[Local use of cytostatic drugs following removal of glioblastomas]. / Lokale Anwendung von Zytostatika nach Exstirpation von Glioblastomen.

Local application of Methotrexate after removal of glioblastomas enables a high chemotherapeutic concentration to be achieved in the wall of the surgical cavity without appreciable side effects on sensitive structures of the body. This procedure, followed by intravenous chemotherapy may prevent local recurrence, on the assumption that glioblastoma recurrences originate in the operation site. Five groups (269 patients) subjected to different strategies of postoperative therapy were compared in terms of average survival time. The group given local chemotherapy following total or subtotal removal of the tumour, then intravenous chemotherapy after 8 days, followed by radiotherapy, demonstrated an average survival time of 75 weeks. In this group the number of living patients at the time of investigation was particularly high, namely 56. The longest survival time was 355 weeks, and this patient was symptomless. There were no side effects or complications of local cytostatic therapy with 50 mg Methotrexate.

[Carpal tunnel syndrome as an unrecognized disease in the aged]. / Das Karpaltunnelsyndrom als verkannte Erkrankung im Alter.

Although the symptoms are very characteristical (in our patients 91,5% pain, 69,2% disturbed sensibility and 29,2% weakness) and the neurological diagnosis is typical (82,9% disturbed sensibility, 30,6% weakness, 57,1% atrophy of the thenar muscle) faults in diagnosis are possible. Particularly in old age it is mistaken for vertebral or vascular diseases. If conservative treatment is ineffective or the compression of the nerve is enlarging fast, surgical treatment will be indicated. In this case you can get freedom of pain in 66,6% in applying the right method of operation (5 different methods in micro-neurosurgery are available). Since May 1981 we use laser-surgery with great success. We checked (in average 13 months after the operation) 111 of 133 patients (33 male, 100 female, age of 16-84 most of them in the 6. decade) and got those results: 58,7% very good, 14,8% good, 15,7% satisfying and 5,8% unchanged.

[Importance of computerized tomography for surgical treatment of intracranial hematomas (author's transl)]. / Die Bedeutung der Computertomographie für die Operationsergebnisse endokranieller traumatischer Hämatome.

The improved treatment by using computerized tomography (CT) located between operating theater and intensive care unit is reported in comparison of 3,382 patients with severe head injuries. By preoperative use of CT the frequency of diagnosed hematomas was about the same (29.5% before CT; 27.0% with CT) but the preoperative diagnosed multiple hematomas were much more frequent (14.0% resp. 27.0%). The most important advantage however is the saving of time by CT in this localisation by which the chance of survival has increased from 54% to 69%. Without any doubt everywhere in neurotraumatology the CT should be situated as near as possible to the intensive care unit and to the operating theater and should be available 24 hours a day.

[Pseudodementia in frontal tumours (author's transl)]. / Zur Pseudodemenz bei Stirnhirntumoren.

Our examinations have revealed personality changes in eighteen out of fifty patients with frontal tumour. The changes may be classified to a certain extent in the same symptomatological category as pseudodementia. In view of the site, size and histological structure of the tumours, the existence and severity of the disorders seem to be independent of tumour vascularization. Such personality changes may be the only pathological sign, even in the presence of large tumours. Earlier diagnostic difficulties (the group of patients dates back to the period prior to CAT scanning) may be largely overcome by the use of computerized axial tomography. Thus the duration of a case up to time of surgery can be reduced (hitherto as long as 10 years or more) and tumours may no longer grow to excessive size.

[Treatment and follow-up treatment in head injuries (author's transl)]. / Zur Behandlung und Nachbehandlung Schädelhirnverletzter.

The treatment and follow-up treatment of head injuries patients requires a drug, which will combat the development of cerebral edema by acting on the blood-brain barrier and restoring the normal function of endothelium and basal membrane. Such a drug should be easy to administer and free from serious side-effects, so that it can be employed for follow-up treatment by the general practitioner without the necessity of hospital facilities (EEG, CT, etc.). In a series of 3557 patients with head injuries Reparil has shown to be a suitable drug in treatment and follow-up treatment of posttraumatic brain edema. In follow-up treatment close medical supervision is essential so that any complications such as intracranial haematomas can be recognized in good time. This applies in particular to patients in high risk groups (advanced age, presence of concurrent diseases, in particular metabolic and circulatory disturbances).

Operative indications in glioblastoma.

General aspects of glioblastomas are considered such as preoperative diagnosis, stereotactic punctures for tissue samples, location and tumour size, interference with CSF circulation. The operative risk and different approaches to treatment are discussed, and the results are compared. The described combined treatment of operative, local cytostatic, and irradiation therapy appears promising, with 22% of patients alive, and a maximum survival time of 51/2 years. Attention is drawn to proper information of the patient and his family regarding the disease and possible outcome.