[Therapy and prognosis of spontaneous intracerebral hemorrhages with ventricular involvement]

Clinical experiences on intracerebral hematomas with intraventricular involvement are recorded, and cases from 1976 to 1982 are surveyed. Important criteria for conservative and operative procedure are concluded. Localization of hematoma and follow-up clinical condition of the individual cases are the most reliable indicators in the choice of treatment. Good prognosis of hemorrhages caused by angioma is emphasized, if these are operated upon.

[Reversible panmyelopathy following captopril treatment]

In a 46-year-old female patient suffering from renal hypertension due to polycystic kidney degeneration with creatinine values between 3 and 5 mg/dl leucopenia developed 3 weeks after beginning antihypertensive therapy with the angiotensin-converting-enzyme inhibitor captopril. On continuation of treatment signs of haemorrhagic diathesis appeared 7 months later. Cytology and histology led to the diagnosis of panmyelopathy which, from the clinical findings and the close patient follow-up, was to be regarded as captopril-induced. Bone-marrow regeneration could be shown 6 months after discontinuing the drug. In renal insufficiency, captopril treatment should be monitored using regular haematological tests and the drug withdrawn when leuco- or thrombocytopenia occurs.

[A case of transverse spinal cord syndrome following contamination of a peridural catheter]

Two weeks after removal of a peridural catheter a transverse lesion of the cord with paraplegia developed. At operation a paravertebral abscess, osteomyelitis of the lamina L2 and L3, and epidural abscess, a phlegmonous duritis and myelitis of the conus-cauda region by transmigration was found. The catheter had been in position for four days. The infection was caused by staphylococcus epidermidis. After laminectomy L2 and L3 as well as local and systemic application of antibiotics, according to the results of sensitivity tests, neurological deficits disappeared nearly completely.

Pharmacokinetic studies of high-dose metoclopramide with and without forced diuresis

The pharmacokinetics of high-dose metoclopramide (10 mg/kg body wt. in five infusions of 2 mg/kg body wt. each) was studied in 11 patients (5 females, 6 males) in two groups: group A with and group B (consisting of five patients) without forced diuresis. When the drug was infused, forced diuresis had no influence on the pharmacokinetics of metoclopramide (serum level after the 1st infusion was 851 +/- 361 ng/ml in group A versus 840 +/- 348 ng/ml in group B; after the 5th infusion it was 2,005 +/- 588 ng/ml in group A versus 2,463 +/- 1,350 ng/ml in group B). There were significant differences in the 24-h serum levels (582 +/- 308 ng/ml in group A versus 379 +/- 170 ng/ml in group B; P less than 0.05) and in the elimination half life (8.5 +/- 2.6 h in group A versus 6.1 +/- 1.1 h in group B; P less than 0.05). The results demonstrate that the dosage regimen originally suggested by Gralla for cytostatic drugs, with forced diuresis for high-dose metoclopramide therapy, may also be applied, with no dosage reduction, with to other cytostatic drugs which do not require forced diuresis.

Antiemetic efficacy of moderately high-dose metoclopramide in patients receiving varying doses of cisplatin. Controlled comparison with a combination of methylprednisolone and metoclopramide

In 29 patients (48 courses of chemotherapy), a randomized double-blind crossover study was undertaken to establish the antiemetic effectiveness of a combination of metoclopramide at a moderately high dose (5 mg/kg body weight) with 1 g methylprednisolone (treatment A) as compared with metoclopramide monotherapy (5 mg/kg body weight; treatment B). With cisplatin doses of 60 mg/m2, a good antiemetic effect (0-1 vomiting episodes in 24 h) was observed in 9 out of 10 patients under treatment A as well as under treatment B. With a cisplatin dose of 120 mg/m2, treatment A produced a good antiemetic effect in 9 out of 11 patients (82%), while treatment B produced such an effect in only 3 out of 11 patients (27%; p less than 0.5). The results obtained permit the following conclusions to be made: At doses of cisplatin of up to 60 mg/m2, the antiemetic effect produced by metoclopramide (5 mg/kg body weight) given alone is adequate. At doses of cisplatin of 120 mg/m2 and more, high-dose methylprednisolone has a good additive antiemetic effect vis-à-vis metoclopramide (5 mg/kg body weight). The antiemetic effect of this combination corresponds approximately to the antiemetic effect produced with high-dose metoclopramide (10 mg/kg body weight) administered alone.

[A new material in neurosurgery]

A new alcoholic prolamine solution is now available (ETHIBLOC, supplied by Ethicon, Norderstedt) which can be used in neurosurgery for a variety of purposes. This material hardens quickly in an aqueous medium. Animal experiments have not shown any damaging action on the brain, meninges, or bone. The excellent tolerance of the material was seen in a total of 22 patients operated on with the help of Ethibloc. It is particularly well suited for closing frontal CSF fistulas, incised frontal sinuses, and for rearranging or shunting in case of cerebral vascular deformities. It can also be used as a carrier of antibiotics in osteomyelitis, for covering up minor defects of the dura mater, for dura sealing, and for closing the bone after trephination. The preparation is transformed completely to connective tissue within a period of 40 to 90 days. New techniques of surgery are described which have become possible by the use of Ethibloc.

[A new technic for the sealing of a frontobasal cerebrospinal fluid fistula. Experiences with a hardening alcoholic protamine solution]

Fractures of the frontal base of the skull are often accompanied by rhinoliquorrhea. To prevent infections of the brain they must always be closed surgically. We report on a new method of closing the dura mater defect using an alcoholic prolamine solution, which hardens within a few minutes. After 40 to 90 days the mass has been replaced by connective tissue. We describe our experience with 24 patients who were successfully operated on using this method and followed up for two years.

[Chemotherapy of malignant tumors, vomiting and nausea--what to do?]

Very marked nausea and vomiting are the most frequently observed side effects of modern cytostatic agents, and make it necessary to include powerful anti-emetic drugs in any oncological chemotherapeutic concept. The selection of suitable anti-emetics, however, often proves difficult. The reasons for this are discussed. A number of important basic rules that should be observed with any anti-emetic treatment are proposed. Finally, a standardised stepwise anti-emetic plan is suggested for discussion.

[Treatment of non-small cell bronchial cancer with high-dosage cisplatin and vindesine. Results of a prospective study]

Thirty-seven patients with advanced, histologically confirmed non-small-cell lung cancer received combination chemotherapy with high-dose (120 mg/m2, day 1 and 29, thereafter every 6 weeks) cisplatin and vindesine (3 mg/m2, day 1, 8, 15, 22, and 29, thereafter every two weeks). All patients had measurable disease and had not previously received chemotherapy. 20 out of 37 patients responded to therapy. Two patients with adenocarcinoma, and one patient with squamous carcinoma of the lung experienced complete remission, 11 out of 37 patients partial remission, three patients a minor response, while in three patients the tumour neither remitted nor progressed. Despite chemotherapy cancer progressed in 17 out of 37 patients. Under supportive care including prehydratation, diuresis, administration of high-dose metoclopramide this aggressive chemotherapy was well tolerated. The response rate was similar to that of other chemotherapeutic regimens. The remission duration (9.5 months) and the survival time (16.5 months) are, however, somewhat better.

[Changes in blood sedimentation and blood counts. Practical value for the early diagnosis of severe illness]

The practical importance of BSR and blood cell changes for the early recognition should not be overestimated. But every symptomless person with raised BSR should be examined very carefully, especially for occult hepatic diseases (active hepatitis, liver cirrhosis), for anaemias, leukaemias, malignant lymphomas and other malignant diseases. The practical use of the diagnosis of blood cell changes is the possible recognition of anaemias, leukaemias and malignant lymphomas.