[Treatment of carotid-cavernous fistula with the Serbinenko balloon catheter]. / Die Behandlung der Karotis-Kavernosus-Fistel mit dem Ballonkatheter nach Serbinenko.

After a critical survey of the methods of treating carotid-cavernosus fistulae employed until now and some special techniques, the endovasal method using the flow-in catheter with droppable microinflator after Serbinenko is described. In this technique, a latex inflator is filled intracavitarily with cold-vulcanized silicon rubber by the transcutaneous-transcarotidal route and left in situ for a selective closure of the fistula. 3 cases treated by the author with late results show the advantages of the method by which the carotid can be reconstructed.

[Intracranial chordoma. Case report of a destructively growing chondroid chordoma in the area of the sella turcica]. / Das intrakranielle Chordom. Fallbericht eines destruktiv wachsenden chondroiden Chordoms im Bereich der Sella turcica.

Evaluating the literature a short survey is given about chordomas of intracranial localization. A case of a chondroid chordoma growing destructively in the base of the skull is described. Because of the localisation in the region of the sella turcica the first diagnosis was an adenoma of the hypophysis or craniopharyngioma. Although it is a chondroid chordoma 14 months after operation a recidive tumour was seen.

[Psychologic adjustment process following high cervical spine paralysis and its support by a bedside reading apparatus]. / Der pyschologische Anpassungsprozess nach hoher Halsmarklähmung und seine Unterstützung durch einen bettseitigen Leseplatz.

The process of psychological adjustment, which has to go on after high levelled lesions of the cervical spinal cord, passes through several phases. It needs a lot of empathy, plenty of time for confidential talks and psychological knowledge as well as an individualizing cooperation between the several levels and stages of combined treatment during rehabilitation. We could give this process a considerable advance by a (half-) automatic bedside-projection of belletristic literature, which can be continuously read on a screen from long film strips by means of a modified Pentacon system. The introduction of this new object in life proved a good support for the threatened personality of those badly handicapped patients.

Distribution of antiepileptic drugs between plasma, plasma water, cerebrospinal fluid, saliva and brain.

The following conclusions can be drawn from our results. The concentrations in cerebrospinal fluid correspond to the concentrations of the unbound part and saliva at a high lipid solubility. Cerebrospinal fluid and brain were interpreted as a uniform compartment. The unbound concentrations of low lipid soluble drugs in plasma do not reflect the concentrations of drugs in cerebrospinal fluid. The correlation between the unbound drug in plasma, CSF and brain must be determined. The concentrations of lipid soluble drugs in plasma, water or saliva is representative for the concentration of antiepileptic drugs in central nervous system.

The distribution of sulfamerazin between plasma, cerebrospinal fluid, and bile in humans.

The concentration-time curves of sulfamerazin were determined in plasma, cerebrospinal fluid (c.s.f.) and bile in two groups of patients (ventricle drainage and Kerr's T-tube drain). In plasma, a half-life of 13.6 hours as well as an invasion and evasion constant of 0.145 hours -1 and 0.051 hours -1, resepectively, were observed. The distribution of half-life times showed a bimodal behavior in these patients. The unbound part of sulfamerazin was 12% and the acetylated products 14%. Unlike plasma in c.s.f. and bile the influx is delayed up to steady state. The decreases of concentration in all three compartments are the same. The concentration ratio of sulfamerazin between C.S.F. and bile and plasma water amounted to 1 and 2.5, respectively. Of the given dose of sulfamerzin, 0.87% was eliminated by bile within 24 hours. The therapeutic conclusions are discussed with regard to the bimodal distribution of half-lives, the minimal inhibition concentrations and the unbound part in the plasma.

The distribution of lithium into cerebrospinal fluid, brain tissue and bile in man.

The concentration of lithium was determined in plasma, cerebrospinal fluid (CSF) and bile in two groups of 5 and 6 patients after oral administration of lithium carbonate (0.2 mVal/kg b.w.) in each group. In a third group of 7 patients the lithium concentration in the brain and also in the CSF and the plasma was determined in the steady state. The influx into CSF was delayed in contrast to that into plasma and bile. The elimination was biexponential. The mean plasma half-life of lithium carbonate was 21 hours. The concentration ratio between CSF and bile, respectively, and plasma was 0.44 +/- 0.03 and 1.48 +/- 0.36 in steady state. Two percent of the given dose was eliminated with the bile within 24 hours. There was no concentration difference in steady state between that for CSF and both white and grey brain matter. It is suggested that the concentration of lithium in CSF represents the brain concentration.

[The ultrastructure of human pituitary adenomas (author's transl)]. / Zur Ultrastruktur menschlicher Hypophysenadenome

34 pituitary adenomas were examined by light and electron microscopical methods. Slices of tumor tissue fixed in formaldehyde or Bouin's solution, respectively, and embeded in paraffin were stained by hematoxylin-eosin, Goldner's method (including Orang G), periodic acid Schiff (PAS) reaction, and in some cases by Herlant's tetrachrom. The ultrastructure was studied using tumor tissue fixed in glutaraldehyde within 1 hour after removal. The adenomas were classified by their light microscopical characteristics as chromophilic or chromophobe tumors. Employing the PAS reaction and Goldner's staining method, 27 adenomas were found to give intense or weak staining reactions. By electron microscopical investigation , all the adenomas studied were seen to contain secretory granules more or less densely packed within the cytoplasm. The number of these granules was strongly correlated with the intensity of the tinctorial properties of the tumor tissue. Out of 11 acidophilic adenomas, 10 were observed consisting of typical STH cells. 4 acromegalic patients were found to possess heavily or poorly granulated STH cell adenomas (two patients in each of these groups). One patient with a clinical history of liver cirrhosis and gynecomastia was observed bearing an acidophilic (and erythrosinophilic) adenomatous hyperplasia of prolactin cells, 13 tumors consisted of cells exhibiting almost weak amphophilic staining properties and secretory granules of 100-250nm diameter, thus resembling cells which have been reported to produced ACTH. One of the patients suffering from these adenomas, showed the clinical signs of M. Cushing. By ultrastructural criterions, 3 adenomas with PAS-positive tumor cells were considered to be composed of gonadotropic cells. Only 7 adenomas were observed which did not give any chromophilic reaction. These tumors consisted of extreme poorly granulated cells which could not be significantly associated with one of the pituitary hormones by their morphological properties. In respect of the abundance of mitochondria, 4 out of the adenomas were designated as oncocytic tumors.

Percutaneous burrhole trephination of the skull: a study of 519 cases.

We want to report on our experiences with the percutaneous trephination using a 2.35 mm round dental drill with serrated saws around it, a "Rosenbohrer". It is a methodically similar activity as described by J. Zentner [11]. From 1981 to 1992 519 patients were treated and 546 trephinations were performed. At the beginning this treatment was only used in connection with intracerebral bleedings and biopsies. In a considerable short time the indication could be extended to the subdural hematoma, tumor cyst, obstructive hydrocephalus as well as to the abscess and the subdural epyema. The rate of infection was 1.28% and the risk of bleeding 0.36%. In our opinion the advantages of this small electrical trephination are the easy handling, the universal use and mobility and the avoidable risk of anesthesia as well as the sterilisation at the same time and the stopping of blood, caused by the contact surface friction.

[Therapy of traumatic hemobilia]. / Beitrag zur Therapie der traumatischen Hämobilie.

Haematobilia is caused by a pathological linking of the arterial vascular system and intrahepatic or extrahepatic bile ducts. This report presents the case of a traumatic haematobilia in a child. Possibilities to achieve safe diagnosis are discussed and suggestions for treatment are considered. In the case presented here, occlusion of the arteriobiliar shunt is effected by means of a rejectable balloon catheter according to Serbinenko. This method has been successfully tried in neurosurgery and developed further, and can be applied to similar disease patterns in disciplines other than neurosurgery.

[Vein of Galen malformation in a newborn infant with clinical symptoms of a cardiologic emergency]. / Vena-Galeni-Malformation bei einem Neugeborenen mit der klinischen Symptomatik eines kardiologischen Notfalls.

We report on the management of one term newborn infant with a malformation of the Vena Galeni. The baby suffered from cyanosis and intractable congestive heart failure without evidence of congenital heart malformation at his second day of life. The diagnosis was established by two-dimensional sonography and Doppler examination. However, we thought it necessary additionally to perform an angiography of the intracerebral vessels before surgical intervention. We conclude that a real time two-dimensional imaging system and a range-gated pulsed Doppler velocimeter should be available in newborn intensive care units. Otherwise neonatologists are forced to transport these infants to pediatric heart centers because of inability to detect such an extracardiac origin of heart and circulatory failure.

[A method for the noninvasive measurement and recording of intracranial pressure via the open fontanelle of infants]. / Methode zur nichtinvasiven Messung und Registrierung des intrakraniellen Druckes (ICP) über die offene Fontanelle des Säuglings.

Measurement and checking of the behaviour of the intracranial pressure (ICP) are of considerable clinical interest for the appraisal and treatment of primary or concomitant cerebral diseases. A non-invasive method of the measurement of the cerebral pressure is presented, which permits measurements and graphic recording according to the aplanation principle of the ICP via the open fontanelle. The pressure uptake of the instrument transformer is effected by a resistance strain gauge, measurement and recording by means of an equipment combination of VEB Messgerätewerk Zwönitz (GDR). Methodological and theoretical foundations are described and normal values of the fontanelle pressure of 80 newborns and babies are submitted.

[Results of treatment in the hyperprolactinemic anovulatory syndrome]. / Behandlungsergebnisse bei dem hyperprolaktinämisch-anovulatorischen Syndrom.

This is a report about the results of Parlodel and neurosurgical treatment of 30 patients with infertility and amenorrhea, in 18 cases combined with galactorrhea. There were 4 cases of non-ovulatory cycles with or without oligomenorrhea. 2 young girls had a primary amenorrhea. All patients wanted to have children. A pituitary tumor was diagnosed in 15 patients, it was microsurgically removed in 7 cases. 18 of 30 patients became pregnant after a drug treatment or combined neurosurgical and drug therapy.