[Disturbances of CSF circulation, pathophysiologic, clinical, diagnostic and therapeutic aspects]. / Liquorzikulationsstörungen. Pathophysiologie, klinik, diagnostik und therapie

Disturbances of CSF circulation arise from the anatomic narrows of the CSF spaces and from the dependence on venous pressure of CSF absorption in the superior sagittal sinus. The author discusses the modern concepts of CSF production and circulation, the causal mechanism for hydrocephalus and the chances of compensating for a rise in CSF pressure by transependymal migration. CSF circulation (CSFc) disturbances can be subdivided into primary processes arising in the internal and external CSF spaces and secondary which are due to distant consequences of intracranial processes via interaction of the blood/CSF volume and parenchyma of the brain within the closed capsule of the skull according to the teaching of Monroe-Kellie. Extra-cranial processes in the neck, the mediastinum and heart are primary CSFc disturbances which-via an increase in intracranial venous pressure-lead to a reduction of CSF absorption. Among the hypotonic CSFc disturbances loss of CSF volume due to fistulae, diagnostic or surgical measures are the most important. 205 cases from the literature are the basis of a description of the clinical picture, the main subjective symptoms and neurologic signs. The problems of diagnosis of CSFc disturvances are demonstrated on 3 cases from the author's department. They were due to a colloid cyst of the foramen of Monroe, a stenosis of the aqueduct and a "normal pressure hydrocephalus". The relative value of additional technical investigations into the diagnosis of CSFc disturbances is assessed critically. The techniques of PEG, ventriculography and radioisotope cisterno- and ventriculography are compared and their special indications determined. Treatment of hypotonic CSFc disturbances is surgical revision and/or an atrio-ventricular shunt. Conservative measures only effect postponement. Treatment of hypotonic CSFc disturbances for which loss of CSF volume cannot be established, has so far had only unsatisfactory results.

[Relapsing tetanus (author's transl)]. / Rezidivierender Tetanus

Tetanus relapses are caused by reactivated tetanus spores which have remained in the region of the wound, and made possible by unsatisfactory immunisation during a tetanus infection. From previously communicated individual case reports, the frequency of relapse, the length of the interval and the type of course are grouped together and compared with a case of our own. Electromyography plays a decisive role in the differential diagnosis of clinically similar syndromes and hysterical reactions. The characteristic electrophysiological findings are presented from the example of our own patient. Finally the therapeutic consequences are pointed out.

[Osmotic fragility in subfractions of leucocytes in hematological diseases (author's transl)]. / Die osmotische Resistenz in Leukozyten-Subfraktionen bei hämatologischen Krankheiten.

Leucocytes of normal persons and patients with acute and chronic granulocytic leukemia, chronic lymphocytic leukemia, and non-Hodgkin lymphoma were separated into subfractions by centrifugation in discontinuous Ficoll density gradient. Osmotic resistance was examined in hypotonic NaCl solutions with decreasing concentration and by determining LDH activity in the supernatant. Suspensions of myelocytes, polymorphnuclear granulocytes, and lymphocytes of normal persons and patients with chronic lymphocytic leukemia demonstrated the same osmotic resistance. Only myeloblasts were osmotically less fragile, and tumor cells of non-Hodgkin lymphoma more fragile.

[Alcohol induced changes in hemopoiesis (author's transl)]. / Alkoholtoxische Veränderungen der Hämatopoiese. Eine prospektive Studie bei chronischen Alkoholikern.

In a prospective trial with 120 chronic alcoholics (July, 1978 to January, 1980) on admission the following haematological values significantly different from those of the normal population were found: elevated erythrocyte mean corpuscular volume (64%), increased mean corpuscular hemoglobin (32%), thrombocytopenia (48%), increased percentage of bone marrow sideroblasts (35%), decreased percentage of sideroblasts (37%), megaloblastic bone marrow changes (55%) including nuclear abnormalities (32%), and vacuolization in red cell (20%) and white cell (16%) precursors. These changes were independent of liver cirrhosis with hypersplenism (increased mean corpuscular volume in 52% of the patients who did not have liver cirrhosis, increased mean corpuscular volume in 76% of the patients who were cirrhotic but not suffering from major bleeding). Platelets returned to normal values within 6 days of discontinuation of alcohol ingestion. In respect to iron metabolism we found the following changes: decreased serum iron concentration (32%), increased iron concentration (42%), increased total iron binding capacity (54%), increased ferritin (41%), decreased transferrin (20%). In contrast to data from the Anglo-American literature, serum folate concentrations were mostly normal in our patients (87%). This may be due to different eating and drinking habits. The percentage of bone marrow sideroblasts was also lower in our patients than those described in the literature mentioned above. The changes in maturation are likely to be caused partially by a toxic effect of alcohol on nuclear metabolism of bone marrow cells.

[Enzyme activities in normal platelets of different specific gravity (author's transl)]. / Enzymaktivitäten in normalen Thrombozyten verschiedener Dichte

Platelets of normal persons were separated into five fractions by centrifugation in discontinuous Ficoll density gradients. Enzyme activities of lactic dehydrogenase, phosphoglycerate kinase, glyceraldehyde phosphate dehydrogenase, pyruvate kinase, glucose-6-phosphate dehydrogenase and content of protein were constantly higher in the heavy fraction IV compared with the light fraction I. With regard to the platelet volume, however, these differences were compensated almost completely.

[Isoenzymes of acid phosphatase in blood cells of normal subjects and patients with leukemia (author's transl)]. / Isoenzym-Muster saurer Phosphatasen aus normalen und leukämischen weissen Blutzellen.

The activities of acid phosphatases (AP) were measured in leukocytes from patients with chronic myelocytic leukemia (CML), macrophages, granulocytes, in the fractionated mononuclear cells of patients with CML and with hairy-cell-leukemia (HCL) and in the cells from patients with acute leukemia (AL). The lowest activities were found in lymphocytes of normal subjects and of patients with chronic lymphatic leukemia (CLL) and in thrombocytes. Isoenzyme (IsE) 1 was characteristic for thymocytes, IsE 2 for granulocytes, IsE 3 for pathologic blast-cells, lymphocytes and thrombocytes, IsE 4 for macrophages, IsE 5 with components a and b for the mononuclear fraction of patients with HCL. In addition IsE 5 was detected in lymphocytes, macrophages and CLL-cells. In 4 patients with HCL the relative percentage of IsE-5-fraction was slightly greater than the percentage of tartrate resistant cells. In two patients with questionable HCL well marked IsE-5-fractions were recognized but no tartrate resistant cells. In one patient with HCL a relatively high percentage of tartrate resistant hairy-cells and in comparison an inadaquate low IsE-5-fraction was found. These different relations were explained with the more sensitive method of gelelectrophoresis and different affinity of substrates to AP.

[Enzyme activities in platelets of different specific gravity in thrombocytosis of various etiology (author's transl)]. / Enzymaktivitäten und Proteingehalt von Thrombozyten verschiedener Dichte bei Thrombozytosen unterschiedlicher Atiologie.

Platelets of patients with thrombocytosis following splenectomy, in chronic granulocytic leukaemia and in polycythaemia vera were separated into five fractions by centrifugation in discontinuous Ficoll density gradient. Platelet volume, content of protein and enzyme activities of lactic dehydrogenase, phosphoglycerate kinase and glyceraldehyde phosphate dehydrogenase were distinctly higher for the three groups in the heavy fraction IV compared with the light fraction I. With regard to the platelet volume, however, these differences were compensated almost completely like in the normal persons.