual factors was not related to activity limitations based on disturbances of body functions and structures. Also, demographic variables such as age, sex or chronicity were not significantly linked to contextual factors. Since contextual factors together contributed 41.6% (SD=17.2%) to the overall disability they have major relevance for the rehabilitation process, because they essentially decide on the extent to which abilities acquired by the rehabilitant during rehabilitation actually be transfered to his everyday life. Therefore, rehabilitation programmes need to include assessment and treatment of contextual factors. It hence is necessary to develop instruments to quantify contextual factors.

Multiple factors can contribute to the development of osteodystrophy in patients with chronic liver disease (CLD). Recently, two new cytokines, osteoprotegerin (OPG) and the receptor activator of nuclear factor-kB ligand (RANKL), have been implicated in the pathogenesis of postmenopausal osteoporosis and other metabolic bone diseases. Therefore, the aim of our study was to evaluate bone metabolism, bone mineral density (BMD) and OPG/RANKL system in 65 male patients with CLD and in 65 healthy controls. Our patients showed lower BMD values than controls both at lumbar and femoral levels. Moreover, they had an unbalanced bone turnover with an increased resorption phase, as shown by high levels of urinary deoxypyridinoline and a decreased formation phase, as shown by the slightly, but significant, low levels of bone-alkaline phosphatase. Patients showed lower plasma levels of free-testosterone than controls and higher - although not significantly so - plasma levels of 17 beta-estradiol. Furthermore, patients with CLD had higher levels of sex hormone-binding globulin and OPG, and lower levels of 25-hydroxyvitamin D (25-HOD) and IGF-I than the control group, while RANKL levels were similar in the two groups. In conclusion, our data do not confirm the hypothesis that the OPG/RANKL system could exert a key role in the pathogenesis of hepatic osteodystrophy, but rather that the observed increase in OPG levels may represent either the result of the inflammatory process per se or a compensation for the observed enhanced bone resorption.

Common etiopathogenic factors may explain the association of systemic sarcoidosis with inflammatory bowel disease.We report two cases of such an association: one of sarcoidosis that developed 2 years after proctocolectomy for ulcerative colitis and one of sarcoidosis and Crohn's colitis. Factors like increased cellular immunity or circulating immunocomplexes or autoantibodies may have a role. Exogenous agents or familiarity may also be involved.It is postulated that the association between sarcoidosis and inflammatory bowel disease (both ulcerative colitis and Crohn's disease) does not occur by chance alone and that the two conditions may share some genetic or immunologic alterations. The two diseases, however, follow an independent clinical course.

Anhedonia, a cardinal sign of depression, is discussed to originate from a transmitter dysbalance in the central dopaminergic reward system. This system involves neuroanatomically many structures of the olfactory system. Hence the question arises whether anhedonia can be quantified when depressive patients judge smells hedonically. Sensory evaluation of olfactory stimuli by 16 depressive patients was compared that of an age-matched control group. In the group comparison, mono- and birhinal sensory thresholds as well as judgment of intensity were not significantly different. For four of the eight smells, the hedonic judgements were found to be identical between the group of depressives and controls, with the remaining smells not significantly different. There were no differences in the consistency of ranking of smells. In a longitudinal (test-retest) assessment there were again no differences in intensity, familiarity, and hedonic quality of the smells. The findings suggest that changes in the dopaminergic transmitter balance during the state of depression causing anhedonia affect neither olfactory perception nor the hedonic judgement of smells. Contrary to the clinical picture, anhedonia thus seems not to arise at the level of sensory perception yet but should be considered a more complex construct of disturbed central processing.

In man and experimental animals, partial and total gastrectomy and gastric vagotomies disturb extracellular mineral homeostasis, osteopenia being among the late outcomes. The sequence of events is complex and insufficiently understood. We report on the long-term effects of gastric fundectomy (FX; FX-1, n=11; sham-operated controls, n=14) sparing gastric vagal fibers at the lesser curvature in the rat, a procedure eliminating gastric acid production but preserving gastric reservoir function. After FX-1 there was a marked increase of gastrinemia [FX-1: 590 (SE 95); controls: 82 (5) pg-equiv/ml; P0.001], serum 1,25-dihydroxyvitamin D [FX-1: 188 (17); controls: 86 (6) pg/ml; P0.001], phosphaturia [FX-1: 32 (2); controls 23 (2) micromol/h; P0.001] due to increased fractional phosphate clearance, elevated urinary net acid [FX-1: 21 (2); controls: 16 (1) micromol/h; P=0.03], and low urinary pH. The urinary excretion of hydroxyproline was increased [FX-1: 137 (15); controls: 99 (8) micromol/h; P=0.01], and crosslinks were also high. These changes were associated with a significant decrease of bone ash calcium, magnesium, and phosphorus. Bone histomorphometry revealed signs of high bone turnover. No signs of hyperparathyroidism were detectable. Acute stimulation of serum gastrin by gastric acid abolishing omeprazole failed to provoke extra-osseous changes, as seen in the long-term after fundectomy. It was concluded that the described type of fundectomy disturbs gastrinemia, acid-base and phosphorus metabolism, thereby initiating osteopenia. This animal model may be suitable for research into post-gastrectomy bone disease.

Our aim was the assessment of frequency and evolution of osteopenia in patients with inflammatory bowel disease and identification of related factors.Bone mineral density (BMD) of the lumbar spine was measured in 54 patients with Crohn's disease (CD) and in 49 patients with ulcerative colitis (UC) and was repeated after a mean observation period of 21 (range, 8-50) months in 30 CD and 14 UC patients. Eighteen age-matched healthy subjects served as controls. Serum biochemistry (parathyroid hormone, osteocalcin, alkaline phosphatase, insulin-like growth factor 1, minerals, and markers of inflammation) was assessed at the time of the second BMD measurement.Reduced BMD values were found in 48% of CD, and in 38% of UC patients. Compared with control subjects, the mean BMD was significantly lower in CD (p0.003) and UC (p0.0001) patients. BMD was positively correlated with the body mass index (p0.05) and inversely correlated with the lifetime steroid dose (p0.03). After 21 months the BMD of CD patients was virtually unchanged, with an annual variation (%deltaBMD/yr) of -0.31 +/- 0.49, whether treated with steroids or not, whereas in UC patients the BMD decreased significantly (p0.02) with a %deltaBMD/yr of -2.47 +/- 0.82 (p0.02 vis CD). This decrease can be attributed to steroid treatment. No biochemical alterations were detected in patients with rapid bone loss, compared with those with stable BMD.Low bone density is frequent in both CD and UC, but apparently stable in CD. The evolution of BMD suggests that low bone density is associated with the pathogenesis of CD, whereas in UC it seems to be correlated with the side effects of corticosteroid treatment.

In humans, gastric surgery results in in osteopenia via mechanisms that are insufficiently understood; surgery-induced changes in the hormonal axes involving the stomach, thyroid, and the parathyroids may play a role. To study this in more detail, we evaluated calcium (Ca), magnesium (Mg), and phosphorus (P) metabolism as well as physical, chemical, and histomorphometric bone parameters in rats rendered hypergastrinemic by fundectomy (FX). In independent experiments, the response to an oral Ca challenge was investigated in intact rats versus FX, and in thyroidectomized versus thyroid-intact FX rats. Sixteen weeks following FX, body weight was approximately 80% that of sham-operated controls. In urine, P excretion was elevated fivefold, the pH was significantly decreased, and cAMP excretion was elevated as compared with controls; serum parathyroid hormone (PTH), calcitonin, 25OHD, Ca, Mg, and P were normal; gastrin and 1,25(OH)2D were elevated. On the basis of bone ash mineral content, FX rats developed significant osteopenia, and histomorphometry indicated only slightly elevated bone turnover and mineralization. Following oral Ca, thyroid-intact FX rats developed hypercalcemia, serum gastrin decreased, and calcitonin increased significantly; in thyroidectomized FX rats, calcitonin remained at baseline levels although there was a similar degree of hypercalcemia; PTH decreased during the hypercalcemic period in both groups. Serum gastrin did not correlate with calcitonin or PTH, and in multivariate regression analysis the only predictor of serum 1, 25(OH)2D was urinary phosphorus. It was concluded that in the FX rat (1) osteopenia is not caused by intestinal Ca malabsorption, vitamin D, Ca deficiency, or secondary hyperparathyroidism; (2) osteopenia may be related to PTH-independent urinary hyperexcretion of P, followed by a rise of serum 1,25(OH)2D; (3) the existence of endocrine axes among gastrin, calcitonin, and PTH cannot be substantiated. FX osteopenia appears to be related to gastric acid abolition, and the reactive hypergastrinemia probably stabilizes the mass and turnover of bone.

We carried out a 3-year pilot study of 59 consecutive women with osteoporosis of primary biliary cirrhosis (PBC), allocating them to two groups according to the severity of bone demineralization assessed by means of dual-photon absorptiometry (DPA) of the lumbar spine, Group A (36 patients; bone mineral density [BMD] > 0.800 g/cm2) received no treatment; group B (23 patients; BMD < 0.800 g/cm2) was treated as follows: oral 1,25-dihydroxyvitamin D (0.5 microgram twice a day for 5 days) followed by a 1-month course with oral calcium carbonate (1,500 mg/day) +carbocalcitonin (40 UMRC intramuscularly three times weekly). This treatment was repeated every 3 months. The following parameters were assessed at baseline and every 12 months: DPA, serum and urinary minerals, serum parathyroid hormone (PTH), osteocalcin (BGP), 25-hydroxyvitamin D, and 1,25-dihydroxyvitamin D. During follow-up, 11 initially untreated patients whose BMD dropped below 0.800 g/cm2 were switched to the treatment group (8 after 12 months and 3 after 24 months). No significant changes were observed in either group for PTH, BGP, or vitamin D metabolites. Comparing patients who were always treated, those who were never treated, and those who switched to the treatment group (ever treated) in this 36-month period, the percentage of annual bone loss in the never-treated patients was significantly less (p < 0.002) than in the ever-treated patients, suggesting the presence of two subgroups in PBC patients; one with rapid bone loss and the other with slow bone loss. Moreover, in the ever-treated patients, ADFR (activate, depress, free, repeat) therapy resulted in an improvement in BMD (p < 0.05 compared with the value before therapy). We conclude that ADFR therapy is effective in the treatment of patients with PBC with severe osteodystrophy, despite no change in osteoblastic activity, although controlled, randomized studies are in order to confirm our data.

The usual indices of activity of Inflammatory Bowel Disease fail to evaluate an important aspect of patients' status, their Quality of Life (QOL). A questionnaire dealing with four important aspects of QOL (intestinal and systemic symptoms, emotional and social function) was developed and validated. The questionnaire was administered to 72 healthy controls, 57 patients with Ulcerative Colitis and 55 with Crohn's Disease with different disease severity. Compared to controls, QOL was impaired not only in the more severe forms of disease, but also in patients in remission. In Crohn's Disease, QOL was not closely correlated with the clinical features, thus indicating that the impairment of QOL cannot be inferred from the clinical status and that patients do not "adapt" with the passing of time. The questionnaire allows a more comprehensive definition of the patients' state of health, identifying features which might be underestimated as they fail to emerge from the routine clinical evaluation. A tool of this kind could be used alongside the activity index of disease, both in clinical studies and during routine follow-up.

We studied 361 Viennese patients (m = 111, f = 250) admitted to our observation ward after attempted suicide by drug ingestion over a two-year period. Age and sex distribution, social status, time of attempt, motives, and drugs used were documented, as well as the therapeutic management of the cases. The patients were divided into 4 age groups: 57 juveniles, 179 young adults, 80 middle-aged adults and 45 geriatric patients. These groups were compared with each other in manifold respects. Our analysis showed that the geriatric patients who had attempted suicide by drug ingestion differed from those of other groups insofar as there was a lack of exogenous influence with regard to motives and methods. They may represent a separate entity more akin to suicide than to attempted suicide. Vienna data on attempted suicide by drug ingestion did not differ markedly from international data.

We studied 38 geriatric patients admitted to our observation ward after attempted suicide by drug ingestion. Age and sex distribution, social status, time of attempt, drugs and therapeutic procedures were registered and compared to suicide attempts of other age groups (n = 231). Our analysis showed that geriatric attempted suicides differed from those of other age groups by less exogenous influences, in motivation, methods and therapeutic procedures. They may represent an own entity of disease nearer to suicide than to attempted suicide.

We studied 259 patients (m: 204, f: 55) admitted to our observation ward after drinking alcohol with blood levels above 3.9 g/l. Epidemiological data, clinical and laboratory data and therapeutic procedures were registered. Our analysis showed that such high blood levels of ethanol were only tolerated by a definite age-group of chronic alcoholics with mild organic injuries. Elevated mean cell volume and gamma-glutamyl transpeptidase and additionally low BUN may be useful markers for chronic alcohol consumption.

We studied 153 patients admitted to our observation ward after attempted suicide within the last 12 months. The time of attempt, age and sex distribution, social status, kind of suicide attempt and therapeutic procedures were registered. Our analysis showed, that exogenous factors like weather and season (April, November/December) must be considered as important for the time of suicide attempt. Furthermore we noted, that vacations, young age, isolation and unemployment were conducive to suicide attempt. Geriatric attempted suicides differed from those of other age groups in motivation and methods. They may represent on own entity of disease.

Vascular cell adhesion molecule 1 (VCAM-1)/inducible cell adhesion molecule 110 is a mononuclear leukocyte-selective adhesion molecule, expressed on vascular endothelium following activation by certain cytokines or endotoxin. This inducible transmembrane protein and member of the immunoglobulin gene superfamily was previously reported to contain six immunoglobulinlike domains. Using the polymerase chain reaction, a VCAM-1 cDNA was obtained from mRNA of interleukin-1 (IL-1)-treated cultured human umbilical vein endothelial cells (HUVEC). The cDNA clone contained an additional 276 base-pair (bp) domain, located between domains 3 and 4. This new domain is most homologous to the existing N-terminal domain (domain 1). The internal 276-bp region is encoded by a single exon of the human VCAM-1 gene, indicating that the two forms of mRNA arise by alternative splicing. Both forms of VCAM-1 mRNA were detected by polymerase chain reaction in IL-1-stimulated HUVEC, although the seven-domain form appeared predominant. On the surface of HUVEC only a 110-kd polypeptide, consistent with the seven-immunoglobulinlike domain form of VCAM-1, was detectable by immunoprecipitation. Alternative splicing of the VCAM-1 gene in cytokine-activated endothelium may generate functionally distinct cell-surface adhesion molecules.

Eleven healthy male subjects aged 23 to 38 years (including 2 smokers) were exposed to purified air (= control experiment), to NO2, O3, and SO2 alone, to mixtures of NO2 + SO2, and NO2 + O3 in MAK1 concentration, and to a mixture of NO2 + SO2 + O3 in MAK and MIK2 concentrations for 2 h. Nine of these subjects underwent a bronchial challenge by inhaling in a standardized procedure, an aerosol containing 1%, 2%, and 3% acetylcholine after a 2-h exposure to clean air and to a mixture of NO2 + SO2 + O3 in MAK and MIK concentrations, respectively.

An otolith disorder is described in a patient with a subluxed stapes footplate. Otoneurological examination, including tympanoscopy, showed that nonphysiological mechanical stimulation of the otoliths by a (pathologically) hypermobile stapes footplate typically manifests with a pattern of sound-induced paroxysms of ocular tilt reaction (OTR), oscillopsia and postural imbalance (otolith Tullio phenomenon). The rare condition of sound-induced otolithic stimulation in an otherwise healthy young man offered a unique opportunity to investigate otolith reflex control of the eye, head and posture in man. Electro-oculographic recordings and special video analysis (time resolution: 1000 images/s) revealed an initial rapid and phasic counterclockwise rotatory upward deviation with a latency of 22 ms, followed by a smaller tonic effect which lasted as long as sound stimulation (480 +/- 20 Hz, 95 dB A). Latencies of the otolithic vestibulospinal reflex, recorded using surface EMG during upright stance with the eyes closed, were surprisingly short with activation of the ipsilateral tibialis anterior muscle 47 ms after the stimulus, and of the ipsilateral gastrocnemius muscle after 52 ms. A considerable postural pertubation was measured by means of a Kistler platform, with the shortest latency for displacement of the centre of pressure of 80 ms and a preferred body sway direction from right-backward to left-forward. When the Valsalva manoeuvre was performed, tonic eye movements and oscillopsia were induced opposite in direction to those produced by the sound reflecting a push-and-pull deviation of the otoliths.

Neuronal plasticity in the mammalian visual system has been studied with a variety of experimental methods like induction of artificial squint and eye rotation. To investigate neuronal plasticity in the human visual system, we examined a patient with a congenital convergent squint of his left eye, who later suffered a vascular lesion in his left occipital lobe that led to an incomplete hemianopia in his right visual field. The examination revealed that the visual field representation in the striate cortex is rigidly prewired with reference to the anatomical fovea. In contrast, plasticity in the oculomotor system enables the patient to use a functional visual axis that does not correspond to the anatomical fovea. Local alterations of sensitivity within the visual field that indicate interactions among non-corresponding retinal points provide additional evidence of functional plasticity.

This report examines 18 surgically proven L3/4 herniated nucleus pulposus (HNP), all having myelogram, CT and adequate neurological evaluation. It will focus on four cases where the herniation involved the neural canal (intervertebral canal). Comparison to the 14 spinal canal central herniations will be made. The clinical findings for lateral L3/4 HNP allowed a preimaging diagnosis to be made in three of the four cases. In the central group the correct preimaging diagnosis was made one of the 14 cases (P less than 0.01). There are numerous reasons why the central L3/4 HNP preimaging diagnosis is inaccurate as well as difficult to establish and these reasons are discussed in detail. The myelographic and CT findings of the lateral L3/4 HNP are clearly elaborated. All herniations were extruded. They poorly responded to conservative management. The duration of illness, onset of pain to surgical disk removal, for the lateral herniations was 34.8 days and, 154.4 days for the central group (P less than 0.05). The myelogram is a disappointing test in the diagnosis of lateral L3/4 HNP, but highly accurate in spinal canal L3/4 HNP. CT is a preferred imaging test being virtually positive in all cases.

In the constant search for nutritious foods to substitute in the diet of the allergic patient, as well as for suitable menstrua for cosmetics and medications, coconut is suggested as a hypoallergenic and underutilized source. Impressions of its hypoallergenicity are encouraged by a review of the medical literature and by observations and experimental data of the authors.

Omnipause neurons take part in the generation of saccadic eye movements. They lie around the midline in the caudal pontine reticular formation, in an area usually ascribed to the nucleus raphe pontis (rp). In this study of the monkey (Macaca fascicularis and M. mulatta), we describe four series of experiments aimed at establishing that omnipause neurons lie within a distinctive cytoarchitectonic entity, which we call the nucleus raphe interpositus (rip): (1) cytoarchitectural study, (2) recording-lesion experiments to establish in which cell group omnipause neurons lie, (3) cytochrome oxidase distribution in the omnipause region and neighboring structures, and (4) neuroanatomical tracing experiments to demonstrate afferents to the omnipause region. In the detailed cytoarchitectural study of the midline structures in the caudal pons and rostral medulla, a distinctive group of neurons (rip) adjoining the ventrocaudal border of rp and dorsal to the nucleus raphe magnus (rm) is described. The striking features of rip are the uniformly arranged, narrow row of the cells either side of the midline, and the extensive horizontally oriented dendritic trees of its neurons. The abducens rootlets (NVI) pass through the reticular formation at the same rostrocaudal level as rip and form a reliable landmark for its location. Cytochrome-oxidase-stained sections demonstrated additional differences between rip and adjacent cell groups: in rip the neurons and their extensive dendrites stained strongly, but not the surrounding neuropile, whereas in rp both the neurons and the neuropile stained darkly, so that individual neurons were difficult to see. Unlike rp, rip coincides with the location of omnipause neurons, and lesions marking the sites of individual omnipause units lay within its boundaries. Tritiated leucine was injected into superior colliculus (sc), which is known to have monosynaptic connections with omnipause neurons. Labelled axons and patterns of silver grains taken to indicate the presence of terminal branching were found in and around rip, but no significant labelling was seen in rp or rm. It is concluded that the omnipause neurons lie within the rip in the monkey. These functional and morphological differences between rip and the adjacent raphe nuclei are used to justify its characterization as an independent cell group in the monkey. In order to relate these findings to man, cytochrome oxidase experiments were carried out on the human brainstem, and the pattern of staining at the level of the abducens rootlets was correlated with the cytoarchitecture.(ABSTRACT TRUNCATED AT 400 WORDS)