[Adjuvant drug treatment of alcoholism with acamprosate: between sectoral budgets and disease management]. / Die adjuvante Arzneimitteltherapie der Alkoholkrankheit mit Acamprosa--Zwischen sektoraler Budgetierung und Disease Management.

OBJECTIVE: On the basis of several controlled clinical investigations the cost-effectiveness of acamprosate as adjuvant therapy of alcohol-dependent patients has yet been evaluated. These optimal conditions cannot be found in the daily ambulant practice and results in asking which of the alternatives, "standard plus acamprosate" or "standard without acamprosate", is more cost-effective in maintaining abstinence in alcohol dependent patients under realistic conditions. PATIENTS AND METHODS: In an open multi-centre study, medical care, costs and therapeutic outcome was prospectively documented. Prior to enrolling, all patients were obliged to undergo a detoxification procedure. At a mean age of 45 years the patients suffered an average of ten years from alcohol dependence. 521 patients were documented in the acamprosate cohort and 265 patients in the cohort "other therapy" over one year. Two thirds of the participating patients were male. RESULTS: At 33.6 % the rate of abstinence was remarkably higher in the acamprosate cohort in comparison to the cohort "other" at 21.1 % abstinent patients. The mean total costs per patient and year amounted to DM 3191 in the acamprosate-cohort and were significantly lower than in the cohort "other" with DM 4046. Effectiveness-adjusted costs of DM 9500 per successfully treated patient in the acamprosate-cohort were superior to the cohort "other", amounting to DM 19 148 per successfully treated patient. CONCLUSION: The described economic benefits may be utilised under conditions of an adequate disease management.

[Immunosuppression with tacrolimus (FK 506) and cyclosporin A for preventing graft rejection after liver transplantation. Retrospective evaluation of medical costs based on the FG-O157 Study in 224 patients (Germany)]. / Immunsuppression mit Tacrolimus (FK 506) und Cyclosporin A zur Vermeidung von Abstossungsreaktionen nach Lebertransplantation. Retrospektive Auswertung medizinischer Kosten auf Basis der Studie FG-O157 bei 224 Patienten (Deutschland).

The objective of this retrospective analysis was the evaluation of direct/medical costs of immunosuppressive treatment with tacrolimus (FK 506) and cyclosporin A in liver transplantation. The analysis was based on data from the german centers of a pan-European clinical trial where all given drugs as well as all serious events, graft reactions and the number of transplantations were documented. The costs of the treatment with tacrolimus were DM 158,276 per patient; those for cyclosporin A were DM 176,392. The main reason for the difference was the amount and types of drugs administered. The direct costs per surviving patient were in the tacrolimus group DM 192,314 (20 of 113 patients) and in the cyclosporin A group DM 227,669 (25 of 111 patients). The cost-effectiveness ratio for tacrolimus is about 15.5% better than for cyclosporin A.

[Long-term prognosis of cerebral infarct in comparison with a normal population]. / Langzeitprognose von Hirninfarkten im Vergleich zur Normalpopulation.

This investigation analyses up to 5.5 years longterm-prognosis of 956 patients with acute ischemic stroke admitted to hospital between 1.1.86-31.12.90. The probability of survival was calculated by Kaplan-Meier-indices and compared with the population of the state of Nordrhein-Westfalen. The longterm prognosis of all patients and age subgroups with ischemic stroke was worse compared to the normal population. Determinants of longterm mortality were age, obesity, cardiac arrhythmias, diabetes mellitus, coronary heart disease and organic brain syndrome at discharge from hospital. Hypercholesterinaemia and smoking did not affect longterm outcome.

Concentrations in serum of IgG, IgM and IgA and their age-dependence in beagle dogs as determined by a newly developed enzyme-linked-immuno-sorbent-assay (ELISA).

The concentrations of immunoglobulins IgG, IgM and IgA and their age dependence were determined in the serum of normal, untreated beagle dogs by a newly developed sandwich enzyme-linked-immuno-sorbent-assay (ELISA). A clear age-dependent increase between approximately 0.8 and 1.6 years of age was observed for the immunoglobulin IgA, whereas IgG and IgM showed only a slight tendency to an age-dependent increase. For immunotoxicological characterization of various compounds especially in long term studies, this IgA age-dependence has to be considered in the planning and interpretation of studies with beagle dogs.

Cavernous angiomas of the skull.

The authors present a series of 25 cases of haemangioma of the skull and review the literature. Frontal localization was the most frequent, contrary to the data in the literature which suggest predominance in the parietal region. The reported predominance of females has not been confirmed. In the present series the relation of males to females was 17:8. The radiological findings and treatment of haemangiomas are discussed. Direct puncture and injection of contrast medium is the best method of visualization of the tumour. Treatment should be surgical, consisting of total extirpation of the tumour with a margin of healthy tissue. Simple extirpation is indicated only when the soft tissues are involved and there is no bone lesion. Excision en bloc is the tehcnique of choice.

[Roentgenographic findings in hemangioma of the skull (author's transl)]. / Radiologische Befunde bei Hämangiomen des Schädels.

Neuroradiological aspects of diagnosis of skull hemangiomas are analysed in 25 surgically treated cases. Selective internal and external carotid angiographies are important if recurrence after incomplete excision is to avoided.

[Cavernous hemangiomas of the skull. Clinical, radiological and therapeutical aspects]. / Hemangiomas cavernoso do cranio. Aspectos clinicos. Radiologicos e terapeuticos.

A series of 26 cases of hemangioma of the skull and review the literature are reported. The frontal localization was most frequent, contrary to the data of the literature suggesting the predominance of the parietal localization. The reported predominance of females has not been confirmed. In the present series the relation of males to females was 17:9. The radiological findings and treatment of hemangiomas are discussed. Direct puncture and injection of contrast medium is the best method for the visualization of the tumor. Treatment should be surgical consisting of total extirpation of the tumor with a margin of the healthy tissues. Direct extirpation is indicated only when soft-tissues are involved and there is no bone lesion. The en-bloque method is the technique of choice.

[Possibilities of differential diagnosis for positive ventriculography in children (author's transl)]. / Differentialdiagnostische Möglichkeiten der positiven Ventrikulographie im Kindsalter

On the basis of 112 positive ventriculographies showing enlargement of the ventrical system in children and adolescents and excluding supratentorial processes, the possibilities and limitations of ventriculographic differential diagnosis were presented. Pathognomonic findings were found in inflammatory aquaduct occlusions and in meningoceles combined with hydrocephaly. In neoplastic or otherwise induced ventricular enlargement, statements can be made only in regard to the localization and often to the extent of the process. In spite of these limitations, the advantages of the positive contrast are obvious.

[The clinical features and diagnosis of glomus tumours (author's transl)]. / Beitrag zur Klinik und Diagnose von Glomustumoren

The symptoms of chemodectomas are described briefly and the literature reviewed. Two cases are presented; of these, one was a typical glomus jugulare tumour, the other an unusual metastasising glomus tumour. The role of radiological diagnosis is discussed and the value of angiography is stressed. Some suggestions regarding treatment are also made.

[Diagnostic possibilities of positive contrast ventriculography (author's transl)]. / Diagnostische Möglichkeiten der positiven Ventrikulographie

A comparison has been made of the relative merits of air, Conray 60, and Dimer X ventriculography in 100 cases. The great virtue of positive contrast ventriculography is its superior ability to demonstrate abnormalities in the midline and in the posterior cranial fossa. Tomoventriculography using a multiple layer cassette permits exact localization of intraventricular lesions without causing additional discomfort to the patient. The subtraction technique confers additional benefits. Positive contrast ventriculography has its limitations when there are large extraventricular masses.