Zur Frage der Doppelinnervation motorischer Einheiten bei der Polyneuritis

Zusammenfassung Es wird über weitere mechanographische Untersuchungen an den Hypothenarmuskeln des Menschen berichtet. An gesunden Versuchspersonen hatte sich ergeben, daß viele einzelne Fasern dieses Muskels motorisch doppelt versorgt werden (20–50%). Bei der Polyneuritis fehlt eine solche Doppelinnervation oder sie ist in ihrem Ausmaß deutlich verringert. Auf Grund der Lokalisation des Krankheitsprozesses, welcher dafür verantwortlich gemacht werden muß, sehen wir in den vorliegenden Ergebnissen eine Bestätigung unserer hypothetischen Annahme interaxonaler Anastomosen als anatomisches Substrat der beim Gesunden beobachteten Doppelinnervation der einzelnen Muskelfasern.Mit 1 TextabbildungMit dankenswerter Unterstützung durch die Deutsche Forschungsgemeinschaft.     

Über das Auftreten punktförmiger Blutaustritte in Totenflecken (Vibices)

Zusammenfassung Bei der statistischen Auswertung von 1023 Sektionsbefunden wurden in 76 Fällen (=7,4%) Vibices vorgefunden. Neben ihrem sporadischen Auftreten bei Lungenembolie, Pneumonie, Verbluten, Hirnschädigung und Peritonitis war eine überzufällige Häufigkeitsverteilung beim Strom- und Herztod, beim Ersticken sowie bei Vergiftungen insbesondere durch Alkohol und/oder Schlafmittel nachzuweisen. Ein einheitlicher Befund hinsichtlich der Blutstauung in den Gefäßen, des Ausprägungsgrades der Totenflecken sowie der Gefäßwand- und Herzblutbeschaffenheit konnte nicht festgestellt werden. Es wird die Vorstellung erhärtet, daß Vibices auch per diapedesin entstehen können. Als ein wesentliches Moment für ihr Auftreten wird eine starke agonochemische Kreislaufreaktion mit Ausschüttung von Catecholaminen, Histamin und Serotonin erwogen.

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Ecchymosis in death spots (Vibices)

Summary During the statistical evaluation of 1023 dissections vibices have been found in 76 cases (=7.4 p.c.). Vibices appear sporadically in connection with pulmonary embolism, pneumonia, exsanguination, brain damage and peritonitis. They were especially and significantly frequent in cases of death caused by electrocution or heartfailure, by suffocation and poisoning especially through alcohol and/or hypnotics. As far as hyperaemia in vessels, the intensity of death spots, the quality of vascular well and of cardiac blood are concerned, the examination did not produce unified results. Examinations strenghten the assumption that vibices also occur per diapedesin. It is assumed that their appearance is essentially caused by agono-chemical circulation reactions in connection with an increased outpour of catecholamines, histamin and serotonin.

     

Ringschlußreaktionen mit N-(Chlormethyl)carbimidoylchloriden, 2. Mitt. Umsetzungsprodukte mit N,N′-Dimethylthioharnstoff

Heterocyclisation Reactions with N-(Chloromethyl)carboximidoyl Chlorides, II: Reaction with N, N′-Dimethylthiourea N-(Chloromethyl)benzimidoyl chloride ( 1 ) and N, N′-dimethylthiourea ( 2 ) react to form the three isomeric triazine and thiadiazine derivatives 6 , 7 and 8 , which were separated by layer chromatography. Their structures were determined by ¹³C-NMR spectroscopy. The thiadiazine derivative 11 was isolated as a by-product. A mechanism is proposed for its formation.     

A proposal for the repositioning of prophylactic breast radiotherapy of prostate cancer patients

Patients with prostate cancer treated with small-molecular, nonsteroidal anti-androgens frequently develop mammalgia and gynecomastia. To avoid these unwanted effects, pretherapeutic radiation therapy of the male breasts is in common use. Recent findings on the effectivity of prevention and treatment of breast pain and gynecomastia, by both radiation therapy and tamoxifen, and a new comparative study, necessitate a re-evaluation of current prophylactic and therapeutic treatment options. An evidence-based treatment algorithm is derived that diverges from previous recommendations and redefines the role of preventive and therapeutic radiation therapy. For the propylaxis of gynecomastia and breast pain, tamoxifen is superior to single-dose radiation therapy with 10 Gy. Hence, if tamoxifen for this indication should prove to be safe on longer follow-up, radiation therapy would only be indicated in situations where tamoxifen therapy is impossible or contraindicated. The same is proposed for the treatment of early gynecomastia or breast pain except with tamoxifen treatment failure as an additional indication. Higher radiation doses of 4 x 5 Gy, which were shown to be effective in this setting, have not yet been evaluated against anti-estrogen therapy.     

A bronchogenic cyst of the right ventricular endocardium

In a 73-year-old male patient with a history of prostate cancer, a right ventricular endoluminal tumor was diagnosed by echocardiography. An endocardial papillary fibroelastoma or myxoma appeared possible; a malignant tumor could not be ruled out. The tumor was resected using extracorporeal circulation and cardioplegic arrest. Histopathology study revealed a bronchogenic cyst with ciliated epithelium.     

The modifying effects of stimulation pattern and propofol plasma concentration on motor-evoked potentials

The quality of intraoperative motor-evoked potentials (MEPs) largely depends on the stimulation pattern and anesthetic technique. Further improvement in intraoperative MEP recording requires exact knowledge of the modifying effects of each of these factors. Accordingly, we designed this study to characterize the modifying effect of different stimulation patterns during different propofol target plasma concentrations (PTPCs) on intraoperatively recorded transcranial electrical MEPs. In 12 patients undergoing craniotomy, stimulation patterns (300-500 V; 100-1000 Hz; 1-5 stimuli) were varied randomly at different PTPCs (2, 4, and 6 microg/mL). Remifentanil was administered unchanged at 0.2 microg . kg(-1) . min(-1). MEPs were recorded from the thenar and hypothenar muscles. Analysis of MEPs was blinded to the PTPC. Three-way analysis of variance revealed significant main effects of increasing stimulation intensity, frequency, and number of stimuli on MEP amplitude (P < 0.05). Maximum MEP amplitudes and recording success rates were observed with three or more stimuli delivered at 1000 Hz and > or =150 V. A significant main effect of PTPC (2 vs 4 and 6 microg/mL) on MEP amplitude was observed at the thenar recording site only (P < 0.05). An amplitude ratio calculated from corresponding MEPs evoked by double and quadruple stimulation proved to be insensitive to changes in PTPC. In conclusion, MEP characteristics varied significantly in response to changes in stimulation pattern and less to changes in PTPC.     

MR-guided laser irradiation of recurrent glioblastomas

We treated two patients with recurrent glioblastoma multiforme using Nd:YAG laser irradiation in the framework of a salvage therapy. The underlying concept is to achieve cytoreduction by partial coagulation of the tumor. Magnetic resonance imaging (MRI) follow-up examinations revealed a volume reduction of the laser-irradiated areas, while the untreated parts of the tumor exhibited a progression. The survival time after the diagnosis of the recurrence was 16 and 20 months, respectively, which is substantially (about four times) longer than the natural history of the disease would suggest. In conclusion, cytoreduction by laser irradiation may be a promising option for patients suffering from recurrent glioblastoma multiforme. Future work should optimize the therapeutic regimen and evaluate this treatment approach in controlled clinical trials.