A two-step concept to derive a consistent set of intervention levels for radiation emergency planning and to translate international recommendations into practical guidance.

A two-step concept is proposed in order to derive a consistent set of intervention levels for early (sheltering, evacuation) and late (relocation/resettlement, returning) protective actions that have to be considered in radiation emergency planning. In the first step, the dose ratios of the projected effective doses have to be calculated for four defined time periods, which correspond with the integration times for sheltering and relocation. In the second step, it is necessary to adopt an intervention level for one protective action or a more general reference level for a certain time period as, for example, the reference level recommended by the International Commission on Radiological Protection (ICRP) Publication 103 in 2007.

[Chronic pain therapy].

Chronic pain represents a considerable health problem in developed countries, too. This fact is especially important in the socio-economic perspective. The nowadays at least partially known fundamental processes of the development of chronic pain allow for a mechanism-oriented therapeutical approach.

Early metabolic responses in temozolomide treated low-grade glioma patients.

Amino acid transport and protein synthesis are important steps of tumor growth. We investigated the time course of tumor metabolism in low-grade gliomas (LGG) during temozolomide chemotherapy, and compared metabolic responses as measured with positron emission tomography (PET) with volume responses as revealed by magnetic resonance imaging (MR). A homogeneous population of 11 patients with progressive non-enhancing LGG was prospectively studied.

Multiple visual hallucinations and pseudohallucinations in one individual patient: when the world is turning upside down and the television keeps falling to the ground while dwarfs are parading on the ceiling.

We report on a patient who experienced visual hallucinations and pseudohallucinations comprising palinopsia, peduncular hallucinosis, and oblique vision. The most probable etiologies of these phenomena are discussed with respect to clinical presentation and findings on computed tomography and magnetic resonance imaging.

Escalating immunotherapy of multiple sclerosis--new aspects and practical application.

Recent clinical studies in multiple sclerosis (MS) provide new data on the treatment of clinically isolated syndromes, on secondary progression, on direct comparison of immunomodulatory treatments and on dosing issues. All these studies have important implications for the optimized care of MS patients. The multiple sclerosis therapy consensus group (MSTCG) critically evaluated the available data and provides recommendations for the application of immunoprophylactic therapies.

The contribution of the vertical semicircular canals to high-velocity horizontal vestibulo-ocular reflex (VOR) in normal subjects and patients with unilateral vestibular nerve section.

We have examined to what extent the vertical semicircular canals contribute to the nonlinearity of the horizontal VOR imposed by the driving of primary vestibular afferents into inhibitory cutoff at high velocities of head rotation (Ewald's second law). The gain (eye velocity/head velocity) of the horizontal component of the VOR with the head pitched down 30 degrees and pitched up 30 degrees was examined during constant-velocity rotations in normal subjects and patients following unilateral vestibular nerve section. In normal subjects, VOR gain decreases as chair velocity increases from 60-300 degrees/s when the head is pitched up, but VOR gain remains constant when the head is pitched down.

Insulin-associated modulation of neuroendocrine counterregulation, hypoglycemia perception, and cerebral function in insulin-dependent diabetes mellitus: evidence for an intrinsic effect of insulin on the central nervous system.

Evidence for an intrinsic effect of insulin on the central nervous system is accumulating. To test the hypothesis that insulin per se may modulate neuroendocrine counterregulation, hypoglycemia perception, and cerebral function in insulin-dependent diabetes mellitus, we examined 27 patients without any sign of classical autonomic neuropathy or evidence of so-called hypoglycemia unawareness. We used the hyperinsulinemic (0.

Improvement of impaired counterregulatory hormone response and symptom perception by short-term avoidance of hypoglycemia in IDDM.

Objective: To test the hypothesis that impaired counterregulatory hormone response and symptom perception, induced by recurrent hypoglycemic episodes over 2 days, may be improved by short-term (2-day) avoidance of hypoglycemia. RESEARCH AND DESIGN: We examined two groups of insulin-dependent diabetes mellitus (IDDM) patients (n = 16), none of whom exhibited signs of peripheral or autonomic neuropathy. Two sequential euglycemic-hypoglycemic clamp studies were performed applying stable glycemic plateaus of 5.

Recovery of hypoglycaemia-associated compromised cerebral function after a short interval of euglycaemia in insulin-dependent diabetic patients.

To test the hypothesis that compromised cerebral function, induced by recurrent hypoglycaemic episodes, may recover after a short interval of euglycaemia, we examined electrophysiological activity and symptom awareness during two sequential euglycaemic-hypoglycaemic clamp studies in 11 insulin-dependent diabetic patients without any signs of peripheral or autonomic neuropathy. Neurophysiological testing and evaluation of hypoglycaemic symptoms were performed at stable glycaemic plateaus of 5.6, 3.

Neurophysiological impairments in IDDM patients during euglycemia and hypoglycemia.

Objective: To test the hypothesis that latencies of evoked potentials in IDDM patients are delayed compared with healthy control subjects during euglycemia, and that insulin-induced hypoglycemia causes further latency delays of evoked potentials to occur.

Research Design And Methods: We recruited 23 IDDM patients (27.9 +/- 1.

Systemic vasculitis positive for circulating anti-neutrophil cytoplasmic antibodies and with predominantly neurological presentation.

A 57-year-old male patient suffering from dramatically deteriorating diffuse and focal central nervous system symptoms was admitted to hospital after a short prodromal period in a somnolent state. He was diagnosed as having systemic vasculitis positive for circulating anti-neutrophil cytoplasmic antibodies, primarily involving the brain, but also most other organ systems. Circulating anti-neutrophil cytoplasmic antibodies are highly specific for Wegener granulomatosis, though they have been detected in rare cases of other vasculitic syndromes.

Compromised hormonal counterregulation, symptom awareness, and neurophysiological function after recurrent short-term episodes of insulin-induced hypoglycemia in IDDM patients.

To test the hypothesis that recurrent short-term hypoglycemic episodes may impair hormonal counterregulation, symptom awareness, and neurophysiological function during subsequent hypoglycemia, we examined two groups of IDDM patients (n = 18), neither of whom exhibited signs of autonomic neuropathy. Two sequential euglycemic-hypoglycemic clamp studies were performed three days apart with stable glycemic plateaus of 5.6, 3.

Ocular motor dysfunction in stupor and coma.

Ocular motor disorders in stupor and coma are important clinical signs which are easily accessible with observation and a few bedside manoeuvres. Although the manifold signs of ocular motor dysfunction may be confusing to most clinicians, many of the signs can be attributed to clear pathophysiological mechanisms. This holds for conjugate eye deviations as well as for most spontaneous eye movements in coma.

Hormonal counterregulation, symptom awareness, and neurophysiological function in type 1 diabetes during insulin-induced hypoglycaemia.

To evaluate a putative differential impact of human (HI) and porcine (PI) insulin on human brain function we examined 10 Type 1 (insulin-dependent) diabetic patients without any signs of sensory or autonomic neuropathy. The glucose clamp technique was applied to achieve stable glycaemic plateaus of 5.6, 3.

Somatosensory evoked potentials following tongue stimulation in normal subjects and patients with lesions of the afferent trigeminal system.

Somatosensory evoked potentials (SEPs) after unilateral stimulation of the tongue were recorded in 20 normal subjects and in 20 patients with peripheral and central lesions of the afferent trigeminal pathway. Potentials were recorded up to 50 msec latency via electrodes placed on the scalp (between C3/4 and T3/4), the tragus and intra-orally with a fronto-central reference. In several instances simultaneous records from facial and masticatory muscles were obtained in order to detect muscle artifacts.

Stimulus characteristics influence the gain of smooth pursuit eye movements in normal subjects.

Impaired smooth pursuit eye movements are commonly believed to indicate a lesion of the central nervous system. Smooth pursuit performance, however, is strongly dependent on non-specific variables like cooperation, arousal and attentiveness. Therefore, disturbed smooth pursuit can be attributed either to lesions of the smooth pursuit system per se, or to the influence of non-controlled variables (non-structural disturbances).

Static roll and the vestibulo-ocular reflex (VOR).

We measured the effect of static lateral tilt (roll) on the gain and time constant of the vestibulo-ocular reflex (VOR) in five normal subjects by recording both the horizontal and vertical components of eye velocity in space for rotation about an earth vertical axis with the head either upright or rolled to either side. The time constant of the VOR in the upright position was 19.6 +/- 3.

Diagnostic significance of tibial nerve somatosensory evoked potentials (spinal and cortical components) with spinal cord lesions.

Forty normal subjects were investigated with the somatosensory evoked potential technique following stimulation of the posterior tibial nerve in order to yield information upon normal values, and especially the origin of the cervical potential. Subsequently an electrophysiologic localization of tumours along the spinal cord was attempted in 18 patients with spinal tumours. In C2 recordings with Fz reference 3 components, N28, N30, and N34, are visible.