[Malignant atrophic papulosis (Köhlmeier-Degos disease). Failure to respond to interferon alpha-2a, pentoxifylline and aspirin]

A 45 year old female patient presented with the cutaneous manifestations of malignant atrophic papulosis (Köhlmeier-Degos disease) for two years. The typical papules with central porcelain-white atrophy correspond histologically to wedge-shaped necrosis of the connective tissue due to thrombotic occlusion of small vessels in the corium. The pathogenesis of malignant atrophic papulosis and effective treatment modalities are unknown. A slow virus infection has been suggested by some authors. Therefore, we attempted an immune therapy with interferon alpha-2a over a period of 11 months, but failed to cause a significant effect on the appearance and progression of the skin lesions. Furthermore, we could not confirm the effectiveness of a recently reported treatment modality with pentoxifylline and aspirin administered to our patient over a period of 5 months.

Modifiable stroke risk factors in volunteers willing to participate in a prevention program

The current trends in stroke incidence require continued efforts to improve primary prevention. Compared to large-scale public health approaches, more limited programs targeting volunteers may offer some advantages. We invited all 12,824 members of a health insurance company program who lived within 50 km form one of two study sites to participate in a vascular screening program and aimed at reducing modifiable risk factors. 1,837 persons registered and participated (14.3%, mean age 53 +/- 12 years, 50% men). Using the Framingham stroke risk profile for persons aged 55 years or above (n = 961, 52.3%), 97 stroke events can be predicted for this age group within 10 years. The majority of these 97 events will occur in those with men resting blood pressure values +/- 140mm Hg (systolic) or +/- 90 mm Hg (diastolic; 420 persons, mean age 64 +/- 7 years, 60 expected events), or with a particularly high age- and sex-adjusted risk (288 persons, mean age 68 +/- 7 years, 60 expected events). Our pilot study provides an estimate of the prevalence of modifiable vascular risk factor among volunteer participants of a prevention program. Possible benefits of this approach will be investigated in a second step using a randomized intervention.

Transcranial Doppler ultrasound for the assessment of intracranial arterial flow velocity--Part 1. Examination technique and normal values

We present the examination technique and normal values of flow velocity from intracranial basal cerebral arteries for a recently developed pulsed Doppler system operating at 2 MHz emitting frequency. Peak systolic, peak diastolic, and mean flow velocity values are analyzed from fast-Fourier transformed (FFT) Doppler spectra at selected depths for 50 presumed normal subjects ranging in age from 22 to 79 years. Interindividual variation is high for peak flow but moderate for mean flow velocity values, which hence are more likely to discriminate normal from abnormal. Flow velocity values within the posterior cerebral artery (PCA) and the basilar artery (BA) are significantly lower than in the anterior cerebral artery (ACA) and the middle cerebral artery (MCA), which is also unique in showing significantly decreasing values with increasing age: calculated mean flow velocities are 47.3 +/- 13.6 and 45.3 +/- 13.5 cm/sec in the ACA, and 58.4 +/- 8.4 and 44.7 +/- 11.1 cm/sec in the MCA in patients less than 40 years and greater than 60 years, respectively, but 34.2 +/- 7.8 and 29.9 +/- 9.3 (PCA) (patients less than 40 years and patients greater than 60 years), and 34.9 +/- 7.8 and 30.5 +/- 12.4 (BA) (patients less than 40 years and patients greater than 60 years). A new scanning system is introduced, which we suggest will reduce interindividual variations and improve the accurate separation of nearby vessels, which are major causes for the comparatively large standard deviations at present.

[Development of electroencephalography for the localization of invasive lesions]

Hjorth described a special multielectrode derived from a theory of Laplace. This type of derivation will accentuate the contribution of the potential field under the active electrode relative to the surrounding electrical activity and is therefore called "source derivation". Preliminary clinical studies seem to confirm the supposition that source derivations tend to focus activity from individual electrodes in a better way than standard derivations do. Technical changes in a 16-channel EEG are the reason for simultaneously EEG-recording to test the method of the standard derivation (uni- and bipolar) against the source derivation. Total of 4280 EEGs have been recorded concerning the generalisation of activity, focal activity by epilepsia, cerebro-vascular disease and tumors of the brain. In most of the recordings focal activity was more sharply pronounced in source than in conventional derivations with problematical reference points.

[Electron microscopic findings in a polyneuropathy complicating panarteritis nodosa]

Electromicroscopial changes were observed in arterioles, nerves, and striated skeleton muscle cells in a case of clinically and histologically definite polyarteritis nodosa with polyneuropathy. Inflammatory infiltrates were found in and around arteriolar walls; motor nerves were partly demarkated and presynaptic motor endplates were degenerated. The myofibrills of skeleton muscle cells showed a disorganization that is regarded as the morphological substrate for the clinically observed muscular weakness in this case.