[Physiology of heat regulation]

Plasticity of the central nervous system--a neurosurgeon's experience of cerebral compensation and decompensation

Cerebral plasticity constitutes one of the most decisive factors in recovery and readaptation after cerebral lesions. In contrast to the considerable progress in current studies on normal neuronal plasticity including the idea of "l'homme neuronal", the concept of plasticity postulated by Albrecht Bethe in 1929 received little attention. The author, as a neurosurgeon, has tried to describe cranial morphological plasticity, morphological and functional plasticity in infantile encephalopathies and especially in hemiatrophic lesions. It is supposed that a true morphological substrate exists due to compensatory hyperplasia of the uninvolved hemisphere. Modern neurosurgical techniques have demonstrated that the functional plastic capacity is much larger than has been supposed, even in the elderly. Some aspects of the mechanisms of compensation and decompensation of cortical and subcortical structures as well as of the central regulation systems are discussed. The full extent of the amazing recovery and functional reorganization is reached by plastic capacity, personal motivation, adequate training and sufficient time. The contribution ends with an exposition of a personal philosophy concerning psycho-somatic dualism, the body-mind problem, the future of the human brain and the ethical outlook, based on the progressive biological evolution of the basal neocortex and the immanent functional development (H. Spatz).

Clinical and morphological studies of pituitary and diencephalic space-occupying lesions before and after operation, with special reference to temperature regulation

In this study investigations are reported which analyze the clinical and morphological results in the treatment of diencephalic tumours. Depending on their location, these tumours are classified according to the extent of hypothalamic compression. The following parameters were studied: body temperature, blood pressure, pulse rate, serum electrolytes, water balance, and serum glucose. Hormonal tests were carried out to detect disturbances of pituitary and diencephalic function. The clinical findings were verified by morphological study of the hypothalamus in serial sections. The study covers 193 patients with sellar and diencephalic tumours. This analysis led to the following conclusions: 1. The postoperative temperature course is a reliable parameter for the diagnosis of diencephalic damage. 2. Diabetes insipidus is evidence of a diencephalic lesion. 3. Disturbances in the regulation of the serum glucose, electrolytes, blood pressure, and pulse rate are signs of a diffuse diencephalic lesion. 4. Endocrinological disturbances in the late phase indicate permanent diencephalic damage. This study indicates that the clinical findings in the acute postoperative period permit evaluation of the extent of the hypothalamic damage. These findings are consistent with Rothballer's observations on the pre-operative evaluation of these tumours.

[Changes in the central regulation of temperature in severe cranial injuries: its significance in relation to prognosis and therapy]

As alterações da regulação central da temperatura corpórea nos casos de traumatismos cranianos graves são classificada e analisadas, procurando os autores salientar suas características, visando ao prognóstico e à terapêutica. Com base nas várias modalidades de distúrbios térmicos, nas alterações de outras funções de caráter vegetativo e nos achados neurológicos, são expostas normas terapêuticas gerais.