[Rare metabolic and cerebral complications after polychemotherapy of a testicular tumor]. / Seltene metabolische und zerebrale Komplikationen nach Polychemotherapie eines Hodentumors.

In a 21-year-old patient with a tumor of the right testis, CT indicated a pathologically altered lymph node in the interaortocaval region. After high inguinal orchiectomy we performed a modified retroperitoneal lymph node dissection and monitored its success by immediate section for microscopic examination. Pathohistological investigation yielded immature teratoma. The patient was given two courses of adjuvant polychemotherapy containing cisplatin. Two days after the conclusion of the second course he was readmitted with grand mal epilepsy and visual agnosia. Two months later another grand mal epileptic fit occurred. The patient also suffered from marked metabolic disorders, such as hypokalemia, hyperreninism, hyperaldosteronism, kaliuresis, and hypertension. We consider these to be toxic side effects of cisplatin resulting in nephropathy. Evidence of cisplatin-induced encephalopathy was obtained by NMR tomography and EEG which indicated barrier disorders. Symptoms were relieved and continuous normalization of blood pressure, potassium level, and water and electrolyte balance was achieved by the administration of potassium substitution, ACE inhibition, and an aldosterone antagonist. The patient has since remained in a stable condition.

[Involvement of the lungs in neurofibromatosis]. / Lungenbeteiligung bei Neurofibromatose.

Two patients, a 66-year-old man (case 1) and a 55-year-old woman (case 2), had been known (for 40 and 35 years, respectively) to have type 1 neurofibromatosis. Dyspnoea, recently even at rest, had developed in both over the past few years. Both were emaciated (weight 62 kg, height 180 cm; 42 kg, 166 cm, respectively). In both the chest radiography had net-like increased interstitial markings. Computed tomography in case 1 showed largely subpleural small-blister-like changes bilaterally (honeycomb lung), while there were large apical cysts bilaterally in case 2. Lung function tests demonstrated restrictive changes in case 1 (vital capacity 48% of norm, relative one-second capacity 88%) and severe ventilation abnormality in case 2 (vital capacity 42% of norm, relative one-second capacity 47%). Both had marked hypoxaemia even at rest and the walking limit was 200 m in case 1, 40 m in case 2. The pulmonary changes were most likely manifestations of the neurofibromatosis. Symptomatic treatment consisted of long-term oxygen therapy with a portable liquid oxygen system (flow rate: 1-2 l/min at rest and 3-5 l/min on exercise; duration: 24 h/d). This achieved a walking distance without hypoxaemia of 500 and 200 m, respectively, with marked improvement in the patients' condition.

[Difficulties and errors in ambulatory therapy of Parkinson disease]. / Schwierigkeiten und Fehler in der ambulanten Parkinson-Therapie.

The clinical findings as well as the follow-up of 52 patients with progressive Parkinsonism were analyzed and the following results obtained: The reasons for the clinical progression of the disease were most often acute secondary illnesses not involving the CNS, Parkinsonism-independent CNS lesions ("Parkinson plus"), the absolute as well as relative L-DOPA overdose and, lastly but significantly, the effects and side-effects of too many prescribed drugs. Our findings resulted in the following therapeutic recommendations: A monotherapy should be used for as long as possible with slowly increasing doses up to the threshold of tolerance. Only if necessary should alternative drugs or a combination of not more than two drugs be used. Parkinsonism progresses even with the present best therapy. So far, it was only been possible to mitigate this progress, but not to prevent it. In the late stage of the disease it is more appropriate to accept some remaining symptoms than to risk an overdose or polypharmacy with its attendant problems.

[Traumatic cerebral infarct in multistage dissection of the extracranial internal carotid artery]. / Traumatischer Hirninfarkt bei mehrzeitig verlaufender Dissektion der extrakraniellen Arteria carotis interna.

A 26-year-old motorcyclist bounced against the side of a turning car with about the speed of 70 km/h. On admission to the clinic, he was awake with stable circulation. The main injuries were contusion of the chest with pneumothorax on the right side, blunt trauma of the abdomen without hematoperitoneum, and a fracture of the right femur. There was no visible trauma of the head, but only circumscribed cutaneous bleeding on the right side of the neck. About 16 h later, he showed an alteration in his level of consciousness and gradually "malignant" cerebral infarction of the left hemisphere with increasing intracranial pressure developed. Brain function began to cease and death occurred on the 4th day. The autopsy revealed neither traumatic damage to the skull, brain or cervical spine, nor were there pathological findings in the cerebral vessels. The main damage consisted of multiple dissections of the inner wall of the left internal carotid artery and the left medial cerebral artery. Proceeding from a temporarily sealed tear of the extracranial vessel, a large intramural hemorrhage had occurred between the media and adventitia and had compressed the lumen completely. The intracranial portion was closed by expanding thrombosis. These lesions are of indirect origin and are the result of vast overstretching of the arteries by the head turning over the edge of the top of the car. The victim was found at once after the crash with his body hanging the deeply dented side of the car and the head (with the helmet on) on the roof.

[Intermittent confusional states as an expression of epileptic seizures in elderly patients]. / Intermittierende Verwirrtheitszustände als Ausdruck epileptischer Anfälle bei älteren Patienten.

We report on eight elderly people with acute recurrent confusional states. The cause of these was a symptomatic epileptic focal complex (psychomotor) seizure status.

Spontaneous dissecting aneurysm of cervical cerebral arteries. Report of six cases and review of the literature.

Six cases of spontaneous dissecting aneurysm of the internal carotid and vertebral arteries are reported. The angiographic findings and the clinical aspects of the disease are described. The lesion is not as rare as generally assumed.