[No correlation between suppressor cell function and disease activity in natural history studies of patients with systemic lupus erythematosus]

In ten patients with systemic lupus erythematosus lymphocyte suppressor cell function was repeatedly monitored over a period of nine months. The method used is based on the finding that in vitro addition of ConA to PWM-stimulated lymphocytes activates suppressor T cells which in turn inhibit immunoglobulin synthesis. Nine of ten SLE patients exhibited significant impairment of IgG suppression but no correlation was found between the outcome of the IgG suppressor cell assay and disease activity or the treatment protocol applied.

Stereotaxic biopsy and radioactive implantation for interstitial therapy of tumors of the pineal region

Stereotaxic biopsy was performed in 10 patients with tumors of the pineal region. On the basis of intraoperative tissue diagnosis, low-energy radioactive sources (125I) were implanted in seven patients for interstitial irradiation during the same stereotaxic procedure. Results were good in five cases. This therapeutic modality appears to be indicated in cases of proven low-grade malignancy, inasmuch as the implantation of radioactive sources in a highly malignant lesion carries the risk of severe, often irreversible, damage to the surrounding brain, because of possible seed migration.

Stereotactic Mesencephalic Tractotomy in the Treatment of Pancoast Syndrome

A series of 38 patients with Pancoast syndrome treated by means of stereotactic mesencephalic tractotomy (SMT) is presented. The immediate postoperative results were good in all patients with complete pain relief, and without any impairment of respiratory function (in contrast to percutaneous cervical cordotomy). After 1–7 months’ follow-up the analgesic effect was unchanged in 33 (86.8%) out of 38 patients. Six patients (15.7%) showed recurrence of pain on the same side, while 4 patients (10.5%) presented contralateral pain. Immediate postoperative side effects of oculomotor palsy (18.4%) and dysesthesias (28%) remained unchanged at follow-up in 6 patients (16%). The intervention was well tolerated by all patients, and there was no mortality.

Treatment of low malignancy brain neoplasms by means of stereotactic interstitial radiotherapy

The authors report their results of 37 patients with low malignancy brain tumors seated in deep or highly functional areas not amenable to traditional surgery, nor to conventional radiochemotherapy. In the past 5 years these patients were treated by means of stereotactic interstitial radiotherapy. The isotope employed in all cases was 125I. Stereotactic radioisotope implants were always preceded by multiple stereotactic biopsies affording precise histological diagnoses. A 6-month to 5-year follow-up shows a survival rate of 72.6% (29 patients), and of these patients, 80.9% (26 out of 29) had complete social reentry.

Primary intracranial lymphomas

We reviewed the cases of 16 patients with primary intracranial lymphomas. The clinical and radiological data proved to be helpful in suggesting the diagnosis, but only tumoral biopsy provided unequivocal diagnosis. In our cases radiotherapy proved to be the most effective treatment.

The use of the Nd-YAG laser in neurosurgery

Whereas the focused CO2 laser may be used as a cutting instrument in less vascularized tissue with limited trauma to the surrounding tissue, use of the defocused Nd-YAG laser results in homogeneous coagulation with an energy-dependent depth effect. Thus, residual tumor tissue may be cauterized selectively with a depth effect which can be predicted with satisfactory precision. Tumor shrinkage and demarcation based on different absorption properties facilitates dissection and, moreover, allows the preservation of healthy tissue. The excellent coagulating properties of the Nd-YAG laser render it especially effective in cases of highly vascularized meningeal tumors.

[Neodymium YAG laser in clinical urology. Current status and clinical experiences]

Of all the lasers available for medical applications only the Neodymium-YAG laser has been retained with a clear indication for open and endoscopic tumor destruction in urology. This is due to the biophysical properties of this laser. The main indications for Neodymium-YAG laser application are benign and malignant tumors of the glans penis and the penis shaft as well as multiple small tumors distributed over the urethra and bladder mucosa. But tumors of the ureter and renal pelvis can also be destroyed endoscopically with the laser. The advantages of Neodymium-YAG laser application are: the great radicality of the contact-free tumor destruction coupled with closure of the blood and lymphatic vessels of the tumor, no hemorrhages, no anesthesia, only conscious sedation, and above all, short operation times that make the procedure suitable for use in outpatients.

Biophysical basis and technical requisites for the use of Nd-YAG laser in neurosurgery

The different interactions between laser light and biological tissue are demonstrated for the CO2- and the Nd-YAG-laser by histological examinations. For Neurosurgery the following results became significant: The CO2 laser has become an important tool in contactless cutting and vaporization. The Nd-YAG-laser is suitable as a coagulator whenever the site and vascularity make the removal of a tumour difficult. For the various surgical techniques in Neurosurgery using the Nd-YAG laser, special laser attachments have been developed including micro-surgical and endoscopic instruments.

Extraneural metastases from primary pineal tumors. Review of the literature

Extraneural metastases from primary pineal tumors are extremely rare: only 15 such cases could be found in th literature. Another case is presented of a 10-year-old boy who developed multiple pulmonary and skeletal metastases from a presumed primary pineal germinoma. The incidence and pathogenesis of distant dissemination in the different types of pineal tumors are discussed, with special comment on the controversial role of the direct surgical approach and shunting of cerebrospinal fluid.

[Experiences with the Nd-YAG laser in the surgical treatment of intra- and suprasellar tumors]

The Neodym-YAG-laser has been used in 15 transcranial and 15 transsphenoidal operations of intra- und suprasellar tumors. The surgical results are reflected by ophthalmological and endocrinological controls. The incidence and nature of surgical complications is also reported. The practical experiences during the surgical procedure as well as the results are indicating, that the Nd-YAG-laser is superior to conventional surgical methods. In addition to a better control of bleeding, laser surgery allows a more radical removal and inactivation of tumor tissue without a higher risk of lesioning the adjacent structures.

Effect of ASTA Z 7557 (INN mafosfamide) a precursor of 4-hydroxy-cyclophosphamide on human T-lymphocytes' Fc-receptors and immunoregulatory functions

The precursor ASTA Z 7557 of the in vivo active metabolite 4-hydroxy-cyclophosphamide (4OH-Cy) of cyclophosphamide (Cy) was tested for selective effects on human T-lymphocytes' Fc gamma-receptor expression and certain immunoregulatory functions. It has been found that ASTA Z 7557 does not alter the expression of Fc gamma-F- or Fc gamma-I-receptors on the T-cell membrane nor does it exhibit differential toxicity for either T-cell subpopulation. PWM-induced B-cell proliferation is inhibited by ASTA Z 7557, whereas B-cells' Ig-synthesis as well as ConA-driven T-cell proliferation is only blocked with higher doses of the reagent. Final concentrations above 1 microgram/ml may therefore abrogate ConA-induction of suppressor T-lymphocytes. Already ConA-activated suppressor cells of PWM-driven B-cell cultures, however, are not inhibited even with high doses of ASTA Z 7557.

Eye-safety requirements for Nd:YAG laser application in gastroenterology, urology, and neurosurgery

The preconditions relating to radiation safety for application of the Nd:YAG laser in the various fields of open and endoscopic surgery are studied. Potential eye hazards of clinical personnel using a Nd:YAG laser photocoagulator in surgical procedures are investigated and methods of eye protection are discussed. The amount of exposure of the eye to radiation back-scattered from stomach and bladder tissue, as can occur in clinical practice, has been determined for several commercially available rigid cystoscopes and flexible gastroscopes. In addition, the amount of back-scatter from brain and liver tissue has been established under the usual surgical working conditions. The International Electrotechnical Commission (IEC) and the American National Standard Institute (ANSI) provisions relating to laser safety are briefly explained in relation to the use of the Nd:YAG laser. The results of experimental investigations are compared with the maximum permissible exposure (MPE) limiting values as per the IEC and ANSI drafts. The precautions necessary for safe application of the Nd:YAG laser in the various medical spheres are described.

Interception of lymphatic drainage by Nd: YAG laser irradiation in rat urinary bladder

Lymphatic drainage can be demonstrated by colloidal indian ink injection. A small intramural indian ink spot in the bladder dome is separated from the rest of the rat urinary bladder by encircling transmural Neodymium-YAG (Nd:YAG) laser irradiation. In untreated animals there is an ink flow via the lymphatic vessels to the regional lymph nodes within several hours. In treated animals, after laser irradiation, the indian ink remains in the bladder dome and a penetration of the irradiated area cannot be found by macroscopic and histologic examination. Indian ink will be found in the regional lymph nodes after the ninth day of absorption of the coagulation necrosis and recanalisation of the intercepted lymphatics. Evidence for the interception of the lymphatic drainage is demonstrated by the distinctly delayed ink flow and the injected ink's remaining in the irradiated area. From this, we conclude that Nd:YAG laser irradiation is especially suitable for tumor coagulation, since simultaneous interception of lymphatic drainage will inhibit the spreading of tumor cells.

Percutaneous trigeminal thermorhizotomy in treatment of malignant facial pain

Fifty-eight patients suffering from intractable pain in the trigeminal distribution due to neoplasms of the intracranial or facial regions underwent controlled percutaneous coagulation of the Gasserian ganglion (trigeminal thermorhizotomy). Of them, 35 were evaluated at varying time intervals from the intervention (mean: 7 months). While pain was completely relieved in 71 per cent of cases at discharge, the follow-up examination was consistent with 49 per cent of analgesias. The rationale of percutaneous thermocoagulation in malignant facial pain is given and the pertinent literature summarized.

[Interstitial radiotherapy using I-125 seeds in brain neoplasms of slow development]

The opportunity of stereotactic biopsy for the histological diagnosis of brain tumors, the radiobiologic bases, clinical implications and technical possibilities of interstitial radiation therapy are discussed. The results of 9 cases, out of 14 treated to-date over 20 months, with a minimum follow-up of 4 months, are presented.

Leptomeningeal angiomatosis and aplasia congenita of the scalp. Case report

This 9-year-old boy had two circular areas of aplasia congenita of the scalp in the territory of the first division of the trigeminal nerve and an ipsilateral parieto-occipital leptomeningeal capillary venous angioma. He had an associated giant aneurysm of the distal posterior cerebral artery on the same side as the vascular malformation. The patient had a long history of seizures and presented with intracerebral bleeding. This case may be considered as a variant of Sturge-Weber syndrome. Further observations must be added to consider this entity as a separate neurocutaneous disease.

[Destruction of ureteral tumors with the neodymium-YAG laser. A new, organ-preserving surgical procedure]

Only the neodymium-YAG laser is suitable for destroying tumors endoscopically, because it shows a very high transmission through water and a slight absorption in the tissue. It means scattering becomes important and leads to a homogeneous and uniform distribution of the radiation in the tissue producing a deep thermal effect. An examination of a section through a bladder wall under light microscope after neodymium-YAG laser irradiation shows a layered, sharply delimited coagulation necrosis that extends to all of the bladder wall layers and reaches the outermost zones. In this way it is possible to destroy not only the exophytic part of a tumor but also the tumor base in the tissue. Since 1976 we destroyed more than 4000 bladder tumors by laser application. For tumors on the ureter or kidney pelvis a special endoscope, described by Perez-Castro Ellendt and modified by us, can be used, if it is not possible to perform a conventional operation. It is reported about four cases of distal ureter tumors (GI-II) in patients who had refused an operation for removing the tumor bearing ureter segments. Now, for more than one and half a year all patients are free of tumors and the irradiated ureters show a good function. This novel procedure is not for routine, but for high risk patients or patients, who refuse an open operation.

Transurethral laser coagulation for treatment of urinary bladder tumors

Owing to the biophysical properties involved, the Nd:YAG laser is most suited for coagulation of even inhomogeneous tissue. We determined the optimal laser parameters for therapy of urinary bladder tumors. Deep homogeneous necroses can be obtained without perforation risk of the bladder wall, and the procedure does not cause dangerous damage to the intestinal loops. We have studied animal experiments by close examination and systematic inquiry, and thus we were able to determine sufficient laser parameters in dependence on tissue thickness. Clinical studies verified these results for living human tissue. After some years of clinical use of the Nd:YAG laser we can make the first statistical statements.

[Fc gamma receptor-bearing T lymphocytes in systemic lupus erythematosus in relation to disease activity and treatment]

In peripheral blood of SLE-patients fluctuating patterns of Fc-gamma-receptor bearing T-lymphocytes have been observed, when long term monitoring has been performed. No influence of disease activity and corticoid treatment on number of Fc-gamma-receptor bearing lymphocytes was seen.

Stereotaxic rostral mesencephalotomy in treatment of malignant faciothoracobrachial pain syndromes. A survey of 14 treated patients

Stereotaxic rostral mesencephalotomy was performed 19 times in 14 patients suffering from intractable pain syndromes due to malignant diseases. The satisfying results in terms of pain relief during a necessarily short follow-up period (mean 4.9 months) are outlined. Undesired side effects were mainly confined to oculomotor disorders, which partly subsided over the months following the operation. Some technical aspects of the procedure and the pertinent literature are briefly discussed.

CT scan and metrizamide CT cisternography in arachnoid cysts of the middle cranial fossa: classification and pathophysiological aspects

Thirty-one cases of arachnoid cysts of the middle cranial fossa were investigated by CT scan, 7 of them undergoing additional metrizamide CT cisternography. In this paper we analyze and correlate the different findings from these two examinations and propose a classification of arachnoid cysts of the middle cranial fossa into three basic types. Pathophysiological and surgical implications are discussed.