[Diabetic foot syndrome and its risks: amputation, handicap, high-cost sequelae]. / Das diabetische Fusssyndrom und seine Risiken: Amputation, Behinderung, hohe Folgekosten.

Amputation, Handicap, High Subsequent Costs. Lack of "Outpatient Wards for Diseases Involving the Feet" in German hospitals. A Challenge to Prevention: In consequence of diabetic polyneuropathy, about 25% of all diabetics develop neuropathic foot complications often resulting in amputation (about 30,000 cases in Germany per annum). Suffering and handicaps of the patients, as well as the high costs involved (estimated at 800 million Deutsche Mark per annum) systematic prophylaxis and early identification of patients at risk are imperative. According to experts every second amputation could be avoided if treatment of diabetic foot complications is started as early as possible. To prevent expensive in-hospital treatment, an outpatient clinical treatment may be offered on an interdisciplinary basis (internist, neurologist, orthopaedist, surgeon, radiologist). About 50 "outpatient wards for diseases involving the feet" exist up to now in German hospitals. Appropriate fees, subsidy by sick funds (and if necessary by politicians) and co-operation with general practitioners, internists etc. are indispensable. Other important co-operators are the family doctors. With regard to health care, preventive activities and publicity, co-operation of the local Public Health departments would also be feasible.

[Participation in the 1992 World Diabetes Day in the Ammerland district--a contribution to health promotion]. / Aktion zum Welt-Diabetes-Tag 1992 im Landkreis Ammerland--ein Beitrag zur Gesundheitsförderung.

Departments of Health can function as important initiators of health promotion on community level. This includes the support of efforts for cooperation ("corporate identity"). A one-day-project for the World Diabetes Day (June 27, 1992) in the Ammerland county (Lower Saxony) gives an insight on possible activities, results and conclusions.

[Implementation of preventive measures recommended by the federal public health office and acceptance of advice by managers of commercial solaria--studies by the public health office of the Ammerland district]. / Umsetzung vom BGA empfohlener Schutzmassnahmen und Akzeptanz von Beratung bei Betreibern gewerblich betriebener Solarien--Untersuchungen des Gesundheitsamtes im Landkreis Ammerland.

Commercial solaria are not always up to the standards that would be desirable from a Public Health point of view in respect of protection of users against health hazards of exposure to UV radiation, and also with regard to supervision, qualified personal advice given to users by the staff, and qualification of the staff members to give such advice. Hygiene is definitely also a problem, as is evident from bacteriological swabs made from tanning beds. However, the talks conducted by a local Public Health board in Lower Saxony (North Germany) revealed considerable open-mindedness on the part of the entrepreneurs who were quite willing to follow expert health advice and to display a poster with recommendations regarding protective measures. This was combined with a questioning procedure that has proved successful with the proprietors.

Iron-induced atypical meningioma cells?

Polymorphous tumor cells with bizarre giant nuclei are characteristic of the so-called atypical meningioma. Some of these cells are iron-positive. Meningioma cells apparently are able to store iron excessively. It is discussed whether an extremely high intracellular iron uptake is responsible for atypical meningioma growth. Derangement of mitotic spindles may lead to polyploid chromosome sets and thereby to giant nuclei. This seems likely because induction of tumor growth after iron injection has been described. Spodographic examinations showed that even histologically inconspicuous tumor cells contain fine-grained iron. Application of the Prussian-blue reaction to spodograms reveals distinctly higher iron contents than common paraffin sections had proved.

Studies on mucous substances in myxomatous meningiomas.

Three cases of myxomatous meningiomas with unusually abundant myxopoiesis are reported. Histochemical and staining methods are applied to characterize the mucous substances. They are identified as a complex of neutral and acid mucopolysaccharides with a protein component. Histochemical and histological findings are correlated. The question is discussed whether an excessive myxopoiesis of meningioma cells represents regressive changes or specialized cellular activity.

A combined neurofibroma-granular cell tumor of the middle cranial fossa.

A case of a combined neurofibroma-granular cell tumor in a 52 years old gunsmith is presented. The tumor developed after an intracranial trigeminal nerve operation 25 years previously. The solid tumor in the left middle cranial fossa had displaced and infiltrated the temporal lobe. It had expanded via the optic nerve into the left orbit, and further the apex partis petrosae was destroyed. The neurofibroma part shows histological aspects of malignancy, the granular cell tumor, considering its infiltrating and destructive growth, may be regarded as malignant as well. In intermingling portions of the tumor, transitional types of fiber-like and granular cells are prominent. In the peripheral zone of the tumor apparently reactively proliferated polynuclear astrocytes are seen with occasionally intracytoplasmatic lymphocytes (emperipolesis?). A short review of the literature and the theories concerning the histogenesis of the granular cell tumor is given. Whereas most authors in recent years suggest a Schwann cell origin, based on electron microscopic findings, this intermediate tumor type motivates us to postulate a mesodermal origin of the granular cell tumor. The question of viral influence is discussed briefly.

Lymphocytes within glial cells ("emperipolesis") in a case of a granular cell tumor.

A case of a combined neurofibroma - granular cell tumor of the left middle cranial fossa with infiltration of the temporal lobe and expansion into the orbit is presented. The granular cell tumor shows big fibrillary astrocytes in its peripheral zone. Even in the tumor-free brain tissue adjacent to the tumor plenty of these obviously reactively proliferated astrocytes are found. Furthermore, lymphocytes within the cytoplasm of such astrocytes ("emperipolesis") strike the eye. Neither the lymphocytes nor the astrocytes show signs of damage. A review of the literature and the theories concerning the phenomenon of emperipolesis are given. The problem of its biological significance and the question whether emperipolesis is the result of invasion of engulfment must remain unsolved.

Granular cell tumor of the optic nerve.

A case of a combined neurofibroma-granular cell tumor is presented. The tumor had developed in the left middle cranial fossa after an intracranial trigeminal nerve operation 23 years before. It had displaced and infiltrated the temporal lobe and expanded probably via the fissura orbitalis into the orbit. The thickened optic nerve revealed a marked widening of the subdural fissure by typical granular cells. The cufflike tumor cell aggregation in the subdural fissure had compressed the optic fascicle, thereby inducing a demyelinisation and axonal degeneration. A reactive gliosis in the optic fascicle masks the typical pattern of the optic nerve atrophy. The gangliocytes of the third retinal neuron are atrophic and replaced by reactively proliferated fibrillary astrocytes. A short review of the literature and theories concerning histogenesis of the granular cell tumor (neurogenic or mesoderma) is given. An intermediary type of neurofibromatous and granular cells which we found motivates us to agree with a mesodermal origin.

Luxol-fast-blue-staining of nerve cell nucleoli as indicator for acidotic lesion in cases of intracranial hypertension?

The allochromatic behaviour of nerve cell nucleoli in the Luxol-fast-blue-method (blue nucleoli) in cases of raised brain pressure is probably due to a lactacidotic pH-shift basing on cerebral hypoxia. In 109 out of 134 cases with blue nucleoli signs of cerebral hypertension could be observed. The IEP of nerve cell nucleoli was determined in the nuclei pontis. Clinical and pathophysiological data were evaluated.